학술논문
Hospital-acquired bloodstream infections in critically ill cirrhotic patients: a post-hoc analysis of the EUROBACT-2 international cohort study.
Document Type
Article
Author
Wozniak, Hannah; Tabah, Alexis; Barbier, François; Ruckly, Stéphane; Loiodice, Ambre; Akova, Murat; Leone, Marc; Conway Morris, Andrew; Bassetti, Matteo; Arvaniti, Kostoula; Ferrer, Ricard; de Bus, Liesbet; Paiva, Jose Artur; Bracht, Hendrik; Mikstacki, Adam; Alsisi, Adel; Valeanu, Liana; Prazak, Josef; Timsit, Jean-François; Buetti, Niccolò
Source
Subject
*PATIENT selection
*CIRRHOSIS of the liver
*CRITICALLY ill
*PATIENTS
*CROSS infection
*DATA analysis
*RESEARCH funding
*BLOODBORNE infections
*CATHETER-related infections
*HOSPITAL care
*MULTIPLE regression analysis
*FRAIL elderly
*FISHER exact test
*DRUG resistance in microorganisms
*HOSPITAL mortality
*MULTIVARIATE analysis
*DESCRIPTIVE statistics
*CHI-squared test
*MANN Whitney U Test
*LONGITUDINAL method
*ODDS ratio
*KAPLAN-Meier estimator
*INTENSIVE care units
*STATISTICS
*ENTEROCOCCUS faecium
*RESEARCH methodology
*CHLAMYDIALES
*CONFIDENCE intervals
*COMPARATIVE studies
*PROPORTIONAL hazards models
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Language
ISSN
2110-5820
Abstract
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. [ABSTRACT FROM AUTHOR]