@article{3110476,
    title = "Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels",
    author = "Hanberger, H. and Antonelli, M. and Holmbom, M. and Lipman, J. and Pickkers, P. and Leone, M. and Rello, J. and Sakr, Y. and Walther, S.M. and Vanhems, P. and Vincent, J.-L. and Betsch, H. and Fogh, B. and Espersen, K. and Jacobsen, K. and Berezowicz, P. and Harjola, V. and Sofianos, E. and Armaganidis, A. and Routsi, C. and Bitzani, M. and Chalkiadaki, A. and Michalopoulos, A. and Mouloudi, E. and Ioannidou, E. and Myrianthefs, P. and Koulenti, D. and Karampela, I. and Kyriazopoulos, G. and Mandragos, K. and Clouva-molyvdas, P. and Moraiti, A. and Pneumatikos, I. and Filos, K. and Zakynthinos, E. and Kotanidou, A. and Vakalos, A. and Sprung, C. and Lev, A. and Kishinevsky, E. and Cohen, J. and Sofer, S. and Vesconi, S. and Greco, S. and Borelli, M. and Cecilia, P. and Sapuppo, M. and Lazzero, A. and Mangani, V. and Petrucci, N. and Minerva, M. and De blasio, E. and Marzorati, S. and Rosi, R. and Giarratano, A. and Margarit, O. and Guberti, A. and Scolz, S. and Stelian, E. and Emmi, V. and Caspani, M. and Rosano, A. and Abbruzzese, C. and Colonna, S. and Ceriani, R. and De Blasi, R. and Panella, L. and Borrelli, F. and Lorella, P. and Ruatti, H. and Munch, C. and Sorbara, C. and Fiore, G. and Chieregato, A. and Conti, V. and Guadagnucci, A. and Pizzamiglio, M. and Locicero, M. and Marri, I. and Sicignano, A. and Conte, V. and Oggioni, R. and De Gasperi, A. and De Negri, P. and Santagostino, G. and Fumagalli, R. and Marino, G. and Castiglione, G. and Sforza, D. and Giuseppe, N. and Bassetti, M. and Ferraro, F. and Clementi, S. and Alessandro, D. and Cotogni, P. and Ranieri, MV. and Antonelli, M. and Martinelli, L. and Gianesello, L. and Gullo, A. and Morelli, A. and Biancofiore, G. and Della Rocca, G. and Borg, M. and De Pont, A. and Rosseel, P. and Ten Cate, J. and Van Berkel, G. and Corsten, S. and Bakker, J. and Vogelaar, J. and Blom, H. and Kieft, H. and Kuiper, M. and Gille, A. and Pickkers, P. and Vet, J. and Ammann, J. and Den Boer, S. and Wesselink, R. and Speelberg, B. and Pham, C. and Rodgers, M. and Bergmans, D. and Groeneveld, J. and Loevstad, R. and Klepstad, P. and Erno, P. and Junker, A. and Bártolo, A. and Castelo-Branco Sousa, M. and Esteves, F. and Martins, A. and Oliveira, T. and Ponce, P. and Mourão, L. and Febra, C. and Carmo, E. and Lopes, V. and Póvoa, P. and Rezende, A. and Costa, H. and Moreira, P. and Pádua, F. and Leite, A. and Almeida, E. and Alves, M. and Sousa, A. and Telo, L. and Dias, C. and Paiva, J. and Ribeiro, R. and Amaro, P. and Carneiro, A. and Moreno, R. and Matos, R. and Afonso, S. and Bouw, M. and França, C. and Rubio, O. and Mañez, R. and Campiñez, M. and Alvarez, M. and Jorda, R. and Naveira-Abeigón, E. and Monedero, P. and Alemparte-Pardavila, E. and Garcia del Valle, S. and Perez Calvo, C. and Palomar, M. and Guerrero, F. and Caballero Zirena, A. and Arribas, M. and Bustamante Munguira, E. and Ruiz, J. and Iglesias, L. and Zavala, E. and Valencia, M. and Blesa Malpica, A. and Martinez-Sagasti, F. and Nieto, M. and Aguilar, G. and Martinon-Torres, F. and Lorente, C. and Insausti, J. and Vegas Pinto, R. and Santos, I. and Escriba, A. and Olaechea, P. and Muñoz, E. and Antón Caraballo, E. and Galdos-Anuncibay, P. and Lopez Camps, V. and Esteban-Reboll, F. and Estella, A. and Bocero, L. and Ibañez, A. and Pueyo, L. and María Jesús, L. and Iglesias, L. and Silva, J. and Garro, P. and Ramos-gómez, L. and Rovira, A. and Martin Delgado, M. and Monton Dito, J. and Garcia, F. and Navarro, J. and Latour-Perez, J. and Albaya, A. and Bustinza, A. and Sole-violán, J. and Ugarte Peña, P. and Yuste, I. and De Rojas Román, J. and Vallés, J. and Esteban, E. and Quintana Tort-Martorell, E. and Moreno, M. and López Ciudad, V. and Manzano Ramirez, A. and Sánchez-Olmedo, J. and Borges, M. and Amador Amerigo, J. and Guerrero Gomez, F. and Montejo González, J. and Sirvent, J. and Mesalles Sanjuan, E. and Barcenilla-Gaite, F. and Serrano, N. and Cerdá, E. and Lesmes Serrano, A. and Garcia-Fuentes, C. and Macias Pingarrón, J. and Espinosa, E. and Sanchez Garcia, M. and Felices, F. and de la Torre-Prados, M. and Maria Jesus, H. and Luis, V. and Jara, R. and Briones Lopez, M. and Posada, P. and Galvan, B. and Mariscal, F. and Gil, B. and Sierra, R. and Rico-Feijoo, J. and Corcobado Márquez, C. and Izura, J. and González, J. and Soto Ibáñez, J. and Petersen, P. and Johansson, L. and Blomqvist, H. and Peterzén, B. and Wyon, N. and Stiernstrom, H. and Lindström, I. and Paulsson, A. and Agvald-Ohman, C. and Petersson, J. and Friberg, H. and Einar, V. and Hammarskjöld, F. and Schindele, M. and Arvidsson, S. and Sellgren, J. and Hulting, J. and Häggqvist, J. and Rudenstam, J. and Lind, D. and Kokinsky, E. and Owall, A. and Jacobson, S. and Nydahl, A. and Atalan, K. and Ates, C. and Kahveci, A. and Fistikci, H. and Kaya, A. and Ozgencil, E. and Kizilkaya, M. and Bosnak, M. and Bodur, H. and Akan, M. and Guven, M. and Turkoglu, M. and Topeli, A. and Togal, T. and Uzel, N. and Akinci, I. and Cakar, N. and Tugrul, S. and Demirkiran, O. and Adanir, T. and Dogruer, K. and Turkmen, A. and Guven, H. and Ulger, F. and Kocak, S. and the EPIC II Group of Investigators",
    journal = "BMC Infectious Diseases",
    year = "2014",
    volume = "14",
    number = "1",
    publisher = "BioMed Central Ltd.",
    issn = "1471-2334",
    doi = "10.1186/1471-2334-14-513",
    keywords = "amikacin;  aminoglycoside antibiotic agent;  amoxicillin plus clavulanic acid;  amphotericin B;  ampicillin;  ampicillin plus flucloxacillin;  aztreonam;  beta lactam antibiotic;  caspofungin;  cefazolin;  cefuroxime;  cephalosporin derivative;  ciprofloxacin;  cotrimoxazole;  fluconazole;  imipenem;  macrolide;  meropenem;  metronidazole;  oxazolidinone derivative;  penicillin derivative;  penicillin G;  piperacillin plus tazobactam;  polypeptide antibiotic agent;  quinoline derived antiinfective agent;  tigecycline;  tobramycin;  vancomycin;  voriconazole;  antiinfective agent, Acinetobacter;  adult;  aged;  antibiotic prophylaxis;  antibiotic resistance;  antibiotic therapy;  Article;  artificial ventilation;  Aspergillus;  bacterial infection;  bacterial strain;  Candida;  chronic kidney failure;  chronic obstructive lung disease;  comorbidity;  controlled study;  critically ill patient;  Denmark;  Enterobacteriaceae;  Escherichia coli;  female;  Finland;  Greece;  hemodialysis;  hemofiltration;  hospital patient;  human;  Human immunodeficiency virus infection;  infection;  insulin dependent diabetes mellitus;  intensive care unit;  Israel;  Italy;  Klebsiella;  length of stay;  major clinical study;  male;  Malta;  methicillin resistant Staphylococcus aureus;  methicillin susceptible Staphylococcus aureus;  mortality;  mycosis;  Netherlands;  Norway;  Portugal;  prevalence;  Pseudomonas aeruginosa;  risk factor;  Spain;  Staphylococcus epidermidis;  Streptococcus pneumoniae;  Sweden;  Turkey (republic);  vancomycin resistant Enterococcus;  Bacteria;  Bacterial Infections;  classification;  comparative study;  cross-sectional study;  drug effects;  Europe;  genetics;  hospitalization;  isolation and purification;  middle aged;  statistics and numerical data;  treatment outcome, Aged;  Anti-Bacterial Agents;  Bacteria;  Bacterial Infections;  Cross-Sectional Studies;  Drug Resistance, Bacterial;  Europe;  Female;  Hospitalization;  Humans;  Intensive Care Units;  Male;  Middle Aged;  Treatment Outcome",
    abstract = "Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome. © 2014 Hanberger et al.; licensee BioMed Central Ltd."
}