TY - JOUR
T1 - The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections
AU - Buetti, Niccolò
AU - Tabah, Alexis
AU - Setti, Nour
AU - Ruckly, Stéphane
AU - Barbier, François
AU - Akova, Murat
AU - Aslan, Abdullah Tarik
AU - Leone, Marc
AU - Bassetti, Matteo
AU - Morris, Andrew Conway
AU - Arvaniti, Kostoula
AU - Paiva, José Artur
AU - Ferrer, Ricard
AU - Qiu, Haibo
AU - Montrucchio, Giorgia
AU - Cortegiani, Andrea
AU - Kayaaslan, Bircan
AU - De Bus, Liesbet
AU - De Waele, Jan J.
AU - Timsit, Jean François
AU - EUROBACT-2 Study Group
AU - European Society of Intensive Care Medicine (ESICM)
AU - European Society of Clinical Microbiology
AU - the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP)
AU - OUTCOMEREA Network
A2 - Parcell, Benjamin J
A2 - Cole, Stephen
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/6
Y1 - 2024/6
N2 - 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.
AB - 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.
KW - Bacteraemia
KW - Centre
KW - Hospital-acquired bloodstream infections
KW - Outcome indicator
KW - Process indicator
UR - http://www.scopus.com/inward/record.url?scp=85188059394&partnerID=8YFLogxK
U2 - 10.1007/s00134-024-07348-0
DO - 10.1007/s00134-024-07348-0
M3 - Article
C2 - 38587556
AN - SCOPUS:85188059394
SN - 0342-4642
VL - 50
SP - 873
EP - 889
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 6
ER -