Editor's Pick: Intensive Care Medicine journal

Editor's Pick: Intensive Care Medicine journal

The Chair of the Editorial and Publications Committee, and Editor of Intensive Care Medicine journal has selected the article "Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study  as one of the "Articles of the Month" for December 2012.

The corresponding author of the article, Jean-Francois Timsit submitted the following Clinical Implications of the EUROBACT study:

Nosocomial bacteremia is frequent and life-threatening event in ICU. The dramatic increase in bacterial resistance especially in Gram negative bacteria may have an impact on prognosis by limiting or delaying treatment with adequate antimicrobials. In a prospective cohort study, (organised by the infection section of ESICM and the University of Grenoble), conducted in 162 ICUs in 24 countries, we studied characteristics and prognostic determinants of 1,156 episodes (58.3 % were gram-negative, 32.8 % gram-positive, 7.8 % fungal, and 1.2 % anaerobes). We found that 48% of episodes were with multi-drug resistant bacteria including 20% with extensively resistant bacterias. Carbapenem was the most frequent empirical antibiotic therapy.  Resistance significantly increased the delay of adequate antimicrobial therapy. The 28-day all-cause fatality rate was 36 %. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate, uncontrolled infection source and timing to adequate treatment.

Our data underline the importance of enhanced measures to prevent HA-BSI and to control the dissemination of resistant micro-organisms. They also indicate a need for developing new antimicrobial agents for MDR.

PHOTO: Corresponding author Jean-Francois Timsit

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