Absence of excess mortality in critically ill patients with nosocomial Escherichia coli bacteremia.
OBJECTIVE
To evaluate excess mortality in critically ill patients with Escherichia coli bacteremia after adjustment for severity of illness.


METHODS
Retrospective (1992-2000), pairwise-matched (1:2), risk-adjusted cohort study.


METHODS
Fifty-four-bed ICU in a university hospital including a medical and surgical ICU, a unit for care after cardiac surgery, and a burns unit.


METHODS
ICU patients with nosocomial E. coli bacteremia (defined as cases; n = 64) and control-patients without nosocomial bloodstream infection (n = 128).


METHODS
Case-patients were matched with control-patients on the basis of the Acute Physiology and Chronic Health Evaluation (APACHE) II system: an equal APACHE II score (+/- 2 points) and diagnostic category. In addition, control-patients were required to have an ICU stay at least as long as that of the respective case-patients prior to onset of the bacteremia.


RESULTS
The overall rate of appropriate antibiotic therapy in patients with E. coli bacteremia was high (93%) and such therapy was initiated soon after onset of the bacteremia (0.6 +/- 1.0 day). ICU patients with E. coli bacteremia had more acute renal failure. No differences were noted between case-patients and control-patients in incidence of acute respiratory failure, hemodynamic instability, or age. No differences were observed in length of mechanical ventilation or length of ICU stay. In-hospital mortality rates for cases and controls were not different (43.8% and 45.3%, respectively; P = .959).


CONCLUSIONS
After adjustment for disease severity and acute illness and in the presence of adequate antibiotic therapy, no excess mortality was found in ICU patients with E. coli bacteremia.
Blot
Stijn
S
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium.
Vandewoude
Koenraad
K
Hoste
Eric
E
De Waele
Jan
J
Kint
Kathleen
K
Rosiers
Fanny
F
Vogelaers
Dirk
D
Colardyn
Francis
F
D018806:APACHE; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D001530:Belgium / Q000453:epidemiology; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents