Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients

A 1-year, large, prospective surveillance study in 5 Italian hospitals

Diego Delle Rose, Pasquale Sordillo, Sabina Gini, Carlotta Cerva, Stefano Boros, Giovanni Rezza, Marcello Meledandri, Maria Teresa Gallo, Grazia Prignano, Roberta Caccese, Mario D'Ambrosio, Giorgia Citterio, Monica Rocco, Francesca Leonardis, Silvia Natoli, Carla Fontana, Marco Favaro, Maria Grazia Celeste, Tiziana Franci, Gian Piero Testore & 2 others Massimo Andreoni, Loredana Sarmati

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Bloodstream infections (BSIs) from multidrug-resistant (MDR) bacteria cause morbidity and mortality in intensive care unit (ICU) patients worldwide. This study investigated the incidence of BSIs in 5 adult general ICUs in Rome, Italy, and evaluated the mortality rate and risk factors associated with these infections. Methods Over a 12-month period, 1,318 patients were enrolled. Demographic characteristics, Simplified Acute Physiology Score II (SAPS II), comorbidities, and BSI isolate data were collected. After stratification for the outcome, statistical analysis was performed to assess the impact of patient risk factors on in-hospital mortality. Results There were 324 BSIs in 175 patients recorded, with an in-hospital mortality rate of 46%. Univariate analysis revealed that SAPS II, cardiac comorbidity, and Klebsiella pneumoniae BSI were significantly associated with a higher risk of death. Having a K pneumoniae BSI and cardiac illness at admission were both confirmed to be associated with death by multivariate analysis (P =.0162 and P =.0158, respectively). Most of the K pneumoniae isolates showed high resistance rates to carbapenems. Conclusion BSIs caused by K pneumoniae and cardiovascular comorbidity in ICU patients are associated with a higher risk of death. Thorough surveillance for MDR pathogens and stratification of the patients' risk on admission into the ICU are key to improving the outcomes of these infections.

Original languageEnglish
Pages (from-to)1178-1183
Number of pages6
JournalAJIC: American Journal of Infection Control
Volume43
Issue number11
DOIs
Publication statusPublished - Nov 1 2015

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Intensive Care Units
Prospective Studies
Mortality
Infection
Comorbidity
Pneumonia
Hospital Mortality
Carbapenems
Klebsiella pneumoniae
Italy
Cohort Studies
Multivariate Analysis
Demography
Morbidity
Bacteria

Keywords

  • Bloodstream infections
  • Intensive care unit
  • Klebsiella pneumoniae
  • Microbiology
  • Mortality
  • Predictors

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Epidemiology
  • Health Policy

Cite this

Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients : A 1-year, large, prospective surveillance study in 5 Italian hospitals. / Delle Rose, Diego; Sordillo, Pasquale; Gini, Sabina; Cerva, Carlotta; Boros, Stefano; Rezza, Giovanni; Meledandri, Marcello; Gallo, Maria Teresa; Prignano, Grazia; Caccese, Roberta; D'Ambrosio, Mario; Citterio, Giorgia; Rocco, Monica; Leonardis, Francesca; Natoli, Silvia; Fontana, Carla; Favaro, Marco; Celeste, Maria Grazia; Franci, Tiziana; Testore, Gian Piero; Andreoni, Massimo; Sarmati, Loredana.

In: AJIC: American Journal of Infection Control, Vol. 43, No. 11, 01.11.2015, p. 1178-1183.

Research output: Contribution to journalArticle

Delle Rose, D, Sordillo, P, Gini, S, Cerva, C, Boros, S, Rezza, G, Meledandri, M, Gallo, MT, Prignano, G, Caccese, R, D'Ambrosio, M, Citterio, G, Rocco, M, Leonardis, F, Natoli, S, Fontana, C, Favaro, M, Celeste, MG, Franci, T, Testore, GP, Andreoni, M & Sarmati, L 2015, 'Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals', AJIC: American Journal of Infection Control, vol. 43, no. 11, pp. 1178-1183. https://doi.org/10.1016/j.ajic.2015.06.023
Delle Rose, Diego ; Sordillo, Pasquale ; Gini, Sabina ; Cerva, Carlotta ; Boros, Stefano ; Rezza, Giovanni ; Meledandri, Marcello ; Gallo, Maria Teresa ; Prignano, Grazia ; Caccese, Roberta ; D'Ambrosio, Mario ; Citterio, Giorgia ; Rocco, Monica ; Leonardis, Francesca ; Natoli, Silvia ; Fontana, Carla ; Favaro, Marco ; Celeste, Maria Grazia ; Franci, Tiziana ; Testore, Gian Piero ; Andreoni, Massimo ; Sarmati, Loredana. / Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients : A 1-year, large, prospective surveillance study in 5 Italian hospitals. In: AJIC: American Journal of Infection Control. 2015 ; Vol. 43, No. 11. pp. 1178-1183.
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abstract = "Background Bloodstream infections (BSIs) from multidrug-resistant (MDR) bacteria cause morbidity and mortality in intensive care unit (ICU) patients worldwide. This study investigated the incidence of BSIs in 5 adult general ICUs in Rome, Italy, and evaluated the mortality rate and risk factors associated with these infections. Methods Over a 12-month period, 1,318 patients were enrolled. Demographic characteristics, Simplified Acute Physiology Score II (SAPS II), comorbidities, and BSI isolate data were collected. After stratification for the outcome, statistical analysis was performed to assess the impact of patient risk factors on in-hospital mortality. Results There were 324 BSIs in 175 patients recorded, with an in-hospital mortality rate of 46{\%}. Univariate analysis revealed that SAPS II, cardiac comorbidity, and Klebsiella pneumoniae BSI were significantly associated with a higher risk of death. Having a K pneumoniae BSI and cardiac illness at admission were both confirmed to be associated with death by multivariate analysis (P =.0162 and P =.0158, respectively). Most of the K pneumoniae isolates showed high resistance rates to carbapenems. Conclusion BSIs caused by K pneumoniae and cardiovascular comorbidity in ICU patients are associated with a higher risk of death. Thorough surveillance for MDR pathogens and stratification of the patients' risk on admission into the ICU are key to improving the outcomes of these infections.",
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T1 - Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients

T2 - A 1-year, large, prospective surveillance study in 5 Italian hospitals

AU - Delle Rose, Diego

AU - Sordillo, Pasquale

AU - Gini, Sabina

AU - Cerva, Carlotta

AU - Boros, Stefano

AU - Rezza, Giovanni

AU - Meledandri, Marcello

AU - Gallo, Maria Teresa

AU - Prignano, Grazia

AU - Caccese, Roberta

AU - D'Ambrosio, Mario

AU - Citterio, Giorgia

AU - Rocco, Monica

AU - Leonardis, Francesca

AU - Natoli, Silvia

AU - Fontana, Carla

AU - Favaro, Marco

AU - Celeste, Maria Grazia

AU - Franci, Tiziana

AU - Testore, Gian Piero

AU - Andreoni, Massimo

AU - Sarmati, Loredana

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background Bloodstream infections (BSIs) from multidrug-resistant (MDR) bacteria cause morbidity and mortality in intensive care unit (ICU) patients worldwide. This study investigated the incidence of BSIs in 5 adult general ICUs in Rome, Italy, and evaluated the mortality rate and risk factors associated with these infections. Methods Over a 12-month period, 1,318 patients were enrolled. Demographic characteristics, Simplified Acute Physiology Score II (SAPS II), comorbidities, and BSI isolate data were collected. After stratification for the outcome, statistical analysis was performed to assess the impact of patient risk factors on in-hospital mortality. Results There were 324 BSIs in 175 patients recorded, with an in-hospital mortality rate of 46%. Univariate analysis revealed that SAPS II, cardiac comorbidity, and Klebsiella pneumoniae BSI were significantly associated with a higher risk of death. Having a K pneumoniae BSI and cardiac illness at admission were both confirmed to be associated with death by multivariate analysis (P =.0162 and P =.0158, respectively). Most of the K pneumoniae isolates showed high resistance rates to carbapenems. Conclusion BSIs caused by K pneumoniae and cardiovascular comorbidity in ICU patients are associated with a higher risk of death. Thorough surveillance for MDR pathogens and stratification of the patients' risk on admission into the ICU are key to improving the outcomes of these infections.

AB - Background Bloodstream infections (BSIs) from multidrug-resistant (MDR) bacteria cause morbidity and mortality in intensive care unit (ICU) patients worldwide. This study investigated the incidence of BSIs in 5 adult general ICUs in Rome, Italy, and evaluated the mortality rate and risk factors associated with these infections. Methods Over a 12-month period, 1,318 patients were enrolled. Demographic characteristics, Simplified Acute Physiology Score II (SAPS II), comorbidities, and BSI isolate data were collected. After stratification for the outcome, statistical analysis was performed to assess the impact of patient risk factors on in-hospital mortality. Results There were 324 BSIs in 175 patients recorded, with an in-hospital mortality rate of 46%. Univariate analysis revealed that SAPS II, cardiac comorbidity, and Klebsiella pneumoniae BSI were significantly associated with a higher risk of death. Having a K pneumoniae BSI and cardiac illness at admission were both confirmed to be associated with death by multivariate analysis (P =.0162 and P =.0158, respectively). Most of the K pneumoniae isolates showed high resistance rates to carbapenems. Conclusion BSIs caused by K pneumoniae and cardiovascular comorbidity in ICU patients are associated with a higher risk of death. Thorough surveillance for MDR pathogens and stratification of the patients' risk on admission into the ICU are key to improving the outcomes of these infections.

KW - Bloodstream infections

KW - Intensive care unit

KW - Klebsiella pneumoniae

KW - Microbiology

KW - Mortality

KW - Predictors

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