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- Title
Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality.
- Authors
Prowle, John R; Echeverri, Jorge E; Ligabo, E Valentina; Sherry, Norelle; Taori, Gopal C; Crozier, Timothy M; Hart, Graeme K; Korman, Tony M; Mayall, Barrie C; Johnson, Paul Dr; Bellomo, Rinaldo; Johnson, Paul D R
- Abstract
<bold>Introduction: </bold>To estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on hospital mortality.<bold>Methods: </bold>We retrospectively studied acquisition of BSI during admissions of >72 hours to adult ICUs from two university-affiliated hospitals. We obtained demographics, illness severity and co-morbidity data from ICU databases and microbiological diagnoses from departmental electronic records. We assessed survival at hospital discharge or at 90 days if still hospitalized.<bold>Results: </bold>We identified 6339 ICU admissions, 330 of which were complicated by BSI (5.2%). Median time to first positive culture was 7 days (IQR 5-12). Overall mortality was 23.5%, 41.2% in patients with BSI and 22.5% in those without. Patients who developed BSI had higher illness severity at ICU admission (median APACHE III score: 79 vs. 68, P < 0.001). After controlling for illness severity and baseline demographics by Cox proportional-hazard model, BSI remained independently associated with risk of death (hazard ratio from diagnosis 2.89; 95% confidence interval 2.41-3.46; P < 0.001). However, only 5% of the deaths in this model could be attributed to acquired-BSI, equivalent to an absolute decrease in survival of 1% of the total population. When analyzed by microbiological classification, Candida, Staphylococcus aureus and gram-negative bacilli infections were independently associated with increased risk of death. In a sub-group analysis intravascular catheter associated BSI remained associated with significant risk of death (hazard ratio 2.64; 95% confidence interval 1.44-4.83; P = 0.002).<bold>Conclusions: </bold>ICU-acquired BSI is associated with greater in-hospital mortality, but complicates only 5% of ICU admissions and its absolute effect on population mortality is limited. These findings have implications for the design and interpretation of clinical trials.
- Subjects
AUSTRALIA; ACADEMIC medical centers; APACHE (Disease classification system); BACTEREMIA; CROSS infection; DATABASES; INTENSIVE care units; RISK assessment; DISEASE incidence; RETROSPECTIVE studies; HOSPITAL mortality
- Publication
Critical Care, 2011, Vol 15, Issue 2, pR100
- ISSN
1364-8535
- Publication type
journal article
- DOI
10.1186/cc10114