Christophe Adrie1, Maité Garrouste-Orgeas2, Wafa Ibn Essaied3, Carole Schwebel4, Michael Darmon5, Bruno Mourvillier6, Stéphane Ruckly7, Anne-Sylvie Dumenil8, Hatem Kallel9, Laurent Argaud10, Guillaume Marcotte11, Francois Barbier12, Virginie Laurent13, Dany Goldgran-Toledano14, Christophe Clec'h15, Elie Azoulay16, Bertrand Souweine17, Jean-François Timsit6. 1. Physiology Department, Cochin University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France. Electronic address: christophe.adrie@cch.aphp.fr. 2. INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical-Surgical Intensive Care Unit, Saint Joseph Hospital, Paris, France. 3. INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France. 4. Medical Intensive Care Unit, Michallon University Hospital, Grenoble, France. 5. Medical ICU, Saint-Etienne University Hospital, Saint-Priest en Jarez, France. 6. INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Bichat University Hospital, Paris, France. 7. INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Outcomerea Network, Paris, France. 8. Medical-Surgical Intensive Care Unit, Antoine Béclère University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Clamart, France. 9. Medical-Surgical Intensive Care Unit, Centre hospitalier de Cayenne, Guyane, France. 10. Medical-Intensive Care Unit, Edouard Heriot Hospital, Lyon University Hospital, Lyon, France. 11. Surgical-Intensive Care Unit, Edouard Heriot Hospital, Lyon University Hospital, Lyon, France. 12. Medical Intensive Care Unit, La Source Hospital - CHR Orléans, Orléans, France. 13. Medical-Surgical Intensive Care Unit, André Mignot Hospital, Versailles-Le Chesnay, France. 14. Medical-Surgical Intensive Care Unit, Gonesse Hospital, Gonesse, France. 15. INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Avicenne University Hospital, Bobigny, France. 16. Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France. 17. Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France.
Abstract
OBJECTIVES: 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. 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.
OBJECTIVES: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. 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.
Authors: Kimberly C Claeys; Evan J Zasowski; Trang D Trinh; Abdalhamid M Lagnf; Susan L Davis; Michael J Rybak Journal: Infect Dis Ther Date: 2017-11-21
Authors: Johan Courjon; Elisa Demonchy; Nicolas Degand; Karine Risso; Raymond Ruimy; Pierre-Marie Roger Journal: Ann Clin Microbiol Antimicrob Date: 2017-05-19 Impact factor: 3.944