Table 1 Comparison between pre- and post-intervention phase among critically ill patients with gram negative bloodstream infection

Demographic data

 Age (years), median (IQR)

67 (55–75)

64 (59–75)

67 (58–75)

0.85

 Sex, male

23 (34.3)

20 (29.4)

43 (31.9)

0.58

Baseline characteristics

 MDR colonization

19 (28.4)

17 (25.0)

36 (26.7)

0.70

 Immunosuppression

13 (19.4)

20 (29.4)

33 (24.4)

0.23

 Charlson comorbidity index, median (IQR)

5 (3–7)

5 (4–7)

5 (3–7)

0.19

Infection characteristics

 Septic shock

41 (61.2)

47 (69.1)

88 (65.2)

0.22

 CRRT

29 (43.3)

24 (35.3)

53 (39.3)

0.38

 MV

43 (64.2)

49 (72.1)

92 (68.1)

0.36

 Baseline SOFA score

8 (6–9)

10 (6–14)

8 (6–11)

0.02

 Pitt score

2 (0–6)

2 (0–3)

2 (0–4)

0.06

BSI characteristics

 Community-acquired

9 (13.4)

7 (10.3)

16 (11.9)

0.05

 Healthcare-related

11 (16.4)

3 (4.4)

14 (10.4)

 Hospital-acquired

47 (70.1)

58 (85.3)

105 (77.8)

 Primary

10 (14.9)

13 (19.1)

23 (17.0)

0.32

 Secondary

48 (73.8)

50 (73.5)

98 (72.6)

0.03

  Intra-abdominal

27 (56.3)

18 (36)

45 (45.9)

  LRTI

11 (22.9)

23 (46.0)

34 (34.7)

  UTI

8 (16.7)

9 (18.0)

17 (17.3)

  Other

2 (4.2)

0 (0)

2 (2.0)

 Device-related

9 (13.8)

5 (7.4)

14 (10.4)

 ICU admission to BSI onset (days) (median, IQR)

4 (1–14)

2 (0–13)

2 (0–13)

0.26

Management of BSI

 FUBC

40 (59.7)

66 (97.1)

106 (78.5)

< 0.001

  Negative FUBC

25 (62.5)

65 (95.6)

90 (83.3)

< 0.001

 SC performed

9 (1.2)

5 (1.4)

14 (10.3)

0.11

 SC not performed

13 (19.4)

7 (10.3)

20 (14.8)

 SC not applicable

29 (43.3)

41 (60.3)

70 (51.9)

Antibiotic management

 Empirical cephalosporin

4 (6.0)

8 (11.9)

12 (9.0)

0.37

 Empirical BL/BLI

13 (19.4)

29 (43.3)

42 (31.3)

0.005

 Empirical carbapenem

42 (62.7)

27 (40.3)

69 (51.5)

0.02

 Appropriate empirical therapy

37 (55.2)

59 (86.9)

96 (71.1)

< 0.001

 Targeted cephalosporin

5 (7.6)

16 (23.5)

21 (15.6)

0.001

 Targeted BL/BLI

9 (13.6)

18 (26.5)

27 (20.1)

0.08

 Targeted novel BL/BLI

14 (20.9)

10 (14.7)

28 (17.8)

0.23

 Targeted carbapenem

37 (56.1)

29 (42.6)

66 (49.3)

0.17

 Targeted escalation

3 (4.5)

2 (2.9)

5 (3.7)

0.98

 Targeted de-escalation

8 (11.9)

14 (20.6)

22 (16.3)

0.56

 Days of appropriate therapy (median, IQR)

16 (12–20)

12 (9–15)

14 (11–17)

< 0.001

 C_ss/MIC ratio > 4 at 48 h from B-lactam start

-

68 (100)

 C_ss/MIC ratio > 4 at 7 days from B-lactam start

-

68 (100)

Dosing reduction after first TDM assessment

-

43 (63.2)

Overall piperacillin/tazobactam DDD/patient

105

168

273

0.002

Median piperacillin/tazobactam DDD/patient

2 (2–12)

3 (2–6)

3 (2–7)

0.78

Overall meropenem DDD/patient

585

232

814

< 0.001

Median meropenem DDD/patient

15 (11–19)

7 (3–10)

11 (7–17)

< 0.001

Outcomes

 SOFA 48 h

7 (5–9)

8 (5–14)

7 (5–10)

0.15

 Delta SOFA 0-48 h

1 (-1-2)

1 (0–2)

1 (0–2)

0.57

 SOFA score 7 days

4 (1–7)

6 (3–10)

5 (2–8)

0.002

 Delta SOFA 0-7days

2 (0–4)

3 (1–6)

2 (1–5)

0.26

 Clinical cure

31 (47.7)

51 (75.0)

82 (61.7)

0.001

 Microbiological failure

20 (29.9)

7 (10.3)

27 (20.0)

0.005

Persistent BSI

11 (16.4)

3 (4.4)

14 (10.4)

0.03

Breakthrough BSI

10 (14.9)

4 (5.9)

14 (10.4)

0.09

Recurrent BSI

12 (17.9)

5 (7.4)

17 (12.6)

0.07

MDRO colonization 30-day

23 (53.5)

6 (12.5)

29 (31.9)

< 0.001

New MDRO colonization 30-day

15 (36.6)

4 (8.3)

19 (21.3)

0.002

MDRO colonization 90-day

13 (36.1)

4 (9.8)

17 (22.1)

0.007

C. difficile infection 30-day

1 (2.6)

2 (4.2)

3 (3.5)

1

All-cause 30-day mortality

24 (35.8)

24 (35.3)

48 (35.6)

1

All-cause 90-day mortality

7 (17.1)

3 (6.8)

10 (11.8)

0.19

Length of hospital stay

42 (24–64)

43 (27–64)

43 (26–64)

0.46

Length of ICU stay

21 (7–36)

18 (6–34)

18 (7–35)

0.41