title: Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients.
abstract: OBJECTIVE
  To analyze the impact of primary and catheterrelated bloodstream infections (PBSI/CRBSI) on morbidity and mortality.
  
  
  METHODS
  A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed.
  
  
  RESULTS
  Out of the 74,585 registered patients, those with at least one episode of monomicrobial PBSI/CRBSI were selected and paired with patients without PBSI/CRBSI for demographic and diagnostic criteria and seriousness of their condition on admission to the Intensive Care Unit (ICU). for mortality analysis, 1,879 patients with PBSI/CRBSI were paired with 7,516 controls. The crude death rate in the ICU was 28.1% among the cases and 18.7% among the controls. Attributable mortality 9.4% (HR:1.20; 95% confidence interval: 1.07-1.34; p<0.001). Risk of death varied according to the source of infection, aetiology, moment of onset of bloodstream infection and severity on admission to the ICU. The median stay in the ICU of patients who survived PBSI/CRBSI was 13 days longer than the controls, also varying according to aetiology, moment of onset of bloodstream infection and severity on admission.
  
  
  CONCLUSIONS
  Acquisition of PBSI/CRBSI in critically ill patients significantly increases mortality and length of ICU stay, which justifies prevention efforts.
authors.affiliation: Intensive Care Medicine Department. Galdakao-Usansolo Hospital, Vizcaya, Spain. pedromaria.olaecheaastigarrag@osakidetza.net
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Olaechea
authors.forename: Mercedes
authors.initials: M
authors.lastname: Palomar
authors.forename: Francisco
authors.initials: F
authors.lastname: Álvarez-Lerma
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Otal
authors.forename: Josu
authors.initials: J
authors.lastname: Insausti
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: López-Pueyo
mesh_terms: D018806:APACHE; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D016208:Databases, Factual; D004198:Disease Susceptibility; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D013030:Spain / Q000453:epidemiology