Кафедра інфекційних хвороб, дитячих інфекційних хвороб, фтизіатрії та пульмонології
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Item Correction: The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections(Springer Verlag, 2024) Buetti, Niccolò; Tabah, Alexis; Setti, Nour; Ruckly, Stéphane; Barbier, François; Akova, Murat; Aslan, Abdullah Tarik; Leone, Marc; Bassetti, Matteo; Morris, Andrew Conway; Arvaniti, Kostoula; Paiva, José‑Artur; Ferrer, Ricard; Qiu, Haibo; Montrucchio, Giorgia; Cortegiani, Andrea; Kayaaslan, Bircan; De Bus, Liesbet; De Waele, Jan J.; Timsit, Jean‑François; Sokhan, AntonItem Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study(Elsevier B.V., 2024) Loiodice, Ambre; Bailly, Sebastien; Ruckly, Stephane; Buetti, Niccolo; Barbier, François; Staiquly, Quentin; Tabah, Alexis; Timsit, Jean-François; Sokhan, A.; Burma, Ya.Objectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for - 1 day and for whom time-to appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n ¼ 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n ¼ 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72e0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9e16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used whenItem Presentation, management, and outcomes of older compared to younger adults with hospital‑acquired bloodstream infections in the intensive care unit: a multicenter cohort study(Urban und Vogel, 2024-06-13) Margalit, Ili; Yahav, Dafna; Hofman, Tomer; Tabah, Alexis; Ruckly, Stéphane; Barbier, François; Singer, Pierre; Timsit, Jean‑François; Prendki, Virginie; Buetti, Niccolò; Sokhan, AntonPurpose. Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI). Methods. Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥18 years) hospitalized in the ICU during 2019–2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge). Results. Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were≥75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Diferences in management included mainly lower rates of efective source control achievement among aged individuals. Older adults also had signifcantly higher day-28 mortality (50% versus 34%, p<0.001), and lower rates of discharge from hospital (12% versus 20%, p<0.001) by this time. Conclusions. Older adults with HA-BSI hospitalized in ICU have diferent baseline characteristics and source of infection compared to younger patients. Management of older adults difers mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients.Item The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections(Springer Verlag, 2024-06) Buetti, Niccolò; Tabah, Alexis; Setti, Nour; Ruckly, Stéphane; Barbier, François; Akova, Murat; Aslan, Abdullah Tarik; Leone, Marc; Bassetti, Matteo; Morris, Andrew Conway; Arvaniti, Kostoula; Paiva, José‑Artur; Ferrer, Ricard; Qiu, Haibo; Montrucchio, Giorgia; Cortegiani, Andrea; Kayaaslan, Bircan; De Bus, Liesbet; De Waele, Jan J.; Timsit, Jean‑François; Sokhan, A.; Burma, Ya.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 frst 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identifed 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% confdence 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.