Intensive-care-unit-acquired bloodstream infections in a regional critically ill population.
Bloodstream infection (BSI) is a serious complication of critical illness but it is uncertain whether acquisition of BSI in the intensive care unit (ICU) increases the risk of death. A study was conducted among all Calgary health region (population approximately 1 million) adults admitted to ICUs for 48 h or more during a three-year period to investigate the occurrence, microbiology and risk factors for developing an ICU-acquired BSI and to determine whether these infections independently predict mortality. One hundred and ninety-nine ICU-acquired BSI episodes occurred during 4933 ICU admissions for a cumulative incidence of 4% and an incidence density of 5.4 per 1000 ICU days. The most common isolates were Staphylococcus aureus (18%), coagulase-negative staphylococci (11%), and Enterococcus faecalis (8%); 12% of infections were due to antimicrobial-resistant bacteria. Admission to the regional neurosurgery/trauma ICU [odds ratio (OR) 2.86; 95% confidence interval (CI) 2.10-3.90] and increasing Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.05 per point, 95% CI 1.03-1.07) were associated with higher risk, whereas a surgical diagnosis (OR 0.69; 95% CI 0.52-0.93) was associated with lower risk of developing ICU-acquired BSI in logistic regression analysis. The crude in-hospital death rate was 45% for patients with ICU-acquired BSI compared with 21% for those without (P < 0.0001) Development of an ICU-acquired BSI was an independent risk factor for death (OR 1.79; 95% CI 1.3-2.5) and increases the risk of dying from critical illness.
Department of Critical Care Medicine, University of Calgary and Calgary Health Region, Calgary, Alta., Canada. kevin.laupland@calgaryhealthregion.ca
K B
KB
Laupland
A W
AW
Kirkpatrick
D L
DL
Church
T
T
Ross
D B
DB
Gregson
D018806:APACHE; D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D015331:Cohort Studies; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012307:Risk Factors