The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections
Date
2024-06
Authors
Buetti, Niccolò
Tabah, Alexis
Setti, Nour
Ruckly, Stéphane
Barbier, François
Akova, Murat
Aslan, Abdullah Tarik
Leone, Marc
Bassetti, Matteo
Morris, Andrew Conway
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Verlag
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 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.
Description
Keywords
hospital-acquired bloodstream infections, bacteraemia, centre, process indicator, outcome indicator, 2024а
Citation
The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections / N. Buetti, A. Tabah, N. Setti [et al.] // Intensive Care Med. – 2024. – № 50 (6). – P. 873–889.