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Dimopoulos, George; Koulenti, Despoina; Tabah, Alexis; Arvaniti, Kostoula; Poulakou, Garyphalia; Matthaiou, Dimitrios; Armaganidis, Apostolos; Timsit, Jean Francois

doi: 10.1097/01.ccm.0000424709.65375.68
Poster: ABSTRACT Only

Introduction: Hospital acquired bloodstream infections (HA-BSI) are an important complication of critical illness and emergence of anti-microbial resistance, particularly in some countries like Greece, has been of increasing concern.

Hypothesis: Resistant microorganisms predominate in HA-BSIs in Greek ICUs.

Methods: Secondary analysis of data collected during EUROBACT study, a large prospective, observational, multicenter study conducted in 162 ICUs of 24 countries worldwide. First episodes of HA-BSI acquired in the ICU or within 48 hours prior to ICU admission were recorded.

Results: Twenty nine Greek ICUs contributed 288 episodes of HA-BSIs. Mean age (SD) was 59.5 (17.9) years; mean (SD) SAPS II was 48.1 (14.1) at ICU admission, and SOFA 8.3 (3.8) at HA-BSI onset. The commonest pathogens were Acinetobacter sp (84/329 isolates; 25.5%), Klebsiella sp (23.4%), Pseudomonas sp (12.2%), and Enterococcus sp (7%); 37 (12.8%) episodes were polymicrobial. Among monomicrobial cases (n=251), 184 (73.3%) were Gram-negative (GNB), 46 (18.3%) Gram-positive (GPC), 19 (7.6%) fungal, and 2 (0.8%) anaerobes. Overall, 241 (73.3%) isolates were classified as multidrug resistant (MDR), 155 (47.1%) extensively resistant (XDR), 4 (1.2%) as pan-drug resistant (PDR); 59.5% GNB and 13% enterococci were resistant to carbapenems and glycopeptides, respectively. Carbapenems were the most frequently empirically prescribed antibiotics, while colistin was the most frequently adequate. Overall 28-day all cause mortality was 33.3% (G??33.7%, GPC30.4%, fungi61.9%, polymicrobial18.9%). In the multivariate analysis, factors adversely affecting outcome were higher SOFA at HA-BSI onset ([per point] OR1.188; 95%CI 1.08-1.31, p=0.0006), need for renal support (OR2.75; 95%CI 1.35-5.59, p=0.0053), and for vasopressors/inotropes (OR2.68; CI 1.18-6.12, p=0.02), whereas adequate empiric treatment had a protective effect (OR 0.48; CI 0.24-0.95, p= 0.03).

Conclusions: XDR and PDR bacteria were predominant in the largest cohort till now of HA-BSIs in Greek ICUs. Reaching the lifesaving objective of prompt administration of adequate empirical treatment may no longer be achievable in a substantial proportion of patients if new therapeutic options aren’t available soon.

Attikon University Hospital, Athens, Greece

Attikon University Hospital, Athens, Greece

Université Grenoble 1, Albert Michallon University Hospital & Albert Bonniot institute; Team 11: Ou, Team 11: OUTCOMEREA- Université Joseph Fourier - Grenoble 1 Institut Albert Bonniot

Papageorghiou General Hospital of Thessaloniki

Attikon University Hospital, Athens, Greece

UJF-Grenoble 1, U823 Institut Albert Bonniot – team 11: OUTCOMEREA, on behalf of EUROBACT Study Group

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins