• Alexis Tabah, Despoina Koulenti, Kevin Laupland, Benoit Misset, Jordi Valles, Frederico Bruzzi de Carvalho, José Artur Paiva, Nahit Cakar, Xiaochun Ma, Philippe Eggimann, Massimo Antonelli, Marc J M Bonten, Akos Csomos, Wolfgang A Krueger, Adam Mikstacki, Jeffrey Lipman, Pieter Depuydt, Aurélien Vesin, Maité Garrouste-Orgeas, Jean-Ralph Zahar, Stijn Blot, Jean Carlet, Christian Brun-Buisson, Claude Martin, Jordi Rello, Georges Dimopoulos, and Jean-François Timsit.
• Albert Michallon University Hospital, Université Grenoble 1, Grenoble, France.
• Intensive Care Med. 2012 Dec 1;38(12):1930-45.

PurposeThe recent increase in drug-resistant micro-organisms complicates the management of hospital-acquired bloodstream infections (HA-BSIs). We investigated the epidemiology of HA-BSI and evaluated the impact of drug resistance on outcomes of critically ill patients, controlling for patient characteristics and infection management.MethodsA prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries.ResultsWe included 1,156 patients [mean ± standard deviation (SD) age, 59.5 ± 17.7 years; 65 % males; mean ± SD Simplified Acute Physiology Score (SAPS) II score, 50 ± 17] with HA-BSIs, of which 76 % were ICU-acquired. Median time to diagnosis was 14 [interquartile range (IQR), 7-26] days after hospital admission. Polymicrobial infections accounted for 12 % of cases. Among monomicrobial infections, 58.3 % were gram-negative, 32.8 % gram-positive, 7.8 % fungal and 1.2 % due to strict anaerobes. Overall, 629 (47.8 %) isolates were multidrug-resistant (MDR), including 270 (20.5 %) extensively resistant (XDR), and 5 (0.4 %) pan-drug-resistant (PDR). Micro-organism distribution and MDR occurrence varied significantly (p < 0.001) by country. The 28-day all-cause fatality rate was 36 %. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate [odds ratio (OR), 1.49; 95 % confidence interval (95 %CI), 1.07-2.06], uncontrolled infection source (OR, 5.86; 95 %CI, 2.5-13.9) and timing to adequate treatment (before day 6 since blood culture collection versus never, OR, 0.38; 95 %CI, 0.23-0.63; since day 6 versus never, OR, 0.20; 95 %CI, 0.08-0.47).ConclusionsMDR and XDR bacteria (especially gram-negative) are common in HA-BSIs in critically ill patients and are associated with increased 28-day mortality. Intensified efforts to prevent HA-BSIs and to optimize their management through adequate source control and antibiotic therapy are needed to improve outcomes.

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