Report of ESGNI–001 and ESGNI–002 studies. Bloodstream infections in Europe

Abstract

Data regarding the incidence, etiology and outcome of bloodstream infections taken on a broad European basis is scarce. We collected such information (ESGNI-001 and ESGNI-002 studies) and compared the situation in EU and non-EU European countries. A total of 122 hospitals from 28 countries participated in one or both studies. The global rate of blood cultures per 1,000 admissions was 242.4, being significantly higher among EU countries (255.9) than in non-EU countries (192.8). Globally, 14.4% of all blood extractions grew one or more microorganisms. The rate of positivity was significantly greater in non-EU countries (19.1%) than in EU countries (13.4%) ( p The five most commonly isolated microorganisms were: Staphylococcus aureus, Escherichia coli, S. epidermidis and other coagulase-negative Staphylococci, S. pneumoniae and Pseudomonas aeruginosa. Overall, 11% of the episodes were polymicrobial (12.7% in EU countries versus 6% in non-EU countries; p =0.13). Gram-positive bacteria represented 52.9% of all isolates, whereas Gram-negative bacteria were 41.2%. Fungi and anaerobes were 4.6% and 1.3% respectively. The acquisition of bloodstream infections was nosocomial in 72.8% of cases (68.3% in EU countries versus 86.5% in non-EU countries, p =0.003). According to the severity of underlying disease, 10.5% of the patients with significant bacteremia had rapidly fatal diseases, 38% had ultimately fatal diseases and 51% had diseases considered as non-fatal according to the McCabe classification. Regarding the severity score of sepsis, 76% were classified as plain sepsis, 14% as severe sepsis, 5.3% developed septic shock and 4.9% went on to have multiorganic failure. When EU and non-EU countries were compared there were no significant differences in the clinical data, reported between both groups. Overall, 22.6% of patients did not receive treatment or treatment was considered inadequate. The mortality rate was 19.0% with a mortality attributable to bacteremia of 7.1%. Again, there were no differences between EU and non-EU countries. The multivariable analysis showed that the factors remaining independent predictors of mortality were: age (OR 1.02–1.09; p =0.0002), severity of underlying diseases and severity of sepsis score.