Nosocomial bacteremia in a medical-surgical intensive care unit: epidemiologic characteristics and factors influencing mortality in 111 episodes.
OBJECTIVE
To analyze the epidemiology and factors influencing mortality of ICU-acquired bacteremia.


METHODS
Prospective clinical study.


METHODS
A medical-surgical ICU in an university hospital.


METHODS
We recorded variables from 111 consecutive ICU-acquired episodes for a 3-year period.


RESULTS
The attack rate was 1.9 episodes per 100 patient-days. The commonest isolates were coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Intravascular catheters were the most frequent source of infection. Overall mortality was 31.5%, and 65.7% of all deaths were directly attributable to infection. Bacteremia from intra-abdominal, lower respiratory tract or unknown origin were associated with a poor prognosis. A logistic regression analysis defined intraabdominal origin (p = 0.01, OR = 15.7) and presence of shock (p = 0.04, OR = 3.3) as independently influencing the risk of death. No significant differences were found for the remaining variables studied.


CONCLUSIONS
Epidemiology and etiology of ICU-acquired bacteremia does not differ seriously in respect to nosocomial bacteremia among unselected populations, although it is associated with a greater incidence and overall mortality. Presence of shock is the most important modificable variable affecting the outcome.
Rello
J
J
Intensive Care Department, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma, Barcelona, Spain.
Ricart
M
M
Mirelis
B
B
Quintana
E
E
Gurgui
M
M
Net
A
A
Prats
G
G
D016470:Bacteremia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects; D002423:Cause of Death; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality