Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study

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Patel J. Rebecca E Tilley Humphreys S.K. Jean Renaud P. Sokhan A. Burma Y. Sligl W. Baig N. McCoshen L. Kutsogiannis D.J. Thompson P. Hewer T. Rabbani R. Huq S.M.R. Hasan R. Motiul Islam M. Gurjar M. Baronia A. Kothari N. Sharma A. Karmakar S. Sharma P. Nimbolkar J. Samdani P. Vaidyanathan R. Ahmedi Rubina N. Jain N. Pahuja M. Singh R. Shekhar S. Syed N.M. Ozair A. Sarwar Siddiqui S. Bose P. Datta A. Rathod D. Patel M. MK R. Sailaja K.B. Dsilva C. Chandran J. Ghosh P. Mukherjee S. Sheshala K. Chandra Misra K. Adekola O.O. Yusuf Yakubu S. Mgbosoro Ugwu E. Olatosi J.O. Desalu I. Asiyanbi G. Oladimeji M. Idowu O. Adeola F. Mer M. Mc Cree M. El Sanousi D.B. Adil Ali Karar A. Saidahmed E. Hamid H.K.S.
December 2024 Elsevier B.V.

Clinical Microbiology and Infection
2024 #30 Issue 12 1559 - 1568 pp.

Objectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for ≥1 day and for whom time-to-appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n = 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n = 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72–0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9–16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI.

Adequacy , Critically ill , Directed acyclic Graph , Hospital-acquired bloodstream infection , Mediation analysis , Sepsis , Time-to-antibiotic

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OUTCOMEREA Research Group, Drancy, France
Grenoble Alpes University, Institut National de la Santé et de la Recherche Medicale 1300, HP2 Grenoble, France
Institut National de la Santé et de la Recherche Medicale, Infection Antimicrobial Modelisation Evolution, Team Decision Science in Infectious Diseases, Paris, U1137, France
ICURESEARCH™, 26 rue Garibaldi, Fontaine, France
Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Service PCI, Geneva, Switzerland
Centre Hospitalier Régional dOrléans, Tours, France
Queensland University of Technology (QUT), Brisbane, QLD, Australia
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD, Australia
Assistance Publique Hôpitaux de Paris, Bichat hospital, Medical and infectious diseases ICU, Paris, F75018, France
Redcliffe Hospital, Intensive Care Unit, Australia
Alfred Hospital, Department of Intensive Care and Hyperbaric Medicine, Australia
Ipswich Hospital, Intensive Care Unit, Australia
Mater Hospital, And Mater Research Institute – The University of Queensland, Mater Misericordiae Limited, The Department of Intensive Care, Australia
Mater Private Hospital, And Mater Research Institute – The University of Queensland, Mater Misericordiae, The Department of Intensive Care, Australia
Bankstown-Lidcombe Hospital, Intensive Care Unit, Australia
Lyell Mcewin Hospital, Lyell Mcewin Hospital Intensive Care Unit, Australia
Cabrini Hospital, Intensive Care, Australia
St John Of God Murdoch Hospital, Intensive Care Unit, Australia
Royal Brisbane and Women S Hospital, Intensive Care Services, Australia
The Prince Charles Hospital, Adult Intensive Care Services, Australia
Princess Alexandra Hospital, Intensive Care, Australia
Fiona Stanley Hospital, Intensive Care Unit, Australia
Rockhampton Hospital, Intensive Care Unit, Australia
Ripas Hospital, Icu 3
Raja Isteri Pengiran Anak Saleha Hospital, Icu1
Gleneagles Jpmc, Icu
Suri Seri Begawan Hospital, Intensive Care Unit
Zhongda Hospital, Southeast University, Department of Critical Care Medicine, China
Yijishan Hospital, First Affiliated Hospital of Wannan Medical College, Department of Critical Care Medicine, China
First Affiliate Hospital of Kunming Medical University, Micu/Eicu, China
Qilu Hospital of Shandong University, Department of Critical Care Medicine, China
Hebei Petrochina Central Hospital, Intensive Care Unit, China
Hangzhou Second Hospital, Affiliated Hospital of Hangzhou Normal University, China
Tianjin Third Central Hospital, Department of Critical Care Medicine, China
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Department Of Critical Care Medicine, China
The Second Hospital of Jilin University, Department Of Critical Care, China
Taizhou People S Hospital, Intensive Care Unit, China
The First Affiliated Hospital of Nanjing Medical University, Department Of Geriatrics Intensive Care Unit, China
Zhejiang Hospital, Intensive Care Unit, China
Henan Provincial People S Hospital, Department of Critical Care Medicine, China
Qingdao Municipal Hospital, Intensive Care Unit, China
The Second Hospital of Lanzhou University, Department Of Critical Care Medicine, China
The Chinese University of Hong Kong, Prince of Wales Hospital, Department Of Anaesthesia And Intensive Care, Hong Kong
Kameda Medical Center, Department of Intensive Care Medicine, Japan
University Hospital Kyoto Prefectural University of Medicine, Intensive Care Unit, Japan
Hiroshima University Hospital, ICU, Japan
Yokosuka General Hospital Uwamachi, Critical Care Medicine, Japan
Tokyo Metropolitan Tama Medical Center, Emergency and Critical Care Center, Japan
Kurashiki Central Hospital, Emergency Intensive Care Unit, Japan
Tokyo Medical and Dental University, Department of Intensive Care Medicine, Japan
St. Marianna University School of Medicine Hospital, Mixed ICU, Japan
Osaka City General Hospital, Emergency and Critical Care Medical Hospital, Japan
St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Mixed ICU, Japan
Yokohama City University Hospital, Infection Prevention and Control Department, Japan
Yokohama City University Hospital, Intensive Care Department, Japan
University Malaya Medical Centre, Department of Anaesthesiology and Intensive Care, Malaysia
Hospital Tengku Ampuan Rahimah, Anaesthesia and Intensive Care, Malaysia
Hospital Sarikei, Anaesthesiology & Intensive Care Unit, Malaysia
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Hospital Tuanku Fauziah, Intensive Care Unit, Malaysia
School Of Medical Sciences Universiti Sains Malaysia, Department of Anaesthesiology and Intensive Care, Malaysia
Hospital Universiti Sains Malaysia, Department of Anaesthesiology and Intensive Care, Malaysia
The Medical City Ortigas, Intensive Care Unit, Philippines
Samsung Medical Center, Medical Icu, South Korea
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Hallym University Sacred Heart Hospital, Micu, South Korea
Micu, Chonbuk National University Hospital, South Korea
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Singapore General Hospital, Neurosurgical Intensive Care Unit, Singapore
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Cairo University Hospital (Qasr Al Ainy), Critical Care Department, Egypt
Medical Research Institute, Alexandria University, Biomedical Informatics and Medical Statistics (Icu), Egypt
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Tanta University Faculty of Medicine, Emergency Medicine and Traumatology Department, Egypt
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Ahvaz Jundishapur University of Medical Sciences, Air Pollution and Respiratory Diseases Research Center, Iran
Ahvaz Jundishapur University of Medical Sciences, Neurology Department, Iran
Ahvaz Jundishapur University of Medical Sciences, Infectious and Tropical Diseases Research Center, Health Research Institute, Iran
Ahvaz Jundishapur University of Medical, Pain Research Center, Iran
Ahvaz Jundishapur University of Medical Sciences, Neurosurgery Department, Iran
Ahvaz Jundishapur University of Medical Sciences, General Surgery Department, Iran
Tabriz University of Medical Sciences, Research Center for Integrative Medicine in Aging, Aging Research Institute, Iran
Jahrom University of Medical Sciences, Peimanieh Hospital, Iran
Shiraz University of Medical Sciences, Shahid Rajaee Trauma Hospital, Iran
Shiraz University of Medical Sciences, Trauma Research Center, Shahid Rajaee Hospital, Iran
Zahedan University of Medical Sciences, Anesthesiology and Critical Care Department, Iran
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Mohammed VI University Hospital of Oujda, Faculty Of Medicine and Pharmacy Oujda, Mohammed Premier University, Anesthesia and Resuscitation Department, Morocco
Mohammed VI University Hospital, Medical Icu, Marrakech, Morocco
National Institute of Oncology of Rabat, Intensive Care Unit, Morocco
ICU, Alia governmental hospital, Hebron / West Bank, Palestine: Dr. Sarah Amro. Gaza city, Alshifaa hospital, Gaza, Palestine
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Damascus University Cardiac Surgery Hospital Near Al-Mouwasat University Hospital, Mazzeh Kiwan, Cardiac Surgery Icu
Habib Bourguiba University Hospital, Department of Intensive Care, Tunisia
Military Hospital of Tunis, Department of Anesthesiology And Intensive Care Unit, Lr12dn01, Tunisia
Hcas Cuenca Alta, Terapia Intensiva, Argentina
Hospital Central De Formosa, Servicio De Terapia Intensiva, Argentina
Hospital Español De Mendoza, Terapia Intensiva De Adultos, Argentina
Hospital Zatti, Ucia, Argentina
Instituto De Diagnostico De La Plata, Unidad De Terapia Intensiva, Argentina
Clinica Universidad De La Sabana, Critical Care Unit, Colombia
Universidad De La Sabana, Infectious Diseases Department, Colombia
Hospital Medica Sur, Department of Critical Care Medicine, Mexico
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A.S.Z., Iz, Belgium
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University Hospital Of Poitiers, Surgical And Neuro Intensive Care Units, France
University Of Montpellier, Phymedexp Inserm Cnrs, France
University Hospital Ulm, Icu G1, Germany
Jena University Hospital, Dept. Of Anesthesiology and Intensive Care Medicine, Germany
Universitätsklinikum Leipzig, Medical Icu, Germany
University Hospital Heidelberg, Station 13 Iopsis, Germany
University Hospital Muenster, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
University Hospital of Saarland, Dept. Of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Germany
University Medical Center, National Research Oncology Center, Intensive Care Unit, Kazakhstan
Karaganda Medical University, Department of Emergency Medicine, Anesthesiology and Resuscitation Non-Commercial Joint-Stock Company, Kazakhstan
Medical Center Hospital of The Presidents Affairs Administration of The Republic of Kazakhstan, Intensive Care Unit, Kazakhstan
National Research Oncology Center, Department of Oncohematological Resuscitation, Resuscitation, Intensive Care, Kazakhstan
Papageorgiou Hospital, Intensive Care Unit, Greece
Agioi Anargiroi Hospital, Agioi Anargiroi Icu, Greece
G Papanikolaou General Hospital, 1st Icu, Greece
G Papanikolaou General Hospital, B Icu, Greece
General Hospital G. Gennhmatas, Gnth “G Gennhmatas”, Greece
General Hospital of Athens G. Gennimatas, Icu, Greece
Gh Imathia Veria, Icu, Greece
Icu, Hygeia General Hospital, Greece
Intensive Care Unit, General Hospital of Giannitsa, Greece
Intensive Care Unit, Hippocration General Hospital Of Athens, Greece
Katerini General Hospital, Gnk Icu, Greece
Konstantopoulion-Patision Hospital, Icu, Greece
Mediterraneo Hospital, Icu/Hdu, Greece
Saint Savvas Hospital, Icu, Greece
Sismanogleio Hospital, Sismanogleion Icu, Greece
Theageneio Anticancer Hospital, Icu, Greece
University Hospital Attikon, National And Kapodistrian University Of Athens, Department Of Critical Care, Greece
University Hospital Heraklion, Department of Intensive Care, Greece
University Hospital of Alexandroupolis, Department Of Intensive Care, Greece
University Hospital of Ioannina, Intensive Care Unit, Greece
Città Della Salute E Della Scienza - Molinette, Anestesia E Rianimazione Universitaria, Italy
Fondazione Policlinico Universitario A. Gemelli Irccs. Universita Cattolica Del Sacro Cuore. Italy, Uoc Di Anestesia, Rianimazione, Terpia Intensiva E Tossicologia Clinica, Italy
Irccs Ospedale Policlinico San Martino, U.O. Anestesia E Rianimazione, Italy
Irccs Sacro Cuore Don Calabria, Terapia Intensiva, Italy
Madonna Delle Grazie, U.O.C. Anestesia E Rianimazione, Italy
Ospedale Policlinico San Martino, Irccs Per Loncologia E Le Neuroscienze, Uo Clinica Anestesiologica E Terapia Intensiva, Italy
Policlino Paolo Giaccone, Università Degli Studi Di Palermo, Terapia Intensiva Polivalente, Italy
Regina Elena National Cancer Institute of Rome, Anesthesia and Intensive Care Department, Italy
Santandrea Hospital Sapienza University of Rome, Department of Medical And Surgical Science And Translational Medicine Intensive Care Unit, Italy
University Hospital O.O.R.R., Department of Anesthesia And Intensive Care, Italy
Hospital In Puszczykowo, Poznan University of Medical Sciences, Department of Anaesthesiology and Intensive Therapy, Poland
Oddzial Kliniczny Anestezjologii I Intensywnej Terapii, 10 Wojskowy Szpital Kliniczny, Poland
Szpital Wojewodzki W Opolu, Oddzial Anestezjologii I Intensywnej Terapii, Poland
Uck Wum, Oddzial Intensywnej Terapii (Icu), Poland
Wojewodzki Szpital Zespolony, Oddzial Anestezjologii I Intensywnej Terapii, Poland
Wss Im. Wl. Bieganskiego, Oddzial Anestezjologii I Intensywnej Terapii - Osrodek Pozaustrojowych Technik Wspomagania Czynnosci Nerek I Wątroby, Poland
St James Hospital, Intensive Care Unit: Prof Ignacio Martin-Loeches
Centro Hospitalar Medio Tejo - Unidade Abrantes, Ucip, Portugal
Centro Hospitalar Universitário do Porto, Sci 1, Portugal
Centro Hospitalar Vila Nova De Gaia/Espinho, Unidade De Cuidados Intensivos Polivalente, Portugal
CHUA Faro, Smi-1, Portugal
Hospital De Cascais Dr Jose De Almeida, Unidade de Cuidados Intensivos, Portugal
Hospital Curry Cabral, Intensive Care Medicine Department, Portugal
Hospital Sao Francisco Xavier, CHLO, Unidade De Cuidados Intensivos Polivalente, Portugal
Hospital Pedro Hispano, Serviço De Medicina Intensiva, Portugal
CHULC, Hospital Sao José, Unidade de Urgência Médica, Portugal
ULS Litoral Alentejano, Serviço de Medicina Intensiva, Portugal
ULS Nordeste, Unidade de Cuidados Intensivost, Portugal
ULSAM, UCI, Portugal
ULS Baixo Alentejo, Unidade Cuidados Intensivos Polivalente, Portugal
Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, 1st Anesthesia and Intensive Care Department, Romania
Clinical Emergency Hospital Bucharest, Anesthesia and Intensive Care Department, Romania
Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, 2nd Anesthesia and Intensive Care Department, Romania
Fundeni Clinical Institute, 3rd Department of Anesthesia and Intensive Care, Romania
University Of Medicine and Pharmacy “Grigore T Popa”, Anesthesia and Intensive Care Department, Romania
V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk Regional Clinical Hospital, Dep. Anaesthesiology and Intensive Care #3, Russian Federation
City Clinical N.I.Pirogov Hospital, Clinical Pharmacology, Russian Federation
City Clinical N.I.Pirogov Hospital, Icu, Russian Federation
E.A. Vagner Perm State Medical University, Intensive Care Unit, Russian Federation
Krasnoyarsk Regional Clinical Hospital, Dep. Anaesthesiology and Intensive Care #3, Russian Federation
Petrovsky National Research Centre of Surgery, Intensive Care, Russian Federation
Privolzhskiy District Medical Center, Department Anesthesiology and Intensive Care, Russian Federation
Vall Dherbon, Intensive Care Medicine, Spain
Hospital Clinic De Barcelona, Surgical Icu, Spain
Hospital De La Santa Creu I Sant Pau, Intensive Care Unit, Spain
Hospital De Terrassa, Medicina Intensiva, Spain
Hospital Del Mar, Critical Care Unit, Spain
Hospital Germans Trias I Pujol, Critical Care Unit, Spain
Hospital Parc Tauli, Icu, Spain
Hospital Punta De Europa, Intensive Care Unit, Spain
Hospital Universitario Central De Asturia, Uci-Huca, Spain
Hospital Universitario La Paz, Intensive Care Unit, Servicio De Medicina Intensiva, Spain
Hospital Universitario La Paz, Surgical Critical Care Unit, Spain
Hospital Universitarion Son Espases, Unidad De Cuidados Intensivos, Spain
University Hospital Severo Ochoa, Intensive Care Unit, Spain
Skane University Hospital, Intensive- And Perioperative Care, Sweden
Ostra Sjukhuset Sahlgrenska University Hospital, Anopiva, Sweden
Umeå University, Anesthesiology and Intensive Care Medicine, Surgical and Perioperative Sciences, Sweden
Universitetssjukhuset I Linkoping, Anopiva, Sweden
Inselspital, Bern University Hospital, Department of Intensive Care Medicine, Switzerland
Chuv, Service De Médecine Intensive Adulte, Switzerland
Hacettepe University of Faculty of Medicine, Intensive Care Unit(ICU), Turkey
Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Anesthesiology, Turkey
Acibadem Fulya Hospital, Infectious Diseases, Turkey
Acibadem Kadikoy Hospital, ICU, Turkey
Ankara University Faculty Medicine Ibni Sina Hospital, Medical ICU, Turkey
Ankara Yildirim Beyazit University, Ankara City Hospital, Infectious Diseases and Clinical Microbiology, Turkey
Aydin Adnan Menderes University Research Hospital, Anesthesia and Reanimation ICU, Turkey
Baskent University Hospital, Infectious Diseases and Clinical Microbiology, Turkey
Bitlis Goverment Central Hospital, Bitlis Icu, Turkey
Duzce University Hospital, Medical ICU, Turkey
Erciyes University, ICU, Turkey
Fatih Sultan Mehmet Research and Training Hospital, Infection Diseases, Turkey
Hitit University Erol Olcok Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Turkey
Istanbul Medipol University, Kosuyolu Hospital, Infectious Diseases and Clinical Microbiology, Turkey
Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Sadi Sun ICU, Turkey
Karadeniz Technical University Faculty of Medicine, Infectious Disease and Clinical Microbiology, Turkey
Karadeniz Technical University Farabi Hospital, Anesthesia ICU 1, Turkey
Kartal Dr. Lutfi Kirdar Training and Research Hospital, ICU, Turkey
Kayseri City Hospital, ICU, Turkey
Mersin University Hospital, Department of Infectious Diseases and Clinical Microbiology, Turkey
Pamukkale Univ, Anesthesiology and Reanimation, Turkey
School Of Medicine, Medipol Mega University Hospitals Complex, Department of Anesthesiology and Reanimation, Turkey
University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, The Department of Infectious Diseases and Clinical Microbiology and ICU, Turkey
Turgut Ozal Medical Center, Department of Infectious Diseases and Clinical Microbiology, Turkey
University of Health Sciences Istanbul Umraniye Training and Research Hospital, Anaestesia and Reanimation, Turkey
University of Health Sciences, Turkey
Lutfi Kirdar Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Turkey
Addenbrookes Hospital, John V Farman Intensive Care Unit, United Kingdom
Addenbrookes Hospital, Neurocritical Care Unit (NCCU), United Kingdom
Charing Cross Hospital - Imperial College NHS Trust, Intensive Care Unit, Level 11, United Kingdom
Countess Of Chester Foundation Trust, Intensive Care Unit, United Kingdom
Darlington Memorial Hospital Intensive Care Unit, County Durham and Darlington NHS Foundation Trust, United Kingdom
Croydon University Hospital, Critical Care Unit, United Kingdom
Department Of Anaesthetics and Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, United Kingdom
Department Of Microbiology, Queen Elizabeth Hospital Birmingham, United Kingdom
Freeman Hospital, ICCU 37, United Kingdom
Hammersmith Hospital - Imperial College NHS Trust, Intensive Care Unit, Level 11, United Kingdom
James Cook University Hospital, Icu2/3, United Kingdom
Medway Maritime Hospital, Intensive Care Unit, United Kingdom
Ninewells Hospital and Medical School NHS Tayside, Intensive Care Unit, United Kingdom
North Cumbria University Hospitals NHS Trust, United Kingdom
North Manchester General Hospital, Critical Care Ward, United Kingdom
Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Critical Care Department, United Kingdom
Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Critical Care Unit, United Kingdom
Royal Gwent Hospital, Critical Care Unit, United Kingdom
Royal London Hospital, Adult Critical Care Unit, United Kingdom
Royal Marsden NHS Foundation Trust, Critical Care Unit, United Kingdom
Royal Victoria Hospital, Regional Intensive Care Unit, Belfast, United Kingdom
Sandwell And West Birmingham Hospitals NHS Trust, Intensive Care Unit, United Kingdom
St Marys Hospital - Imperial College NHS Trust, Intensive Care Unit, Level 11, United Kingdom
Stepping Hill Hospital, Stepping Hill ICU, United Kingdom
University Hospitals of North Midlands, Critical Care Unit, United Kingdom
Warwick Hospital, Intensive Care Unit, United Kingdom
West Suffolk NHS Foundation Trust, Critical Care, United Kingdom
Wirral University Teaching Hospital, Intensive Care Unit, United Kingdom
Kharkiv Clinical Infectious Diseases Hospital, Intensive Care, Ukraine
University of Alberta Hospital, General Systems Intensive Care Unit (Gsicu), Canada
Royal Alexandra Hospital, General Systems Intensive Care Unit (Gsicu), Canada
General Icu, Dhaka, Bangladesh
Asgar Ali Hospital, Critical Care Medicine, Bangladesh
Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Department of Critical Care Medicine, Lucknow, India
All India Institute of Medical Sciences (AIIMS) Jodhpur, Department of Anaesthesiology & Critical Care Medicine, India
All India Institute of Medical Sciences (AIIMS), Pulmonary Medicine ICU, Department of Pulmonary Medicine, India
Breach Candy Hospital Trust, SICU, India
Cauvery Heart And Multi-Speciality Hospital, MICU, India
CHL Hospitals, Dept of Critical Care Services, India
Indira Gandhi Institute of Medical Sciences, Trauma & Emergency, India
King Georges Medical University, Department of Critical Care Medicine, India
Medica Superspecialty Hospital, Medica Institute of Critical Care, India
Sir H N Reliance Foundation Hospital, Critical Care Unit, India
Sri Ramachandra Institute of Higher Education and Research, Department of Critical Care Medicine, India
St Johns Medical College Hospital, Department of Critical Care Medicine, MICU, India
Tata Medical Center, Critical Care Medicine, India
Yashoda Hospital, Somajiguda, Hyderabad, India
Ahmadu Bello University Teaching Hospital Shika Zaria Abuth Zari, Icu Abuth Zaria, Nigeria
Lagos University Teaching Hospital, Department of Anaesthesia And Intensive Care, Nigeria
One Life Hospital, One Life Intensive Care Unit, Nigeria
University College Hospital, Anaesthesia, Nigeria
Charlotte Maxeke Johannesburg Academic Hospital, Ward 576, South Africa
Al-Rajhi Hospital, Medicine, Sudan
East Nile Hospital, Intensive Care Unit, Sudan

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Queensland University of Technology (QUT)
Faculty of Medicine
Intensive Care Unit
Assistance Publique Hôpitaux de Paris
Redcliffe Hospital
Alfred Hospital
Ipswich Hospital
Mater Hospital
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Bankstown-Lidcombe Hospital
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St John Of God Murdoch Hospital
Royal Brisbane and Women S Hospital
The Prince Charles Hospital
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Fiona Stanley Hospital
Rockhampton Hospital
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Gleneagles Jpmc
Suri Seri Begawan Hospital
Zhongda Hospital
Yijishan Hospital
First Affiliate Hospital of Kunming Medical University
Qilu Hospital of Shandong University
Hebei Petrochina Central Hospital
Hangzhou Second Hospital
Tianjin Third Central Hospital
Shanghai General Hospital
The Second Hospital of Jilin University
Taizhou People S Hospital
The First Affiliated Hospital of Nanjing Medical University
Zhejiang Hospital
Henan Provincial People S Hospital
Qingdao Municipal Hospital
The Second Hospital of Lanzhou University
The Chinese University of Hong Kong
Kameda Medical Center
University Hospital Kyoto Prefectural University of Medicine
Hiroshima University Hospital
Yokosuka General Hospital Uwamachi
Tokyo Metropolitan Tama Medical Center
Kurashiki Central Hospital
Tokyo Medical and Dental University
St. Marianna University School of Medicine Hospital
Osaka City General Hospital
St. Marianna University School of Medicine
Yokohama City University Hospital
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University Malaya Medical Centre
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Hospital Sarikei
Queen Elizabeth 1 Hospital
Hospital Serdang
Hospital Tuanku Fauziah
School Of Medical Sciences Universiti Sains Malaysia
Hospital Universiti Sains Malaysia
The Medical City Ortigas
Samsung Medical Center
Seoul National University Hospital
Hallym University Sacred Heart Hospital
Micu
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Singapore General Hospital
Singapore General Hospital
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National University Hospital System Medical Intensive Care Unit
Tan Tock Seng Hospital
Changi General Hospital
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National Taiwan University Hospital
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Medical Research Institute
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Ahvaz Jundishapur University of Medical
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Shiraz University of Medical Sciences
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Zahedan University of Medical Sciences
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National Heart Institute
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Città Della Salute E Della Scienza - Molinette
Fondazione Policlinico Universitario A. Gemelli Irccs. Universita Cattolica Del Sacro Cuore. Italy
Irccs Ospedale Policlinico San Martino
Irccs Sacro Cuore Don Calabria
Madonna Delle Grazie
Ospedale Policlinico San Martino
Policlino Paolo Giaccone
Regina Elena National Cancer Institute of Rome
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Wss Im. Wl. Bieganskiego
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ULS Litoral Alentejano
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Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu
Clinical Emergency Hospital Bucharest
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Fundeni Clinical Institute
University Of Medicine and Pharmacy “Grigore T Popa”
V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
City Clinical N.I.Pirogov Hospital
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E.A. Vagner Perm State Medical University
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Addenbrookes Hospital
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Charing Cross Hospital - Imperial College NHS Trust
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Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)
All India Institute of Medical Sciences (AIIMS) Jodhpur
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CHL Hospitals
Indira Gandhi Institute of Medical Sciences
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Medica Superspecialty Hospital
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Tata Medical Center
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Ahmadu Bello University Teaching Hospital Shika Zaria Abuth Zari
Lagos University Teaching Hospital
One Life Hospital
University College Hospital
Charlotte Maxeke Johannesburg Academic Hospital
Al-Rajhi Hospital
East Nile Hospital

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