Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study
Issued Date
2024-01-01
Resource Type
ISSN
1198743X
eISSN
14690691
Scopus ID
2-s2.0-85206947039
Pubmed ID
39326671
Journal Title
Clinical Microbiology and Infection
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Microbiology and Infection (2024)
Suggested Citation
Loiodice A., Bailly S., Ruckly S., Buetti N., Barbier F., Staiquly Q., Tabah A., Timsit J.F., Lipman J., Pollock H., Ben Margetts, Udy A., Young M., Bhadange N., Tyler S., Ledtischke A., Finnis M., Dwivedi J., Saxena M., Biradar V., Soar N., Sarode V., Brewster D., Regli A., Weeda E., Ahmed S., Fourie C., Laupland K., Ramanan M., Walsham J., Meyer J., Litton E., Maria Palermo A., Yap T., Eroglu E., George Attokaran A., Jaramillo C., Nafees K.M., Nafees K.M.K., Aqilah Haji Abd Rashid N., Adi Muhamad Ibnu Walid H., Mon T., Dhakshina Moorthi P., Sudhirchandra S., Sridharan D.D., Haibo Q., Xie J., Jianfeng X., Wei-Hua L., Zhen W., Qian C., Luo J., Chen X., Wang H., Zhao P., Zhao J., Wusi Q., Mingmin C., Xu L., Yin C., Wang R., Wang J., Yin Y., Zhang M., Ye J., Hu C., Zhou S., Huang M., Yan J., Wang Y., Qin B., Ye L., Weifeng X., Peije L., Geng N., Ling L., Hayashi Y., Karumai T., Yamasaki M., Hashimoto S., Hosokawa K., Makino J., Matsuyoshi T., Kuriyama A., Shigemitsu H., Mishima Y., Nagashima M., Yoshida H., Fujitani S., Omori K., Rinka H., Saito H., Atobe K., Kato H., Takaki S., Sulaiman H., Shahnaz Hasan M., Fadhil Hadi Jamaluddin M., Pheng L.S., Visvalingam S. Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study. Clinical Microbiology and Infection (2024). doi:10.1016/j.cmi.2024.09.011 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101780
Title
Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study
Author(s)
Loiodice A.
Bailly S.
Ruckly S.
Buetti N.
Barbier F.
Staiquly Q.
Tabah A.
Timsit J.F.
Lipman J.
Pollock H.
Ben Margetts
Udy A.
Young M.
Bhadange N.
Tyler S.
Ledtischke A.
Finnis M.
Dwivedi J.
Saxena M.
Biradar V.
Soar N.
Sarode V.
Brewster D.
Regli A.
Weeda E.
Ahmed S.
Fourie C.
Laupland K.
Ramanan M.
Walsham J.
Meyer J.
Litton E.
Maria Palermo A.
Yap T.
Eroglu E.
George Attokaran A.
Jaramillo C.
Nafees K.M.
Nafees K.M.K.
Aqilah Haji Abd Rashid N.
Adi Muhamad Ibnu Walid H.
Mon T.
Dhakshina Moorthi P.
Sudhirchandra S.
Sridharan D.D.
Haibo Q.
Xie J.
Jianfeng X.
Wei-Hua L.
Zhen W.
Qian C.
Luo J.
Chen X.
Wang H.
Zhao P.
Zhao J.
Wusi Q.
Mingmin C.
Xu L.
Yin C.
Wang R.
Wang J.
Yin Y.
Zhang M.
Ye J.
Hu C.
Zhou S.
Huang M.
Yan J.
Wang Y.
Qin B.
Ye L.
Weifeng X.
Peije L.
Geng N.
Ling L.
Hayashi Y.
Karumai T.
Yamasaki M.
Hashimoto S.
Hosokawa K.
Makino J.
Matsuyoshi T.
Kuriyama A.
Shigemitsu H.
Mishima Y.
Nagashima M.
Yoshida H.
Fujitani S.
Omori K.
Rinka H.
Saito H.
Atobe K.
Kato H.
Takaki S.
Sulaiman H.
Shahnaz Hasan M.
Fadhil Hadi Jamaluddin M.
Pheng L.S.
Visvalingam S.
Bailly S.
Ruckly S.
Buetti N.
Barbier F.
Staiquly Q.
Tabah A.
Timsit J.F.
Lipman J.
Pollock H.
Ben Margetts
Udy A.
Young M.
Bhadange N.
Tyler S.
Ledtischke A.
Finnis M.
Dwivedi J.
Saxena M.
Biradar V.
Soar N.
Sarode V.
Brewster D.
Regli A.
Weeda E.
Ahmed S.
Fourie C.
Laupland K.
Ramanan M.
Walsham J.
Meyer J.
Litton E.
Maria Palermo A.
Yap T.
Eroglu E.
George Attokaran A.
Jaramillo C.
Nafees K.M.
Nafees K.M.K.
Aqilah Haji Abd Rashid N.
Adi Muhamad Ibnu Walid H.
Mon T.
Dhakshina Moorthi P.
Sudhirchandra S.
Sridharan D.D.
Haibo Q.
Xie J.
Jianfeng X.
Wei-Hua L.
Zhen W.
Qian C.
Luo J.
Chen X.
Wang H.
Zhao P.
Zhao J.
Wusi Q.
Mingmin C.
Xu L.
Yin C.
Wang R.
Wang J.
Yin Y.
Zhang M.
Ye J.
Hu C.
Zhou S.
Huang M.
Yan J.
Wang Y.
Qin B.
Ye L.
Weifeng X.
Peije L.
Geng N.
Ling L.
Hayashi Y.
Karumai T.
Yamasaki M.
Hashimoto S.
Hosokawa K.
Makino J.
Matsuyoshi T.
Kuriyama A.
Shigemitsu H.
Mishima Y.
Nagashima M.
Yoshida H.
Fujitani S.
Omori K.
Rinka H.
Saito H.
Atobe K.
Kato H.
Takaki S.
Sulaiman H.
Shahnaz Hasan M.
Fadhil Hadi Jamaluddin M.
Pheng L.S.
Visvalingam S.
Author's Affiliation
Saint Marianna University School of Medicine Yokohama City Seibu Hospital
Faculty of Medicine
Rockhampton Hospital
Fiona Stanley Hospital
The Second Hospital of Jilin University
Université Grenoble Alpes
Jiangsu Province Hospital
Qilu Hospital of Shandong University
Yokosuka Kyosai Hospital
Tokyo Metropolitan Tama Medical Center
Henan Provincial People's Hospital
Qingdao Municipal Hospital
Hangzhou First People's Hospital
Raja Isteri Pengiran Anak Saleha Hospital
Kameda Medical Center
Shanghai General Hospital
The University of Queensland
Royal Brisbane and Women's Hospital
Lanzhou University
Hiroshima University Hospital
Yokohama City University Hospital
Princess Alexandra Hospital
Wannan Medical College
Bankstown-Lidcombe Hospital
Hôpital Bichat-Claude-Bernard AP-HP
Osaka City General Hospital
Redcliffe Hospital
Lyell McEwin Health Service
Centre Hospitalier Regional et Universitaire de Tours
University Hospital, Kyoto Prefectural University of Medicine
University of Malaya Medical Centre
Kunming Medical University
Queensland University of Technology
CHR d'Orléans
Hôpitaux Universitaires de Genève
The Alfred
Kurashiki Central Hospital
Southeast University
Cabrini Hospital Malvern
Tokyo Medical and Dental University
The Prince Charles Hospital
Chinese University of Hong Kong
Inserm
St. Marianna University Hospital Kawasaki
Ripas Hospital
Gleneagles Jpmc
Suri Seri Begawan Hospital
Outcomerea
ICURESEARCH™
Hebei Petrochina Central Hospital
Hospital Tengku Ampuan Rahimah
Zhejiang Hospital
St John of God Murdoch Hospital
Taizhou People's Hospital
Tianjin Third Central Hospital
Réanimation Médicale et Infectieuse
Ipswich Hospital
Faculty of Medicine
Rockhampton Hospital
Fiona Stanley Hospital
The Second Hospital of Jilin University
Université Grenoble Alpes
Jiangsu Province Hospital
Qilu Hospital of Shandong University
Yokosuka Kyosai Hospital
Tokyo Metropolitan Tama Medical Center
Henan Provincial People's Hospital
Qingdao Municipal Hospital
Hangzhou First People's Hospital
Raja Isteri Pengiran Anak Saleha Hospital
Kameda Medical Center
Shanghai General Hospital
The University of Queensland
Royal Brisbane and Women's Hospital
Lanzhou University
Hiroshima University Hospital
Yokohama City University Hospital
Princess Alexandra Hospital
Wannan Medical College
Bankstown-Lidcombe Hospital
Hôpital Bichat-Claude-Bernard AP-HP
Osaka City General Hospital
Redcliffe Hospital
Lyell McEwin Health Service
Centre Hospitalier Regional et Universitaire de Tours
University Hospital, Kyoto Prefectural University of Medicine
University of Malaya Medical Centre
Kunming Medical University
Queensland University of Technology
CHR d'Orléans
Hôpitaux Universitaires de Genève
The Alfred
Kurashiki Central Hospital
Southeast University
Cabrini Hospital Malvern
Tokyo Medical and Dental University
The Prince Charles Hospital
Chinese University of Hong Kong
Inserm
St. Marianna University Hospital Kawasaki
Ripas Hospital
Gleneagles Jpmc
Suri Seri Begawan Hospital
Outcomerea
ICURESEARCH™
Hebei Petrochina Central Hospital
Hospital Tengku Ampuan Rahimah
Zhejiang Hospital
St John of God Murdoch Hospital
Taizhou People's Hospital
Tianjin Third Central Hospital
Réanimation Médicale et Infectieuse
Ipswich Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for ≥1 day and for whom time-to-appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n = 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n = 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72–0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9–16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI.