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
dc.contributor.authorRuckly, Stéphane
dc.contributor.authorYılmaz, Mesut
dc.contributor.authorTunay, Burcu
dc.contributor.authorÇakmak, Rümeysa
dc.contributor.authorHamid, Hytham
dc.date.accessioned2025-07-22T13:05:52Z
dc.date.available2025-07-22T13:05:52Z
dc.date.issued2024
dc.departmentİstanbul Medipol Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Ana Bilim Dalı
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.
dc.description.sponsorshipAgence Nationale de la Recherche (ANR) ; MIAI artificial intelligence Chairs of excellence ; Swiss National Science Foundation (SNSF) ; European Society of Intensive Care Medicine (ESICM) ; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study Group for Infections in Critically Ill Patients (ESGCIP) ; Norva Dahlia Foundation ; Redcliffe Hospital Private Practice Trust Fund
dc.identifier.citationLoiodice, A., Bailly, S., Ruckly, S., Yılmaz, M., Tunay, B., Çakmak, R. ... Hamid, H. (2024). 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. Clinical Microbiology and Infection, 30(12), 1559-1568. http://dx.doi.org/10.1016/j.cmi.2024.09.011
dc.identifier.doi10.1016/j.cmi.2024.09.011
dc.identifier.endpage1568
dc.identifier.issn1198-743X
dc.identifier.issn1469-0691
dc.identifier.issue12
dc.identifier.pmid39326671
dc.identifier.scopus2-s2.0-85206947039
dc.identifier.scopusqualityQ1
dc.identifier.startpage1559
dc.identifier.urihttp://dx.doi.org/10.1016/j.cmi.2024.09.011
dc.identifier.urihttps://hdl.handle.net/20.500.12511/13014
dc.identifier.volume30
dc.identifier.wosWOS:001367994300001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorYılmaz, Mesut
dc.institutionauthorTunay, Burcu
dc.institutionauthorÇakmak, Rümeysa
dc.institutionauthorid0000-0001-8022-7325
dc.institutionauthorid0000-0002-0383-7792
dc.institutionauthorid0000-0001-8930-741X
dc.language.isoen
dc.relation.ecinfo:eu-repo/grantAgreement/EC/FP7/ANR-19-P3IA-0003
dc.relation.ecinfo:eu-repo/grantAgreement/EC/FP7/P4P4PM_194449
dc.relation.ecinfo:eu-repo/grantAgreement/EC/FP7/ANR-15-IDEX-02
dc.relation.ispartofClinical Microbiology and Infection
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectAdequacy
dc.subjectCritically Ill
dc.subjectDirected Acyclic Graph
dc.subjectHospital-Acquired Bloodstream Infection
dc.subjectMediation Analysis
dc.subjectSepsis
dc.subjectTime-to-Antibiotic
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 study
dc.typeArticle

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