Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

Pérez-Crespo, Pedro María Martínez; Lanz-García, Joaquín Felipe; Bravo‐Ferrer, José María; Cantón-Bulnes, María Luisa; Sousa, Adrián; Aguirre, Josune Goikoetxea; Reguera-Iglesias, José María; Jiménez, Eva León; Castillo, Carlos Armiñanzas; Vallejo, María Ángeles Mantecon; Ciordia, Teresa Marrodán; Rodríguez, Julián; Boix-Palop, Lucía; Pedragosa, Jordi; Sáenz, Alfredo; Blanco, Juan Sevilla; Galán-Sánchez, Fátima; Kindelán, Clara Natera; Jiménez, Alfonso del Arco; Bahamonde-Carrasco, Alberto; Amat, Alejandro Smithson; García, David Vinuesa; Rodrı́guez, Carmen; Molina, Isabel María Reche; Camacho, Inés Pérez; Sánchez-Porto, Antonio; García, Marcos Guzmán; Carral, Berta Becerril; Lucas, Esperanza Merino de; López-Hernández, Inmaculada; López-Cortés, Luis Eduardo

doi:10.1016/j.ijantimicag.2021.106352

Cited by 17 publications

(24 citation statements)

References 36 publications

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“…In a cohort of over 150,000 critically ill adults at U.S. hospitals between 2009 and 2015, ICU-onset BSI occurred in approximately 1% of ICU encounters (prevalence = 1.47 cases per 1,000 person-ICU days), 41.5% of patients having at least one blood culture drawn during their ICU stay. This estimate is near the lower end of the range reported in prior studies (range = 1.2–6.7% of all ICU admissions) (8–10, 24). Of note, real world data provide more of a “sampled prevalence” which will vary by scenario (i.e., ICU-BSI POA vs ICU-onset BSI).…”

Section: Discussionsupporting

confidence: 48%

“…Existing evidence on prevalence of and risk factors for ICU-onset BSI has limited generalizability due to differences in regional microbial epidemiology, case mix, and ICU care practices across reports and over time (5–8). Furthermore, the relatively limited sample size of prior studies (9, 10) has precluded simultaneous assessment of many candidate risk factors or BSI populations beyond a specific BSI type (e.g., central venous catheter-related BSI).…”

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confidence: 99%

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Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals*

Gouél‐Cheron

Swihart

Warner

et al. 2022

Critical Care Medicine

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Section: Discussionsupporting

confidence: 48%

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confidence: 99%

Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals*

Gouél‐Cheron

Swihart

Warner

et al. 2022

Critical Care Medicine

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“…At the same time, delay in the administration of appropriate treatment is associated with increased mortality in P. aeruginosa BSI [ 3 , 4 , 5 , 26 ], which is crucial, especially when resistant or multi-drug-resistant P. aeruginosa is involved or suspected, due to the limited number of potentially useful antibiotics for these infections. However, the association between phenotypic resistance, virulence factors and biofilm-forming ability remains controversial [ 27 ].Thus, although the prevalence of P. aeruginosa as a cause of CO-BSI is low [ 7 , 8 ], it is necessary to identify in advance which patients would benefit from the use of antipseudomonal agents.…”

Section: Discussionmentioning

confidence: 99%

“…The PRO-BAC study was a multicentre prospective cohort study conducted in 26 Spanish hospitals (18 tertiary and 8 community hospitals) between 1 October 2016 and 31 March 2017, including all episodes of clinically significant BSI in adult patients (>14 years); no exclusion criteria were applied [ 8 ]. All methodological details were previously published [ 8 ]. Blood cultures were obtained, processed and interpreted in accordance with standard recommendations [ 9 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…Since P. aeruginosa is predominantly a nosocomial pathogen, antipseudomonal antibiotics, especially antipseudomonal beta-lactams, in empirical regimens are often reserved for hospital-acquired infections to avoid overuse. Indeed, invasive infections due to P. aeruginosa outside the hospital setting are regarded as unusual [ 6 , 7 ]; in 2016, this microorganism caused 1.4% of community-acquired BSIs and 3.6% of healthcare-related BSIs in Spain [ 8 ]. However, inappropriate empirical antimicrobial treatment is associated with worse prognosis and mortality in P. aeruginosa BSI, including those that are community-onset [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Pseudomonas aeruginosa Community-Onset Bloodstream Infections: Characterization, Diagnostic Predictors, and Predictive Score Development—Results from the PRO-BAC Cohort

et al. 2022

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Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients >14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60–79), 68.8% were male, median Charlson score was 5 (IQR 3–7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14–3.12)], haematological malignancy [2.45 (1.20–4.99)], obstructive uropathy [2.86 (1.13–3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10–10.92)] and healthcare-associated BSI [1.85 (1.13–3.02)]. Anindex predictive of CO-BSI-PA was developed; scores ≥ 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI.

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Clinical characteristics, predisposing factors and outcomes for Enterococcus faecalis versus Enterococcus faecium bloodstream infections: a prospective multicentre cohort study

Scharloo,

Cogliati Dezza,

López-Hernández

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purposes Enterococcal BSI is associated with significant morbidity and mortality, with fatality rates of approximately 20–30%. There are microbiological and clinical differences between E. faecalis and E. faecium infections. The aim of this study was to investigate differences in predisposing factors for E. faecalis and E. faecium BSI and to explore prognostic factors. Methods This study was a post-hoc analysis of PROBAC, a Spanish prospective, multicenter, cohort in 2016–2017. Patients with E. faecalis or E. faecium BSI were eligible. Independent predictors for BSI development in polymicrobial and monomicrobial BSI and in-hospital mortality in the monomicrobial group were identified by logistic regression. Results A total of 431 patients were included. Independent factors associated with E. faecium BSI were previous use of penicillins (aOR 1.99 (95% CI 1.20–3.32)) or carbapenems (2.35 (1.12–4.93)), hospital-acquired BSI (2.58 (1.61–4.12)), and biliary tract source (3.36 (1.84–6.13)), while congestive heart failure (0.51 (0.27–0.97)), cerebrovascular disease (0.45 (0.21–0.98)), and urinary tract source (0.49 (0.26–0.92)) were associated with E. faecalis BSI. Independent prognostic factors for in-hospital mortality in E. faecalis BSI were Charlson Comorbidity Index (1.27 (1.08–1.51)), SOFA score (1.47 (1.24–1.73)), age (1.06 (1.02–1.10)), and urinary/biliary source (0.29 (0.09–0.90)). For E. faecium BSI, only SOFA score (1.34 (1.14–1.58) was associated with in-hospital mortality. Conclusions The factors associated with E. faecium and E. faecalis BSI are different. These variables may be helpful in the suspicion of one or other species for empiric therapeutic decisions and provide valuable information on prognosis.

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Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

Cited by 17 publications

References 36 publications

Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals*

Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals*

Pseudomonas aeruginosa Community-Onset Bloodstream Infections: Characterization, Diagnostic Predictors, and Predictive Score Development—Results from the PRO-BAC Cohort

Clinical characteristics, predisposing factors and outcomes for Enterococcus faecalis versus Enterococcus faecium bloodstream infections: a prospective multicentre cohort study

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