Reappraisal of attributable mortality in critically ill patients with nosocomial bacteraemia involving Pseudomonas aeruginosa.
In a retrospective study, population characteristics and outcome were investigated in intensive care unit (ICU) patients with hospital-acquired Pseudomonas aeruginosa bacteraemia admitted over a seven-year period (January 1992 through December 1998). A matched cohort study was performed in which all ICU patients with P. aeruginosa bacteraemia were defined as cases (N=53). Matching (1:2 ratio) of the controls (N=106) was based on the APACHE II classification: an equal APACHE II score (+/-1 point) and an equal diagnostic category. Patients with P. aeruginosa bacteraemia had a higher incidence of acute respiratory failure, haemodynamic instability, a longer ICU stay and length of ventilator dependence (P<0.05). In-hospital mortalities for cases and controls were 62.3 vs. 47.2% respectively (P=0.073). Thus, the attributable mortality was 15.1% (95% confidence intervals: -1.0-31.2). In a multivariate survival analysis the APACHE II score was the only variable independently associated with mortality. In conclusion, P. aeruginosa bacteraemia is associated with a clinically relevant attributable mortality (15%). However, we could not find statistical evidence of P. aeruginosa being an independent predictor of mortality.
Blot
S
S
Department of Intensive Care, Ghent University Hospital, Belgium. stijn.blot@rug.ac.be
Vandewoude
K
K
Hoste
E
E
Colardyn
F
F
D018806:APACHE; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D016638:Critical Illness; D003428:Cross Infection / Q000150:complications / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008875:Middle Aged; D019370:Observation; D011552:Pseudomonas Infections / Q000150:complications / Q000401:mortality*; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D016019:Survival Analysis