Variability in forgoing life-sustaining treatment practices in critically Ill patients with hospital-acquired bloodstream infections: a secondary analysis of the EUROBACT-2 international cohort

The decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, cente...

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Published in:Critical care (London, England) England), 2024-08, Vol.28 (1), p.287, Article 287
Main Authors: Wozniak, Hannah, Tabah, Alexis, De Waele, Jan J, Timsit, Jean-François, Buetti, Niccolò
Format: Article
Language:English
Subjects:
Aged
Analysis
Cohort Studies
COVID-19
Critical Illness - epidemiology
Critical Illness - therapy
Cross Infection
Decision making
Ethics
Female
Health aspects
Hospital patients
Humans
Intensive care
Intensive Care Units - organization & administration
Intensive Care Units - statistics & numerical data
Life support systems
Male
Medical care, Cost of
Medical research
Medicine, Experimental
Middle Aged
Nosocomial infections
Treatment refusal
Withholding Treatment - statistics & numerical data
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Summary:The decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, center and country-level factors and these decisions. We analyzed data from the EUROBACT-2 study (June 2019-January 2021) from 265 centers worldwide, focusing on non-COVID-19 patients who died in the hospital or within 28 days after HABSI. We assessed whether death was preceded by a decision to forgo life-sustaining treatment, examining country, center, patient, and pathogen variables. To assess the association of each potentially important variable with the decision to forgo life-sustaining treatment, univariable mixed logistic regression models with a random center effect were performed. Among 1589 non-COVID-19 patients, 519 (32.7%) died, with 191 (36.8%) following a decision to forgo life-sustaining treatment. Significant geographical differences were observed, with no reported decisions to forgo life-sustaining treatment in African countries and fewer in the Middle East compared to Western Europe, Australia, and Asia. Once a center effect was considered, only health expenditure (Odds ratio 1.79, 95%CI: 1.45-2.21, p 
ISSN:1364-8535
1466-609X
1466-609X
1364-8535
1366-609X
DOI:10.1186/s13054-024-05072-1