Abstract
IntroductionThe aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality.MethodsPatients with a longer than 48 hour stay in a mixed 10 bed ICU in a tertiary-level teaching hospital were prospectively enrolled between May 2002 and June 2003. Risk factors for hospital mortality were analyzed with a logistic regression model.ResultsOf 335 patients, 80 developed ICU-acquired infection. Among the patients with ICU-acquired infections, hospital mortality was always higher, regardless of whether or not the patients had had infection on admission (infection on admission group (IAG), 35.6% versus 17%, p = 0.008; and no-IAG, 25.7% versus 6.1%, p = 0.023). In IAG (n = 251), hospital stay was also longer in the presence of ICU-acquired infection (median 31 versus 16 days, p < 0.001), whereas in no-IAG (n = 84), hospital stay was almost identical with and without the presence of ICU-acquired infection (18 versus 17 days). In univariate analysis, the significant risk factors for hospital mortality were: Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, sequential organ failure assessment (SOFA) score >8, ICU-acquired infection, age ≥ 65, community-acquired pneumonia, malignancy or immunosuppressive medication, and ICU length of stay >5 days. In multivariate logistic regression analysis, ICU-acquired infection remained an independent risk factor for hospital mortality after adjustment for APACHE II score and age (odds ratio (OR) 4.0 (95% confidence interval (CI): 2.0–7.9)) and SOFA score and age (OR 2.7 (95% CI: 2.9–7.6)).ConclusionICU-acquired infection was an independent risk factor for hospital mortality even after adjustment for the APACHE II or SOFA scores and age.
Highlights
The aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality
In IAG (n = 251), hospital stay was longer in the presence of ICU-acquired infection, whereas in no-IAG
In multivariate logistic regression analysis, ICU-acquired infection remained an independent risk factor for hospital mortality after adjustment for Acute Physiology and Chronic Health Evaluation (APACHE) II score and age (odds ratio (OR) 4.0 (95% confidence interval (CI): 2.0–7.9)) and Sequential Organ Failure Assessment (SOFA) score and age (OR 2.7)
Summary
The aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality. Patients admitted into intensive care units (ICUs) are at great risk for acquiring nosocomial infections. They are susceptible to infection because of their underlying diseases or conditions associated with impaired immunity as well as several violations of their immune system or risks of aseptic mistakes in patient management during invasive monitoring and they are prone to secondary infections after exposure to broad-spectrum antimicrobials [1]. In one earlier casecontrol study, after adjustment for risk factors, ICU-acquired catheter-related infection was not a significant risk factor for mortality [6]. Increased mortality has been reported among ICU patients with Gram-negative bacteremia [11,12] or intraabdominal infections [13]
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