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The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • José Artur Osório De Carvalho Paiva

    Autor

Participantes de fora da FMUP

  • Buetti, Niccolo
  • Tabah, Alexis
  • Setti, Nour
  • Ruckly, Stephane
  • Barbier, Francois
  • Akova, Murat
  • Aslan, Abdullah Tarik
  • Leone, Marc
  • Bassetti, Matteo
  • Morris, Andrew Conway
  • Arvaniti, Kostoula
  • Ferrer, Ricard
  • Qiu, Haibo
  • Montrucchio, Giorgia
  • Cortegiani, Andrea
  • Kayaaslan, Bircan
  • De Bus, Liesbet
  • De Waele, Jan J.
  • Timsit, Jean-Francois
  • European Soc Intensive Care Med
  • Eurobact-2 Study Group
  • Study Grp Infections
  • Outcomerea Network

Unidades de investigação

Abstract

Purpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79 95% CI 1.34-2.38) surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45 95% CI 1.09-1.93) and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63 95% CI 0.47-0.84) TDM for aminoglycoside available everyday (OR 0.66 95% CI 0.44-1.00) or within a few hours (OR 0.5 95% CI 0.37-0.70) 24/7 consultation of clinical pharmacists (OR 0.67 95% CI 0.47-0.95)percentage of vancomycin-resistant enterococci ( VRE) between 10% and 25% in the ICU (OR 1.67 95% CI 1.00-2.80) and decreasing HDI values were associated with 28-day mortality. Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.

Dados da publicação

ISSN/ISSNe:
1432-1238, 0342-4642

Intensive Care Medicine  Springer Verlag

Tipo:
Article
Páginas:
873-889
PubMed:
38498170

Citações Recebidas na Web of Science: 10

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Keywords

  • Hospital-acquired bloodstream infections; Bacteraemia; Centre; Process indicator; Outcome indicator

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