title: Risk factors for incidence and case-fatality rates of healthcare-associated infections: a 20-year follow-up of a hospital-based cohort.
abstract: Information is lacking on the integrated evaluation of mortality rates in healthcare-associated infections (HAIs). Our aim was to differentiate the risk factors responsible for the incidence from those for the case-fatality rates in association with HAIs. We therefore examined the time trends of both incidence and case-fatality rates over a 20-year period at a tertiary-care teaching medical centre in Taiwan and the mortality rate was expressed as the product of the incidence rate and the case-fatality rate. During the study period the overall mortality rate fell from 0·46 to 0·32 deaths/1000 patient-days and the incidence rate fell from 3·41 to 2·31/1000 patient-days, but the case-fatality rate increased marginally from 13·5% to 14·0%. The independent risk factors associated with incidence of HAIs were age, gender, infection site, admission type, and department of hospitalization. Significant prognostic factors for HAI case-fatality were age, infection site, intensive care, and clinical department. We conclude that the decreasing trend for the HAI mortality rate was accompanied by a significant decline in the incidence rate and this was offset by a slightly increasing trend in the case-fatality rate. This deconstruction approach could provide further insights into the underlying complex causes of mortality for HAIs.
authors.affiliation: Division of Biostatistics,Graduate Institute of Epidemiology and Preventive Medicine,College of Public Health,National Taiwan University,Taipei,Taiwan.
authors.forename: R-F
authors.initials: RF
authors.lastname: Wang
authors.affiliation: Division of Biostatistics,Graduate Institute of Epidemiology and Preventive Medicine,College of Public Health,National Taiwan University,Taipei,Taiwan.
authors.forename: S-H
authors.initials: SH
authors.lastname: Shen
authors.affiliation: Division of Biostatistics,Graduate Institute of Epidemiology and Preventive Medicine,College of Public Health,National Taiwan University,Taipei,Taiwan.
authors.forename: A M-F
authors.initials: AM
authors.lastname: Yen
authors.affiliation: Department of Emergency Medicine,Shin Kong Wu Ho-Su Memorial Hospital,Taipei,Taiwan.
authors.forename: T-L
authors.initials: TL
authors.lastname: Wang
authors.affiliation: School of Medicine,Fu-Jen Catholic University,New Taipei City,Taiwan.
authors.forename: T-N
authors.initials: TN
authors.lastname: Jang
authors.affiliation: Infection Control Committee,Shin Kong Wu Ho-Su Memorial Hospital,Taipei,Taiwan.
authors.forename: S-H
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine,National Taiwan University Hospital,Taipei,Taiwan.
authors.forename: J-T
authors.initials: JT
authors.lastname: Wang
authors.affiliation: Division of Biostatistics,Graduate Institute of Epidemiology and Preventive Medicine,College of Public Health,National Taiwan University,Taipei,Taiwan.
authors.forename: H-H
authors.initials: HH
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Case-fatality; healthcare-associated infection; incidence; incidence-death cohort