Risk of mortality with a bloodstream infection is higher in the less severely ill at admission

Peter W Kim; Trish M Perl; Eithne F Keelaghan; Patricia Langenberg; Eli N Perencevich; Anthony D Harris; Xiaoyan Song; Mary-Claire Roghmann

doi:10.1164/rccm.200407-916OC

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Risk of mortality with a bloodstream infection is higher in the less severely ill at admission

Journal article

Peer reviewed

Risk of mortality with a bloodstream infection is higher in the less severely ill at admission

Peter W Kim, Trish M Perl, Eithne F Keelaghan, Patricia Langenberg, Eli N Perencevich, Anthony D Harris, Xiaoyan Song and Mary-Claire Roghmann

American journal of respiratory and critical care medicine, Vol.171(6), pp.616-620

03/15/2005

DOI: 10.1164/rccm.200407-916OC

PMID: 15591469

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Abstract

Health care-associated bloodstream infections are common in critically ill patients; however, investigators have had difficulty in quantifying the clinical impact of these infections given the high expected mortality among these patients. To estimate the impact of health care-associated bloodstream infections on in-hospital mortality after adjusting for severity of illness at critical care admission. A cohort of medical and surgical intensive care unit patients. Severity of illness at admission, bloodstream infection, and in-hospital mortality. Among the 2,783 adult patients, 269 developed unit-associated bloodstream infections. After adjusting for severity of illness, patients with a lower initial severity of illness who developed an infection had a greater than twofold higher risk for in-hospital mortality (hazard ratio [HR] = 2.42, 95% confidence interval [CI] 1.70, 3.44) when compared with patients without infection and with a similar initial severity of illness. In contrast, patients with a higher initial severity of illness who subsequently developed an infection did not have an increased risk for in-hospital mortality (HR = 0.96, 95%CI 0.76, 1.23) when compared with patients without infection but with a similar initial severity of illness. These results suggest that these infections in less ill patients have a higher attributable impact on subsequent mortality than in more severely ill patients. Focusing interventions to prevent bloodstream infections in less severely ill patients would be expected to have a greater benefit in terms of mortality reduction.

Intensive Care Units

Sepsis - prevention & control

Prospective Studies

Hospital Mortality

Humans

Middle Aged

Patient Admission

Proportional Hazards Models

Critical Illness

Male

Risk

Sepsis - mortality

Female

APACHE

Length of Stay - statistics & numerical data

Cohort Studies

Details

Title: Subtitle: Risk of mortality with a bloodstream infection is higher in the less severely ill at admission
Creators: Peter W Kim - VA Maryland Health Care System, 100 N. Greene St. (Lower level), Baltimore, MD 21201, USA
Trish M Perl
Eithne F Keelaghan
Patricia Langenberg
Eli N Perencevich
Anthony D Harris
Xiaoyan Song
Mary-Claire Roghmann
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.171(6), pp.616-620
Publisher: United States
DOI: 10.1164/rccm.200407-916OC
PMID: 15591469
ISSN: 1073-449X
eISSN: 1535-4970
Grant note: UR8/CCU 315092-03 / ODCDC CDC HHS
Language: English
Date published: 03/15/2005
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983779492402771

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