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. 2023 Feb;49(2):178-190.
doi: 10.1007/s00134-022-06944-2. Epub 2023 Feb 10.

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Alexis Tabah  1   2   3   4 , Niccolò Buetti  5   6 , Quentin Staiquly  7 , Stéphane Ruckly  6   7 , Murat Akova  8 , Abdullah Tarik Aslan  9 , Marc Leone  10 , Andrew Conway Morris  11   12   13 , Matteo Bassetti  14 , Kostoula Arvaniti  15 , Jeffrey Lipman  16   17   18 , Ricard Ferrer  19 , Haibo Qiu  20 , José-Artur Paiva  21   22   23 , Pedro Povoa  24   25   26 , Liesbet De Bus  27 , Jan De Waele  28   29 , Farid Zand  30 , Mohan Gurjar  31 , Adel Alsisi  32   33 , Khalid Abidi  34 , Hendrik Bracht  35 , Yoshiro Hayashi  36 , Kyeongman Jeon  37 , Muhammed Elhadi  38 , François Barbier  39 , Jean-François Timsit  40   41 ; EUROBACT-2 Study Group, ESICM, ESCMID ESGCIP and the OUTCOMEREA Network
Collaborators, Affiliations

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Alexis Tabah et al. Intensive Care Med. 2023 Feb.

Abstract

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials.

Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021.

Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28.

Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

Keywords: antibiotic resistance; bacteremia; bloodstream infection; hospital-acquired.

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Conflict of interest statement

AT has nothing to disclose, NB has nothing to disclose, QS has nothing to disclose, SR has nothing to disclose, MA reports honoraria paid to his university for educational activities by Pfizer, Sanofi, MSD and Astra Zeneca, ATA has nothing to disclose, ML reported consulting and lecture fees from Amomed Pharma, Aspen, LFB and Gilead, ACM has received payment for speaking on behalf of Boston Scientific and sits on the Scientific Advisory Board of Cambridge Infection Diagnostics, a start-up seeking to develop novel diagnostics for infectious diseases, MB received advisory board, speaker activities from Angelini, Bayer, Biomerieux, Cidara, Gilead, Menarini, MSD, Pfizer, Roche, Shionogi, study grants from: Angelini, Shionogi, Cidara, Gilead, Pfizer, and MSD, KA has nothing to disclose, JL has received lecture fees and honoraria from MSD, RF reports Payment for lectures, speakers bureaus or advisory boards from Grifols, MSD, Pfizer, Gilead, Shionogi, Thermofisher, Hill Rom, AOP Health, BD, HQ has nothing to disclose, JAP reports consulting, advisory boards or lectures fees and honoraria for MSD, Pfizer, Astra-Zeneca, Gilead, Jansen, Cepheid, AOP Orphan Pharmaceuticals, PP reported advisory boards participation for Gilead, Technophage and Sanofi, lectures fees from MSD, Gilead and Pfizer, and research grant from Abionic, LDB has nothing to disclose, JdW has consulted for Pfizer, MSD (honoraria paid to institution), FZ has nothing to disclose, MG has nothing to disclose, AA has nothing to disclose, KA has nothing to disclose, HB has nothing to disclose, YH has nothing to disclose, KJ has nothing to disclose, ME has nothing to disclose, FB reported consulting and lecture fees, conference invitation from MSD and lecture fees from BioMérieux, J-FT reported advisory boards participation for Merck, Gilead, Beckton-Dickinson, Pfizer, Shinogi, Medimune, Paratek, research grants from Merck, Pfizer, Thermofischer.

Figures

Fig. 1
Fig. 1
Relationship between resistance and timing of adequate antimicrobial therapy. Cumulative percentage of patients receiving at least one adequate antimicrobial, on each time-period before and after the date of collection of the first positive blood culture, shown by antimicrobial resistance status. MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis includes all methicillin resistant coagulase-negative staphylococcus, VRE: vancomycin-resistant Enterococcus. Closed brackets [;] denote inclusive of the end of the range and open brackets]; [ denote the exclusion of the end of the range
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