Wozniak, HannahHannahWozniakTabah, AlexisAlexisTabahBarbier, FrançoisFrançoisBarbierRuckly, StéphaneStéphaneRucklyLoiodice, AmbreAmbreLoiodiceAkova, MuratMuratAkovaLeone, MarcMarcLeoneConway Morris, AndrewAndrewConway MorrisBassetti, MatteoMatteoBassettiArvaniti, KostoulaKostoulaArvanitiFerrer, RicardRicardFerrerde Bus, LiesbetLiesbetde BusPaiva, Jose ArturJose ArturPaivaBracht, HendrikHendrikBrachtMikstacki, AdamAdamMikstackiAlsisi, AdelAdelAlsisiValeanu, LianaLianaValeanuPrazak, JosefJosefPrazakTimsit, Jean-FrançoisJean-FrançoisTimsitBuetti, NiccolòNiccolòBuetti2024-10-262024-10-262024-05-02https://boris-portal.unibe.ch/handle/20.500.12422/177164BACKGROUND Hospital-acquired bloodstream infections are common in the intensive care unit (ICU) and have a high mortality rate. Patients with cirrhosis are especially susceptible to infections, yet there is a knowledge gap in the epidemiological distinctions in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients in the ICU. It has been suggested that cirrhotic patients, present a trend towards more gram-positive infections, and especially enterococcal infections. This study aims to describe epidemiological differences in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients hospitalized in the ICU regarding infection sources, microorganisms and mortality. METHODS Using prospective Eurobact-2 international cohort study data, we compared hospital-acquired bloodstream infections sources and microorganisms in cirrhotic and non-cirrhotic patients. The association between Enterococcus faecium and cirrhosis was studied using a multivariable mixed logistic regression. The association between cirrhosis and mortality was assessed by a multivariable frailty Cox model. RESULTS Among the 1059 hospital-acquired bloodstream infections patients included from 101 centers, 160 had cirrhosis. Hospital-acquired bloodstream infection source in cirrhotic patients was primarily abdominal (35.6%), while it was pulmonary (18.9%) for non-cirrhotic (p < 0.01). Gram-positive hospital-acquired bloodstream infections accounted for 42.3% in cirrhotic patients compared to 33.2% in non-cirrhotic patients (p = 0.02). Hospital-acquired bloodstream infections in cirrhotic patients were most frequently caused by Klebsiella spp (16.5%), coagulase-negative Staphylococci (13.7%) and E. faecium (11.5%). E. faecium bacteremia was more frequent in cirrhotic patients (11.5% versus 4.5%, p < 0.01). After adjusting for possible confounding factors, cirrhosis was associated with higher E. faecium hospital-acquired bloodstream infections risk (Odds ratio 2.5, 95% CI 1.3-4.5, p < 0.01). Cirrhotic patients had increased mortality compared to non-cirrhotic patients (Hazard Ratio 1.3, 95% CI 1.01-1.7, p = 0.045). CONCLUSIONS Critically ill cirrhotic patients with hospital-acquired bloodstream infections exhibit distinct epidemiology, with more Gram-positive infections and particularly Enterococcus faecium.en600 - Technology::610 - Medicine & healtharticle10.48350/1964693869829110.1186/s13613-024-01299-x