Table 3.
Patient characteristics at diagnosis of hospital-acquired bloodstream infection and day-28 mortality
| Characteristics | All patients (N = 2600) | Dead on D28 (n = 966) | Alive on D28 (n = 1634) | OR [95% CI] | p value |
|---|---|---|---|---|---|
| Time from ICU admission to HA-BSI | |||||
| Acquired prior to ICU admission | 558 (21.5) | 188 (19.5) | 370 (22.6) | 1.03 [0.82; 1.29] | 0.017 |
| Early ICU-acquired (≤ 7 days) | 810 (31.2) | 327 (33.9) | 483 (29.6) | 1.32 [1.08; 1.6] | |
| Late ICU-acquired (> 7 days) | 1232 (47.4) | 451 (46.7) | 781 (47.8) | 1 | |
| Maximum temperature | |||||
| < 38.2 °C | 1412 (54.5) | 588 (61.2) | 824 (50.6) | 1 | < 0.001 |
| ≥ 38.2 °C | 1179 (45.5) | 373 (38.8) | 806 (49.4) | 0.72 [0.6; 0.86] | |
| Sepsis or septic shock | |||||
| No sepsis or sepsis without shock | 1776 (68.5) | 538 (55.9) | 1238 (76) | 1 | < 0.001 |
| Septic shock—no steroids | 446 (17.2) | 213 (22.1) | 233 (14.3) | 2.38 [1.89; 2.99] | |
| Septic shock—steroids administered | 370 (14.3) | 211 (21.9) | 159 (9.8) | 3.85 [2.98; 4.97] | |
| SOFA score | 8 [5; 11] | 10 [7; 13] | 7 [5; 10] | 1.21 [1.19; 1.24] | < 0.001 |
| Ventilation status | |||||
| Low flow oxygen or no oxygen | 493 (19) | 104 (10.8) | 389 (23.8) | 1 | < 0.001 |
| High flow oxygen nasal canula | 163 (6.3) | 50 (5.2) | 113 (6.9) | 1.69 [1.11; 2.57] | |
| Non-invasive mechanical ventilation or CPAP | 153 (5.9) | 50 (5.2) | 103 (6.3) | 1.84 [1.2; 2.81] | |
| Invasive Mechanical Ventilation | 1791 (68.9) | 762 (78.9) | 1029 (63) | 2.81 [2.18; 3.61] | |
| ECMO (VA or VV) | 41 (1.6) | 21 (2.2) | 20 (1.2) | 1.92 [0.99; 3.72] | 0.053 |
| Vasopressors (adrenaline or noradrenaline) | 1376 (52.9) | 614 (63.6) | 762 (46.6) | 2.44 [2.04; 2.93] | < 0.001 |
| Vasopressin | 113 (4.3) | 61 (6.3) | 52 (3.2) | 2.89 [1.89; 4.4] | < 0.001 |
| Gram-negative bacteriaa | 1623 (62.4) | 608 (62.9) | 1015 (62.1) | 0.98 [0.82; 1.17] | 0.823 |
| DTR Gram-negative | 350 (13.5) | 185 (19.2) | 165 (10.1) | 1.71 [1.33; 2.21] | < 0.001 |
| Gram-positive bacteriaa | 859 (33) | 312 (32.3) | 547 (33.5) | 0.98 [0.82; 1.17] | 0.821 |
| Resistant Gram-positive (MRSA, MRSE or VRE) | 323 (12.4) | 112 (11.6) | 211 (12.9) | 0.86 [0.66; 1.11] | 0.248 |
| Fungusa | 227 (8.7) | 102 (10.6) | 125 (7.6) | 1.39 [1.04; 1.86] | 0.026 |
| Strict anaerobe bacteriaa | 57 (2.2) | 15 (1.6) | 42 (2.6) | 0.76 [0.41; 1.41] | 0.382 |
| Polymicrobial blood culture | 290 (11.2) | 106 (11) | 184 (11.3) | 1 [0.77; 1.32] | 0.973 |
| Source of HA-BSI | |||||
| Intravascular catheter | 686 (26.4) | 239 (24.7) | 447 (27.4) | 1 | 0.027 |
| Intra-abdominal | 392 (15.1) | 145 (15) | 247 (15.1) | 1.33 [1; 1.76] | |
| Other | 217 (8.3) | 69 (7.1) | 148 (9.1) | 1.01 [0.71; 1.44] | |
| Primary | 425 (16.3) | 169 (17.5) | 256 (15.7) | 1.26 [0.96; 1.65] | |
| Respiratory | 694 (26.7) | 288 (29.8) | 406 (24.8) | 1.39 [1.09; 1.77] | |
| Urinary | 186 (7.2) | 56 (5.8) | 130 (8) | 0.9 [0.62; 1.3] | |
| More than 1 possible source of infection | 853 (32.8) | 322 (33.3) | 531 (32.5) | 1.14 [0.94; 1.37] | 0.191 |
| Time to adequate antimicrobial therapy | |||||
| ≤ 24 h, n (%) | 1339 (51.5) | 463 (47.9) | 876 (53.6) | 1 | < 0.001 |
| ]24;48] hours, n (%) | 336 (12.9) | 117 (12.1) | 219 (13.4) | 1.03 [0.79; 1.34] | |
| ]48;120] hours, n (%) | 396 (15.2) | 134 (13.9) | 262 (16) | 0.96 [0.74; 1.23] | |
| > 120 h, n (%) | 125 (4.8) | 38 (3.9) | 87 (5.3) | 0.72 [0.47; 1.09] | |
| Never, n (%) | 403 (15.5) | 214 (22.2) | 189 (11.6) | 1.98 [1.55; 2.53] | |
| Source control | |||||
| Not required | 1235 (47.5) | 488 (50.5) | 747 (45.7) | 1 | < 0.001 |
| Required, achieved | 1117 (43) | 321 (33.2) | 796 (48.7) | 0.63 [0.52; 0.76] | |
| Required, but NOT achieved | 248 (9.5) | 157 (16.3) | 91 (5.6) | 2.6 [1.92; 3.51] |
Continuous variables are presented as median [IQR] and categorical variables as n (%).Closed brackets [;] denote inclusive of the end of the range and open brackets]; [ denote the exclusion of the end of the range. HA-BSI: hospital-acquired blood stream infection, CPAP: continuous positive airway pressure ECMO: extra-corporeal membrane oxygenation, VA: venoarterial, VV: venovenous. DTR: Difficult to treat resistance MRSA: methicillin-resistant Staphylococcus aureus, MRSE: methicillin-resistant Staphylococcus epidermidis and includes all coagulase negative staphylococcus reported as non-susceptible to methicillin, VRE: vancomycin-resistant Enterococcus
aSum of percentages exceed 100 because a patient may have had several pathogens in the blood culture, referring to the 11.2% polymicrobial blood cultures