Scoring system for nosocomial pneumonia in ICUs.
OBJECTIVE
To develop a scoring system for stratifying patients in intensive care units (ICUs) by risk of developing nosocomial pneumonia (NP), based on variables generally available in an ICU, and to determine the probability of a patient developing NO in the ICU.


METHODS
a 2-year prospective cohort study conducted in a medical and surgical ICU.


METHODS
756 patients admitted to the ICU for 48 h or more were followed up until the development of NP or death or discharge from the ICU.


RESULTS
129 (17.1%) patients developed NP, 106 (14%) in the first 2 weeks. The following independent risk factors were identified by multivariate analysis: no infection on admission [relative risk (RR) = 3.1, 95% confidence intervals (CI) = 2.0 to 4.81; thorax drainage (RR = 2.1, 95% CI = 1.2 to 3.5); administration of antacids (RR = 2.1, 95% CI = 1.4 to 3.1); partial pressure of oxygen (PO2) > 110 mmHg (RR = 1.6, 95% CI = 1.0 to 2.6); administration of coagulation factors (RR = 1.8 95% CI = 1.0 to 3.2); male gender (RR = 2.7, 95% CI = 1.2 to 6.3); urgent surgery (RR = 2.4, 95% CI = 0.9 to 6.4); and neurological diseases (RR = 4.2, 95% CI = 1.9 to 9.4). To obtain a predictive risk index for NP, a scoring system was developed using a multivariate model. The probability of developing NP varied between 11.0% in the lowest risk group and 42.3% in the highest risk group. The patients' risk of acquiring NP was seven times higher in the highest score category (i.v.) than in the lowest one (I).


CONCLUSIONS
ICU patients can be stratified into high- and low-risk groups for NP. No infection on admission, thorax drainage, administration of antacids, and PO2 > 110 mmHg were associated with a higher risk of NP during the entire 2-week period.
Kropec
A
A
Department of Environment Medicine and Hospital Epidemiology, University Hospital, Freiburg, Germany.
Schulgen
G
G
Just
H
H
Geiger
K
K
Schumacher
M
M
Daschner
F
F
D000328:Adult; D000704:Analysis of Variance; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012306:Risk; D012307:Risk Factors; D014218:Triage / Q000379:methods*