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Update in Hospital-acquired Bacteremia Respiratory Infections: Experience From the EUROBACT Study

Timsit, Jean-François MD, PhD*,†,‡; Tabah, Alexis MD*,†,‡,§; Koulenti, Despoina MD; Ruckly, Stéphane MSc†,‡; Laupland, Kevin B. MD†,¶; Garrouste-Orgeas, Maité MD†,‡,#; Zahar, Jean-Ralph MD, PhD‡,**; Blot, Sjin RN, MNSc, PhD††; de Carvalho, Frederico Bruzzi MD‡‡; Paiva, José A. MD§§; Dimopoulos, George MD, PhD§

doi: 10.1097/CPM.0000000000000014
Respiratory Infections

To describe the characteristics and determinants of outcome of hospital-acquired bloodstream infection (HA-BSI) due to respiratory infection among patients admitted to intensive care units (ICUs). We performed a post hoc analysis of the EUROBACT multicenter cohort study, conducted in 162 ICUs in 24 countries. The HA-BSIs due to candidemia and from mixed respiratory and nonrespiratory sources were excluded. From the overall 1156 included in EUROBACT, 230 patients were classified as having HA-BSI respiratory infections (HA-BSI requiring ICU admission, n=40; ICU-acquired noninvasively ventilated respiratory BSI, n=30; and ICU-acquired invasively ventilated BSI, n=160) and were compared with 749 patients with HA-BSI not related to respiratory infections. HA-BSI respiratory infections were more frequently due to gram negatives (76.3% vs. 56.7%, P<0.0001), mainly Acinetobacter baumannii (18.3% vs. 10.4%, P=0.0007), Klebsiella spp. (18.7% vs. 11%, P=0.0013), and were less frequently because of gram-positive cocci (23.3% vs. 41.2%, P<0.0001), with the exception of Staphylococcus aureus (11.3% vs. 9.5%, P=0.39). HA-BSI respiratory infections were more frequently associated with multiple drug-resistant pathogens (53.9% vs. 42.7%, P=0.0003), were more common in medical patients, and were more likely to be ICU-acquired as compared with nonrespiratory infections. After adjustment for severity and other risk factors, HA-BSI of respiratory origin was a risk factor for day-28 mortality (odds ratio=1.52 [1.02-2.27], P=0.04). Among the cohort of 230 patients with HA-BSI of respiratory origin, those with HA-BSI requiring ICU admission presented more often with septic shock (24/40=60%) as compared with ICU-acquired HA-BSI episodes occurring in noninvasively (9/30=30%) and invasively (71/160=44%, P=0.04) ventilated patients. Recovered microorganisms were similar between the 3 groups of HA-BSI of respiratory origin. When adjusted for confounding factors, the risk of death was lower for ICU-acquired HA-BSI occurring among invasive ventilated patients (odds ratio=0.41 [0.19-0.92], P=0.03) than for patients not invasively ventilated before HA-BSI of respiratory origin. The EUROBACT multicenter study confirms that the lung as a respiratory source of infection is associated with more gram-negative resistant pathogen and a poorer prognosis. When associated with BSI, lung infections occurring in noninvasively mechanical ventilated patients are associated with more septic shock and a worse prognosis than patients with bacteremic ventilator-associated pneumonia.

Supplemental Digital Content is available in the text.

*Medical ICU, Albert Michallon University Hospital

U 823, Albert Bonniot Institute, Grenoble 1 University

Outcomerea Organization

#Paris Descartes University, Paris Sorbonne Cité, Medical Surgical ICU, Paris Saint-Joseph Hospital

**Infection Control Unit, Necker University Hospital, Paris, France

§Department of Intensive Care Medicine, Royal Brisbane & Women’s Hospital, Brisbane, Qld, Australia

Department of Critical Care, University Hospital ATTIKON, Medical School University of Athens, Athens, Greece

Department of Critical Care Medicine, Peter Lougheed Centre, University of Calgary, and Alberta Health Services, Calgary, AB, Canada

††General Internal Medicine & Infectious Diseases, Ghent University Hospital, Ghent, Belgium

‡‡Centro De Terapia Intensiva, Hospital Mater Dei, Belo Horizonte, Brazil

§§Emergency and Intensive Care Department, Centro Hospitalar S. Joao, Porto, Portugal

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

This manuscript was written on behalf of the EUROBACT study group, whose members are listed in the Appendix (Supplemental Digital Content 1, The EUROBACT study was designed by the infection section of the European Society of Intensive Care Medicine (ESICM).

The study was endorsed by the European Critical Care Research Network (ECCRN) in May 2009 and received the Clinical Research Award with a 20 k€ research grant from the ECCRN in November 2011.

Disclosure: The authors declare that they have no conflicts of interest.

Address correspondence to: Jean-François Timsit, MD, PhD, Medical and infectious diseases ICU APHP Hopital Bichat 75018 Paris France. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.