The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections
Male
Bacteremia / drug therapy
Original
[SDV]Life Sciences [q-bio]
Critical Illness
Hospital-acquired bloodstream infections
Critical Illness / mortality
610
Bacteremia
/dk/atira/pure/subjectarea/asjc/2700/2706
Bacteremia / mortality
Outcome and Process Assessment
Intensive Care Units / organization & administration
Process indicator.
Europe/epidemiology
Process indicator
info:eu-repo/classification/ddc/616
Cross Infection / drug therapy
Humans
Bacteraemia; Centre; Hospital-acquired bloodstream infections; Outcome indicator; Process indicator
Outcome indicator
Prospective Studies
Drug Monitoring / statistics & numerical data
Aged
Anti-Bacterial Agents / therapeutic use
Cross Infection
Intensive Care Units / statistics & numerical data
Middle Aged
Centre
Bacteremia/mortality
Anti-Bacterial Agents
Europe
Health Care
[SDV] Life Sciences [q-bio]
Intensive Care Units
Critical Illness/mortality
Anti-Bacterial Agents/therapeutic use
name=Critical Care and Intensive Care Medicine
Outcome and Process Assessment, Health Care
Intensive Care Units/statistics & numerical data
Drug Monitoring / methods
Bacteraemia
Cross Infection/mortality
Female
Cross Infection / mortality
Drug Monitoring
Europe / epidemiology
Drug Monitoring/methods
DOI:
10.1007/s00134-024-07348-0
Publication Date:
2024-03-18T08:03:05Z
AUTHORS (729)
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.
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CITATIONS (3)
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