. 2024 Dec 19;9(4):229-238.

doi: 10.3138/jammi-2024-0023. eCollection 2024 Dec.

Intensive Care Unit-onset Bloodstream Infections Represent a Distinct Category of Hospital-onset Infections: A Multicentre, Retrospective Cohort Study. Queensland Critical Care Network (QCCRN)

Alexis Tabah^{1

2

3}, Felicity Edwards¹, Mahesh Ramanan^{3

4

5

6}, Kyle C White^{1

3

7}, Kiran Shekar^{3

4}, Philippa McIlroy⁸, Antony Attokaran^{9

10}, Siva Senthuran^{11

12}, James McCullough^{13

14}, Aashish Kumar¹⁵, Stephen Luke¹⁶, Neeraj Bhadange¹⁷, Peter Garrett^{18

19}, Kevin B Laupland^{1

20}

Affiliations

¹ Queensland University of Technology, Brisbane, Queensland, Australia.
² Intensive Care Unit, Redcliffe Hospital, Metro North Hospital & Health Services, Queensland, Australia.
³ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁴ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵ Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia.
⁶ Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁷ Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁸ Cairns Hospital, Cairns, Queensland, Australia.
⁹ Intensive Care Unit, Rockhampton Hospital, Rockhampton, Queensland, Australia.
¹⁰ University of Queensland, Rural Clinical School, Rockhampton, Queensland, Australia.
¹¹ Intensive Care Unit, Townsville Hospital, Townsville, Queensland, Australia.
¹² College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia.
¹³ Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
¹⁴ School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.
¹⁵ Intensive Care Unit, Logan Hospital, Logan, Queensland, Australia.
¹⁶ Intensive Care Unit, Mackay Hospital, Mackay, Queensland, Australia.
¹⁷ Intensive Care Unit, Ipswich Hospital, Ipswich, Queensland, Australia.
¹⁸ Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
¹⁹ School of Medicine & Dentistry, Griffith University, Mount Gravatt, Queensland, Australia.
²⁰ Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.

PMID: 40672712
PMCID: PMC12258631
DOI: 10.3138/jammi-2024-0023

Intensive Care Unit-onset Bloodstream Infections Represent a Distinct Category of Hospital-onset Infections: A Multicentre, Retrospective Cohort Study. Queensland Critical Care Network (QCCRN)

Alexis Tabah et al. J Assoc Med Microbiol Infect Dis Can. 2024.

. 2024 Dec 19;9(4):229-238.

doi: 10.3138/jammi-2024-0023. eCollection 2024 Dec.

Authors

Affiliations

¹ Queensland University of Technology, Brisbane, Queensland, Australia.
² Intensive Care Unit, Redcliffe Hospital, Metro North Hospital & Health Services, Queensland, Australia.
³ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁴ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵ Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia.
⁶ Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁷ Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁸ Cairns Hospital, Cairns, Queensland, Australia.
⁹ Intensive Care Unit, Rockhampton Hospital, Rockhampton, Queensland, Australia.
¹⁰ University of Queensland, Rural Clinical School, Rockhampton, Queensland, Australia.
¹¹ Intensive Care Unit, Townsville Hospital, Townsville, Queensland, Australia.
¹² College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia.
¹³ Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
¹⁴ School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia.
¹⁵ Intensive Care Unit, Logan Hospital, Logan, Queensland, Australia.
¹⁶ Intensive Care Unit, Mackay Hospital, Mackay, Queensland, Australia.
¹⁷ Intensive Care Unit, Ipswich Hospital, Ipswich, Queensland, Australia.
¹⁸ Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
¹⁹ School of Medicine & Dentistry, Griffith University, Mount Gravatt, Queensland, Australia.
²⁰ Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.

PMID: 40672712
PMCID: PMC12258631
DOI: 10.3138/jammi-2024-0023

Abstract
in English, French

Background: The location of onset of bloodstream infections (BSIs) associated with intensive care unit (ICU) admission may influence their clinical and epidemiological characteristics.

Methods: A multicentre, retrospective cohort study was conducted in Queensland, Australia, and BSIs associated with ICU admission were identified and classified as community-onset, hospital-onset, or ICU-onset if first isolated within, after 48 hours but within 48 hours of ICU admission, or after 48 hours following ICU admission, respectively.

Results: We included 3,540 episodes of ICU-associated BSI, with 1,693 classified as community-onset, 663 hospital-onset, and 1,184 ICU-onset. Compared with hospital-onset BSIs, patients with ICU-onset BSIs were younger, had fewer comorbidities, had lower APACHE II scores, and were more likely male. Patients with ICU-onset BSI were more likely to be surgical admissions and have a primary cardiovascular or neurological diagnosis. The distribution of infective agents varied significantly among community-, hospital-, and ICU-onset BSI groups. The all-cause 30-day case-fatality rates for first-episode community-onset, hospital-onset, and ICU-onset BSIs were 17.1%, 21.7%, and 23.5%, respectively (p < 0.001).

Conclusion: With different epidemiological features and causal pathogens, ICU-onset BSI represents a distinct BSI group arising in hospitalized patients.

Historique: Le foyer d'apparition des infections transmissibles par le sang (ITSg) associé à l'admission en soins intensifs peut influer sur leurs caractéristiques cliniques et épidémiologiques.

Méthodologie: Les chercheurs ont réalisé une étude de cohorte rétrospective multicentrique à Queensland, en Australie, ont répertorié les ITSg associées à une admission en soins intensifs et les ont classées comme d'origine communautaire, d'origine hospitalière ou déclarées en soins intensifs si elles avaient d'abord été isolées dans les 48 heures, après 48 heures, mais dans les 48 heures suivant l'admission en soins intensifs ou plus de 48 heures après l'admission en soins intensifs, respectivement.

Résultats: Les chercheurs ont inclus 3 540 épisodes d'ITSg associés aux soins intensifs, dont 1 693 ont été classées comme d'origine communautaire, 663 comme d'origine hospitalière et 1 184 comme déclarées en soins intensifs. Par rapport aux ITSg d'origine hospitalière, les patients atteints d'une ITSg déclarée en soins intensifs étaient plus jeunes, avaient des maladies connexes, avaient des scores APACHE II plus faibles et étaient plus susceptibles d’être de sexe masculin. Les patients atteints d'une ITSg déclarée en soins intensifs étaient plus susceptibles d'avoir été hospitalisés en vue d'une opération et d'avoir un diagnostic cardiovasculaire ou neurologique primaire. La répartition des agents infectieux variait considérablement dans les groupes atteints d'une ITSg d'origine communautaire, d'origine hospitalière ou déclarée en soins intensifs. Le taux de fatalité toutes causes confondues au bout de 30 jours en cas de premier épisode d'ISTg d'origine communautaire, d'origine hospitalière et déclarée en soins intensifs s’élevait à 17,1%, 21,7% et 23,5%, respectivement (p < 0,001).

Conclusion: Compte tenu de leurs caractéristiques épidémiologiques distinctives et de leurs agents pathogènes causaux, les ITSg s’étant déclarées en soins intensifs représentent un groupe d'ITSg distinctes chez les patients hospitalisés.

Keywords: bloodborne infections; epidemiology; infection control; sepsis.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

**Figure 1:. Study population and location of ICU-associated BSI episodes**
BSI = Bloodstream infection; ICU = Intensive care unit

**Figure 2:. Frequency of pathogens for each onset location**
ICU = Intensive care unit

See this image and copyright information in PMC

References

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Intensive Care Unit-onset Bloodstream Infections Represent a Distinct Category of Hospital-onset Infections: A Multicentre, Retrospective Cohort Study. Queensland Critical Care Network (QCCRN)

Affiliations

Intensive Care Unit-onset Bloodstream Infections Represent a Distinct Category of Hospital-onset Infections: A Multicentre, Retrospective Cohort Study. Queensland Critical Care Network (QCCRN)

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

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Abstract in English, French

Conflict of interest statement

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Abstract
in English, French