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Risk Factors for Death Due to Nosocomial Infection in Intensive Care Unit Patients: Findings From the Krankenhaus Infektions Surveillance System

Published online by Cambridge University Press:  02 January 2015

P. Gastmeier ,
D. Sohr ,
C. Geffers ,
M. Behnke  and
H. Rüden
P. Gastmeier*
Affiliation:
Institute of Medical Microbiologyand Hospital Epidemiology, Hannover Medical School, Hannover
D. Sohr
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
C. Geffers
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
M. Behnke
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
H. Rüden
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
*
Institute of Medical Microbiologyand Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Str. 1, D 30625 Hannover, Germany ([email protected])
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Abstract

Objective.

To determine risk factors for death among patients with nosocomial pneumonia and patients with primary bloodstream infections (BSI) in intensive care units (ICUs).

Design.

Prospective cohort study.

Setting.

Data collected from January 1997 through June 2003 from ICUs registered with the Krankenhaus Infektions Surveillance System in Germany.

Patients.

A total of 8,432 patients with nosocomial pneumonia from 202 ICUs and 2,759 patients with nosocomial primary BSI from 190 ICUs.

Methods.

The following risk factors were considered in the analysis: age, sex, time in the ICU before onset of infection, type of ICU, type and size of hospital, intubation, central venous catheter use, total parenteral nutrition, and type of pathogen.

Results.

A total of 750 patients (8.9%) with nosocomial pneumonia and 302 patients (10.9%) with nosocomial primary BSI died. Multiple logistic regression analysis identified treatment in a medical or surgical ICU (odds ratio [OR], 1.55 [95% confidence interval {CI}, 1.32-1.82]) or a hospital with more than 1,000 beds (OR, 2.14 [95% CI, 1.81-2.56]), age older than 65 years (OR, 1.54 [95% CI, 1.31-1.81]), and infection with methicillin-resistant Staphylococcus aureus (OR, 2.39 [95% CI, 1.81-3.12]) or multidrug-resistant Pseudomonas aeruginosa (OR, 3.00 [95% CI, 1.90-4.63]) as independent determinants of death from nosocomial pneumonia. Age older than the median of 63 years (OR, 1.44 [95% CI, 1.12-1.86]) and methicillin-resistant S. aureus as the causative agent (OR, 2.98 [95% CI, 1.81-5.82]) were both associated with increased mortality from primary BSI. The types of infecting pathogens, particularly those resistant to multiple drugs, were also strong outcome predictors among ICU patients.

Conclusions.

The study results underline the need for further investigations of the role of antimicrobial resistance in the outcome of patients with nosocomial pneumonia and patients with primary BSI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 4 , April 2007 , pp. 466 - 472
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Safdar, N, Dezfulian, C, Collard, H, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–2193.Google Scholar
2.Wenzel, R, Edmond, M. The impact of hospital acquired bloodstream infections. Emerg Infect Dis 2001;7:174–177.Google Scholar
3.Heyland, D, Cook, D, Griffith, L, Keenan, S, Brun-Buisson, C, for the Canadian Critical Care Trial Group. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999;159:1249–1256.Google Scholar
4.Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gilbert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.CrossRefGoogle ScholarPubMed
5.Combes, A, Figliolini, C, Trouillet, J, et al.Incidence and outcome of polymicrobial ventilator-associated pneumonia. Chest 2002;121:1618–1623.CrossRefGoogle ScholarPubMed
6.Osmon, S, Ward, S, Fraser, V, Kollef, M. Hospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa. Chest 2004;125:607–616.CrossRefGoogle ScholarPubMed
7.Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.Google Scholar
8.Gastmeier, P, Geffers, C, Sohr, D, Dettenkofer, M, Daschner, F, Rüden, H. Five years working with the German Nosocomial Infection Surveillance System KISS. Am J Infect Control 2003;31:316–321.Google Scholar
9.Emori, TG, Culver, DH, Horan, TC, et al.National Nosocomial Infection Surveillance System (NNIS): description of surveillance methodology. Am J Infect Control 1991;19:19–35.CrossRefGoogle Scholar
10.Garner, JS, Emori, WR, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
11.Rello, J, Ollendorf, D, Oster, G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–2121.CrossRefGoogle Scholar
12.Vincent, I-L, Bihari, D, Suter, PM, et al.The prevalence of nosocomial infections in intensive care units in Europe. JAMA 1995;274:639–644.Google Scholar
13.Bercault, N, Boulain, T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med 2001;29:2303–2309.Google Scholar
14.Ibrahim, E, Tracy, L, Hill, C, Fraser, V, Kollef, M. The occurrence of ventilator-associated pneumonia in a community hospital. Chest 2001;120:555–561.CrossRefGoogle Scholar
15.Leroy, O, Sanders, V, Girardie, P, et al.Mortality due to ventilator-associated pneumonia: impact of medical versus surgical ICU admittance status. J Crit Care 2001;16:90–97.Google Scholar
16.Torres, A, Aznar, R, Gatell, J, et al.Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523–528.CrossRefGoogle ScholarPubMed
17.Hugonett, S, Harbarth, S, Sax, H, Duncan, R, Pittet, D. Nursing resources: a major determinant of nosocomial infections. Curr Opin Infect Dis 2004;17:329–333.Google Scholar
18.Luna, C, Viujachich, P, Niederman, M, Gherardi, C, Matera, J, Jolly, E. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111:676–687.Google Scholar
19.Moine, P, Timsit, J, Lassence, A, et al.Mortality associated with late-onset pneumonia in the intensive care unit: results of a multi-center cohort study. Intensive Care Med 2002;28:154–163.Google Scholar
20.Osmon, S, Warren, D, Seiler, S, Shannon, W, Fraser, V, Kollef, M. The influence of infection on hospital mortality for patients requiring >48 h of intensive care. Chest 2003;124:1021–1029.CrossRefGoogle ScholarPubMed
21.Cosgrove, S, Sakoulas, G, Perencevich, E, Schwaber, M, Karchmer, A, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.Google Scholar
22.Whitby, M, McLaws, M-L, Berry, G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 2001;175:264–267.Google Scholar
23.Rello, J, Jubert, P, Valles, J, Artigas, A, Rue, M, Niederman, M. Evaluation of outcome in intubated patients with pneumonia due to Pseudomonas aeruginosa. Clin Infect Dis 1996;23:973–978.Google Scholar
24.Blot, S, Vandewoude, K, Hoste, E, Colardyn, F. Reappraisal of attributable mortality in critically ill patients with nosocomial bacteremia involving Pseudomonas aeruginosa. J Hosp Infect 2003;53:18–24.CrossRefGoogle ScholarPubMed
25.Ibelings, M, Bruining, H. Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. Eur J Surg 1998;164:411–418.CrossRefGoogle ScholarPubMed
26.Gonzalez, C, Rubio, M, Romero-Vivas, J, Gonzalez, M, Picazo, JJ. Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 1999;29:1171–1177.Google Scholar
27.Combes, A, Luyt, C, Fagon, J, et al.Impact of methicillin resistance on outcome of Staphylococcus aureus ventilator-associated pneumonia. Am J Respir Crit Care Med 2004;170:786–792.Google Scholar