Risk factors and outcome in ICU‐acquired infections

Magnason, S.; Kristinsson, Karl G.; Stefánsson, Tryggvi; Erlendsdóttir, Helga; Jónsdóttir, Kristín; Kristjánsson, Már; Jonmundsson, E.; Baldursdóttir, Lovísa; Sigvaldason, Helgi; Guðmundsson, Sveinn

doi:10.1111/j.1399-6576.2008.01763.x

Cited by 31 publications

(21 citation statements)

References 36 publications

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“…Conversely to our results, many previous studies have shown that greater illness severity on ICUadmission, expressed with APACHE II or APACHE III score, is related to the higher risk of developing ICU-BSI [13,[32][33][34]. The finding of a negative relationship between APACHE II minus age points at ICUadmission, and the development of ICU-BSI in our study, suggests a high rate of early mortality among critically ill patients with domicile infections, which has lowered their chance for development of ICU-BSI.…”

Section: Variablescontrasting

confidence: 99%

“…Due to longer use of ICU facilities (CVC, MV and ICU stay) in our patients, the observed overall ICU-BSI rate of 26.1% in elderly and 21.1% in younger adults were much higher in comparison to those reported from other studies, which ranged between 2.7-9.0% [15,19,33,[35][36][37]. Relatively expressed ICU-BSI incidence of 12.4 ICU-BSIs in elderly and 12.3 in younger adults per 1,000 ICU days in our observed severe infectious disease patients fits among the results of other studies, where that incidence in patients treated at ICU, because of different medical and surgical conditions, was mostly in the range of 5-19/1,000 ICU days [19,35,37].…”

Section: Variablescontrasting

confidence: 61%

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Relationship between age and intensive care unit-acquired bloodstream infections in infectious disease patients in Croatia

Topić

Santini

Baršić

2018

J Infect Dev Ctries

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Introduction: Intensive care unit-acquired bloodstream infections (ICU-BSI) belong to the most important nosocomial infections. Since there is scarce data available on their relationship with older age, we performed this study to estimate the age-related incidence of ICU-BSI and the odds of acquiring ICU-BSI in elderly critically ill infectious disease patients. Methodology: A retrospective observational analysis of prospectively collected demographic and clinical data of adult mechanically ventilated infectious disease patients, treated in a teaching hospital in Croatia between 1994 and 2008, using univariate, bivariate, and multivariate logistic regression analyses. Results: Of the 1,093 included patients, 509 (46.6%) were ≥ 65 years old, among 256 (23.4%) of whom a total of 353 ICU-BSI episodes were recorded. No significant difference among ICU-BSI causative microorganisms between the observed age groups was found (P = 0.4940). The rate of patients with ICU-BSI was higher among elderly ones (26.1 vs. 21.1%, P = 0.048), and elderly patients used the ICU facilities (ICU stay, duration of mechanical ventilation and central venous catheter [CVC] use) significantly longer (P < 0.05). However, older age was not positively related with the development of ICU-BSI (OR 0.99, 95% CI: 0.71-1.38); as opposed to the duration of CVC use (OR 1.09, 95% CI: 1.07-1.10). Conclusion: It seems that among adult mechanically ventilated infectious disease patients, borderline significantly higher rate of ICU-BSI among those aged ≥ 65 years was related to longer use of ICU facilities, rather than to their older age itself. The duration of CVC use was identified as the only factor positively related to the development of ICU-BSI.

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Section: Variablescontrasting

confidence: 99%

Section: Variablescontrasting

confidence: 61%

Relationship between age and intensive care unit-acquired bloodstream infections in infectious disease patients in Croatia

Topić

Santini

Baršić

2018

J Infect Dev Ctries

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“…Moreover, candidemia in the ICU is by far more common than in most other wards and can affect up to about 10% of all admitted patients [18,19]. Additionally, Candida species account for approximately 3% of all surgery-related peritoneal infections, both community-acquired infections and nosocomial infections [20].…”

Section: Epidemiology Of Invasive Candidiasismentioning

confidence: 99%

Bench-to-bedside review: Therapeutic management of invasive candidiasis in the intensive care unit

Bassetti¹,

Mikulska²,

Viscoli³

2010

Critical Care

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Candida is one of the most frequent pathogens in bloodstream infections, and is associated with significant morbidity and mortality. The epidemiology of species responsible for invasive candidiasis, both at local and worldwide levels, has been changing - shifting from Candida albicans to non-albicans species, which can be resistant to fluconazole (Candida krusei and Candida glabrata) or difficult to eradicate because of biofilm production (Candida parapsilosis). Numerous intensive care unit patients have multiple risk factors for developing this infection, which include prolonged hospitalisation, use of broad-spectrum antibiotics, presence of intravascular catheters, parenteral nutrition, high Acute Physiology and Chronic Health Evaluation score, and so forth. Moreover, delaying the specific therapy was shown to further increase morbidity and mortality. To minimise the impact of this infection, several management strategies have been developed - prophylaxis, empirical therapy, pre-emptive therapy and culture-based treatment. Compared with prophylaxis, empirical and pre-emptive approaches allow one to reduce the exposure to antifungals by targeting only the patients at high risk of candidemia, without delaying therapy until the moment blood Candida is identified in blood cultures. The agents recommended for initial treatment of candidemia in critically ill patients include echinocandins and lipid formulation of amphotericin B.

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“…BSI is more common in patients who have surgery, are immunocompromised, develop multiorgan dysfunction, require mechanical ventilation or renal replacement therapy, and have greater illness severity on ICU admission [3,20,21]. Some critically ill patients may be genetically predisposed to both developing BSI and dying in hospital [22].…”

Section: Introductionmentioning

confidence: 99%

Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality

et al. 2011

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IntroductionTo estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on hospital mortality.MethodsWe 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.ResultsWe 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).ConclusionsICU-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.

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Risk factors and outcome in ICU‐acquired infections

Abstract: Mortality was increased by ICU-acquired pneumonia and primary bloodstream infections. Our findings did not support the gastro-pulmonary hypothesis of ICU-acquired pneumonia. The proposition that blood transfusions increase the risk of ICU-acquired nosocomial infections was not supported.

Cited by 31 publications

References 36 publications

Relationship between age and intensive care unit-acquired bloodstream infections in infectious disease patients in Croatia

Relationship between age and intensive care unit-acquired bloodstream infections in infectious disease patients in Croatia

Bench-to-bedside review: Therapeutic management of invasive candidiasis in the intensive care unit

Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality

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