Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

Brooks, Daniel I.; Smith, Andrew; Young, Douglas L.; Fulton, Rachael L.; Booth, Malcolm

doi:10.1016/j.ajic.2016.04.214

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…characteristics and outcomes of severe sepsis patients with and without bacteremia. Several studies have reported on the epidemiology of bacteremia and sepsis, although the quality of such studies is varied 5,9,10,[14][15][16][17] . In the present study, higher rates of septic shock were seen in patients with versus without bacteremia.…”

Section: Discussionmentioning

confidence: 99%

“…However, in-hospital mortality was not significantly different between patients with and without bacteremia in our study. Previous studies have reported various mortality rates in patients with bacteremia [6][7][8]10,15 . The diversity of the study population, setting, and study design may have contributed to the different impacts of bacteremia, which may have been influenced by the proportion of patients with each pathogenic species in each study 5,14 , or evidence of pathogen may have aided in selecting the appropriate antibiotic 16 .…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and outcomes of bacteremia among ICU-admitted patients with severe sepsis

Komori

Abe

Kushimoto

et al. 2020

Sci Rep

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Shin-ichiro Shiraishi 19 , Kiyotsugu takuma 20 , Ryosuke tsuruta 21 , Akiyoshi Hagiwara 22 , Kazuma Yamakawa 23 , tomohiko Masuno 24 , naoshi takeyama 25 , norio Yamashita 26 , Hiroto ikeda 27 , Masashi Ueyama 28 , Satoshi fujimi 23 , Satoshi Gando 29,30 & JAAM foRecASt group 31 † the clinical implications of bacteremia among septic patients remain unclear, although a vast amount of data have been accumulated on sepsis. We aimed to compare the clinical characteristics and outcomes of severe sepsis patients with and without bacteremia. this secondary analysis of a multicenter, prospective cohort study included 59 intensive care units (ICUs) in Japan between January 2016 and March 2017. The study cohort comprised 1,184 adults (aged ≥ 16 years) who were admitted to an ICU with severe sepsis and diagnosed according to the Sepsis-2 criteria. Of 1,167 patients included in the analysis, 636 (54.5%) had bacteremia. Those with bacteremia had significantly higher rates of septic

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of bacteremia among ICU-admitted patients with severe sepsis

Komori

Abe

Kushimoto

et al. 2020

Sci Rep

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“…Length of stay and mortality were found to be increased in ICU patients with bacteremia. [ 21 ] In a study conducted in a tertiary ICU, bacteremia was an independent risk factor for nosocomial infection-related mortality. [ 22 ] According to our study results, overall mortality was not significantly different between bacteremic and nonbacteremic patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Procalcitonin in Predicting Bacteremia in Intensive Care Unit

Demırdal¹,

Şen²,

Nemli³

2018

Indian Journal of Critical Care Medicine

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Background and Aims:Several biomarkers are used in the diagnosis of bacteremia. Procalcitonin (PCT) is more specific than other biomarkers in differentiating bacterial and nonbacterial inflammation. It was aimed to evaluate the diagnostic and prognostic value of PCT in bacteremic patients in Intensive Care Unit (ICU).Materials and Methods:A total of 156 patients diagnosed with noninfectious systemic inflammatory response syndrome, sepsis, and severe sepsis/septic shock in ICU between December 2014 and July 2015 were evaluated in this prospective cohort study.Results:The study group consisted of 64 (41%) bacteremic patients and the control group consisted of 92 (59%) nonbacteremic patients. The overall mortality rate was 60.3%. Although PCT levels in the bacteremic group (11.9 ± 21.5 ng/dL) were higher than nonbacteremic group (5.9 ± 11.5 ng/dL), this difference was not significant (P = 0.168). The mean levels of PCT in bacteremic patients with Gram-negative bacteria were 16.3 ± 27.6 ng/dL, whereas Gram-positive bacteria were 7.3 ± 10.7 ng/dL (P = 0.145). The mean PCT levels were significantly higher in nonsurvivors compared to survivors (10.1 ± 18.0 vs. 5.7 ± 13.7 ng/dL; P < 0.001).Conclusions:PCT may be an effective biomarker for diagnosing sepsis and predicting disease severity and mortality. There is a need for further well-designed studies to confirm the diagnostic and prognostic value of PCT in septic patients in critical care.

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“…Yet complementary studies are necessary to identify specific patient-groups for whom molecular testing results could majorly improve clinical outcome. The intensive care unit (ICU) copes with a BSI prevalence of 7.8% and an associated mortality rate of 30–40% [8–9]. Calculated as the third most common infection, ICU-BSIs moreover lead to extended length of stay and major hospital costs [10–11].…”

Section: Introductionmentioning

confidence: 99%

The impact of a rapid molecular identification test on positive blood cultures from critically ill with bacteremia: A pre-post intervention study

et al. 2019

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ObjectivesBloodstream infections in critically ill require a speeded-up microbiological diagnosis to improve clinical outcomes. In this pre-post intervention study, we evaluated how a molecular identification test directly performed on positive blood cultures of critically ill improves patient’s therapeutic management.MethodsAll adult patients staying at the intensive care unit (ICU) at the time of positive blood culture detection were study-eligible. In the 8-month pre-intervention period (P0), standard positive blood culture management was performed. In the 10-month intervention period (P1), a BioFire® FilmArray® blood culture identification (FA-BCID) test (bioMérieux) was additionally performed 24/7 at detection. The evaluated clinical outcome was time to optimal antimicrobial treatment of the bloodstream infection. FA-BCID microbiological test performances were also analysed.Results163 positive blood culture episodes were allocated to P0 and 166 to P1. After the withdrawal of episodes in accordance with defined exclusion criteria, outcome analysis was performed on 110 bloodstream infections both in P0 and P1. Time to optimal antimicrobial treatment in P0 was 14h41 compared to 4h39 in P1. FA-BCID test results led to a treatment adjustment in 35/110 (31.8%) P1 episodes including 26 where the adjustment was the optimal antimicrobial treatment. FA-BCID testing identified 96.2% of the on-panel microorganisms thereby covering 85.2% of our ICU-strain epidemiology. Time to identification with FA-BCID testing was calculated at 1h35. Resistance detection was in complete concordance with routine results. Considering 150 FA-BCID tests were initially performed in P1, 4,3 tests were required to have 1 test leading to an improved therapeutic outcome.ConclusionsFA-BCID testing drastically reduced time to optimal antimicrobial treatment in critically ill with bloodstream infections.

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Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

Cited by 16 publications

References 24 publications

Characteristics and outcomes of bacteremia among ICU-admitted patients with severe sepsis

Characteristics and outcomes of bacteremia among ICU-admitted patients with severe sepsis

Diagnostic Value of Procalcitonin in Predicting Bacteremia in Intensive Care Unit

The impact of a rapid molecular identification test on positive blood cultures from critically ill with bacteremia: A pre-post intervention study

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