title: Community- and healthcare-associated infections in critically ill patients: a multicenter cohort study.
abstract: OBJECTIVE
  To compare the spectrum of infection, comorbidities, outcomes, and mortality of patients admitted to the intensive care unit (ICU) due to community-acquired or healthcare-associated severe sepsis.
  
  
  METHODS
  This prospective cohort study was conducted in three university medical centers in Lebanon from February 2005 to December 2006. Patients with severe sepsis were included and followed up until hospital discharge or death.
  
  
  RESULTS
  One hundred and twenty patients were included of whom 60% had community-acquired infections (CAI) and 40% had healthcare-associated infections (HAI). The most common infection in both groups was pneumonia. Hematologic malignancies were the only comorbidity more prevalent in HAI than in CAI (p=0.047). Fungal infections and extended-spectrum beta-lactamase (ESBL) organisms were more frequent in HAI than in CAI (p=0.04 and 0.029, respectively). APACHE and SOFA scores were high and did not differ between the two groups, nor did the proportion of septic shock, while mortality was significantly higher in the HAI patients than in the CAI patients (p=0.004). On multivariate analysis for mortality, independent risk factors were the source of infection acquisition (p=0.004), APACHE II score (p=0.006), multidrug-resistant Pseudomonas infections (p=0.043), and fungal infections (p=0.006).
  
  
  CONCLUSIONS
  Severe sepsis and septic shock had a high mortality rate, especially in the HAI group. Patients with risk factors for increased mortality should be monitored and aggressive treatment should be administered.
authors.affiliation: Hotel Dieu de France Hospital, Pulmonary and Critical Care Division, Saint Joseph University School of Medicine, PO Box 16-6830, Achrafieh Beirut, Lebanon. Electronic address: georges.dabar@usj.edu.lb.
authors.forename: George
authors.initials: G
authors.lastname: Dabar
authors.affiliation: Hotel Dieu de France Hospital, Pulmonary and Critical Care Division, Saint Joseph University School of Medicine, PO Box 16-6830, Achrafieh Beirut, Lebanon.
authors.forename: Carine
authors.initials: C
authors.lastname: Harmouche
authors.affiliation: Lebanese University, Faculties of Pharmacy and of Public Health II, Beirut, Lebanon.
authors.forename: Pascale
authors.initials: P
authors.lastname: Salameh
authors.affiliation: Kidney and Dialysis Research Laboratory, Division of Nephrology, Department of Medicine, Saint Elizabeth's Medical Center, Boston, Massachusetts, USA.
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
authors.affiliation: Kings County Hospital Center, Pulmonary and Critical Care Department, Brooklyn, New York, USA.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Jamaleddine
authors.affiliation: Saint George Hospital, Pulmonary and Critical Care Department, Beirut, Lebanon.
authors.forename: Mirna
authors.initials: M
authors.lastname: Waked
authors.affiliation: Hotel Dieu de France Hospital, Anesthesia and Critical Care Division, Saint Joseph University School of Medicine, Beirut, Lebanon.
authors.forename: Patricia
authors.initials: P
authors.lastname: Yazbeck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D015897:Comorbidity; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012772:Shock, Septic / Q000401:mortality
keywords: Community-acquired; Comorbidities; Healthcare-associated; Infection spectrum; Mortality; Severe sepsis