Nosocomial bacteremia in a medical-surgical intensive care unit: Epidemiologic characteristics and factors influencing mortality in 111 episodes

Rello, Jordi; Ricart, Maite; Mirelis, Beatriz; Quintana, E.; Gurguí, M.; Net, A.; Prats, Guillem

doi:10.1007/bf01707661

Cited by 137 publications

(74 citation statements)

References 38 publications

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“…No significant differences were found for other variables analyzed. In other studies, several factors have been described as predictive of mortality in patients with CVC-related BSI, such as adult respiratory distress syndrome, shock, multiorgan failure, mechanical ventilation, chronic hepatic failure, acute renal failure and APACHE II score greater than 14 (Rello et al, 1994;Valles et al, 1997;Garrouste-Orgeas et al, 2006). Unlike these studies, we could not find an association of mortality with admission APACHE II score.…”

Section: Discussioncontrasting

confidence: 98%

Factors Associated With Mortality Among Patients With Central Venous Catheter-Related Bloodstream Infection in an Intensive Care Unit

Rocha¹

2012

American Journal of Infectious Diseases

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Central venous catheterization is a common practice in the management of critically ill patients and is associated with various complications, such as Bloodstream Infections (BSI), which are major determinants of increased morbidity, mortality and healthcare expenses. Few studies have addressed factors that predict mortality in patients with this complication. The aim of this study was to investigate factors associated with mortality in patients with Central Venous Catheter (CVC)-related BSI in an intensive care unit of a tertiary care hospital in the Federal District, Brazil. This was a retrospective and observational study, in which all CVC-related BSI that occurred between January 2008 and December 2010 were reviewed. We obtained demographic, clinical, biochemical and microbiological data from medical records and investigated its association with mortality during ICU stay. There were 4,504 ICU admissions during the study period and 68 were complicated by CVC-related BSI (4.09 per 1000 catheter-days), most due to gram-negative organisms (45.6%). Overall mortality was 59.7%. Death risk was significantly associated with mechanical ventilation (OR 27.8, p<0.001), the mean number of invasive devices other than the CVC (1.44 Vs 2.37 in controls Vs cases, p<0.001) and increased serum levels of urea (mean value of 44.2 mg dL −1 in survivors vs. 73.9 mg dL −1 in nonsurvivors, p = 0.001). Mortality was not associated with other clinical or biochemical features, neither with microbiological variables, although lethality was high among patients with gram-positive infections (77% Vs 58.33% for fungi and 54.83% for gram-negative). CVC-related BSI was associated with high absolute mortality, which was predicted by mechanical ventilation and a higher number of invasive devices other than the CVC. Knowledge of local factors predictive of mortality is critical for planning strategies to reduce death risk associated with this complication.

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Section: Discussioncontrasting

confidence: 98%

Factors Associated With Mortality Among Patients With Central Venous Catheter-Related Bloodstream Infection in an Intensive Care Unit

Rocha¹

2012

American Journal of Infectious Diseases

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“…Data based on literature 25,26 showed overall mortality around 30%, similar to the fi ndings in our study. However, it was observed that among patients who presented sepsis, 50% died by the thirtieth day after diagnosis.…”

Section: Discussionsupporting

confidence: 92%

“…However, it was observed that among patients who presented sepsis, 50% died by the thirtieth day after diagnosis. Data published in Spain in 1993 26 presented a mortality rate of 65.7%, straightly linked to sepsis. Mortality rate due to sepsis in BASES study was 33.9%, 27 whereas Brun-Buisson et al 20,28 observed death probability of 25% by the 28th day.…”

Section: Discussionmentioning

confidence: 99%

Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil

Tenório¹,

Porfı́rio²,

Lopes³

et al. 2010

Braz J Infect Dis

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We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI), as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas). A prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. Their clinical evolution was followed up for 30 days from October 2005 to December 2006. The relation among the qualitative variables was verifi ed through Chi-square test. The signifi cance level was 5%. The statistical package adopted was SPSS 15.0 for Windows. Up to the thirtieth day, 30.1% of the patients presented bacteremia and 69.9% developed sepsis. Among these, 20.3% developed severe sepsis and 10.5% septic shock. The mortality attributed to it was 37.8%. In bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3%, 50%, 65.5%, and 84.6%, respectively. Respiratory (32.2%) and urinary (14%) sources and the ones related to central venous catheter (14%) were prevalent. In the wards 55.12% of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69% (p < 0.05). Chronic renal failure, diabetes melitus, and neuropathy were present in 21.7%, 26.6%, and 29.4% of the cases, respectively. Coagulase-negative Staphylococcus (25.9%), Staphylococcus aureus (21%), and Klebsiella pneumoniae (14%) were the most present microorganism in the sample. The high morbidity and mortality rates in this study are attributed to the lack of knowledge on BSI characteristics and on instituted protocols for detection and treatment in early stages.

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“…7,14,18,22,24,26,36,42,43,45,51,[64][65][66][67] In a comparison between the former East and West Germany, Rüden et al 68 found a lower prevalence of nosocomial infections in the former East German states, mainly due to a lower use of devices. An estimated 5 million central venous catheters are inserted into patients in the United States each year, 69 but it is difficult to measure how much the utilization of infusion IV devices has increased in recent years.…”

Section: Discussionmentioning

confidence: 99%

Increasing Bacteremia Due to Coagulase-Negative Staphylococci: Fiction or Reality?

Thylefors¹,

Harbarth²,

Pittet³

1998

Infect. Control Hosp. Epidemiol.

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BACKGROUND:The role of coagulase-negative staphylococci (CNS) in bacteremias continues to be controversial. Until the 1970s, CNS were mostly recognized as contaminants, being part of the cutaneous flora. Since then, several studies have reported increasing incidence and severity of infections due to CNS.PURPOSE:To review the literature concerning the epidemiology of CNS bacteremia in the United States and Europe with reference to the multiple definitions of infection versus contamination, considering the effect of potential biases influencing the validity of the reported results.METHODS:Literature search of the MEDLINE database from January 1980 to February 1998. Studies with fewer than 500 episodes of bloodstream infections or fewer than 100 episodes of CNS bacteremia were not included in the pooled analysis.RESULTS:(1) CNS remain the most frequent contaminants (58%-83% of positive blood cultures); (2) the proportion of all bloodstream infections caused by CNS is increasing (R=.51); (3) the overall incidence of true CNS bacteremia is increasing (R=.54, P=.0014); (4) comparing the United States to Europe, there is an increasing trend in the incidence of nosocomial bacteremia due to CNS in the United States (R=.82, P=.0006), but no trend is seen in European studies; (5) the mortality associated with true CNS bacteremia varies between 4.9% and 28%.DISCUSSION:This review confirms the increasing importance of CNS bacteremias, measured both as a proportion and as an incidence of bloodstream infections. The contributions of several possible explanations for the incidence increase and the difference between the United States and Europe need further evaluation: (1) increased recognition and awareness of CNS infections among clinicians; (2) a gradual change in the definition of true bacteremia from an obligatory two positive blood cultures to one positive blood culture associated with a clinical picture compatible with infection; (3) a change in blood culture practices and techniques; (4) an increase in the numbers of blood cultures performed, which is reported both in the United States and in Europe; (5) a shift toward more elderly patients with increasingly severe underlying illnesses; and (6) increasing use of intravascular devices.CONCLUSIONS:The apparent trend of increasing CNS bacteremia seems to be valid. Whether there is a real difference between the United States and Europe concerning the increase of CNS bacteremia is difficult to establish due to the large number of confounding factors. Few studies take into account the number of blood cultures performed or the use of intravascular devices to adjust for the observed trends. Further on-site surveillance studies are needed to investigate the phenomenon more extensively.

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Nosocomial bacteremia in a medical-surgical intensive care unit: Epidemiologic characteristics and factors influencing mortality in 111 episodes

Cited by 137 publications

References 38 publications

Factors Associated With Mortality Among Patients With Central Venous Catheter-Related Bloodstream Infection in an Intensive Care Unit

Factors Associated With Mortality Among Patients With Central Venous Catheter-Related Bloodstream Infection in an Intensive Care Unit

Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil

Increasing Bacteremia Due to Coagulase-Negative Staphylococci: Fiction or Reality?

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