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Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy

2016; Elsevier BV; Volume: 74; Issue: 2 Linguagem: Inglês

10.1016/j.jinf.2016.11.001

1532-2742

Christophe Adrie, Maïté Garrouste-Orgeas, Wafa Essaied, Carole Schwebel, Michaël Darmon, Bruno Mourvillier, Stéphane Ruckly, Anne-Sylvie Dumenil, Hatem Kallel, Laurent Argaud, Guillaume Marcotte, Francois Barbier, Virginie Laurent, Dany Goldgran-Toledano, C. Clec’h, Elie Azoulay, Bertrand Souweine, J.-F. Timsit, J.-F. Timsit, Elie Azoulay, Yves Cohen, Maïté Garrouste-Orgeas, Lilia Soufir, Alban Le Monnier, Jean‐Ralph Zahar, Christophe Adrie, Michaël Darmon, Corinne Alberti, C. Clec’h, Jean‐François Timsit, Sébastien Bailly, Stéphane Ruckly, C Pommier, Wafa Ifn Essaeid, Aurélien Vannieuwenhuyze, Bernard Allaouchiche, Claire Ara-Somohano, Laurent Argaud, Francois Barbier, Jean‐Pierre Bédos, Agnès Bonadona, Anne‐Laure Borel, Caroline Bornstain, Lila Bouadma, Alexandre Boyer, Jean-Pierre Colin, Anne-Sylvie Dumenil, Antoine Gros, Rébecca Hamidfar-Roy, Hakim Haouache, Samir Jamali, Hatem Kallel, Guillaume Marcotte, Alexandre Lautrette, Christian Laplace, Benoît Misset, Laurent Montésino, Bruno Mourvillier, Benoît Misset, Guillaume Lacave, Virgine Lemiale, Virginie Laurent, Eric Marriotte, Benjamin Planquette, Jean Reignier, Romain Sonneville, Bertrand Souweine, Carole Schwebel, Gilles Troché, Marie Thuong, Dany Goldgran-Toledano, Eric Vantalon, Caroline Tournegros, L Ferrand, Nadira Kaddour, Boris Berthe, Kaouttar Mellouk, Sophie Letrou, Igor Théodose, Julien Fournier, Véronique Deiler,

Antibiotic Use and Resistance

ICU-acquired bloodstream infection (ICUBSI) in Intensive Care unit (ICU) is still associated with a high mortality rate. The increase of antimicrobial drug resistance makes its treatment increasingly challenging.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.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.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.