학술논문
Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units: a prospective observational cohort study.
Document Type
Article
Author
Aslan, Abdullah Tarık; Tabah, Alexis; Köylü, Bahadır; Kalem, Ayşe Kaya; Aksoy, Firdevs; Erol, Çiğdem; Karaali, Rıdvan; Tunay, Burcu; Guzeldağ, Seda; Batirel, Ayşe; Dindar, Emine Kübra; Akdoğan, Özlem; Bilir, Yeliz; Ersöz, Gülden; Öztürk, Barçın; Selçuk, Mehtap; Yilmaz, Mesut; Akyol, Ahmet; Akbaş, Türkay; Sungurtekin, Hülya
Source
Subject
*INTENSIVE care units
*COHORT analysis
*EPIDEMIOLOGY
*CLINICAL epidemiology
MORTALITY risk factors
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Language
ISSN
0305-7453
Abstract
Objectives To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. Methods The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. Results Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55–78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp. 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14–1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58–3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12–3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25–6.95) and not achieving source control (aHR 2.02, 95% CI 1.15–3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06–0.90) and source control (aHR 0.46, 95% CI 0.28–0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17–1.43) and age (aHR 1.05, 95% CI 1.03–1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20–0.87) was associated with survival. Conclusions Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs. [ABSTRACT FROM AUTHOR]