Risk Factors and Outcome of Nosocomial Infections: Results of a Matched Case-control Study of ICU Patients

Abstract

Intensive-care-unit (ICU) patients are at risk for both acquiring nosocomial infection and dying, and require a high level of therapy whether infection occurs or not. The objective of the present study was to precisely define the interrelationships between underlying disease, severity of illness, therapeutic activity, and nosocomial infections in ICU patients, and their respective influences on these patients' outcome. In a 10-bed medical ICU, we conducted a case-control study with matching for initial severity of illness, with daily monitoring of severity of illness and therapeutic activity scores, and with analysis of the contribution of nosocomial infections to patients' outcomes. Forty-one cases of patients who developed nosocomial infections during a 1-yr period were paired with 41 controls without nosocomial infection according to three criteria: age (+/- 5 yr), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (+/- 5 points), and duration of exposure to risk. Successful matching was achieved for 118 of 123 (96%) variables. Neurologic failure on the third day after ICU admission was the sole independent risk factor for nosocomial infection (adjusted odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.09 to 1.64; p = 0.007). Unlike control patients, case patients showed no clinical improvement and required a high level of therapeutic activity between ICU admission and the day of infection. Mortality attributable to nosocomial infection was 44%. Excess length of stay and duration of antibiotic treatment attributable to nosocomial infection were 14 d and 10 d, respectively. Attributable therapeutic activity as measured with the Therapeutic Intervention Scoring System (TISS) and Omega score was 368 and 233 points, respectively. Such consequences were observed in patients who developed multiple infections. These findings suggest that a persistent high level of therapeutic activity and persistent impaired consciousness are risk factors for nosocomial infections in ICU patients. These infections are responsible for excess mortality, prolongation of stay, and excess therapeutic activity resulting in important cost overruns for health-care systems.

Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

“…31,[39][40][41][42] S aureus is responsible for a high percentage of nosocomial infections in postsurgical and ICU patients. [1][2][3][4][5] Our data show for the first time that GLN-supplemented PN specifically reduces infections attributed to S aureus, fungi, and enteric Gram-negative bacteria, which were markedly decreased with GLN-PN in the nonpancreatic surgery cohort ( Table 4). Gut barrier function (sugar permeability) studies are difficult to perform accurately in critically ill patients and are contraindicated in patients with ileus or other forms of gut failure requiring parenteral feeding, but such studies would have been of interest.…”

Surveillance of Pediatric Health Care Associated Infection in a University Hospital: Six-Years of Prospective Follow-up

“…Kliniğimizde altı aylık dönemde antibiyotik kullanım günlerine bakıldığında en sık 3. kuşak sefalosporinlerin, ardından sırasıyla aminopenisilin ve aminoglikozid grubunun, glikopeptidlerin ve karbapenemlerin kullanıldığını görüyoruz. Literatürde genel olarak çocuk servislerinde antibiyotik kullanı-mıyla ilgili veriler bulunamamıştır, ancak National Nosocomial Infection Surveillance (NNIS) 2004 verilerine göre ÇYBÜ'de en sık kullanılan antibiyotik grubu 3. kuşak sefalosporinler, sonra sırasıyla aminopenisilinler, vankomisin gelmektedir (24) . Sonuçlar kliniğimizdeki bulgularla benzerlik göster-mektedir.…”

“…Bu bulgular diğer çalışmalarla uyumlu görünse de, çocuk-larda ekstrinsik ve intrinsik risk faktörlerinin değer-lendirildiği çalışmalar azdır (24,25) . Çalışmamızdaki gibi çocuklarda ko-morbid durumların değerlendiril-diği İsviçre'deki bir çalışmada; astım, kistik fibroz, diğer kronik akciğer hastalıkları, neoplazma-solid tümör, lösemi, lenfoma, konjenital immün yetersiz-lik, HIV, metabolik hastalık, vezikoüreteral reflü, siyanotik konjenital kalp hastalığı, asiyanotik konjenital kalp hastalığı, karaciğer sirozu ve malformasyon sendromları skorlanmış ve skorun belirli bir değerin üstünde olması SBİE gelişimi için anlamlı risk kabul edilmiştir (16) .…”

Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

“…13 Various epidemiologic methods can be used to the magnitude of this effect remains controversial and deevaluate the PAF, including expert assessment of case series, pends on study design, type of infection, and target popuIn contrast to the rich literature available in the field of lation. 4 " 12 Previous investigations have reported mortality eschronic disease epidemiology, controlled studies aiming to timates related to ICU-acquired NI of 4%-50%. 1 " 6,9 ' 10 The determine the proportion of hospital deaths attributable to corresponding relative risks of death due to ICU-acquired NI NI are both rare and insufficient for the calculation of stawere 1.4-4.0, and the corresponding odds ratios were 1.7-ble estimates.…”