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

Niccolò Buetti (Lead / Corresponding author), Alexis Tabah, Nour Setti, Stéphane Ruckly, François Barbier, Murat Akova, Abdullah Tarik Aslan, Marc Leone, Matteo Bassetti, Andrew Conway Morris, Kostoula Arvaniti, José Artur Paiva, Ricard Ferrer, Haibo Qiu, Giorgia Montrucchio, Andrea Cortegiani, Bircan Kayaaslan, Liesbet De Bus, Jan J. De Waele, Jean François TimsitEUROBACT-2 Study Group, European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology, the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP) , OUTCOMEREA Network, Benjamin J Parcell (Contributing member), Stephen Cole (Contributing member)

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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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 0.51, 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.

Original languageEnglish
Pages (from-to)873-889
Number of pages17
JournalIntensive Care Medicine
Volume50
Issue number6
Early online date18 Mar 2024
DOIs
Publication statusPublished - Jun 2024

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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