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

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dc.contributor.authorLoiodice, Ambre
dc.contributor.authorBailly, Sébastien D.Sign©bastien
dc.contributor.authorRuckly, Stéphane
dc.contributor.authorBuetti, N.
dc.contributor.authorBarbier, François S.
dc.contributor.authorStaiquly, Quentin
dc.contributor.authorTabah, Alexis
dc.date.accessioned2025-10-11T20:45:20Z
dc.date.available2025-10-11T20:45:20Z
dc.date.issued2024
dc.departmentDüzce Üniversitesien_US
dc.description.abstractObjectives: 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 < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72–0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9–16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI. © 2025 Elsevier B.V., All rights reserved.en_US
dc.identifier.doi10.1016/j.cmi.2024.09.011
dc.identifier.endpage1568en_US
dc.identifier.issn1198-743X
dc.identifier.issn1469-0691
dc.identifier.issue12en_US
dc.identifier.pmid39326671en_US
dc.identifier.scopus2-s2.0-85206947039en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage1559en_US
dc.identifier.urihttps://doi.org/10.1016/j.cmi.2024.09.011
dc.identifier.urihttps://hdl.handle.net/20.500.12684/21290
dc.identifier.volume30en_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherElsevier B.V.en_US
dc.relation.ispartofClinical Microbiology and Infectionen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.snmzKA_Scopus_20250911
dc.subjectAdequacyen_US
dc.subjectCritically Illen_US
dc.subjectDirected Acyclic Graphen_US
dc.subjectHospital-acquired Bloodstream Infectionen_US
dc.subjectMediation Analysisen_US
dc.subjectSepsisen_US
dc.subjectTime-to-antibioticen_US
dc.subjectColistinen_US
dc.subjectEchinocandinen_US
dc.subjectPiperacillin Plus Tazobactamen_US
dc.subjectVancomycinen_US
dc.subjectAnti-bacterial Agentsen_US
dc.subjectCarbapenem Derivativeen_US
dc.subjectColistinen_US
dc.subjectEchinocandinen_US
dc.subjectPiperacillin Plus Tazobactamen_US
dc.subjectVancomycinen_US
dc.subjectAntiinfective Agenten_US
dc.subjectAdulten_US
dc.subjectAgeden_US
dc.subjectAntibiotic Therapyen_US
dc.subjectArticleen_US
dc.subjectBloodstream Infectionen_US
dc.subjectCohort Analysisen_US
dc.subjectComparative Studyen_US
dc.subjectControlled Studyen_US
dc.subjectDirected Acyclic Graphen_US
dc.subjectFemaleen_US
dc.subjectHospital Admissionen_US
dc.subjectHospital Infectionen_US
dc.subjectHospitalizationen_US
dc.subjectHumanen_US
dc.subjectIntensive Care Uniten_US
dc.subjectMajor Clinical Studyen_US
dc.subjectMaleen_US
dc.subjectMortalityen_US
dc.subjectMulticenter Studyen_US
dc.subjectObservational Studyen_US
dc.subjectPatient Selectionen_US
dc.subjectPrognosisen_US
dc.subjectProportional Hazards Modelen_US
dc.subjectProspective Studyen_US
dc.subjectSecondary Analysisen_US
dc.subjectTime To Treatmenten_US
dc.subjectTreatment Guidelineen_US
dc.subjectUndertreatmenten_US
dc.subjectBacteremiaen_US
dc.subjectClinical Trialen_US
dc.subjectCross Infectionen_US
dc.subjectDrug Therapyen_US
dc.subjectMicrobiologyen_US
dc.subjectMiddle Ageden_US
dc.subjectVery Elderlyen_US
dc.subjectAgeden_US
dc.subjectAged, 80 And Overen_US
dc.subjectAnti-bacterial Agentsen_US
dc.subjectBacteremiaen_US
dc.subjectCross Infectionen_US
dc.subjectFemaleen_US
dc.subjectHumansen_US
dc.subjectIntensive Care Unitsen_US
dc.subjectMaleen_US
dc.subjectMiddle Ageden_US
dc.subjectPrognosisen_US
dc.subjectProportional Hazards Modelsen_US
dc.subjectProspective Studiesen_US
dc.titleEffect 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 studyen_US
dc.typeArticleen_US

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