Predictors of nosocomial bloodstream infections among critically ill adult trauma patients.
OBJECTIVE
To identify the independent predictors of nosocomial bloodstream infections (BSIs) among critically ill adult trauma patients.


METHODS
A prospective, cohort design was used to study patients who met predetermined inclusion criteria. Basic descriptive and univariate statistical analyses were performed to identify unadjusted predictors. A forward stepwise multivariate logistic regression analysis was then conducted to identify independent predictors of nosocomial BSI.


METHODS
Level I university-affiliated shock trauma center.


METHODS
Three hundred sixty-one critically ill adult trauma patients, 55 of whom developed nosocomial BSIs (15.2%).


RESULTS
Data analysis of 45 variables indicated that only 9 were independent predictors of nosocomial BSI: presence of a chest tube, use of immunosuppressive agents, presence of microbial resistance, length of stay, presence of preexisting infection, percentage change of serum albumin levels, patient disposition, transfusion of 10 or more units of blood, and number of central venous catheters (CVCs) for patients who had 4 or more. The classification index of the final regression model at a cut-off point of 0.5 had a specificity of 97.4%, a sensitivity of 60%, a positive predictive value of 76.7%, a negative predictive value of 93%, and an overall precision of 91%.


CONCLUSIONS
In this study, only 9 variables were independent predictors of nosocomial BSI. Our findings are specific to critically ill adult trauma patients and should be interpreted within the context of this particular population.
El-Masri
Maher M
MM
University of Windsor, Faculty of Nursing, 401 Sunset, CHN Room G110, Windsor, Ontario, Canada N9B 3P4.
Hammad
Tarek A
TA
McLeskey
Sandra W
SW
Joshi
Manjari
M
Korniewicz
Denise M
DM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D014947:Wounds and Injuries / Q000453:epidemiology*