Sistema de Salut de Catalunya
Institut Català de la Salut
[Wozniak H] Division of Critical Care, Department of Acute Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. [Tabah A] Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia. Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia. Queensland University of Technology, Brisbane, QLD, Australia. Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. [Barbier F] Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France. [Ruckly S] Université de Paris, INSERM, IAME UMR 1137, Paris, France. ICUREsearch, Biometry, Fontaine, France. [Loiodice A] ICUREsearch, Biometry, Fontaine, France. [Akova M] Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey. [Ferrer R] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca de Shock, Disfunció Orgànica i Ressuscitació (SODIR), Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2024-05-08T06:52:01Z
2024-05-08T06:52:01Z
2024-05-02
Bloodstream infections; Cirrhotic patients
Infecciones del torrente sanguíneo; Pacientes cirróticos críticos
Infeccions del torrent sanguini; Pacients cirròtics crítics
Background: Hospital-acquired bloodstream infections are common in the intensive care unit (ICU) and have a high mortality rate. Patients with cirrhosis are especially susceptible to infections, yet there is a knowledge gap in the epidemiological distinctions in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients in the ICU. It has been suggested that cirrhotic patients, present a trend towards more gram-positive infections, and especially enterococcal infections. This study aims to describe epidemiological differences in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients hospitalized in the ICU regarding infection sources, microorganisms and mortality. Methods: Using prospective Eurobact-2 international cohort study data, we compared hospital-acquired bloodstream infections sources and microorganisms in cirrhotic and non-cirrhotic patients. The association between Enterococcus faecium and cirrhosis was studied using a multivariable mixed logistic regression. The association between cirrhosis and mortality was assessed by a multivariable frailty Cox model. Results: Among the 1059 hospital-acquired bloodstream infections patients included from 101 centers, 160 had cirrhosis. Hospital-acquired bloodstream infection source in cirrhotic patients was primarily abdominal (35.6%), while it was pulmonary (18.9%) for non-cirrhotic (p < 0.01). Gram-positive hospital-acquired bloodstream infections accounted for 42.3% in cirrhotic patients compared to 33.2% in non-cirrhotic patients (p = 0.02). Hospital-acquired bloodstream infections in cirrhotic patients were most frequently caused by Klebsiella spp (16.5%), coagulase-negative Staphylococci (13.7%) and E. faecium (11.5%). E. faecium bacteremia was more frequent in cirrhotic patients (11.5% versus 4.5%, p < 0.01). After adjusting for possible confounding factors, cirrhosis was associated with higher E. faecium hospital-acquired bloodstream infections risk (Odds ratio 2.5, 95% CI 1.3-4.5, p < 0.01). Cirrhotic patients had increased mortality compared to non-cirrhotic patients (Hazard Ratio 1.3, 95% CI 1.01-1.7, p = 0.045). Conclusions: Critically ill cirrhotic patients with hospital-acquired bloodstream infections exhibit distinct epidemiology, with more Gram-positive infections and particularly Enterococcus faecium.
The Eurobact-2 database received research grants from the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study Group for Infections in Critically Ill Patients (ESGCIP), the Norva Dahlia foundation and the Redcliffe Hospital Private Practice Trust Fund. This report was prepared with no specific funding. Open access funding provided by University of Geneva
Article
Published version
English
Septicèmia; Infeccions nosocomials; Unitats de cures intensives; Cirrosi hepàtica; DISEASES::Bacterial Infections and Mycoses::Infection::Cross Infection; HEALTH CARE::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units; DISEASES::Bacterial Infections and Mycoses::Infection::Sepsis; DISEASES::Digestive System Diseases::Liver Diseases::Liver Cirrhosis; ENFERMEDADES::infecciones bacterianas y micosis::infección::infección hospitalaria; ATENCIÓN DE SALUD::instalaciones, servicios y personal de asistencia sanitaria::centros sanitarios::unidades hospitalarias::unidades de cuidados intensivos; ENFERMEDADES::infecciones bacterianas y micosis::infección::sepsis; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades hepáticas::cirrosis hepática
Springer
Annals of Intensive Care;14
https://doi.org/10.1186/s13613-024-01299-x
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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