Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy

Adrie, Christophe; Garrouste-Orgeas, Maïté; Essaied, W; Schwebel, Carole; Darmon, Michaël; Mourvillier, Bruno; Ruckly, Stéphane; Dumenil, Anne-Sylvie; Kallel, Hatem; Argaud, Laurent; Marcotte, Guillaume; Barbier, François; Laurent, Virginie; Goldgran-Tolédano, Dany; Clec’h, Christophe; Azoulay, Élie; Souweine, Bertrand; Timsit, Jean‐François; Cohen, Yves; Soufir, Lilia; Monnier, Alban Le; Zahar, Jean‐Ralph; Alberti, Corinne; Bailly, Sébastien; Pommier, C; Essaeid, Wafa Ifn; Vannieuwenhuyze, Aurélien; Allaouchiche, Bernard; Ara-Somohano, Claire; Bédos, Jean‐Pierre; Bonadona, Agnès; Borel, Anne‐Laure; Bornstain, Caroline; Bouadma, Lila; Boyer, Alexandre; Colin, Jean-Pierre; Gros, Antoine; Hamidfar-Roy, Rébecca; Haouache, Hakim; Jamali, Samir; Lautrette, Alexandre; Laplace, Christian; Misset, Benoît; Montésino, Laurent; Lacave, Guillaume; Lemiale, Virgine; Marriotte, Eric; Planquette, Benjamin; Reignier, Jean; Sonneville, Romain; Troché, Gilles; Thuong, Marie; Vantalon, Eric; Tournegros, Caroline; Ferrand, Loïc; Kaddour, Nadira; Berthe, Boris; Mellouk, Kaouttar; Letrou, Sophie; Théodose, Igor; Fournier, Julien; Deiler, Véronique

doi:10.1016/j.jinf.2016.11.001

Cited by 101 publications

(86 citation statements)

References 39 publications

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“…It is essential to become aware of the pathogen and potential antibiotic resistances [1, 2]. Sufficient diagnostic with BC can reduce mortality, length of stay on the intensive care unit and furthermore hospital expense [3, 4]. A targeted antimicrobial therapy can shorten the use of antibiotics and lower the selection pressure and the development of antibiotic resistances, it is one of the core elements of antibiotic stewardship approaches [5].…”

Section: Introductionmentioning

confidence: 99%

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Salm

Schwab

Behnke

et al. 2018

Antimicrob Resist Infect Control

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BackgroundBlood cultures (BCs) are the gold standard for diagnosing sepsis and are prerequisite for a targeted antibiotic treatment and essential for patient outcomes. Aim of the study was to analyze the frequency of BCs, the rate of central line-associated bloodstream infections (CLABSIs) and to study the association between both parameters on intensive care units in Germany over time.MethodsCross-sectional studies at two points in time (2006, 2015) on ICUs participating in the German hospital infection surveillance system. CLABSIs were defined according to the Center for Disease Control and Prevention (CDC). Univariable and multivariable analyses were performed using generalized linear models.ResultsA total of 639 ICUs participated in 2006 or 2015 and 90 ICUs (“core group”) in both years. Overall, 2,427,921 patient days from 644,575 patients were analyzed. In the ICU core group the frequency of BCs per 1000 patient days doubled from 57.8 (interquartile range [IQR] 29.8–101.2; 2006) to 128.2 (IQR 71.6–183.2; 2015). In the same time, the pooled median CLABSI rate decreased from 0.8 (IQR 0–1.9; 2006) per 1000 central-line catheter days to 0.2 (IQR 0–0.9; 2015).ConclusionsFrom 2006 to 2015 the frequency of BCs increased on ICUs in Germany and is now within the recommended 100 to 200 BCs sets per 1000 patient days.

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Section: Introductionmentioning

confidence: 99%

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Salm

Schwab

Behnke

et al. 2018

Antimicrob Resist Infect Control

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show abstract

“…Even in intensive care units (ICU) where huge risk factors as septic shock or ICU scoring systems often overshadow other clinical determinants, BUO has been associated with inappropriate antibiotic treatment [4] and poor outcome [7]. …”

Section: Introductionmentioning

confidence: 99%

Patients with community-acquired bacteremia of unknown origin: clinical characteristics and usefulness of microbiological results for therapeutic issues: a single-center cohort study

Courjon

Demonchy

Degand³

et al. 2017

Ann Clin Microbiol Antimicrob

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Bacteremia of unknown origin (BUO) are associated with increased mortality compared to those with identified sources. Microbiological data of those patients could help to characterize an appropriate empirical antibiotic treatment before bloodcultures results are available during sepsis of unknown origin. Based on the dashboard of our ward that prospectively records several parameters from each hospitalization, we report 101 community-acquired BUO selected among 1989 bacteremic patients from July 2005 to April 2016, BUO being defined by the absence of clinical and paraclinical infectious focus and no other microbiological samples retrieving the bacteria isolated from blood cultures. The in-hospital mortality rate was 9%. We retrospectively tested two antibiotic associations: amoxicillin–clavulanic acid + gentamicin (AMC/GM) and 3rd generation cephalosporin + gentamicin (3GC/GM) considered as active if the causative bacteria was susceptible to at least one of the two drugs. The mean age was 71 years with 67% of male, 31 (31%) were immunocompromised and 52 (51%) had severe sepsis. Eleven patients had polymicrobial infections. The leading bacterial species involved were Escherichia coli 25/115 (22%), group D Streptococci 12/115 (10%), viridans Streptococci 12/115 (10%) and Staphylococcus aureus 11/115 (9%). AMC/GM displayed a higher rate of effectiveness compared to 3GC/GM: 100/101 (99%) vs 94/101 (93%) (p = 0.04): one Enterococcus faecium strain impaired the first association, Bacteroides spp. and Enterococcus spp. the second. In case of community-acquired sepsis of unknown origin, AMC + GM should be considered.

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“…Egy francia, intenzív osztályokon végzett tanulmány szerint a légúti infekciókkal összefüggő bacteriaemiák 56%-át, míg a húgyúti eredetű véráramfertőzések 74%-át Gram-negatív speciesek okozták. A halálos kimenetel kockázata akkor bizonyult a legmagasabbnak, ha a kórokozó fermentáló bélbaktérium volt és a beteg nem részesült adekvát antibiotikum-terápiában (HR: 4,31 [2,43], p<0,0001) [13]. Egy európai, multicentrikus felmérés szerint, amelyben 1156, intenzív osztályon ápolt beteg adatait elemezték, a véráram-infekciók 58,3%-át Gram-negatív, míg 32,8%-át Gram-pozitív baktériumok okozták.…”

Section: Klinikai Jelentőség Kockázati Csoportok Prognózisunclassified

“…A rezisztenciagének működtetése sok esetben inkább mérsékeli a megbetegítőképességet. A fatális kimenetel okaként a súlyos alapbetegséget, illetve az elmaradó vagy megkésett, adekvát antibiotikum-kezelést nevezhetjük meg [13].…”

Section: Klinikai Jelentőség Kockázati Csoportok Prognózisunclassified

Antibiotikumokkal szemben ellenálló Gram-negatív baktériumok okozta súlyos fertőzések a klinikus szemével. A Birodalom visszavág?

Sinkó

2017

Orvosi Hetilap

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In our days, growing incidence of antibiotic resistant bacteria has become an eminent public health problem. For survival Gram-negative species possess several different tools to withstand antibiotics: they produce degrading and modifying enzymes, decrease their permeability or expel drug molecules. An increasing proportion of severe nosocomial infections are caused by strains resistant to several antimicrobials (multiresistant, extensively resistant or panresistant species). Development of new antibiotic compounds may serve as a possible solution to this problem. Ceftolozane-tazobactam is a new beta-lactam+beta-lactamase-inhibitor combination resistant to most extended spectrum beta-lactamase enzymes showing excellent anti-Pseudomonas activity. It is also effective against strains when beta-lactam resistance is related to porin loss or efflux pump activity. The spectrum of ceftazidime-avibactam also includes carbapenemase-(KPC)-producing Enterobacteriaceae. In addition to novel therapy, an effective infection control system together with the prudent use of antimicrobials (antimicrobial stewardship) is of paramount importance. Orv Hetil. 2017; 158(39): 1528-1534.

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Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy

Cited by 101 publications

References 39 publications

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Patients with community-acquired bacteremia of unknown origin: clinical characteristics and usefulness of microbiological results for therapeutic issues: a single-center cohort study

Antibiotikumokkal szemben ellenálló Gram-negatív baktériumok okozta súlyos fertőzések a klinikus szemével. A Birodalom visszavág?

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