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Title: Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality.
Austin 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 D R ;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
Issue Date: 21-Mar-2011
Publication information: Critical Care 2011; 15(2): R100
Abstract: To estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on hospital mortality.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.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).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.
Gov't Doc #: 21418635
DOI: 10.1186/cc10114
Type: Journal Article
Subjects: Aged
Cross Infection.epidemiology.mortality
Databases, Factual
Hospital Mortality
Hospitals, University
Intensive Care Units.statistics & numerical data
Middle Aged
Retrospective Studies
Risk Assessment
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