Published 2024 | Version v1
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The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections

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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 0.5 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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https://hdl.handle.net/11567/1202335
URN
urn:oai:iris.unige.it:11567/1202335

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UNIGE