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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

Loiodice A 1 , Bailly S 2 , Ruckly S 3 , Buetti N 4 , Barbier F 5 , Staiquly Q 6 Show all authors , Tabah A 7 , Timsit JF 8 , EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology, the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP) and the OUTCOMEREA Network

Affiliations 

  • 1 OUTCOMEREA Research Group, Drancy, France; ICURESEARCH™, 26 rue Garibaldi, Fontaine, France
  • 2 Grenoble Alpes University, Institut National de la Santé et de la Recherche Medicale 1300, HP2 Grenoble, France
  • 3 OUTCOMEREA Research Group, Drancy, France; Institut National de la Santé et de la Recherche Medicale, Infection Antimicrobial Modelisation Evolution, U1137, Team Decision Science in Infectious Diseases, Paris, France; ICURESEARCH™, 26 rue Garibaldi, Fontaine, France
  • 4 Institut National de la Santé et de la Recherche Medicale, Infection Antimicrobial Modelisation Evolution, U1137, Team Decision Science in Infectious Diseases, Paris, France; Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Service PCI, Geneva, Switzerland
  • 5 Centre Hospitalier Régional d'Orléans, Tours, France
  • 6 ICURESEARCH™, 26 rue Garibaldi, Fontaine, France
  • 7 Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia
  • 8 OUTCOMEREA Research Group, Drancy, France; Institut National de la Santé et de la Recherche Medicale, Infection Antimicrobial Modelisation Evolution, U1137, Team Decision Science in Infectious Diseases, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat hospital, Medical and infectious diseases ICU, F75018, Paris France. Electronic address: Jean-francois.timsit@aphp.fr
Clin Microbiol Infect, 2024 Dec;30(12):1559-1568.
PMID: 39326671 DOI: 10.1016/j.cmi.2024.09.011

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 

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