Impact of nosocomial infections on clinical outcome and resource consumption in critically ill patients.
OBJECTIVE
Nosocomial infections still present a major problem in intensive care units (ICUs), accounting for prolonged ICU and hospital stays and worsened outcomes. There exist differences in the literature regarding the impact of nosocomial infections on attributable mortality and resource consumption. The aim of this study was to observe these effects in a large cohort of critically ill patients.


METHODS
Thirty-four Austrian ICUs participated in the study by documenting all nosocomial infections from 1 June to 30 November 2003 according to the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol.


RESULTS
Of 2,392 patients with a length-of-stay (LOS) >2 days, 683 (28.6%) developed at least one nosocomial infection. The most common infection was pneumonia (n = 456), followed by central venous catheter (CVC) infections (n = 101). Risk-adjusted mortality rates (standardized mortality ratios) were significantly increased for infected patients [0.91 (0.83-0.99) vs. 0.68 (0.61-0.74)]. Significant attributable risk-adjusted mortality was found for patients with pneumonia, combined infections (both 32%) and CVC-related infections (26%). LOS in the ICU increased significantly for all infections.


CONCLUSIONS
We conclude that significant attributable mortality for several nosocomial infections exists in a large cohort of critically ill patients, with the highest impact occurring in those with microbiologically diagnosed pneumonia and combined infections. All infections were associated with an increased resource consumption. Effective infection control measures could improve both clinical outcome and proper and effective use of ICU resources.
Burgmann
Heinz
H
Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Hiesmayr
J Michael
JM
Savey
Anne
A
Bauer
Peter
P
Metnitz
Barbara
B
Metnitz
Philipp G H
PG
D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D003422:Critical Care / Q000191:economics / Q000379:methods*; D016638:Critical Illness / Q000191:economics / Q000401:mortality*; D003428:Cross Infection / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000706:statistics & numerical data