Table 1.
Characteristics of participating ICUs and association with day-28 (D28) patient mortality
| Characteristics* | All ICUs (n = 333)* |
All patients (n = 2600) | Dead on D28 (n = 966) | Alive on D28 (n = 1634) | OR [95% CI] |
p value |
|---|---|---|---|---|---|---|
| Geographic region | 0.824 | |||||
| Europe and Central Asia | 184 (55.3) | 1775 (68.3) | 689 (71.3) | 1086 (66.5) | 1 | |
| East Asia and Pacific | 69 (20.7) | 412 (15.8) | 127 (13.1) | 285 (17.4) | 0.83 [0.54; 1.27] | |
| Middle East and North Africa | 48 (14.4) | 268 (10.3) | 91 (9.4) | 177 (10.8) | 0.96 [0.61; 1.54] | |
| South Asia | 14 (4.2) | 54 (2.1) | 24 (2.5) | 30 (1.8) | 1.29 [0.52; 3.2] | |
| Latin America and the Caribbean | 11 (3.3) | 52 (2) | 17 (1.8) | 35 (2.1) | 0.78 [0.33; 1.85] | |
| Sub-Saharan Africa | 5 (1.5) | 20 (0.8) | 6 (0.6) | 8 (0.5) | 1.7 [0.55; 5.21] | |
| North America | 2 (0.6) | 19 (0.7) | 8 (0.8) | 11 (0.7) | 1.34 [0.34; 5.31] | |
| National income | 0.145 | |||||
| High-income | 202 (60.7) | 1479 (56.9) | 485 (50.2) | 994 (60.8) | 1 | |
| Upper-middle-income | 80 (24) | 870 (33.5) | 393 (40.7) | 477 (29.2) | 1.42 [0.99; 2.04] | |
| Low and lower-middle-income** | 51 (14.1) | 251 (9.2) | 88 (9.1) | 163 (10) | 1.11 [0.72; 1.72] | |
| Academic status of the hospital | ||||||
| Teaching hospital | 270 (82.6) | 2207 (85.4) | 823 (85.4) | 1384 (85.4) | 1 | 0.122 |
| Non-teaching hospital | 57 (17.4) | 378 (14.6) | 141 (14.6) | 237 (14.6) | 1.28 [0.94; 1.76] | |
| Type of ICU | ||||||
| Mixed (medical-surgical) | 260 (79.5) | 2040 (78.9) | 732 (75.9) | 1308 (80.7) | 1 | 0.048 |
| Medical | 41 (12.5) | 383 (14.8) | 180 (18.7) | 203 (12.5) | 1.49 [1.07; 2.09] | |
| Surgical | 26 (8) | 162 (6.3) | 52 (5.4) | 110 (6.8) | 0.9 [0.57; 1.43] | |
| Number of ventilator equivalent beds in the ICU ≥ 15 | 176 (53.82) | 1464 (56.63) | 499 (51.8) | 965 (59.5) | 0.81 [0.65; 1.03] | 0.081 |
| Nurse to ventilator-bed ratio | 2 [1.3; 2.9] | 2.2 [1.6; 2.8] | 2.2 [1.6; 2.8] | 2.2 [1.5; 2.9] | 0.99 [0.97; 1] | 0.106 |
| Senior doctor to ventilator-bed ratio | 6.7 [4.3; 10] | 6 [4; 9.5] | 6 [4; 9] | 6.3 [4.3; 9.5] | 0.99 [0.97; 1.01] | 0.213 |
| Senior medical cover is available 24/7 | 304 (93.3) | 2355 (91.5) | 869 (90.3) | 1486 (92.1) | 0.81 [0.53; 1.23] | 0.319 |
| General surgery is available 24/7 | 321(98.2) | 2556 (98.9) | 951 (98.7) | 1605 (99) | 0.8 [0.31; 2.05] | 0.637 |
| Infectious diseases specialist or clinical microbiologist are consulted | ||||||
| 24/7 | 170 (54.8) | 1479 (60) | 566 (60.9) | 913 (59.4) | 1 | 0.57 |
| During business hours | 114 (36.8) | 855 (34.7) | 313 (33.7) | 542 (35.3) | 1.06 [0.82; 1.38] | |
| Never or sporadically | 26 (8.4) | 131 (5.3) | 50 (5.4) | 81 (5.3) | 1.29 [0.8; 2.09] | |
| Clinical pharmacists are consulted | ||||||
| 24/7 | 82 (25.5) | 636 (25.1) | 188 (19.9) | 448 (28.2) | 1 | 0.007 |
| During business hours | 129 (40.1) | 811 (32) | 284 (30.1) | 527 (33.2) | 1.32 [0.99; 1.78] | |
| Never or sporadically | 111 (34.5) | 1084 (42.8) | 471 (49.9) | 613 (38.6) | 1.64 [1.21; 2.24] | |
| TDM of aminoglycosides is available | ||||||
| Everyday | 171 (52.5) | 1249 (48.5) | 383 (39.8) | 866 (53.7) | 1 | 0.002 |
| At least once a week | 30 (9.2) | 213 (8.3) | 81 (8.4) | 132 (8.2) | 1.32 [0.88; 1.98] | |
| Not available | 125 (38.3) | 1113 (43.2) | 498 (51.8) | 615 (38.1) | 1.6 [1.23; 2.09] | |
| TDM of vancomycin is available | ||||||
| Everyday | 200 (61.3) | 1419 (55.1) | 462 (48) | 957 (59.3) | 1 | 0.012 |
| At least once a week | 43 (13.2) | 319 (12.4) | 120 (12.5) | 199 (12.3) | 1.07 [0.74; 1.53] | |
| Not available | 83 (25.5) | 837 (32.5) | 380 (39.5) | 457 (28.3) | 1.55 [1.15; 2.07] | |
| TDM of β-lactams is available | ||||||
| Everyday | 35 (10.7) | 256 (9.9) | 87 (9) | 169 (10.5) | 1 | 0.255 |
| At least once a week | 51 (15.6) | 408 (15.8) | 117 (12.2) | 291 (18) | 0.81 [0.52; 1.27] | |
| Not available | 240 (73.6) | 1911 (74.2) | 758 (78.8) | 1153 (71.5) | 1.1 [0.75; 1.62] | |
Full report of center characteristics is available in ESM eTable 3. Results reported as n (%) for categorical variables and median [IQR] for continuous variables
*All center data were missing for 6 ICUs and 7–12 did not provide staffing or stewardship data
**There were 4 ICUs and 11 patients in the low-income category. 24/7: 24 h a day, 7 days a week. ICU: intensive care unit. TDM: therapeutic drug monitoring. Ventilator equivalent beds refers to the maximum number of ventilated patients the ICU can accommodate at one time