Euro-short (synopsis)

Jean-Francois Timsit-Grenoble, France for the infection section of the ESICM Epidemiology and outcome of hospital-acquired bacteremia Executive committee: Alexis Tabah Stijn Blot Despoina Koulenti Maité Garrouste Jean-François Timsit Steering committee : Carlet J Brun-Buisson C Misset B Martin C Rello J Dimopoulos G Country coordinators: Decruynaere J (Belgium) Misset B (France) Koulenti D (Greece) Mikstacki A (Poland) Paiva JA (Portugal) Bruzzi F (Brazil) Valles J & Ferrer R (Spain) Kruger W (Germany) Lipman J (Australia-New Zeland) Hanberger H (Sweden) Gornik I (Croatia) Antonelli M (Italy) Çakar N (Turkey) Vosylius S (Lithuania) Onyekwelu E (Gambia) Bonten M (the Netherlands) Pugin J(Switzerland) Valentin A(Austria) Thiery G(Bosnia-Herzegovia) Motaouakkil (Morocco) Laupland K(Canada) Csomos A(Hungary) Bruzzi de Carvalho F (Brazil) Mizobe T (Japan) Batranovic U (Republic of Serbia) Arancibia F (Chile) Xiaochun M (China) Al Rahma H (United Arab Emirates) Bacteraemia is associated with sepsis in more than 2/3 of the cases and associated with severe sepsis and septic shock in 25 % to 50% of the cases [1-3]. On the opposite, bacteraemia is recovered from 16% of patients with sepsis and from 30% of patients with severe sepsis or septic shock [1]. Many efforts have been done these years to better characterize severe sepsis and septic shock [4-9]. But it should be useful to contrast the epidemiology of bacteraemia, the most indisputable evidence for infection in 2009. The epidemiology of hospital-acquired bacteraemia admitted in ICU, and the way there are managed in the recent years is not well known in a very large cohort of The risk of ICU-acquired bacteraemia is 5-7/1000 patient day [2, 10-13], and 6.8 per 100 admission of more than 48 hours [10]. The overall mortality rate from bacteraemia has been recently reviewed by Cohen et al and frequently reached 50% in ICU patients [14]. In the series of Geneva, the incidence varied between year between 3.2 and 4.3/100 admission and the D28 mortality was stable at 37% and reached 67% in case of septic shock [15] The mortality risk of hospital-acquired bacteraemia admitted in ICU is not exactly known. We hypothesize that the outcome is similar to the one of icu-acquired bacteraemia. The purpose of the present study is to perform a prospective study about hospital- acquired bacteraemia in ICUs with special emphasis on its epidemiology and outcomes in 2009. The specific objectives of this study are to examine: the incidence, source and epidemiology of bloodstream infections as compared to the consequences of BSI in term of sepsis, severe sepsis, septic shock in 2009 and what the potential impact of previous statin therapy on these [17]? the timing and characteristics of antimicrobial therapy of BSI? the principles and timing of co-interventions in the treatment of BSI in 2009? the patient-based and ICU-based risk factor of poor outcome and of delay of appropriate antibiotic therapy or drainage [10, 18, 19]? - Prospective observational multicenter cohort study. All patients with a bloodstream infection. (For CNS, 2 blood cultures with the same antimicrobial susceptibility profile are mandatory) if the first positive blood culture is sampled after more than 48 h of hospital stay. . Duration of the study: 3 consecutive months. or 10 consecutive hospital-acquired Number of patients admitted during the 3 month period Main characteristics of infectious diseases and microbiology department one number is allocated to each patient and the correspondence between the allocated number and the name of the patient is only keep by the attending physician for further request during a 6-month period. Severity scores and of sepsis at the time of the first positive BC was sampled Timing and details about initial Abx (eg, monotherapy, aminoglycosides use) If not discharged, patients’ severity at day 3 Duration of positive blood culture (date and hour of the sampling of the last Surgical debridment or drainage if appropriate, timing of catheter removal Vital status at ICU and hospital discharge Optional: 3-month mortality and quality of life assessed by a postal Date and hour of sampling of first and subsequent positive blood culture Gram positive (penicillin G or A, methicillin, gentamicin, ofloxacin, Gram negative (third generation cephalosporins, ceftazidime, imipenem, ciprofloxacin, gentamicin, amikacin, colistin) - Agreement to collect the data at the hospital, ICU and patient level. - Systematic susceptibility testings for hospital acquired bacteraemia in ICU If we assumed that 100 patients stayed in the ICU more than 48 hours within the 3- month period, 6 will have at least one ICU-acquired BSI (Garrouste 2006) and 3-6 will present an hospital acquired bacteraemia at ICU admission. 1100 episodes of bacteraemia will be needed to detect risk factors of poor outcome with an odds ratio of 1.5 if the risk factor is present in 25% of the population enrolled and if mortality occurred in 40% of cases, with a type one error of 0.05 and a power We assumed that 10 % of the cases will not be completed. If 150 ICUs accept to participate, 1300 episodes of ICU-acquired BSI will be enrolled. - A Steering committee from the infection section of the ESICM will design the project and another monitoring committee? will be created to validate the data and ask for queries to the investigators. - One study coordinator per country to obtain IRB approval and recruit - The variables included in the forms are on appendix 1 and 2 (cf patient based - Electronic forms preferably or paper forms sent by fax to the monitoring - Data monitoring and data analyses: Research center: Joseph Fourrier University/INSERM U823: “outcome of cancers and critical illnesses” ; 38043 - Data collected will be kept for 5 years and then destroyed. Comparisons between groups according to demographic characteristics, bacteraemia characteristics and timing and adequacy of antimicrobial therapy and administration of other treatments (surgical treatment, steroids, Activated-protein C). Patients and unit characteristics will be described using n (%) for qualitative variables and median (Interquartile range) for quantitative variable. Risk factors of poor outcome will be searched by using hierarchical models with binomial response (country and hospital random factors will be included in the SAS 9.x ML-Win and R softwares will be used. Alberti, C., et al., Epidemiology of sepsis and infection in ICU patients from an
international multicentre cohort study. Intensive Care Med, 2002. 28(2): p. 108-21.
Garrouste-Orgeas, M., et al., A one-year prospective study of nosocomial bacteraemia
in ICU and non-ICU patients and its impact on patient outcome. J Hosp Infect, 2000.
44(3): p. 206-13.
Brun-Buisson, C., F. Doyon, and J. Carlet, Bacteremia and severe sepsis in adults: a
multicenter prospective survey in ICUs and wards of 24 hospitals. French
Bacteremia-Sepsis Study Group. Am J Respir Crit Care Med, 1996. 154(3 Pt 1): p.
617-24.
Adrie, C., et al., Epidemiology and economic evaluation of severe sepsis in France:
age, severity, infection site, and place of acquisition (community, hospital, or intensive
care unit) as determinants of workload and cost. J Crit Care, 2005. 20(1): p. 46-58.
Alberti, C., et al., Systemic inflammatory response and progression to severe sepsis in
critically ill infected patients. Am J Respir Crit Care Med, 2005. 171(5): p. 461-8.
Blanco, J., et al., Incidence, organ dysfunction and mortality in severe sepsis: a
Spanish multicentre study. Crit Care, 2008. 12(6): p. R158.
Brun-Buisson, C., The epidemiology of the systemic inflammatory response. Intensive
Care Med, 2000. 26 Suppl 1: p. S64-74.
Brun-Buisson, C., et al., EPISEPSIS: a reappraisal of the epidemiology and outcome
of severe sepsis in French intensive care units. Intensive Care Med, 2004. 30(4): p.
580-8.
Karlsson, S., et al., Incidence, treatment, and outcome of severe sepsis in ICU-treated
adults in Finland: the Finnsepsis study. Intensive Care Med, 2007. 33(3): p. 435-43.
Garrouste-Orgeas, M., et al., Excess risk of death from intensive care unit-acquired
nosocomial bloodstream infections: a reappraisal. Clin Infect Dis, 2006. 42(8): p.
1118-26.
Renaud, B. and C. Brun-Buisson, Outcomes of primary and catheter-related
bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit
Care Med, 2001. 163(7): p. 1584-90.
Pittet, D., D. Tarara, and R.P. Wenzel, Nosocomial bloodstream infection in critically
ill patients. Excess length of stay, extra costs, and attributable mortality. Jama, 1994.
271(20): p. 1598-601.
Pittet, D., et al., Bedside prediction of mortality from bacteremic sepsis. A dynamic
analysis of ICU patients. Am J Respir Crit Care Med, 1996. 153(2): p. 684-93.
Cohen, J., et al., New method of classifying infections in critically ill patients. Crit
Care Med, 2004. 32(7): p. 1510-26.
Hugonnet, S., et al., Bacteremic sepsis in intensive care: temporal trends in incidence,
organ dysfunction, and prognosis. Crit Care Med, 2003. 31(2): p. 390-4.
Vincent, J.L., et al., The prevalence of nosocomial infection in intensive care units in
Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC)
Study. EPIC International Advisory Committee. Jama, 1995. 274(8): p. 639-44.
Almog, Y., et al., Prior statin therapy is associated with a decreased rate of severe
sepsis. Circulation, 2004. 110(7): p. 880-5.
Garnacho-Montero, J., et al., Timing of adequate antibiotic therapy is a greater
determinant of outcome than are TNF and IL-10 polymorphisms in patients with
sepsis. Crit Care, 2006. 10(4): p. R111.
Garnacho-Montero, J., et al., Mortality and morbidity attributable to inadequate
empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a
matched cohort study. J Antimicrob Chemother, 2008. 61(2): p. 436-41.

Source: http://www.eurobact.eu/pdf/EURO-bact_protocol.pdf