Epidemiology and Prognostic Determinants of Bloodstream Infections in Surgical Intensive Care

Abstract

Hypothesis: A set of clinical variables available at the bedside can be used to predict outcome in critically ill patients with bloodstream infection (BSI).Design: A 3-year retrospective cohort study.Setting: A surgical intensive care unit in Switzerland.Patients: All patients with BSI were potentially eligible.Main Outcome Measures: Clinical variables, organ dysfunctions, and outcome.Results: Among 4530 admissions to the surgical intensive care unit, 224 clinically significant episodes of BSI were recorded (incidence, 4.9%), with a 28-day fatality of 36%. A total of 110 patients had primary bacteremia, of which 39 (35%) were catheter related. Although grampositive organisms were the most frequently isolated pathogens (58% [159/275]), they were associated with lower case-fatality (30%) than BSI due to gram-negative bacteria (44%). Organ dysfunctions associated with the highest risk of death were neurologic dysfunction (hazard ratio [HR], 6.9; 95% confidence interval [CI], 3.3-14.5), hepatic dysfunction (HR, 3.9; 95% CI, 2.1-7.4), and disseminated intravascular coagulation (HR, 3.0; 95% CI, 1.5-6.1). By multivariate analysis, 2 independent predictors of mortality were the APACHE II (Acute Physiology and Chronic Health Evaluation II) score at onset of BSI (HR per 1-point increase, 1.08; 95% CI, 1.04-1.12) and the number of evolving organ dysfunctions (HR, 1.4; 95% CI, 1.2-1.7). Appropriate antimicrobial therapy was associated with improved outcome (HR, 0.4; 95% CI, 0.2-0.6).Conclusions: Bloodstream infection in critically ill patients is a common and frequently fatal condition. Its outcome can be predicted by the severity of illness at onset of BSI and the number of organ dysfunctions evolving thereafter. Appropriate antimicrobial therapy is an important determinant for survival.

Burden of Bloodstream Infection Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model

“…32 The first is inadequate controlling for confounding covariates intrinsic to either the patient, such as severity of illness and comorbid conditions, or the infecting agent, such as the presence of a hypervirulent ESBL-positive clone. 33 The second is treatment related, such as delay of appropriate antimicrobial therapy, 6,34 increased treatment toxicity (such as renal impairment secondary to aminoglycosides), need for surgery, or lack of an active oral agent to facilitate early discharge with outpatient completion of antibiotic therapy. In our study, patients with ESBL-positive BSI were less likely to receive appropriate antibiotic treatment within 24 hours (Table 1).…”

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

“…aeruginosa is a common cause of nosocomial infections, often associated with higher mortality when compared to other bacterial pathogens [21,22] . Especially in the ICU setting severe infections are caused by this aerobic gram-negative bacilli, namely bloodstream infections, whether related or not to the use of a central venous catheter and ventilator-associated pneumonia.…”

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance

“…Sepsis was considered as community-induced if it manifested up to 72h after the patient ' s confinement, and if the patient did not come from another hospital environment 12 . Due to underlying diseases of individuals and their need for long hospitalization, these patients can develop infection from some pathogens restricted to hospital environments, making the recovery of patients harder and making these patientesan infection source that spreads these infections to the community 17 . In our study only 8.7% of infections were acquired in the community.…”