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Abstract

IntroductionThe aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality.MethodsPatients with a longer than 48 hour stay in a mixed 10 bed ICU in a tertiary-level teaching hospital were prospectively enrolled between May 2002 and June 2003. Risk factors for hospital mortality were analyzed with a logistic regression model.ResultsOf 335 patients, 80 developed ICU-acquired infection. Among the patients with ICU-acquired infections, hospital mortality was always higher, regardless of whether or not the patients had had infection on admission (infection on admission group (IAG), 35.6% versus 17%, p = 0.008; and no-IAG, 25.7% versus 6.1%, p = 0.023). In IAG (n = 251), hospital stay was also longer in the presence of ICU-acquired infection (median 31 versus 16 days, p < 0.001), whereas in no-IAG (n = 84), hospital stay was almost identical with and without the presence of ICU-acquired infection (18 versus 17 days). In univariate analysis, the significant risk factors for hospital mortality were: Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, sequential organ failure assessment (SOFA) score >8, ICU-acquired infection, age ≥ 65, community-acquired pneumonia, malignancy or immunosuppressive medication, and ICU length of stay >5 days. In multivariate logistic regression analysis, ICU-acquired infection remained an independent risk factor for hospital mortality after adjustment for APACHE II score and age (odds ratio (OR) 4.0 (95% confidence interval (CI): 2.0–7.9)) and SOFA score and age (OR 2.7 (95% CI: 2.9–7.6)).ConclusionICU-acquired infection was an independent risk factor for hospital mortality even after adjustment for the APACHE II or SOFA scores and age.

Epidemiology of Intensive Care Unit Infections and Impact of Infectious Disease Consultants in Managing Resistant Infections

“…It is also likely that high rates of ESBL among E.Coli species and high rates of extreme drug resistance among P. aeruginosa and A. baumanii (especially respiratory infections) led to lower percentage of patients being covered appropriately by the initial choice of antibiotic. In this study, the overall mortality rate of ICU acquired infections was 31% and it was comparable to previous studies conducted in other parts of the world where mortality ranged from 10-53.6% (Ylipalosaari et al, 2006;Goldman and Pier, 1993).…”

Perfil dos microrganismos associados à colonização e infecção em Terapia Intensiva

“…[6][7][8] Em tais unidades os pacientes colonizados e/ou infectados representam a principal fonte de patógenos pois, na colonização apesar de não haver sintomas clíni-cos e imunológicos de infecção, os microrganismos estão presentes nas superfícies cutâneas e mucosas do hospedeiro.…”

“…[3][4][5] Nas UTIs as taxas de infecções são estimadas entre 18 e 54%, sendo responsável por 5 a 35% de todas as IRAS e por, aproximadamente, 90% de todos os surtos hospitalares. [6][7][8] Em tais unidades os pacientes colonizados e/ou infectados representam a principal fonte de patógenos pois, na colonização apesar de não haver sintomas clíni-cos e imunológicos de infecção, os microrganismos estão presentes nas superfícies cutâneas e mucosas do hospedeiro. 9 Assim, mecanismos de monitorização do perfil microbiológico dos microrganismos associados às IRAS tornam-se uma indispensável ferramenta para apoiar o uso racional de antimicrobianos e as medidas de controle, considerando que a evolução dos microrganismos resistentes (MR) vem ocorrendo de maneira diferenciada em diversos países.…”

Investigation of Mortality Predictors in General Intensive Care Unit Patients with Nosocomial Sepsis: A Retrospective Cohort Study

“…Degoricija et al (14) evaluated 314 episodes of sepsis in a medical ICU and reported that poor outcome was associated with higher SOFA scores on day 1 in the ICU. Also, Ylipalosaari et al (15) reported SOFA scores of > 8 on admission among patients who subsequently developed an ICU acquired infection. We thought that monitoring the SOFA scores might be useful in the follow-up of the patients with nosocomial sepsis.…”