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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy
Journal of Infection, Volume 74, No. 2, Year 2017
Notification
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Description
Objectives ICU-acquired bloodstream infection (ICU[sbnd]BSI) in Intensive Care unit (ICU) is still associated with a high mortality rate. The increase of antimicrobial drug resistance makes its treatment increasingly challenging. Methods We analyzed 571 ICU–BSI occurring amongst 10,734 patients who were prospectively included in the Outcomerea Database and who stayed at least 4 days in ICU. The hazard ratio of death associated with ICU–BSI was estimated using a multivariate Cox model adjusted on case mix, patient severity and daily SOFA. Results ICU–BSI was associated with increased mortality (HR, 1.40; 95% CI, 1.16–1.69; p = 0.0004). The relative increase in the risk of death was 130% (HR, 2.3; 95% CI, 1.8–3.0) when initial antimicrobial agents within a day of ICU–BSI onset were not adequate, versus only 20% (HR, 1.2; 95% CI, 0.9–1.5) when an adequate therapy was started within a day. The adjusted hazard ratio of death was significant overall, and even higher when the ICU–BSI source was pneumonia or unknown origin. When treated with appropriate antimicrobial agents, the death risk increase was similar for ICU–BSI due to multidrug resistant pathogens or susceptible ones. Interestingly, combination therapy with a fluoroquinolone was associated with more favorable outcome than monotherapy, whereas combination with aminoglycoside was associated with similar mortality than monotherapy. Conclusions ICU–BSI was associated with a 40% increase in the risk of 30-day mortality, particularly if the early antimicrobial therapy was not adequate. Adequacy of antimicrobial therapy, but not pathogen resistance pattern, impacted attributable mortality. © 2016 The British Infection Association
Authors & Co-Authors
Adrie, Christophe
France, Paris
Hopital Cochin Ap-hp
France, Saint-denis
Hôpital Delafontaine
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Garrouste-Orgeas, Maïté
France, Paris
Groupe Hospitalier Paris Saint-joseph
France, Paris
Inserm
Schwebel, Carole
France, La Tronche
Hôpital A. Michallon Chu Grenoble
France, Grenoble
Centre Hospitalier Universitaire de Grenoble
Darmon, Michaël
France, Saint-etienne
Centre Hospitalier Universitaire de Saint Etienne
France, Saint-etienne
Université Jean Monnet Saint Etienne
Mourvillier, Bruno H.
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Ruckly, Stéphane
France, Paris
Inserm
France, Paris
Outcomerea
Dumenil, Anne Sylvie
France, Clamart
Hopital Antoine Beclere
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Kallel, Hatem
France, Cayenne
Cayenne General Hospital
France, Cayenne
Centre Hospitalier de Cayenne
Argaud, Laurent
France, Lyon
Hopital Edouard Herriot
France, Lyon
Chu de Lyon
Barbier, François S.
France, Orleans
Chr D'orléans
Clec'H, Christophe
France, Bobigny
Hopital Avicenne
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Azoulay, Elie
France, Paris
Hôpital Saint-louis
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Souweine, Bertrand
France, Clermont-ferrand
Hopital Gabriel Montpied
Timsit, Jean Franc¸ois
France, Paris
Infection, Anti-microbien, Modélisation, Évolution
France, Paris
Inserm
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Cohen, Yves
France, Bobigny
Hopital Avicenne
Soufir, Lilia
France, Paris
Groupe Hospitalier Paris Saint-joseph
Zahar, Jean Ralph
France, Angers
Chu Angers
Alberti, Corinne
France, Paris
Hôpital Robert-debré Ap-hp
Bailly, Sébastien D.Sign©bastien
Unknown Affiliation
Allaouchiche, Bernard
France, Lyon
Hopital Edouard Herriot
Bornstain, Caroline
Unknown Affiliation
Bouadma, Lila
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
Boyer, Alexandre
France, Bordeaux
Groupe Hospitalier Pellegrin
Colin, Jean Pierre
Unknown Affiliation
Jamali, Samir
Unknown Affiliation
Lautrette, Alexandre
France, Clermont-ferrand
Hopital Gabriel Montpied
Laplace, Christian
France, Le Kremlin-bicetre
Hopital de Bicetre
Misset, Benoıˆt Y.
France, Paris
Groupe Hospitalier Paris Saint-joseph
Montésino, Laurent
France, Paris
Hôpital Bichat-claude-bernard Ap-hp
Troché, Gilles
Unknown Affiliation
Thuong, Marie
Unknown Affiliation
Tournegros, Caroline
Unknown Affiliation
Ferrand, Loïc
Unknown Affiliation
Mellouk, Kaouttar Aid
Unknown Affiliation
Statistics
Citations: 83
Authors: 34
Affiliations: 27
Identifiers
Doi:
10.1016/j.jinf.2016.11.001
ISSN:
01634453
Research Areas
Environmental
Health System And Policy