Early- and Late-Onset Bloodstream Infections in the Intensive Care Unit: A Retrospective 5-Year Study of Patients at a University Hospital in China

• Published in: The Journal of infectious diseases 2020-03, Vol.221 (Suppl 2), p.S184-S192
• Main Authors: Xie, Jianfeng, Li, Shuzi, Xue, Ming, Yang, Congshan, Huang, Yingzi, Chihade, Deena B, Liu, Ling, Yang, Yi, Qiu, Haibo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Infective Agents - pharmacology; China - epidemiology; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - mortality; Drug Resistance, Microbial; Female; Hospitals, University; Humans; Intensive Care Units - statistics & numerical data; Male; Middle Aged; Retrospective Studies; Risk Factors; Sepsis - drug therapy; Sepsis - epidemiology; Sepsis - mortality; Survival Analysis; Time Factors
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiz606

Limited data are available regarding the current microbiological characteristics of bloodstream infections (BSIs) in intensive care units (ICUs) in China. This retrospective study aimed to determine the epidemiology of early- and late-onset BSIs in our ICU. We retrospectively collected data about ICU patients with BSI from 2013 to 2017. The patients were divided into the early- and late-onset BSI groups according to if BSI occurred within or beyond 48 hours after ICU admission. Univariate and multivariate logistic regression analyses were used to assess the risk factors for infection with multidrug resistant organisms (MDROs). Of 5474 ICU admissions, 486 (8.9%) patients with BSIs and with 500 microorganisms were included in this study, 246 (50.6%) of whom had early-onset BSIs. Two hundred and seventy patients were infected with MDROs. The proportion of MDRO infections was significantly higher among patients with late-onset BSIs than among those with early-onset BSIs (57.9% vs. 41.5%, P = .017). The ICU mortality rate was significantly higher in the late-onset BSI group (44.6% vs. 33.8%, P = .014) and early and appropriate antimicrobial treatment significantly improved the survival rate among patients with BSI (P < .001). MDROs affected more than half of patients with BSI in the ICU. Early appropriate empirical antimicrobial therapy could improve clinical outcome of patients with BSIs.