Mortality in a Tunisian intensive care unit

Abstract

Introduction Nosocomial infection (NI) constitute a major public health problem. It was extremely frequent and serious, especially in the intensive care unit (ICU). Thus, ICU-NIs increased patient mortality. The objective of this study was to determine rates and predictive factors of ICU of mortality in a Tunisian University Hospital. Methods We conducted a nested case-control study in a 630-beds public University Hospital in Eastern Tunisia. Cases and controls enrollment was based on data collected prospectively by an ICU-wide active surveillance of NI conducted over 12 months: from July first, 2010, through June 30, 2011. Patients admitted to the ICU were included in the study if they stayed in the ICU for more than 48 hours. All analyses were performed with SPSS for Windows, version 19.0. Results Overall, 301 patients were enrolled from ICU. The mean age was 44.8 ± 21.3 years. The mean of length of stay in ICU was 12.7 ± 4. The crude ICU mortality rate was 20.6% (62/301). It was 35.8% for patients who acquired at least one NI during their stay in ICU and 16.2% for those without any NI, yielding an overall crude excess mortality rate of 19.6% (OR = 0.9, 95% CI: 1.6 to 5.3). Overall, 62 case patients were compared to 239 control patients (total) for the final analysis. Logistic regression model demonstrated 5 independents predictive factors of ICU: age older than 65 years (OR: 5.78 [95% CI: 2.03–16.05] P = 0.001), duration of intubation 1–10 days (OR: 6.82 [95% CI: 1.90–24.45] P = 0.003), duration of intubation > 10 days (OR, 11.11 [95% CI: 2.85–43.28] P = 0.001), duration of central venous catherization (CVC) 1–7 days (OR: 6.85 [95% CI: 1.71–27.45] P = 0.007) and duration of CVC > 7 days (OR: 5.55 [95% CI: 1.70–18.04] P = 0.004). Conclusion In this series of ICU patients, duration of intubation and CVC had higher ICU mortality. It could be explained by the frequency of infectious complications that have been generated and the fragility of the clinical condition. So, the implementation of infection control programs could be result in significant reductions in mortality rates in the ICU.