Buetti, N., Tabah, A., Setti, N. et al. .
Intensive Care Med (2024). Published: 18
March 2024
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.
No comments:
Post a Comment