Outcomes of nosocomial bloodstream infections in adult neutropenic patients: a prospective cohort and matched case-control study.
OBJECTIVE
To examine the clinical and epidemiologic features, excess length of stay, extra costs, and mortality attributable to bloodstream infection (BSI) in neutropenic patients with hematologic malignancies.


METHODS
Prospective cohort and matched case-control study.


METHODS
All adult neutropenic patients with hematologic malignancies admitted to Cologne University Hospital between May 1, 1997, and April 30, 1998, were prospectively observed. Case-patients were defined as patients with nosocomial BSI; control-patients were selected among patients without BSI.


RESULTS
During the study period, the BSI rate in neutropenic patients was 14.3 per 100 neutropenic episodes. Eighty-four case-patients were included. Matching was successful for 96% of the cohort; 81 matched pairs were studied. The mean total length of stay was significantly longer for patients with BSI than for control-patients (37 vs 29 days; P = .002). Extra costs attributable to the infection averaged 3,200 dollars (U.S.) per patient. The crude mortality rates of case-patients and control-patients were 16% and 4%, respectively (P = .013), with an attributable mortality of 12% (odds ratio, 11). Eighty-seven percent of patients met the criteria for sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine. Severe sepsis or septic shock occurred in 13% of patients and was correlated with mortality (55% vs 10% in patients without severe sepsis or septic shock; P = .01).


CONCLUSIONS
Nosocomial BSI in neutropenic patients is significantly associated with an excess length of hospital stay, extra costs, and excess mortality. Severe sepsis and septic shock are closely correlated with an adverse outcome.
Wisplinghoff
Hilmar
H
Institute for Medical Microbiology, Immunology and Hygiene, and Department of Internal Medicine, University of Cologne, Cologne, Germany.
Cornely
Oliver A
OA
Moser
Susanne
S
Bethe
Ullrich
U
Stützer
Hartmut
H
Salzberger
Bernd
B
Fätkenheuer
Gerd
G
Seifert
Harald
H
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy / Q000191:economics / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D003428:Cross Infection / Q000150:complications* / Q000188:drug therapy / Q000191:economics / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications*; D017721:Hospital Costs; D017052:Hospital Mortality; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies
D000900:Anti-Bacterial Agents