Article Dans Une Revue Intensive Care Medicine Année : 2024

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

1 Geneva University Hospitals and Geneva University
2 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
3 RH - Redcliffe Hospital [Brisbane, QLD, Australia]
4 QUT - Queensland University of Technology [Brisbane]
5 QCCRN - Queensland Critical Care Research Network [Brisbane, QLD, Australia]
6 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
7 Outcomerea - Outcome Réa
8 CHRO - Centre Hospitalier Régional d'Orléans
9 Hôpital Henri Mondor
10 Hacettepe University = Hacettepe Üniversitesi
11 Hôpital Nord [CHU - APHM]
12 AMU - Aix Marseille Université
13 UniGe - Università degli studi di Genova = University of Genoa
14 Ospedale Policlinico San Martino [Genoa]
15 CAM - University of Cambridge [UK]
16 Addenbrooke's Hospital
17 TPGH - The Papageorgiou General Hospital [Thessaloníki, Greece]
18 Centro Hospitalar Universitário de São João [Porto]
19 Universidade do Porto = University of Porto
20 Infection and Sepsis ID Group [Porto, Portugal]
21 Vall d'Hebron University Hospital [Barcelona]
22 SEU - Nanjing Southeast University
23 Azienda Ospedalerio - Universitaria Città della Salute e della Scienza di Torino = University Hospital Città della Salute e della Scienza di Torino
24 UNITO - Università degli studi di Torino = University of Turin
25 Università degli studi di Palermo - University of Palermo
26 AOUP - Azienda Ospedale Università di Padova = Hospital-University of Padua
27 Ankara Yildirim Beyazit University [Turkey]
28 Ghent University Hospital
29 AP-HP - Hôpital Bichat - Claude Bernard [Paris]

Résumé

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 0.51, 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.
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inserm-04635796 , version 1 (04-07-2024)

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Niccolò Buetti, Alexis Tabah, Nour Setti, Stéphane Ruckly, François Barbier, et al.. The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive Care Medicine, 2024, 50 (6), pp.873-889. ⟨10.1007/s00134-024-07348-0⟩. ⟨inserm-04635796⟩
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