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
Identifieur interne : 001E28 ( Ncbi/Merge ); précédent : 001E27; suivant : 001E29Infections, 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
Auteurs : H Kan Hanberger [Suède] ; Massimo Antonelli [Italie] ; Martin Holmbom [Suède] ; Jeffrey Lipman ; Peter Pickkers [Pays-Bas] ; Marc Leone [France] ; Jordi Rello [Espagne] ; Yasser Sakr [Allemagne] ; Sten M. Walther [Suède] ; Philippe Vanhems [France] ; Jean-Louis Vincent [Belgique]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2014.
Abstract
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.
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).
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.
Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.
The online version of this article (doi:10.1186/1471-2334-14-513) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/1471-2334-14-513
PubMed: 25245620
PubMed Central: 4181425
Links toward previous steps (curation, corpus...)
- to stream Pmc, to step Corpus: 000A93
- to stream Pmc, to step Curation: 000A70
- to stream Pmc, to step Checkpoint: 001516
Links to Exploration step
PMC:4181425Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">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</title>
<author><name sortKey="Hanberger, H Kan" sort="Hanberger, H Kan" uniqKey="Hanberger H" first="H Kan" last="Hanberger">H Kan Hanberger</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1">Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping</wicri:regionArea>
<wicri:noRegion>Linköping</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Antonelli, Massimo" sort="Antonelli, Massimo" uniqKey="Antonelli M" first="Massimo" last="Antonelli">Massimo Antonelli</name>
<affiliation wicri:level="3"><nlm:aff id="Aff2">Università Cattolica del Sacro Cuore - Policlinico Universitario A. Gemelli, Rome, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Università Cattolica del Sacro Cuore - Policlinico Universitario A. Gemelli, Rome</wicri:regionArea>
<placeName><settlement type="city">Rome</settlement>
<region nuts="2">Latium</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Holmbom, Martin" sort="Holmbom, Martin" uniqKey="Holmbom M" first="Martin" last="Holmbom">Martin Holmbom</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1">Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping</wicri:regionArea>
<wicri:noRegion>Linköping</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name>
<affiliation><nlm:aff id="Aff3">Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Herston, QLD Australia</nlm:aff>
<wicri:noCountry code="subfield">QLD Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Pickkers, Peter" sort="Pickkers, Peter" uniqKey="Pickkers P" first="Peter" last="Pickkers">Peter Pickkers</name>
<affiliation wicri:level="3"><nlm:aff id="Aff4">Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen</wicri:regionArea>
<placeName><settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name>
<affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Marseilles, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Marseilles</wicri:regionArea>
<wicri:noRegion>Marseilles</wicri:noRegion>
<wicri:noRegion>Marseilles</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name>
<affiliation wicri:level="3"><nlm:aff id="Aff6">Critical Care Department, Vall d'Hebron University Hospital, CIBERES, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Critical Care Department, Vall d'Hebron University Hospital, CIBERES, VHIR, Universitat Autonoma de Barcelona, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name>
<affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena</wicri:regionArea>
<wicri:noRegion>Jena</wicri:noRegion>
<wicri:noRegion>Jena</wicri:noRegion>
<wicri:noRegion>Jena</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Walther, Sten M" sort="Walther, Sten M" uniqKey="Walther S" first="Sten M" last="Walther">Sten M. Walther</name>
<affiliation wicri:level="1"><nlm:aff id="Aff8">Division of Cardiovascular Medicine, Department of Medicine and Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Division of Cardiovascular Medicine, Department of Medicine and Health, Faculty of Health Sciences, Linköping University, Linköping</wicri:regionArea>
<wicri:noRegion>Linköping</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Vanhems, Philippe" sort="Vanhems, Philippe" uniqKey="Vanhems P" first="Philippe" last="Vanhems">Philippe Vanhems</name>
<affiliation wicri:level="3"><nlm:aff id="Aff9">Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1, Lyon, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1, Lyon</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Lyon</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name>
<affiliation wicri:level="4"><nlm:aff id="Aff10">Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels</wicri:regionArea>
<placeName><settlement type="city">Bruxelles</settlement>
<region nuts="2">Région de Bruxelles-Capitale</region>
<settlement type="city">Bruxelles</settlement>
</placeName>
<orgName type="university">Université libre de Bruxelles</orgName>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">25245620</idno>
<idno type="pmc">4181425</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181425</idno>
<idno type="RBID">PMC:4181425</idno>
<idno type="doi">10.1186/1471-2334-14-513</idno>
<date when="2014">2014</date>
<idno type="wicri:Area/Pmc/Corpus">000A93</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000A93</idno>
<idno type="wicri:Area/Pmc/Curation">000A70</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000A70</idno>
<idno type="wicri:Area/Pmc/Checkpoint">001516</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001516</idno>
<idno type="wicri:Area/Ncbi/Merge">001E28</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">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</title>
<author><name sortKey="Hanberger, H Kan" sort="Hanberger, H Kan" uniqKey="Hanberger H" first="H Kan" last="Hanberger">H Kan Hanberger</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1">Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping</wicri:regionArea>
<wicri:noRegion>Linköping</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Antonelli, Massimo" sort="Antonelli, Massimo" uniqKey="Antonelli M" first="Massimo" last="Antonelli">Massimo Antonelli</name>
<affiliation wicri:level="3"><nlm:aff id="Aff2">Università Cattolica del Sacro Cuore - Policlinico Universitario A. Gemelli, Rome, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Università Cattolica del Sacro Cuore - Policlinico Universitario A. Gemelli, Rome</wicri:regionArea>
<placeName><settlement type="city">Rome</settlement>
<region nuts="2">Latium</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Holmbom, Martin" sort="Holmbom, Martin" uniqKey="Holmbom M" first="Martin" last="Holmbom">Martin Holmbom</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1">Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping</wicri:regionArea>
<wicri:noRegion>Linköping</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name>
<affiliation><nlm:aff id="Aff3">Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Herston, QLD Australia</nlm:aff>
<wicri:noCountry code="subfield">QLD Australia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Pickkers, Peter" sort="Pickkers, Peter" uniqKey="Pickkers P" first="Peter" last="Pickkers">Peter Pickkers</name>
<affiliation wicri:level="3"><nlm:aff id="Aff4">Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen</wicri:regionArea>
<placeName><settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name>
<affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Marseilles, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Marseilles</wicri:regionArea>
<wicri:noRegion>Marseilles</wicri:noRegion>
<wicri:noRegion>Marseilles</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name>
<affiliation wicri:level="3"><nlm:aff id="Aff6">Critical Care Department, Vall d'Hebron University Hospital, CIBERES, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Critical Care Department, Vall d'Hebron University Hospital, CIBERES, VHIR, Universitat Autonoma de Barcelona, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name>
<affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena</wicri:regionArea>
<wicri:noRegion>Jena</wicri:noRegion>
<wicri:noRegion>Jena</wicri:noRegion>
<wicri:noRegion>Jena</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Walther, Sten M" sort="Walther, Sten M" uniqKey="Walther S" first="Sten M" last="Walther">Sten M. Walther</name>
<affiliation wicri:level="1"><nlm:aff id="Aff8">Division of Cardiovascular Medicine, Department of Medicine and Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Division of Cardiovascular Medicine, Department of Medicine and Health, Faculty of Health Sciences, Linköping University, Linköping</wicri:regionArea>
<wicri:noRegion>Linköping</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Vanhems, Philippe" sort="Vanhems, Philippe" uniqKey="Vanhems P" first="Philippe" last="Vanhems">Philippe Vanhems</name>
<affiliation wicri:level="3"><nlm:aff id="Aff9">Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1, Lyon, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1, Lyon</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Lyon</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name>
<affiliation wicri:level="4"><nlm:aff id="Aff10">Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels</wicri:regionArea>
<placeName><settlement type="city">Bruxelles</settlement>
<region nuts="2">Région de Bruxelles-Capitale</region>
<settlement type="city">Bruxelles</settlement>
</placeName>
<orgName type="university">Université libre de Bruxelles</orgName>
</affiliation>
</author>
</analytic>
<series><title level="j">BMC Infectious Diseases</title>
<idno type="eISSN">1471-2334</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>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.</p>
</sec>
<sec><title>Methods</title>
<p>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).</p>
</sec>
<sec><title>Results</title>
<p>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.</p>
</sec>
<sec><title>Conclusions</title>
<p>Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/1471-2334-14-513) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Vincent, Jl" uniqKey="Vincent J">JL Vincent</name>
</author>
<author><name sortKey="Sakr, Y" uniqKey="Sakr Y">Y Sakr</name>
</author>
<author><name sortKey="Sprung, Cl" uniqKey="Sprung C">CL Sprung</name>
</author>
<author><name sortKey="Ranieri, Vm" uniqKey="Ranieri V">VM Ranieri</name>
</author>
<author><name sortKey="Reinhart, K" uniqKey="Reinhart K">K Reinhart</name>
</author>
<author><name sortKey="Gerlach, H" uniqKey="Gerlach H">H Gerlach</name>
</author>
<author><name sortKey="Moreno, R" uniqKey="Moreno R">R Moreno</name>
</author>
<author><name sortKey="Carlet, J" uniqKey="Carlet J">J Carlet</name>
</author>
<author><name sortKey="Le Gall, Jr" uniqKey="Le Gall J">JR Le Gall</name>
</author>
<author><name sortKey="Payen, D" uniqKey="Payen D">D Payen</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Vincent, Jl" uniqKey="Vincent J">JL Vincent</name>
</author>
<author><name sortKey="Rello, J" uniqKey="Rello J">J Rello</name>
</author>
<author><name sortKey="Marshall, J" uniqKey="Marshall J">J Marshall</name>
</author>
<author><name sortKey="Silva, E" uniqKey="Silva E">E Silva</name>
</author>
<author><name sortKey="Anzueto, A" uniqKey="Anzueto A">A Anzueto</name>
</author>
<author><name sortKey="Martin, Cd" uniqKey="Martin C">CD Martin</name>
</author>
<author><name sortKey="Moreno, R" uniqKey="Moreno R">R Moreno</name>
</author>
<author><name sortKey="Lipman, J" uniqKey="Lipman J">J Lipman</name>
</author>
<author><name sortKey="Gomersall, C" uniqKey="Gomersall C">C Gomersall</name>
</author>
<author><name sortKey="Sakr, Y" uniqKey="Sakr Y">Y Sakr</name>
</author>
<author><name sortKey="Reinhart, K" uniqKey="Reinhart K">K Reinhart</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Vincent, Jl" uniqKey="Vincent J">JL Vincent</name>
</author>
<author><name sortKey="Bihari, Dj" uniqKey="Bihari D">DJ Bihari</name>
</author>
<author><name sortKey="Suter, Pm" uniqKey="Suter P">PM Suter</name>
</author>
<author><name sortKey="Bruining, Ha" uniqKey="Bruining H">HA Bruining</name>
</author>
<author><name sortKey="White, J" uniqKey="White J">J White</name>
</author>
<author><name sortKey="Nicolas Chanoin, Mh" uniqKey="Nicolas Chanoin M">MH Nicolas-Chanoin</name>
</author>
<author><name sortKey="Wolff, M" uniqKey="Wolff M">M Wolff</name>
</author>
<author><name sortKey="Spencer, Rc" uniqKey="Spencer R">RC Spencer</name>
</author>
<author><name sortKey="Hemmer, M" uniqKey="Hemmer M">M Hemmer</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Cosgrove, Se" uniqKey="Cosgrove S">SE Cosgrove</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Macedo Vinas, M" uniqKey="Macedo Vinas M">M Macedo-Vinas</name>
</author>
<author><name sortKey="De Angelis, G" uniqKey="De Angelis G">G De Angelis</name>
</author>
<author><name sortKey="Rohner, P" uniqKey="Rohner P">P Rohner</name>
</author>
<author><name sortKey="Safran, E" uniqKey="Safran E">E Safran</name>
</author>
<author><name sortKey="Stewardson, A" uniqKey="Stewardson A">A Stewardson</name>
</author>
<author><name sortKey="Fankhauser, C" uniqKey="Fankhauser C">C Fankhauser</name>
</author>
<author><name sortKey="Schrenzel, J" uniqKey="Schrenzel J">J Schrenzel</name>
</author>
<author><name sortKey="Pittet, D" uniqKey="Pittet D">D Pittet</name>
</author>
<author><name sortKey="Harbarth, S" uniqKey="Harbarth S">S Harbarth</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rubio Terres, C" uniqKey="Rubio Terres C">C Rubio-Terres</name>
</author>
<author><name sortKey="Garau, J" uniqKey="Garau J">J Garau</name>
</author>
<author><name sortKey="Grau, S" uniqKey="Grau S">S Grau</name>
</author>
<author><name sortKey="Martinez Martinez, L" uniqKey="Martinez Martinez L">L Martinez-Martinez</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Patel, G" uniqKey="Patel G">G Patel</name>
</author>
<author><name sortKey="Huprikar, S" uniqKey="Huprikar S">S Huprikar</name>
</author>
<author><name sortKey="Factor, Sh" uniqKey="Factor S">SH Factor</name>
</author>
<author><name sortKey="Jenkins, Sg" uniqKey="Jenkins S">SG Jenkins</name>
</author>
<author><name sortKey="Calfee, Dp" uniqKey="Calfee D">DP Calfee</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Salgado, Cd" uniqKey="Salgado C">CD Salgado</name>
</author>
<author><name sortKey="Farr, Bm" uniqKey="Farr B">BM Farr</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Calandra, T" uniqKey="Calandra T">T Calandra</name>
</author>
<author><name sortKey="Cohen, J" uniqKey="Cohen J">J Cohen</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Rubin, Db" uniqKey="Rubin D">DB Rubin</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Rubin, Db" uniqKey="Rubin D">DB Rubin</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="De Kraker, Me" uniqKey="De Kraker M">ME de Kraker</name>
</author>
<author><name sortKey="Davey, Pg" uniqKey="Davey P">PG Davey</name>
</author>
<author><name sortKey="Grundmann, H" uniqKey="Grundmann H">H Grundmann</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="De Kraker, Me" uniqKey="De Kraker M">ME de Kraker</name>
</author>
<author><name sortKey="Wolkewitz, M" uniqKey="Wolkewitz M">M Wolkewitz</name>
</author>
<author><name sortKey="Davey, Pg" uniqKey="Davey P">PG Davey</name>
</author>
<author><name sortKey="Koller, W" uniqKey="Koller W">W Koller</name>
</author>
<author><name sortKey="Berger, J" uniqKey="Berger J">J Berger</name>
</author>
<author><name sortKey="Nagler, J" uniqKey="Nagler J">J Nagler</name>
</author>
<author><name sortKey="Icket, C" uniqKey="Icket C">C Icket</name>
</author>
<author><name sortKey="Kalenic, S" uniqKey="Kalenic S">S Kalenic</name>
</author>
<author><name sortKey="Horvatic, J" uniqKey="Horvatic J">J Horvatic</name>
</author>
<author><name sortKey="Seifert, H" uniqKey="Seifert H">H Seifert</name>
</author>
<author><name sortKey="Kaasch, Aj" uniqKey="Kaasch A">AJ Kaasch</name>
</author>
<author><name sortKey="Paniara, O" uniqKey="Paniara O">O Paniara</name>
</author>
<author><name sortKey="Argyropoulou, A" uniqKey="Argyropoulou A">A Argyropoulou</name>
</author>
<author><name sortKey="Bompola, M" uniqKey="Bompola M">M Bompola</name>
</author>
<author><name sortKey="Smyth, E" uniqKey="Smyth E">E Smyth</name>
</author>
<author><name sortKey="Skally, M" uniqKey="Skally M">M Skally</name>
</author>
<author><name sortKey="Raglio, A" uniqKey="Raglio A">A Raglio</name>
</author>
<author><name sortKey="Dumpis, U" uniqKey="Dumpis U">U Dumpis</name>
</author>
<author><name sortKey="Kelmere, Am" uniqKey="Kelmere A">AM Kelmere</name>
</author>
<author><name sortKey="Borg, M" uniqKey="Borg M">M Borg</name>
</author>
<author><name sortKey="Xuereb, D" uniqKey="Xuereb D">D Xuereb</name>
</author>
<author><name sortKey="Ghita, Mc" uniqKey="Ghita M">MC Ghita</name>
</author>
<author><name sortKey="Noble, M" uniqKey="Noble M">M Noble</name>
</author>
<author><name sortKey="Kolman, J" uniqKey="Kolman J">J Kolman</name>
</author>
<author><name sortKey="Grabljevec, S" uniqKey="Grabljevec S">S Grabljevec</name>
</author>
<author><name sortKey="Turner, D" uniqKey="Turner D">D Turner</name>
</author>
<author><name sortKey="Lansbury, L" uniqKey="Lansbury L">L Lansbury</name>
</author>
<author><name sortKey="Grundmann, H" uniqKey="Grundmann H">H Grundmann</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Hanberger, H" uniqKey="Hanberger H">H Hanberger</name>
</author>
<author><name sortKey="Walther, S" uniqKey="Walther S">S Walther</name>
</author>
<author><name sortKey="Leone, M" uniqKey="Leone M">M Leone</name>
</author>
<author><name sortKey="Barie, Ps" uniqKey="Barie P">PS Barie</name>
</author>
<author><name sortKey="Rello, J" uniqKey="Rello J">J Rello</name>
</author>
<author><name sortKey="Lipman, J" uniqKey="Lipman J">J Lipman</name>
</author>
<author><name sortKey="Marshall, Jc" uniqKey="Marshall J">JC Marshall</name>
</author>
<author><name sortKey="Anzueto, A" uniqKey="Anzueto A">A Anzueto</name>
</author>
<author><name sortKey="Sakr, Y" uniqKey="Sakr Y">Y Sakr</name>
</author>
<author><name sortKey="Pickkers, P" uniqKey="Pickkers P">P Pickkers</name>
</author>
<author><name sortKey="Felleiter, P" uniqKey="Felleiter P">P Felleiter</name>
</author>
<author><name sortKey="Engoren, M" uniqKey="Engoren M">M Engoren</name>
</author>
<author><name sortKey="Vincent, Jl" uniqKey="Vincent J">JL Vincent</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Park, Sy" uniqKey="Park S">SY Park</name>
</author>
<author><name sortKey="Son, Js" uniqKey="Son J">JS Son</name>
</author>
<author><name sortKey="Oh, Ih" uniqKey="Oh I">IH Oh</name>
</author>
<author><name sortKey="Choi, Jm" uniqKey="Choi J">JM Choi</name>
</author>
<author><name sortKey="Lee, Ms" uniqKey="Lee M">MS Lee</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lodise, Tp" uniqKey="Lodise T">TP Lodise</name>
</author>
<author><name sortKey="Patel, N" uniqKey="Patel N">N Patel</name>
</author>
<author><name sortKey="Kwa, A" uniqKey="Kwa A">A Kwa</name>
</author>
<author><name sortKey="Graves, J" uniqKey="Graves J">J Graves</name>
</author>
<author><name sortKey="Furuno, Jp" uniqKey="Furuno J">JP Furuno</name>
</author>
<author><name sortKey="Graffunder, E" uniqKey="Graffunder E">E Graffunder</name>
</author>
<author><name sortKey="Lomaestro, B" uniqKey="Lomaestro B">B Lomaestro</name>
</author>
<author><name sortKey="Mcgregor, Jc" uniqKey="Mcgregor J">JC McGregor</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Falagas, Me" uniqKey="Falagas M">ME Falagas</name>
</author>
<author><name sortKey="Kasiakou, Sk" uniqKey="Kasiakou S">SK Kasiakou</name>
</author>
<author><name sortKey="Rafailidis, Pi" uniqKey="Rafailidis P">PI Rafailidis</name>
</author>
<author><name sortKey="Zouglakis, G" uniqKey="Zouglakis G">G Zouglakis</name>
</author>
<author><name sortKey="Morfou, P" uniqKey="Morfou P">P Morfou</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Shorr, Af" uniqKey="Shorr A">AF Shorr</name>
</author>
<author><name sortKey="Micek, St" uniqKey="Micek S">ST Micek</name>
</author>
<author><name sortKey="Kollef, Mh" uniqKey="Kollef M">MH Kollef</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Infect. Dis</journal-id>
<journal-title-group><journal-title>BMC Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="epub">1471-2334</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">25245620</article-id>
<article-id pub-id-type="pmc">4181425</article-id>
<article-id pub-id-type="publisher-id">3832</article-id>
<article-id pub-id-type="doi">10.1186/1471-2334-14-513</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-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</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Hanberger</surname>
<given-names>Håkan</given-names>
</name>
<address><email>hakan.hanberger@liu.se</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Antonelli</surname>
<given-names>Massimo</given-names>
</name>
<address><email>m.antonelli@rm.unicatt.it</email>
</address>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Holmbom</surname>
<given-names>Martin</given-names>
</name>
<address><email>martinholmbom@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lipman</surname>
<given-names>Jeffrey</given-names>
</name>
<address><email>j.lipman@uq.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Pickkers</surname>
<given-names>Peter</given-names>
</name>
<address><email>Peter.Pickkers@radboudumc.nl</email>
</address>
<xref ref-type="aff" rid="Aff4"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Leone</surname>
<given-names>Marc</given-names>
</name>
<address><email>Marc.LEONE@ap-hm.fr</email>
</address>
<xref ref-type="aff" rid="Aff5"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rello</surname>
<given-names>Jordi</given-names>
</name>
<address><email>jrello@crips.es</email>
</address>
<xref ref-type="aff" rid="Aff6"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sakr</surname>
<given-names>Yasser</given-names>
</name>
<address><email>Yasser.Sakr@med.uni-jena.de</email>
</address>
<xref ref-type="aff" rid="Aff7"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Walther</surname>
<given-names>Sten M</given-names>
</name>
<address><email>sten.walther@telia.com</email>
</address>
<xref ref-type="aff" rid="Aff8"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vanhems</surname>
<given-names>Philippe</given-names>
</name>
<address><email>philippe.vanhems@chu-lyon.fr</email>
</address>
<xref ref-type="aff" rid="Aff9"></xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Vincent</surname>
<given-names>Jean-Louis</given-names>
</name>
<address><email>jlvincen@ulb.ac.be</email>
</address>
<xref ref-type="aff" rid="Aff10"></xref>
</contrib>
<contrib contrib-type="author"><collab>for the EPIC II Group of Investigators</collab>
</contrib>
<aff id="Aff1"><label></label>
Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden</aff>
<aff id="Aff2"><label></label>
Università Cattolica del Sacro Cuore - Policlinico Universitario A. Gemelli, Rome, Italy</aff>
<aff id="Aff3"><label></label>
Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Herston, QLD Australia</aff>
<aff id="Aff4"><label></label>
Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands</aff>
<aff id="Aff5"><label></label>
Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Marseilles, France</aff>
<aff id="Aff6"><label></label>
Critical Care Department, Vall d'Hebron University Hospital, CIBERES, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain</aff>
<aff id="Aff7"><label></label>
Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany</aff>
<aff id="Aff8"><label></label>
Division of Cardiovascular Medicine, Department of Medicine and Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden</aff>
<aff id="Aff9"><label></label>
Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1, Lyon, France</aff>
<aff id="Aff10"><label></label>
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium</aff>
</contrib-group>
<pub-date pub-type="epub"><day>22</day>
<month>9</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>22</day>
<month>9</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="collection"><year>2014</year>
</pub-date>
<volume>14</volume>
<elocation-id>513</elocation-id>
<history><date date-type="received"><day>3</day>
<month>7</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>11</day>
<month>9</month>
<year>2014</year>
</date>
</history>
<permissions><copyright-statement>© Hanberger et al.; licensee BioMed Central Ltd. 2014</copyright-statement>
<license license-type="open-access"><license-p>This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>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.</p>
</sec>
<sec><title>Methods</title>
<p>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).</p>
</sec>
<sec><title>Results</title>
<p>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.</p>
</sec>
<sec><title>Conclusions</title>
<p>Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/1471-2334-14-513) contains supplementary material, which is available to authorized users.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Infection</kwd>
<kwd>Critically ill</kwd>
<kwd>Antibiotic</kwd>
<kwd>Resistance</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2014</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Allemagne</li>
<li>Belgique</li>
<li>Espagne</li>
<li>France</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Suède</li>
</country>
<region><li>Auvergne-Rhône-Alpes</li>
<li>Catalogne</li>
<li>Gueldre</li>
<li>Latium</li>
<li>Rhône-Alpes</li>
<li>Région de Bruxelles-Capitale</li>
</region>
<settlement><li>Barcelone</li>
<li>Bruxelles</li>
<li>Lyon</li>
<li>Nimègue</li>
<li>Rome</li>
</settlement>
<orgName><li>Université libre de Bruxelles</li>
</orgName>
</list>
<tree><noCountry><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name>
</noCountry>
<country name="Suède"><noRegion><name sortKey="Hanberger, H Kan" sort="Hanberger, H Kan" uniqKey="Hanberger H" first="H Kan" last="Hanberger">H Kan Hanberger</name>
</noRegion>
<name sortKey="Holmbom, Martin" sort="Holmbom, Martin" uniqKey="Holmbom M" first="Martin" last="Holmbom">Martin Holmbom</name>
<name sortKey="Walther, Sten M" sort="Walther, Sten M" uniqKey="Walther S" first="Sten M" last="Walther">Sten M. Walther</name>
</country>
<country name="Italie"><region name="Latium"><name sortKey="Antonelli, Massimo" sort="Antonelli, Massimo" uniqKey="Antonelli M" first="Massimo" last="Antonelli">Massimo Antonelli</name>
</region>
</country>
<country name="Pays-Bas"><region name="Gueldre"><name sortKey="Pickkers, Peter" sort="Pickkers, Peter" uniqKey="Pickkers P" first="Peter" last="Pickkers">Peter Pickkers</name>
</region>
</country>
<country name="France"><noRegion><name sortKey="Leone, Marc" sort="Leone, Marc" uniqKey="Leone M" first="Marc" last="Leone">Marc Leone</name>
</noRegion>
<name sortKey="Vanhems, Philippe" sort="Vanhems, Philippe" uniqKey="Vanhems P" first="Philippe" last="Vanhems">Philippe Vanhems</name>
</country>
<country name="Espagne"><region name="Catalogne"><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name>
</region>
</country>
<country name="Allemagne"><noRegion><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name>
</noRegion>
</country>
<country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name>
</region>
</country>
</tree>
</affiliations>
</record>
Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Asie/explor/AustralieFrV1/Data/Ncbi/Merge
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001E28 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Ncbi/Merge/biblio.hfd -nk 001E28 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Wicri/Asie |area= AustralieFrV1 |flux= Ncbi |étape= Merge |type= RBID |clé= PMC:4181425 |texte= 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 }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Ncbi/Merge/RBID.i -Sk "pubmed:25245620" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Ncbi/Merge/biblio.hfd \ | NlmPubMed2Wicri -a AustralieFrV1
![]() | This area was generated with Dilib version V0.6.33. | ![]() |