Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T04:25:46.878Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Jean-Marie Januel ,
Stephan Harbarth ,
Robert Allard ,
Nicolas Voirin ,
Alain Lepape ,
Bernard Allaouchiche ,
Claude Guerin ,
Jean-Jacques Lehot ,
Marc-Olivier Robert  and
Gérard Fournier
...Show all authors
Jean-Marie Januel*
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France Health Care Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne, University Hospital Centre of Vaud, Lausanne, Switzerland
Stephan Harbarth
Affiliation:
Infection Control Program, Geneva University Hospitals and Medical School, Geneva, Switzerland
Robert Allard
Affiliation:
Department of Social and Preventive Medicine, Public Health Unit, Infectious Diseases Centre, Montreal, Quebec, Canada
Nicolas Voirin
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France
Alain Lepape
Affiliation:
Intensive Care Units, Lyon, France
Bernard Allaouchiche
Affiliation:
Intensive Care Units, Lyon, France
Claude Guerin
Affiliation:
Intensive Care Units, Lyon, France
Marc-Olivier Robert
Affiliation:
Intensive Care Units, Lyon, France
Gérard Fournier
Affiliation:
Intensive Care Units, Lyon, France
Didier Jacques
Affiliation:
Intensive Care Units, Lyon, France
Dominique Chassard
Affiliation:
Intensive Care Units, Lyon, France
Pierre-Yves Gueugniaud
Affiliation:
Intensive Care Units, Lyon, France
François Artru
Affiliation:
Intensive Care Units, Lyon, France
Paul Petit
Affiliation:
Intensive Care Units, Lyon, France
Dominique Robert
Affiliation:
Intensive Care Units, Lyon, France
Ismaël Mohammedi
Affiliation:
Intensive Care Units, Lyon, France
Raphaëlle Girard
Affiliation:
Infection Control Units, Lyon, France
Jean-Charles Cêtre
Affiliation:
Infection Control Units, Lyon, France
Marie-Christine Nicolle
Affiliation:
Infection Control Units, Lyon, France
Jacqueline Grando
Affiliation:
Infection Control Units, Lyon, France
Jacques Fabry
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France Department of Epidemiology, Hygiene and Prevention, Edouard Herriot Hospital, Hospices Civils of Lyon, University Hospital, Lyon, France
Philippe Vanhems
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France Department of Epidemiology, Hygiene and Prevention, Edouard Herriot Hospital, Hospices Civils of Lyon, University Hospital, Lyon, France
*
Health Care Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne, University Hospital Centre of Vaud, 1005 Lausanne, Switzerland ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.

Objective.

TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.

Setting.

Eleven ICUs of a French university hospital.

Design.

We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.

Results.

Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%–6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%–3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%–2.5%) for bloodstream infection, and 0.0% (95% CI, –0.4% to 0.4%) for urinary tract infection.

Conclusions.

ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 4 , April 2010 , pp. 388 - 394
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Eggimann, P, Pittet, D. Infection control in the ICU. Chest 2001;120:2059–2093.Google Scholar
2. Vincent, JL. Nosocomial infections in adult intensive-care units. Lancet 2003;361:2068–2077.Google Scholar
3. Safdar, N, Dezfulian, C, Colard, HR, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–2193.CrossRefGoogle ScholarPubMed
4. Girou, E, Stephan, F, Novara, A, Safar, M, Fagon, JY. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998;157:1151–1158.CrossRefGoogle ScholarPubMed
5. LD, Sanchez-Velazquez, Ponce de Leon Rosales, S, Rangel Frausto, MS. The burden of nosocomial infection in intensive care unit: effects on organ failure, mortality and costs—a nested case-control study. Arch Med Res 2006;37:370–375.Google Scholar
6. Rosenthal, VD, Guzman, S, Orellano, PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay (published correction appears in Am J Infect Control 2003;31:409). Am J Infect Control 2003;31:291–295.CrossRefGoogle Scholar
7. Blot, S, De Bacquer, D, Hoste, E, et al. Influence of matching for exposure time on estimates of attributable mortality caused by nosocomial bacteremia in critically ill patients. Infect Control Hosp Epidemiol 2005;26:352–356.CrossRefGoogle ScholarPubMed
8. Garrouste-Orgeas, M, Timsit, JF, Tafflet, M, et al. Excess risk of death from intensive care unit–acquired nosocomial bloodstream infections: a reappraisal (published correction appears in Clin Infect Dis 2006;42:1818). Clin Infect Dis 2006;42:1118–1126.Google Scholar
9. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
10. Fagon, JY, Novara, A, Stephan, F, Giroud, E, Safar, M. Mortality attributable to nosocomial infections in the ICU. Infect Control Hosp Epidemiol 1994;15:428–434.CrossRefGoogle ScholarPubMed
11. Soufir, L, Timsit, JF, Mahe, C, Carlet, J, Regnier, B, Chevret, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol 1999;20:396–401.CrossRefGoogle ScholarPubMed
12. Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA 1995;274:639–644.CrossRefGoogle ScholarPubMed
13. Rothman, KJ, Greenland, S. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott-Raven;1998.Google Scholar
14. Garcia-Martin, M, Lardelli-Claret, P, Jiménez-Moleon, JJ, Buenos-Cavanillas, A, Luna-del-Castillo, JD, Galvez-Vargas, R. Proportion of hospital deaths potentially attributable to nosocomial infection. Infect Control Hosp Epidemiol 2001;22:708–714.CrossRefGoogle ScholarPubMed
15. Fabbro-Peray, P, Sotto, A, Defez, C, et al. Mortality attributable to nosocomial infection: a cohort of patients with and without nosocomial infection in a French university hospital. Infect Control Hosp Epidemiol 2007;28:265–272.Google Scholar
16. Gail, MH. A bibliography and comments on the use of statistical models in epidemiology in the 1980s. Stat Med 1991;10:1819–1885.CrossRefGoogle ScholarPubMed
17. Savey, A, Lepape, A, Tressière, B, Ayzac, L, Fabry, J. ICUs-AI for the Southeast of France. Surveillance network protocol. C. CLIN Sud-Est [in French]. . Accessed June 2009.Google Scholar
18. Vanhems, P, Lepape, A, Savey, A, Jambou, P, Fabry, J. Nosocomial pulmonary infection by antimicrobial-resistant bacteria of patients hospitalized in intensive care units: risk factors and survival. J Hosp Infect 2000;45:98–106.CrossRefGoogle ScholarPubMed
19. Bruzzi, P, Green, SB, Byar, DP, Brinton, LA, Schairer, C. Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol 1985;122:904–914.CrossRefGoogle ScholarPubMed
20. Le Gall, JR, Loirat, P, Alperovitch, A, et al. A simplified acute physiology score for ICU patients. Crit Care Med 1984;12:975–977.CrossRefGoogle ScholarPubMed
21. Salemi, C, Morgan, J, Padilla, S, Morrissey, R. Association between severity of illness and mortality from nosocomial infection. Am J Infect Control 1995;23:188–193.CrossRefGoogle ScholarPubMed
22. Suetens, C, Savey, A, Labeeuw, J, Morales, I; HELICS-ICU. The ICU-HELICS Programme: towards European surveillance of hospital-acquired infections in intensive care units. Euro Surveill 2002;7:127–128.CrossRefGoogle ScholarPubMed
23. Gardner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice. St Louis, MO: Mosbys 1996:A1–A20.Google Scholar
24. Miettinen, OS. Proportion of disease caused or prevented by a given exposure, trait or intervention. Am J Epidemiol 1974;99:325–332.Google Scholar
25. Wacholder, S, Benichou, J, Heineman, EF, Hartge, P, Hoover, RN. Attributable risk advantagesof a broad definition of exposure. Am J Epidemiol 1994;140:303–309.CrossRefGoogle Scholar
26. Hanley, JA. A heuristic approach to the formulas for population attributable fraction. J Epidemiol Community Health 2001;55:508–514.CrossRefGoogle Scholar
27. Rockhill, B, Newman, B, C, Weinberg. Use and misuse of population attributable fractions. Am J Public Health 1998;88:15–19.CrossRefGoogle ScholarPubMed
28. Kuritz, SJ, Landis, JR. Attributable risk ratio estimation from matched-pairs case-control data. Am J Epidemiol 1987;125:324–328.Google Scholar
29. Kuritz, SJ, Landis, JR. Attributable risk estimation from matched case-control data. Biometria 1988;44:355–367.Google Scholar
30. Walter, SD. The estimation and interpretation of attributable risk in health research. Biometrics 1976;32:829–849.Google Scholar
31. Poole, C. Exposure opportunity in case-control studies. Am J Epidemiol 1986;123:352–358.CrossRefGoogle ScholarPubMed
32. Kuritz, SJ, Landis, JR. Re: “Exposure opportunity in case-control studies”. Am J Epidemiol 1987;125:1095–1096.CrossRefGoogle Scholar
33. Bland, JM, Altman, DG. The odds ratio. BMJ 2000;320:1468.CrossRefGoogle ScholarPubMed
34. Kelsey, JL, Whittemore, AS, Evans, AS, Thompson, WD. Methods in observational epidemiology. 2nd ed. New York, NY: Oxford University Press;1996.Google Scholar
35. Doll, R, Hill, AB. Smoking and carcinoma of the lung. Br Med J 1950;221:739–748.Google Scholar
36. Levin, MI, Goldstein, H, Gerhardt, PR. Cancer and tobacco smoking. J Am Med Assoc 1950;143:336–338.CrossRefGoogle ScholarPubMed
37. Ezzati, M, Lopez, AD. Estimates of global mortality attributable to smoking in 2000. Lancet 2003;362:847–852.Google Scholar
38. de Smet, AM, Kluytmans, JA, Cooper, BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009;360:20–31.CrossRefGoogle ScholarPubMed
39. Samore, MH, Harbarth, S. A methodologically focused review of the literature in hospital epidemiology and infection control. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins;2004:1645–1657.Google Scholar
40. Levin, ML. The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum 1953;9:531–541.Google ScholarPubMed
41. Moalla, M, Baratin, D, Giard, M, Vanhems, P. Incidence of methicillin-resistant Staphylococcus aureus nosocomial infections in intensive care units in Lyon University hospitals, France, 2003-2006. Infect Control Hosp Epidemiol 2008;29:454–456.Google Scholar
42. Macgowan, AP; BSAC Working Parties on Resistance Surveillance. Clinical implications of antimicrobial resistance for therapy. J Antimicrob Chemother 2008;62(Suppl 2):S105–S114.Google Scholar
43. Blot, S, Depuydt, P, Vandewoude, K, De Bacquer, D. Measuring the impact of multidrug resistance in nosocomial infection. Curr Opin Infect Dis 2007;20:391–396.Google Scholar