Dimopoulos G, Koulenti D, Tabah A, Poulakou G, Vesin A, Arvaniti K, Lathyris D, Matthaiou D K, Armaganidis A, Timsit J F
Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece -
Minerva Anestesiol. 2015 Apr;81(4):405-18. Epub 2014 Sep 15.
Aim of this study was to evaluate the epidemiology and outcomes of hospital-acquired bloodstream infections (HA-BSI) in Greek intensive care units (ICU).
Secondary analysis of data from 29 ICU collected during the EUROBACT study, a large prospective, observational, multination survey of HA-BSI. First episodes of HA-BSI acquired in the ICU or within 48 hours prior to admission were recorded.
Gram-negative bacteria predominated namely Acinetobacter sp, Klebsiella sp, Pseudomonas sp (73.3% of monomicrobial infections) followed by Gram-positive cocci (18.3%); fungi (7.6%) and anaerobes (0.8%). Overall 73.3% of isolates were multidrug resistant (MDR), 47.1% extensively resistant (XDR) and 1.2% pan-drug resistant (PDR). Carbapenems were the most frequent empirically prescribed antibiotics, while colistin was the most frequently adequate; for both, calculated mean total daily doses were suboptimal. Overall 28-day all-cause mortality was 33.3%. In the multivariate analysis, factors adversely affecting outcome were higher SOFA score at HA-BSI onset (OR 1.19; 95% CI 1.08-1.31, P=0.0006), need for renal supportive therapy (OR 2.75; 95% CI 1.35-5.59, P=0.0053), and for vasopressors/inotropes (OR 2.68; CI 1.18-6.12, P=0.02); adequate empirical treatment had a protective effect (OR 0.48; CI 0.24-0.95, P=0.03).
TIMELY administration of adequately dosed treatment regimens and early ICU admission of critically ill patients could help in improving outcomes.
本研究旨在评估希腊重症监护病房（ICU）医院获得性血流感染（HA-BSI）的流行病学情况及转归。
对欧洲细菌耐药性监测研究（EUROBACT）期间收集的29个ICU的数据进行二次分析，该研究是一项关于HA-BSI的大型前瞻性观察性多国调查。记录在ICU获得的或入院前48小时内发生的HA-BSI的首发情况。
革兰阴性菌占主导，即不动杆菌属、克雷伯菌属、假单胞菌属（占单一微生物感染的73.3%），其次是革兰阳性球菌（18.3%）；真菌（7.6%）和厌氧菌（0.8%）。总体而言，73.3%的分离株为多重耐药（MDR），47.1%为广泛耐药（XDR），1.2%为泛耐药（PDR）。碳青霉烯类是经验性使用最频繁的抗生素，而黏菌素是最常有效的抗生素；两者的计算平均每日总剂量均未达最佳。总体28天全因死亡率为33.3%。在多变量分析中，对转归产生不利影响的因素包括HA-BSI发生时较高的序贯器官衰竭评估（SOFA）评分（比值比[OR]1.19；95%置信区间[CI]1.0
