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

Published version
Peer-reviewed

Repository DOI


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Authors

Tabah, Alexis 
Setti, Nour 
Ruckly, Stéphane 
Barbier, François 

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.

Description

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347


Funder: European Society of Clinical Microbiology and Infectious Diseases; doi: http://dx.doi.org/10.13039/501100001704


Funder: Norva Dahlia foundation and the Redcliffe Hospital Private Practice Trust Fund


Funder: University of Geneva

Keywords

Bacteraemia, Centre, Hospital-acquired bloodstream infections, Outcome indicator, Process indicator, Humans, Cross Infection, Male, Female, Critical Illness, Intensive Care Units, Middle Aged, Prospective Studies, Aged, Anti-Bacterial Agents, Bacteremia, Europe, Drug Monitoring, Outcome and Process Assessment, Health Care

Journal Title

Intensive Care Med

Conference Name

Journal ISSN

0342-4642
1432-1238

Volume Title

50

Publisher

Springer Science and Business Media LLC
Sponsorship
MRC (MR/V006118/1)
Clinician Scientist Fellowship grant number: MR/V006118/1)