Multidrug-resistant Bloodstream Infections Research Articles

Mortality due to Multidrug-Resistant Gram-Negative Bacteremia in an Endemic Region: No Better than a Toss of a Coin.

The incidence of multidrug-resistant (MDR) bloodstream infections (BSIs) is associated with high morbidity and mortality. Little evidence exists regarding the epidemiology of BSIs and the use of appropriate empirical antimicrobial therapy in endemic regions. Novel diagnostic tests (RDTs) may facilitate and improve patient management. Data were assessed from patients with MDR Gram-negative bacteremia at a university tertiary hospital over a 12-month period. In total, 157 episodes of MDR Gram-negative BSI were included in the study. The overall mortality rate was 50.3%. Rapid molecular diagnostic tests were used in 94% of BSI episodes. In univariate analysis, age (OR 1.05 (95% CI 1.03, 1.08) p < 0.001), Charlson Comorbidity Index (OR 1.51 (95% CI 1.25, 1.83) p < 0.001), procalcitonin ≥ 1(OR 3.67 (CI 95% 1.73, 7.79) p < 0.001), and monotherapy with tigecycline (OR 3.64 (95% CI 1.13, 11.73) p = 0.030) were the only factors associated with increased overall mortality. Surprisingly, time to appropriate antimicrobial treatment had no impact on mortality. MDR pathogen isolation, other than Klebsiella pneumoniae and Acinetobacter baumanii, was associated with decreased mortality (OR 0.35 (95% CI 0.16, 0.79) p = 0.011). In multivariate analysis, the only significant factor for mortality was procalcitonin ≥ 1 (OR 2.84 (95% CI 1.13, 7.11) p = 0.025). In conclusion, in an endemic area, mortality rates in MDR BSI remain notable. High procalcitonin was the only variable that predicted death. The use of rapid diagnostics did not improve mortality rate.

Prevalence of multidrug resistant bloodstream infections in febrile neutropenic patients with hematolymphoid malignancies: A retrospective observational study from a newly established tertiary oncology center in India

Prevalence of multidrug resistant bloodstream infections in febrile neutropenic patients with hematolymphoid malignancies: A retrospective observational study from a newly established tertiary oncology center in India

Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital.

The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. Retrospective cohort study. 960 bed tertiary academic medical center. Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. Retrospective analysis of prevalence and outcomes. Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Management of Patients with Hematological Diseases.

Antimicrobial stewardship programs (ASPs) in hematological patients are especially relevant. However, information about ASPs in this population is scarce. For 11 years, we quarterly assessed antimicrobial consumption and incidence and death rates of multidrug-resistant (MDR) bloodstream infections (BSI) in the hematology Department. Healthcare activity indicators were also monitored yearly. We performed an interrupted time-series analysis. Antimicrobials showed a sustained reduction with a relative effect of −62.3% (95% CI −84.5 to −40.1) nine years after the inception of the ASP, being especially relevant for antifungals (relative effect −80.4%, −90.9 to −69.9), quinolones (relative effect −85.0%, −102.0 to −68.1), and carbapenems (relative effect −68.8%, −126.0 to −10.6). Incidence density of MDR BSI remained low and stable (mean 1.10 vs. 0.82 episodes per 1000 occupied bed days for the pre-intervention and the ASP period, respectively) with a quarterly percentage of change of −0.3% (95% CI −2.0 to 1.4). Early and late mortality of MDR BSI presented a steady trend (quarterly percentage of change −0.7%, 95% CI −1.7 to 0.3 and −0.6%, 95% CI −1.5 to 0.3, respectively). Volume and complexity of healthcare activity increased over the years. The ASP effectively achieved long-term reductions in antimicrobial consumption and improvements in the prescription profile, without increasing the mortality of MDR BSI.

Long-Term Carbapenems Antimicrobial Stewardship Program.

Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.

Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections.

During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of −6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.

Bloodstream infections by gram-negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome.

Kidney transplant recipients (KTRs) are at increased risk of infections. The aims of this study were to describe the incidence of bloodstream infections (BSIs) by gram-negative bacteria in a cohort of KTRs, the risk factors for BSI due to multi-drug-resistant (MDR) gram-negative bacteria, and the predictors for unfavorable outcome, defined as death or nephrectomy or return to dialysis, within 30days from BSI. We conducted a retrospective cohort study at the renal transplant unit of a tertiary care hospital in Athens, Greece. In a total of 1962 KTRs, we recorded 195 BSI episodes in 182 single patients (male/female=97/85), with a median (interquartile range) age of 57.2 (44-64.9) years. The incidence was 1.393/100 patient-years. The most common source of infection was urinary tract (70.9%), and Escherichia coli (63.7%) was the most common pathogen. 19.2% of the infecting organisms were MDR; previous antibiotic use (OR 8.2; CI 2.1-32.9) and previous stay in the intensive care unit (OR 34.2; CI 1.6-730.2) were associated with MDR BSIs. 6% of patients died, and 2.2% underwent nephrectomy, while no patients had to return to dialysis. Diabetes mellitus (OR 8.1; 95% CI 1.3-50.3), Pseudomonas aeruginosa BSI (OR 46.1; 95% CI 3.9-552.3), and septic shock (OR 46.7; 95% CI 1.7-1304.9) were independent predictors of unfavorable outcome. Bloodstream infections in KTRs have a significant impact on allograft and patients outcome.

Induction Related Mortality in Acute Myeloid Leukemia: Multivariate Model of Predictive Score from the Indian Acute Leukemia Research Database (INwARD) of the Hematology Cancer Consortium (HCC)

Background: Remission induction is the most intensive phase of acute myeloid leukemia (AML) treatment, associated with significant morbidity and mortality. Collaborative research and advances in supportive care have steadily improved outcomes in developed countries with induction mortality less than 5%. Challenges for treatment in resource limited settings are varied including delayed presentation, higher disease burden, baseline infections and poor general condition precluding standard intensive therapy, higher rates of resistant infections, and several social and financial constraints. Consequently, a significant proportion of patients do not receive definitive therapy and for those who are treated there is a considerably high risk of induction mortality. In an attempt to identify the subset of patients with highest risk of death during induction, we have developed a multivariate model of induction mortality score using baseline features relevant to our clinical setting by utilizing Indian acute leukemia research database [INwARD] established in 2018 by Hematology Cancer Consortium (HCC). Method: Retrospective data from January 2018 to May 2019 for adult AML was collected from 11 member institutions in a central online data management system. Selection of potential variables that would predict mortality was based on clinical and statistical significance. Thus, 10 variables defining baseline patient and disease characteristics (age, ECOG performance status, duration of symptoms in days, albumin, creatinine, bilirubin, white cell count, platelet, peripheral blood blast percentage, and presence of infection requiring intravenous antibiotic within one week prior of starting induction), were considered for the predictive model using machine learning algorithms: Logistic regression (LR) and Support Vector Machine (SVM). SVM was chosen as the best algorithm based on the AUCs. In order to get robust threshold, sensitivity, specificity and predictive values bootstrapping was done 10,000 times. The final statistics were based on the mean (SD) of bootstrapped sample. R software was used to bootstrap and analyze the data. Result: Of the 611 adult AML cases available during study period, 392 treated with the intensive '3+7' or its abbreviated regimen were considered for analysis. Median age of this cohort was 36 years (range 18 - 67), male to female ratio 1.34. European Leukemia Net (ELN) risk group distribution is shown in Fig 1a. Complete remission was attained in 52.8%. Induction mortality was 16.9 % ranging from 6.1% to 43% across different centers. Most common cause of death was infection (66.7%). Multi-drug resistant blood stream infection was documented in 25.4% cases. For the SVM model for predicting induction mortality using 10 covariates, the AUC based on the bootstrap validation was 91.3% with the best threshold probability being 0.262 (Fig 1b). Thus, a cut off score of 0.262 in the SVM model predicted induction death with sensitivity of 93.6% and specificity of 87.7%. Performance of each variable in the SVM model is shown in Fig 1c and comparison of the LR and SVM model in Fig 1d. Conclusion: Score predicting induction death with high accuracy will be a valuable tool in guiding clinicians against the use of intensive induction therapy, in tailoring of treatment as per individual patients' risk and proper resource allocation. Despite the limitations of retrospective data, wide disparity in resources, patient profile and treatment costs across centers accounting for variability in mortality rates, this study represents one major attempt to find answer to a locally relevant clinical problem of high induction mortality in a cohort of young adult AML, utilizing contemporary pooled data through multi-center collaboration. Optimal cut off point for the score needs to be validated in independent patient cohorts and have to be re-calibrated periodically. Further, an online calculator is being designed on the HCC online system to work as ready reckoner for clinicians. Figure 1 a) ELN risk group distribution b) descriptive statistics of bootstrapped SVM Model c) performance of each covariate in SVM model d) ROC Curve: Comparison of LR and SVM method Figure 1 Disclosures No relevant conflicts of interest to declare.

Multidrug-resistant Gram-negative Bacterial Bloodstream Infections in Children’s Hospitals in Japan, 2010–2017

The risk factors of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bloodstream infection (BSI) are not yet known in children. Our aim was to evaluate risk factors and outcomes associated with MDR GNB BSI in children. Patients with GNB BSI were enrolled between April 2010 and March 2017 at 8 children's hospitals in Japan. Clinical and microbiologic data were collected retrospectively. The risk factors and outcomes of MDR and non-MDR GNB BSI were compared. In total, 629 GNB BSI episodes met the case definition. The median age and proportion of males were 2 years (interquartile range, 0.3-8.7) and 50.7%, respectively. An underlying disease was found in 94% of patients. The proportion of BSI cases that developed >48 hours after admission was 76.2%. MDR comprised 24.5% of BSI cases. The MDR rate did not change over time (P = 0.540). The effective coverage rate of the initial empiric therapy for the MDR and non-MDR BSI cases was 60.4% and 83.4%, respectively (P < 0.001). The all-cause mortality rate at 28 days for all BSI, MDR-BSI and non-MDR BSI cases was 10.7%, 13.6% and 9.7%, respectively (P = 0.167). MDR BSI was independently associated with cancer chemotherapy within 30 days (odds ratio [OR] 43.90), older age (OR 1.05) and admission to the neonatal ward (OR 0.019). One-fourth of GNB BSI cases were MDR. Cancer chemotherapy and older age were risk factors for MDR GNB BSI in children's hospitals. MDR did not increase the all-cause mortality rate.

Bloodstream Infections in Early Postsurgery Liver Transplant: An Analysis of 401 Patients Over 10 Years

Bloodstream infections are a major factor contributing to morbidity and mortality following liver transplantation. The increasing occurrence of multidrug-resistant bloodstream infections represents a challenge for the prevention and treatment of those infections. The aim of this study was to evaluate the occurrence and microbiological profile of bloodstream infections during the early postoperative period (from day 0 to day 60) in patients undergoing liver transplantation from January 2005 to June 2016 at the State University of Campinas General Hospital. A total of 401 patients who underwent liver transplantation during this period were included in the study. The most common cause of liver disease was hepatitis C virus cirrhosis (34.01%), followed by alcoholic disease (16.24%). A total of 103 patients had 139 microbiologically proven bloodstream infections. Gram-negative bacteria were isolated in 63.31% of the cases, gram-positive bacteria in 28.78%, and fungi in 7.91%. Fifty-six infections (43.75%) were multidrug-resistant bacteria, and 72 (56.25%) were not. There was no linear trend concerning the occurrence of multidrug-resistant organisms throughout the study period. Patients with multidrug-resistant bloodstream infections had a significantly lower survival rate than those with no bloodstream infections and those with non–multidrug-resistant bloodstream infections. In conclusion, the occurrence of bloodstream infections during the early postoperative period was still high compared with other profile patients, as well as the rates of multidrug-resistant organisms. Even though the occurrence of multidrug resistance has been stable for the past decade, the lower survival rates associated with that condition and the challenge related to its treatment are of major concern.

Development of an Infection Risk Index for Microbiome Targeted Intervention in Children at High-Risk of Multidrug-Resistant Bloodstream Infections

Background Bloodstream infections (BSI) cause significant morbidity and mortality following pediatric hematopoietic stem cell transplantation (HSCT) and are increasingly from multidrug-resistant pathogens. Most of these BSI pathogens arise from the intestines. Increased evidence demonstrates commensal gut anaerobes maintain host resistance from enteric infection, while loss of commensals increases host susceptibility. Antibiotic use reduces gut anaerobes and allows a compensatory increased pathogen burden that precedes BSI; BSI risk is related to colonization burden. Recent reports suggest fecal microbiota transplantation (FMT) can displace an enteric pathogens and broad-spectrum antibiotic resistance genes during restoration of a healthy microbiome. However, the impact of intestinal microbiota on colonization, transmission, and invasive MDR infections is poorly understood in children undergoing HSCT. Methods Using metagenomic shotgun sequencing (MSS) data of longitudinal stool samples from high-risk children, including 63 undergoing HSCT with 166 samples preceding BSI onset (n = 23), we developed a metagenomic-based infection risk index (IRI) from key microbiome features (scaled Brady-Curtis distance relative to healthy controls and relative anaerobe and pathogen abundance). Traditional cart data analysis was compared to advanced machine learning algorithms that consider microbiome distribution, longitudinal sampling, and feature selection. Results A metagenomic-derived IRI from our cohort identified children having up to an 8-fold increased BSI risk. Evaluation of these key microbiome features as a diagnostic screening test by traditional cart analysis accurately identified patients at-risk for BSI with 91% sensitivity using its negative likelihood ratio. However, its specificity of 51% prohibits targeting interventions to those at greatest risk (Figure 1). Therefore, advanced machine learning algorithms were used for metagenomic-derived BSI prediction. While training results suggest overfitting, its performance promises clinical utility with a sensitivity of 92% and specificity of 84% warranting optimization and validation in HSCT patients (Figure 2). Analysis during heterologous FMT interventions in 5 symptomatic high-risk children (including 1 HSCT patient) revealed a concomitant pathogen-dominated gut microbiome harboring a high burden of broad-spectrum antibiotic resistance genes prior to each FMT. Following FMT, we confirmed restoration of a healthy gut microbiome with abundant anaerobes had a low metagenomic-derived IRI in all cases (Figure 3). Conclusions The application of advanced machine learning to shotgun metagenomic data provides the resolution required for accurate BSI prediction to identify HSCT patients at greatest risk preceding an illness providing new opportunity for early FMT intervention to prevent BSI.

Meropenem antimicrobial stewardship program: clinical, economic, and antibiotic resistance impact.

There are few prospective studies with sufficient duration in time to evaluate clinical and antibiotic resistance impact of antibiotic stewardship programs (ASP). This is a descriptive study between January 2012 and December 2017, pre-post intervention. A meropenem ASP was initiated in January 2015; in patients who started treatment with meropenem, an infectious disease physician performed treatment recommendations to prescribers. Prospective information was collected to evaluate adequacy of meropenem prescription to local guidelines and to compare results between cases with accepted or rejected intervention. Analysis was performed to verify variables associated with intervention acceptance and with any significant change in meropenem consumption, hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs), and 30-day all-cause crude death in MDR BSIs. Adequacy of meropenem prescription and de-escalation from meropenem treatment to narrower-spectrum antibiotic improved progressively over time, after ASP implementation (p < 0.001). Interventions on prescription were performed in 330 (38.7%) patients without meropenem justified treatment; in 269, intervention was accepted and in 61 not. Intervention acceptance was associated with shorter duration of treatment, cost, and inpatient days (p < 0.05); intervention rejection was not associated with severity of patient. During the period 2015-2017, meropenem consumption decreased compared with 2012-2014 (rate ratio [RR] 0.67; 95% CI 0.58-0.77, p < 0.001). Also decreased were hospital-acquired MDR BSI rate (RR 0.63; 95% CI 0.38-1.02, p = 0,048) and 30-day all-cause crude death in MDR BSIs (RR 0.45; 95% CI 0.14-1.24, p = 0.096), coinciding in time with ASP start-up. The decrease and better use of meropenem achieved had a sustained clinical, economic, and ecological impact, reducing costs and mortality of hospital-acquired MDR BSIs.

Increased Costs Associated with Bloodstream Infections Caused by Multidrug-Resistant Gram-Negative Bacteria Are Due Primarily to Patients with Hospital-Acquired Infections.

The clinical and economic impacts of bloodstream infections (BSI) due to multidrug-resistant (MDR) Gram-negative bacteria are incompletely understood. From 2009 to 2015, all adult inpatients with Gram-negative BSI at our institution were prospectively enrolled. MDR status was defined as resistance to ≥3 antibiotic classes. Clinical outcomes and inpatient costs associated with the MDR phenotype were identified. Among 891 unique patients with Gram-negative BSI, 292 (33%) were infected with MDR bacteria. In an adjusted analysis, only history of Gram-negative infection was associated with MDR BSI versus non-MDR BSI (odds ratio, 1.60; 95% confidence interval [CI], 1.19 to 2.16; P = 0.002). Patients with MDR BSI had increased BSI recurrence (1.7% [5/292] versus 0.2% [1/599]; P = 0.02) and longer hospital stay (median, 10.0 versus 8.0 days; P = 0.0005). Unadjusted rates of in-hospital mortality did not significantly differ between MDR (26.4% [77/292]) and non-MDR (21.7% [130/599]) groups (P = 0.12). Unadjusted mean costs were 1.62 times higher in MDR than in non-MDR BSI ($59,266 versus $36,452; P = 0.003). This finding persisted after adjustment for patient factors and appropriate empirical antibiotic therapy (means ratio, 1.18; 95% CI, 1.03 to 1.36; P = 0.01). Adjusted analysis of patient subpopulations revealed that the increased cost of MDR BSI occurred primarily among patients with hospital-acquired infections (MDR means ratio, 1.41; 95% CI, 1.10 to 1.82; P = 0.008). MDR Gram-negative BSI are associated with recurrent BSI, longer hospital stays, and increased mean inpatient costs. MDR BSI in patients with hospital-acquired infections primarily account for the increased cost.

A one year study of multi-drug resistant blood stream infections caused by Escherichia coli, Klebsiella pneumoniae and Enterobacter spp in a tertiary care hospital

A one year study of multi-drug resistant blood stream infections caused by Escherichia coli, Klebsiella pneumoniae and Enterobacter spp in a tertiary care hospital

Effectiveness of simple strategies in reducing multidrug resistant bloodstream infections in the NICU of a tertiary care hospital in Karachi, Pakistan

Effectiveness of simple strategies in reducing multidrug resistant bloodstream infections in the NICU of a tertiary care hospital in Karachi, Pakistan

Carbapenems and subsequent multiresistant bloodstream infection: does treatment duration matter?

It has been proposed that initial empirical broad-spectrum antibiotic therapy will result in better clinical outcomes and that shorter courses will reduce the ‘collateral damage’ of promoting antibiotic resistance. There are few data from Intensive Care Units (ICUs) that support this latter conclusion. A prospective observational study was undertaken at the National University Hospital, Singapore, to examine the relationship between duration of carbapenem therapy and subsequent nosocomial multidrug-resistant (MDR) bloodstream infection (BSI). Over a 2-year period, 415 ICU patients receiving empirical carbapenem therapy were prospectively followed. MDR BSI occurred on 35 occasions in 31 patients, comprising 21 carbapenem-resistant Acinetobacter baumannii, 3 carbapenem-resistant Pseudomonas aeruginosa and 11 meticillin-resistant Staphylococcus aureus (MRSA). There was no difference in the duration of carbapenems for those who developed MDR BSI compared with those who did not [median duration 8 days (range 3–23 days) vs. 9 days (range 3–59 days); P = 0.78]. On multivariate analysis using the Cox proportional hazard model the hazard ratio was 0.935 ( P = 0.070). In this cohort of critically ill patients, a shorter duration of carbapenem therapy was not shown to protect against subsequent development of MDR BSI. Strategies that depend primarily on reducing broad-spectrum antibiotic duration may be inadequate in preventing the emergence of MDR organisms.

Daily cost of antimicrobial therapy in patients with Intensive Care Unit-acquired, laboratory-confirmed bloodstream infection

This study analysed daily antimicrobial costs of Intensive Care Unit (ICU)-acquired, laboratory-confirmed bloodstream infection (BSI) per patient admitted to the ICU of a university hospital, based on prospectively collected data over a 4-year period (2003–2006). Costs were calculated based on the price of the agent(s) initiated on the first day of appropriate treatment and according to: (i) focus of infection; (ii) pathogen; and (iii) antimicrobial agent. The study included 310 adult patients who developed 446 BSI episodes. Mean overall daily antimicrobial cost was €114.25. Daily antimicrobial cost was most expensive for BSIs with unknown focus (€137.70), followed by catheter-related (€122.73), pulmonary (€112.80), abdominal (€98.00), wound (€89.21), urinary (€87.85) and other inciting focuses (€81.59). Coagulase-negative staphylococci were the most prevalent pathogens isolated. Treatment of BSIs caused by Candida spp. was the most costly. The daily antimicrobial costs per infected patient with multidrug-resistant BSI was ca. 50% higher compared with those without (€165.09 vs. €82.67; P < 0.001). Among the total of 852 prescriptions, β-lactam antibiotics accounted for approximately one-third of the overall daily cost of antimicrobial agents. The antibiotic cost associated with ICU-acquired, laboratory-confirmed BSI is significant and should be reduced by implementing infection control measures and preventive strategies.