Impact of infection on admission and of the process of care on mortality of patients admitted to the Intensive Care Unit: the INFAUCI study

Abstract

A prospective, cohort, clinical, observational study was performed in 14 Intensive Care Units (ICUs) to evaluate the contemporary epidemiology, morbi-mortality and determinants of outcome of the population with an infection on admission. All 3766 patients admitted during a consecutive 12-month period were screened. Their median age was 63 [26-83], 61.1% were male and 69.8% had significant comorbidities. On admission to the ICU 1652 patients (43.9%) had an infection, which was community acquired in 68.2% (one-fifth with healthcare-associated criteria) and ward-acquired in the others. Roughly half presented to the ICU with septic shock. As much as 488 patients with community-acquired infections were deemed stable enough to be first admitted to the ward, but had similar mortality to unstable patients directly admitted to the ICU (35.9% vs. 35.1%, p 0.78). Only 48.3% of this infected population had microbiological documentation and almost one-quarter received inappropriate initial antibiotic therapy. This, along with comorbidities, was a main determinant of mortality. Overall, infected patients on admission had higher mortality both in the ICU (28.0% vs. 19.9%, p <0.001) and in the hospital (38.2% vs. 27.5%, p <0.001) and even after being discharged to the ward (14.2% vs. 9.6%, p <0.001). Also, patients not infected on admission who acquired an infection in the ICU, had an increased risk of dying in the hospital (odds ratio 1.41 [1.12-1.83]). Consequently, infection, regardless of its place of acquisition, was associated with increased mortality. Improving the process of care, especially first-line antibiotic appropriateness, and preventing ICU-acquired infections, may lead to better outcomes.

Evidence Associated with the Use of Oxazolidinones for the Treatment of Skin and Skin Structure Infections: A Retrospective Study

“…1), were also found in other studies. 9,18 In fact, the increasing number of patients with multiple comorbidities (especially diabetes) that are admitted with an infection represent a significant burden for the health system, not only due to the required prolonged hospitalization, but also because it may be challenging to treat these patients appropriately. This population has a frequent exposure to health care facilities and antibiotics, which can lead to an increase in the number of resistant microorganisms and, therefore, to a higher risk of therapeutic failure, infection recurrence and death.…”

“…Even in patients admitted to Intensive Care Units, SSSI may represent a substantial burden, representing as much as 5% -6% 8,9 of the total number of infections, and seem to be more common during Spring and Summer. 9 Most SSSI are caused by Gram positive bacteria, especially Staphylococcus aureus and β-haemolytic Streptococci. 3,10 The prevalence of Staphylococcus aureus seems to be increasing and has become the single most reported pathogen.…”

Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study

“…The Infection on Admission to the ICU (INFAUCI) study was a prospective, observational, cohort, multicentre study [17]. The study protocol was described elsewhere [17].…”

“…The Infection on Admission to the ICU (INFAUCI) study was a prospective, observational, cohort, multicentre study [17]. The study protocol was described elsewhere [17]. Briefly all adult patients (age ≥ 18 years) consecutively admitted during one year to one of the 14 Portuguese participating units were included and followed until death or 6 months after ICU admission.…”

Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran

“…The current advances in critical care and the advent of broad-spectrum antibiotics not only have resulted in patients' longer survival but also in increasing the incidence of opportunistic infections such as IFIs over the past decade [18] . Currently, IFIs constitute a clinical issue on the rise in the ICUs both in the developing and developed world [19,20] .…”