Hospital-Acquired Blood Stream Infection in an Adult Intensive Care Unit

Abstract

Background. Hospital-acquired blood stream infections are a common and serious complication in critically ill patients. Methods. A retrospective case series was undertaken investigating the incidence and causes of bacteraemia in an adult intensive care unit with a high proportion of postoperative cardiothoracic surgical and oncology patients. Results. 405 eligible patients were admitted to the intensive care unit over the course of nine months. 12 of these patients developed a unit-acquired blood stream infection. The average Acute Physiology And Chronic Health Evaluation II (APACHE II) score of patients who developed bacteraemia was greater than that of those who did not (19.8 versus 16.8, respectively). The risk of developing bacteraemia was associated with intubation and higher rates of invasive procedures. The mortality rate amongst the group of patients that developed bacteraemia was 33%; this is in contrast to the mortality rate in our unit as 27.2%. There was a higher proportion of Gram-negative bacteria isolated on blood cultures (9 out of 13 isolates) than in intensive care units reported in other studies. Conclusion. Critical-care patients are at risk of secondary bloodstream infection. This study highlights the importance of measures to reduce the risk of infection in the intensive-care setting, particularly in patients who have undergone invasive procedures.

Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals*

“…In a cohort of over 150,000 critically ill adults at U.S. hospitals between 2009 and 2015, ICU-onset BSI occurred in approximately 1% of ICU encounters (prevalence = 1.47 cases per 1,000 person-ICU days), 41.5% of patients having at least one blood culture drawn during their ICU stay. This estimate is near the lower end of the range reported in prior studies (range = 1.2–6.7% of all ICU admissions) (8–10, 24). Of note, real world data provide more of a “sampled prevalence” which will vary by scenario (i.e., ICU-BSI POA vs ICU-onset BSI).…”

“…Existing evidence on prevalence of and risk factors for ICU-onset BSI has limited generalizability due to differences in regional microbial epidemiology, case mix, and ICU care practices across reports and over time (5)(6)(7)(8). Furthermore, the relatively limited sample size of prior studies (9,10) has precluded simultaneous assessment of many candidate risk factors or BSI populations beyond a specific BSI type (e.g., central venous catheter-related BSI). We conducted a large database analysis of ICU patients in U.S. hospitals to determine the prevalence, patient and care setting, and treatment-related factors associated with the risk of acquiring ICU-onset BSI.…”

Clinical Characteristics and Nomogram for Predicting Mortality in Patients with Postoperative Bloodstream Infection in Surgical Intensive Care Unit

“…Te most common causative pathogens were Grampositive pathogens in this study which was higher than previous studies. Tis is because that most previous studies excluded all coagulase-negative Staphylococcus pathogens [2]. Since parts of PBSIs ensued from catheter-related infections including central venous catheter, urinary catheter, and various drainage tubes, which could result in coagulasenegative Staphylococcus pathogen infections, we did not exclude all coagulase-negative Staphylococcus pathogens.…”

“…Bloodstream infection (BSI) is defned by positive blood cultures in patients with systemic signs of infection. Hospital-acquired BSIs are one of the most common and serious complications in postoperative patients, especially those admitted to the intensive care unit (ICU) [1,2]. Postoperative bloodstream infections (PBSIs) are associated with prolonged ICU and hospital stays, higher costs, and also increased rates of morbidity and mortality [3][4][5][6].…”

Infecção de corrente sanguínea e multirresistência em unidade de terapia intensiva

“…Bloodstream Infections (BSI) acquired in Intensive Care Units (ICUs) are defined as cases in which a positive blood culture is obtained for a clinically significant bacterial pathogen more than 72 hours after admission to the ICU [1][2][3] . They have particular epidemiological aspects when compared to community or hospital-origin BSI and are often caused by multidrug-resistant (MDR) strains.…”