Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp . (20.3%), Escherichia coli (15.8%), and Pseudomonas spp . (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06944-2.

Background Candidemia is the most common invasive fungal disease in intensive care units (ICUs). Objective We aimed to investigate cases of candidemia infection developing in the ICU and factors associated with mortality due to this infection. Materials and Methods This is a retrospective study including patients admitted to a tertiary university hospital ICU between January 2012 and December 2020. Patients over 18 years of age who had candida growth in at least one blood culture taken from central or peripheral samples (>48 h after admission to the ICU) without concurrent growth were evaluated. Results The study group consisted of 136 patients with candida. Eighty-seven (63.97%) patients were male, with a median age of 69.5 (59–76.5) years. The 7-day mortality rate was 35.29%, while the 30-day mortality rate was 69.11%. As a result of multiple logistic regression analysis, after adjusting for age and malignancy, high APACHE II score and low platelet-lymphocyte ratio (PLR) - were found to be significant factors in predicting both 7-day and 30-day mortality. Conclusion In this study, PLR and APACHE II scores were shown to be independent predictors of mortality in patients with candidemia in the ICU.

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Background/Aim: Breast cancer is the second most common cause of cancer-related death in women worldwide. Predicting the prognosis in breast cancer with very high mortality is important in terms of disease treatment and increasing life expectancy. In our study, we aimed to examine the importance of some inflammatory markers and scoring systems in predicting prognosis in patients with breast cancer who were hospitalized in the intensive care unit. Methods: This retrospective cohort study was conducted in the Department of Medical Oncology and Intensive Care Unit between 2014 and 2020. Breast cancer patients who were admitted to the intensive care unit at any stage of their treatment during the study and followed up and treated in the medical oncology department of the hospital were included in the study. All data were compared between groups (discharged or exitus) based on survival status. Socio-demographic information, laboratory findings (hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, eosinophils, monocytes, C-reactive protein [CRP], albumin, lactate dehydrogenase [LDH], clinical status [co-morbidities, length of stay in intensive care, mechanical ventilation, and reason for hospitalization in the intensive care unit]), and survival data of the patients were collected retrospectively from hospital medical records. We also recorded treatment-related data and relapse/progression information. Neutrophil–lymphocyte, platelet–lymphocyte, and lymphocyte–monocyte ratios (NLR, PLR, and LMR, respectively) were calculated. Results: Thirty-seven (52.1%) patients died and 34 (47.9%) patients survived. The NLR (P=0.021), Modified Glasgow Prognostic score (P<0.001), APACHE II score (P<0.001) and mortality probability model (MPM II) upon admission (P<0.001) were significantly higher in the exitus group than in the survivors. The lymphocyte_monocyte ratio (P=0.030) and prognostic nutritional index (P=0.004) were significantly higher in the discharged group than in the death group. When we evaluated performance of the prognostic scores to predict mortality, we found that the APACHE II score (area under the curve [AUC]: 0.939, 95% confidence interval [CI]: 0.888–0.990), MPM II-Admission (AUC: 0.936, 95% CI: 0.880–0.992), and modified Glasgow Prognostic Score ([mGPS] AUC: 0.727, 95% CI: 0.600–0.854) had the highest area under curve values. Multivariable regression revealed that longer chemotherapy duration (≥2 weeks), an mGPS score of two points, and high MPM-II (≥36 points) were independently associated with mortality. Conclusion: Among the inflammatory markers and scores examined, mGPS and MPM-II were found to be independently associated with mortality in breast cancer patients who were hospitalized in the intensive care unit. In addition, patients with longer chemotherapy duration had a higher risk of mortality, but this result was limited by various possible confounders.

e13055 Background: We aimed to examine whether inflammatory markers and various risk scoring systems could be utilized to predict the prognosis of breast cancer patients hospitalized in the intensive care unit. Methods: In this retrospective cohort study, we evaluated 71 breast cancer patients followed and treated by the Medical Oncology Department of Medipol University Faculty of Medicine who were admitted to the intensive care unit at any stage of their treatment between 2014 and 2020. In addition to scoring systems developed to assess prognosis in the ICU, we recorded and calculated various inflammation-related markers. All data were compared between groups formed according to survival status. Results: The median age was 58 (range: 33-90) years. Thirty-seven (52.1%) patients had died and 34 (47.9%) patients had survived. Neutrophil lymphocyte ratio (p = 0.021), Modified Glasgow prognostic score (p < 0.001), APACHE II score (p < 0.001) and MPM II (admission) (p < 0.001) were significantly higher in the exitus group than in the survivors. Lymphocyte monocyte ratio (p = 0.030) and prognostic nutritional index (p = 0.004) were significantly higher in the discharged group than in the exitus group. When we evaluated performance of the prognostic scores to predict mortality, we found APACHE II score (AUC: 0.939, 95% CI: 0.888 - 0.990), MPM II-Admission (AUC: 0.936, 95% CI 0.880 - 0.992) and mGPS (AUC: 0.727, 95% CI: 0.600 - 0.854) had the highest area under curve values. Multivariable regression revealed that longer chemotherapy duration (≥2 weeks), having an mGPS score of 2 points, and high MPM-II (≥36 points) were independently associated with mortality. Conclusions: Among the inflammatory markers and scores examined, mGPS and MPM-II were found to be independently associated with mortality in breast cancer patients hospitalized in the intensive care unit. In addition, patients with longer chemotherapy duration had a higher risk of mortality, but this result was limited by various possible confounders.