Journal Article

Excess Risk of Death from Intensive Care Unit—Acquired Nosocomial Bloodstream Infections: A Reappraisal

Zahar, Jean-Ralph, Timsit, Jean François, Cohen, Yves, Garrouste-Orgeas, Maite, Jamali, Samir, Tafflet, Muriel, Soufir, Lilia, Cheval, Christine, Costa de Beauregard, Marie-Alliette, Misset, Benoit, Descorps-Declere, Adrien, Mourvillier, Bruno, De Lassence, Arnaud, Adrie, Christophe, Carlet, Jean, Lazard, Thierry, Azoulay, Elie

2006

Overview

Background. Overall rates of bloodstream infection (BSI) are often used as quality indicators in intensive care units (ICUs). We investigated whether ICU-acquired BSI increased mortality (by ⩾10%) after adjustment for severity of infection at ICU admission and during the pre-BSI stay. Methods. We conducted a matched, risk-adjusted (1 : n), exposed-unexposed study of patients with stays longer than 72 h in 12 ICUs randomly selected from the Outcomerea database. Results. Patients with BSI after the third ICU day (exposed group) were matched on the basis of risk-exposure time and mortality predicted at admission using the Three-Day Recalibrated ICU Outcome (TRIO) score to patients without BSI (unexposed group). Severity was assessed daily using the Logistic Organ Dysfunction (LOD) score. of 3247 patients with ICU stays of >3 days, 232 experienced BSI by day 30 (incidence, 6.8 cases per 100 admissions); among them, 226 patients were matched to 1023 unexposed patients. Crude hospital mortality was 61.5% among exposed and 36.7% among unexposed patients (P < .0001). Attributable mortality was 24.8%. The only variable associated with both BSI and hospital mortality was the LOD score determined 4 days before onset of BSI (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03–1.16; P = .0025). The adjusted OR for hospital mortality among exposed patients (OR, 3.20; 95% CI, 2.30–4.43) decreased when the LOD score determined 4 days before onset of BSI was taken into account (OR, 3.02; 95% CI, 2.17–4.22; P < .0001). The estimated risk of death from BSI varied considerably according to the source and resistance of organisms, time to onset, and appropriateness of treatment. Conclusions. When adjusted for risk-exposure time and severity at admission and during the ICU stay, BSI was associated with a 3-fold increase in mortality, but considerable variation occurred across BSI subgroups. Focusing on BSI subgroups may be valuable for assessing quality of care in ICUs.

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Anesthesia & intensive care / Anesthésie & soins intensifs / Articles and Commentaries / Bacteremia / Blood / Calibration / Catheters / Critical care / Cross Infection - blood / Cross Infection - epidemiology / Cross Infection - mortality / Cross Infection/blood/epidemiology/mortality / Databases, Factual / Death / France / Health risk assessment / Hospital admissions / Hospital units / Hospitals / Human health sciences / Humans / Infections / Intensive Care Units / Microorganisms / Mortality / Nosocomial infection / Operating rooms / Risk Factors / Sciences de la santé humaine / Studies / Survival Analysis / Teaching hospitals / Treatment Outcome