Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units

IntroductionCentral venous catheters (CVC) are devices of great importance in health care. The advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (BSI). In spite of its importance, few national studies have addressed this issue.ObjectiveThe aim this study was to determine the incidence of BSI in patients with CVC, hospitalized in ICU, as well as the variables associated with this complication.MethodsMulticentric cohort study carried out at ICUs of three hospitals at Universidade Federal de São Paulo complex.ResultsA total of 118 cases of BSI in 11.546 catheters day were observed: 10.22 BSI per 1,000 catheters day. On average, BSI was associated to seven additional days of hospital stay in our study (p < 0.001), with a significant difference between types of catheters. Concerning the place of insertion, there was no statistical difference in BSI rates.ConclusionWe concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001). The median duration of catheter use was 14 days among patients with BSI and 9 days in patients without infection (p < 0.001). There was higher prevalence of Gram-negative infections. The risk factors for BSI were utilization of multiple-lumen catheters, duration of catheterization and ICU length of stay.     

Alcohol drinking as a predictor of intensive care and hospital mortality in general surgery: a prospective study

Aims To analyse whether alcohol drinking increases admission to intensive care and in‐hospital mortality in general surgery. Design and participants A prospective cohort study on a consecutive series of 1505 hospitalized patients in a Service of General Surgery of a tertiary hospital. Measurements Drinking pattern was defined by quantity, frequency and volume of drinking. Information on relevant confounders was obtained: smoking, body mass index, nutritional status (measured by serum albumin), cholesterol and its fractions, severity of the underlying disease and all therapeutic measures. Multivariate logistic regression was applied to assess the relationship between drinking and both admission to intensive care and in‐hospital death. Results Twenty‐nine (1.9%) patients died and 33 (2.1%) were admitted to the intensive care unit (ICU). Drinking was heavier in men, patients without antecedents of cancer, with lower preoperative risk assessment scores, number of co‐morbidities and age and higher serum albumin levels. After adjusting for age, severity of underlying disease, smoking and serum albumin, male drinkers of 72+ g/day had an increased risk of being admitted to ICU, the effect being stronger for week‐day drinking (odds ratio, OR = 8.48; 95% confidence interval, CI = 1.68–42.8). A significant association was also seen between week‐day drinking (72+ g/day) and death in men (OR = 7.19, 95% CI = 1.43–36.1). Numbers for women were too small to evaluate. Conclusion Heavy drinking increases admission to intensive care and in‐hospital mortality in hospitalized male patients undergoing general surgery procedures.     

重症监护病房机械通气相关性肺炎危险因素的前瞻性队列研究

目的　通过研究重症监护病房 (ICU)机械通气相关性肺炎 (VAP)的发病危险因素 ,为ICU的VAP防治提供基础的流行病学资料 ,为制定和采取预防控制措施提供科学依据。方法　以1999年 12月～ 2 0 0 1年 2月我院ICU行气管插管或气管切开患者为对象 ,采用前瞻性队列研究 ,作单因素和logistic回归分析 ,筛选VAP发病的可能危险因素。结果　研究期间共有 2 85例患者行人工气道机械通气 ,98例符合条件入选本研究 ,其中 5 2例发生VAP ,发生率为 5 3 1% ;以插管日计算 ,每 10 0 0个插管日发生 32 4例VAP。将 2 1项变量行单因素分析结果显示 ,COPD史 >15年、白蛋白 <30g/L、连续使用抗生素 >3d等 13项因素有统计学意义。logistic多因素分析显示 ,VAP的独立发病危险因素有 :同时使用 2种以上抗生素、重复气管插管、APACHEⅡ评分 >15分、胃液pH >4、机械通气时间延长。结论　ICU发生VAP是多种因素共同作用的结果。对已筛选的可能危险因素 ,需通过临床试验进一步证实。     

Severe community-acquired pneumonia in an intensive care unit: risk factors for mortality

OBJECTIVE: To evaluate severe community-acquired pneumonia (SCAP) patients in an intensive care unit (ICU) with regard to risk factors for mortality and to compare ICU patients with matched non-ICU patients to evaluate whether our judgement for ICU admission was appropriate or not. MATERIALS AND METHODS: During a 7-year period, all patients with CAP who were admitted to the ICU were examined. They underwent clinical and radiographic evaluations, and two commonly used severity of illness scores were also calculated using the Simplified Acute Physiological Score (SAPS) and the Acute Physiology and Chronic Health Evaluation (APACHE) II methods. To detect risk factors for ICU admission using existing guidelines, each study patient was matched with two patients hospitalized in a general medical ward. RESULTS: Seventy-two patients were identified during the study period. Their mean age was 72.9 years, and 35 patients (48.6%) subsequently died. For the univariate analysis, there were significant differences with the pulse rate > or = 130/min, blood urea nitrogen > or = 30 mg/dl, multilobar shadow, SAPS > or = 13, APACHE II > or = 23, and the occurrence of septic shock between the survivors and those who died. For the multivariate analysis, septic shock (p = 0.0005, odds ratio of 26.6) and blood urea nitrogen > or = 30 mg/dl (p = 0.037, odds ratio of 5.38) were associated with mortality. Regarding the characteristics of different clinical predictions for ICU admission, the revised American Thoracic Society criteria might have been the most accurate. CONCLUSION: Septic shock was associated with high mortality, which is a more accurate and higher predictor of mortality than was physical examination, laboratory or radiographic findings.     

Severe forms of influenza infections admitted in intensive care units: Analysis of mortality factors

Background

The severe forms of influenza infection requiring intensive care unit (ICU) admission remain a medical challenge due to its high mortality. New H1N1 strains were hypothesized to increase mortality. The studies below represent a large series focusing on ICU-admitted influenza patients over the last decade with an emphasis on factors related to death.

Methods

A retrospective study of patients admitted in ICU for influenza infection over the 2010–2019 period in Réunion Island (a French overseas territory) was conducted. Demographic data, underlying conditions, and therapeutic management were recorded. A univariate analysis was performed to assess factors related to ICU mortality.

Results

Three hundred and fifty adult patients were analyzed. Overall mortality was 25.1%. Factors related to higher mortality were found to be patient age >65, cancer history, need for intubation, early intubation within 48 h after admission, invasive mechanical ventilation (MV), acute respiratory distress syndrome (ARDS), vaso-support drugs, extracorporal oxygenation by membrane (ECMO), dialysis, bacterial coinfection, leucopenia, anemia, and thrombopenia. History of asthma and oseltamivir therapy were correlated with a lower mortality. H1N1 did not impact mortality.

Conclusion

Patient's underlying conditions influence hospital admission and secondary ICU admission but were not found to impact ICU mortality except in patients age >65, history of cancer, and bacterial coinfections. Pulmonary involvement was often present, required MV, and often evolved toward ARDS. ICU mortality was strongly related to ARDS severity. We recommend rapid ICU admission of patients with influenza-related pneumonia, management of bacterial coinfection, and early administration of oseltamivir.     

Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study

In order to determine the prevalence of intensive care unit (ICU)-acquired infection at ICUs in Turkey and to identify associated risk factors, predominant infecting organisms and mortality rates, a 1-d point prevalence study was carried out on 19 September 2001. A total of 56 ICUs from 22 university and teaching hospitals participated and a total of 236 completed case report forms were accepted for analyses. A total of 115 patients (48.7%) had 1 or more ICU- related nosocomial infections on the study d. Pneumonia and lower respiratory tract infection (28.0%), laboratory confirmed blood stream infection (23.3%) and urinary tract infection (15.7%) were the most frequent types. Endotracheal tube, urinary catheter, multi-trauma on admission, stress ulcer prophylaxis, nasogastric feeding and mechanical ventilation were risk factors. The most frequently reported isolates were Pseudomonas aeruginosa (20.8%), Staphylococcus aureus (18.2%), Acinetobacter spp. (18.2%) and Klebsiella spp. (16.1%). Of the patients, 72.9% were receiving antimicrobials on the study d for treatment or prophylaxis. Most frequently administered antimicrobials were aminoglycosides (37.2%), carbapenems (31.4%), glycopeptides (23.3%), cephalosporins (18.0%) and antifungals (5.8%). According to a 4-week follow-up, 70 (29.7%) patients died, 22 (9.3%) of whom died from ICU related infections. In conclusion this study showed that ICU related infections are common and often associated with resistant microorganisms. The results provide epidemiological information that will help to implement infection control policies in ICUs.     

Duration of handwashing in intensive care units: a descriptive study

The duration of handwashing was studied in two community hospitals (teaching and nonteaching). The duration in seconds of 180 handwashes by health care personnel and 52 handwashes by non-health care personnel were recorded. The mean duration for health care personnel was 8.62 +/- 0.29 SEM; the degree of patient contact did not influence the duration of handwashing. The duration of handwashing was two times longer in health care personnel vs. non-health care personnel (8.62 +/- 0.29 vs. 4.14 +/- 0.42; t = 7.7; p less than 0.001). Comparisons revealed no statistically significant difference in duration between personnel at teaching and nonteaching hospitals or among those in different occupations. The data indicate that the duration of handwashing among health care personnel is below the standard recommended by authorities in hospital infection control. This may be an important factor in the transmission and persistence of nosocomial infection in critical care units. The antimicrobial efficacy of handwashing agents should be reevaluated considering the actual duration of handwashing by health care personnel within the hospital environment or efforts should be made to increase the duration of handwashing.     

Candidemia in intensive care unit patients: Risk factors for mortality

Summary Aim of this study was to evaluate whether risk factors which predict the development of candidemia may also predict death in ICU patients with candidemia. During an 8-year-period all ICU patients whose blood cultures yieldedCandida species (n=40) were retrospectively evaluated in a case-control fashion. The average incidence ofCandida bloodstream infections was 5.5 per 10,000 patient days, ranging from 2.4 in 1990 to 7.4 in 1994.C. albicans was the most common pathogen in candidemic patients, but the proportion of non-C. albicans strains showed an increasing trend during 1989–1993, with a major shift towards non-C. albicans species in 1994. The overall mortality of patients with candidemia was 58%. Mortality was highest in the group of patients with multi-organ dysfunction syndrome, especially among those in need of hemodialysis. Risk factors for the development of candidemia, such as age, malignancy, steroid use, i.v. catheterization, and the use of broad-spectrum antibiotics were not correlated with mortality in the ICU patients studied.     

ICU患者呼吸机相关肺部念珠菌感染的物种分布、药敏及患者死亡危险因素的分析

目的 呼吸机相关肺部念珠菌感染(VAPCI)是ICU患者死亡的重要因素之一,但目前数据有限。我们旨在通过研究了解梅州地区ICU VAPCI患者的流行病学,抗真菌治疗和患者死亡危险因素。方法 选择该地区3家三级医院2010年1月至2017年12月ICU中发生VAPCI的319例患者为研究对象,进行呼吸道标本培养,测定分离念珠菌菌株的抗菌敏感性,运用Logistic多元回归分析ICU VAPCI患者死亡的危险因素。结果 8年间ICU VAPCI的发生率为2.19%(319/14 597),病死率为53.29% (171/319); 319例患者分离共获得念珠菌菌株343株,其中白色念珠菌所占比例最高,达46.36%(159/343),其它依次为热带念珠菌、光滑念珠菌、近平滑念珠菌、克柔念珠菌和季也蒙念珠菌等非白念珠菌,合计占53.64%(184/343);药敏结果显示,6种念珠菌对5种常用抗真菌药物的敏感率除了光滑念珠菌对3种唑类药物敏感率略低于80%外,其他敏感率都高于80%,其中白色念珠菌的敏感率都高于90%;Logistic多元回归分析显示,年龄、恶性肿瘤、血清白蛋白、APACHEII评分、合并基础疾病≥ 3、导管留置时间和住ICU时间是VAPCI的独立的死亡危险因素;ROC分析显示,APACHEII评分大于19分和血清白蛋白低于或等于25 g/L是这两项独立危险因素的最佳预测值。结论 ICU VAPCI致病菌株以白色念珠菌为主,死亡率高,临床应重视对具备上述危险因素患者加强监测和真菌药敏监测,降低患者死亡率。     

重症监护室医院获得性肺炎发病及预后危险因素分析

目的 了解教学医院监护室（ＩＣＵ）内获得性肺炎的发病及预后危险因素，为制定相应防治措施作参考。方法 以近２年上海中山医院外科监护室（ＳＩＣＵ）、呼吸监护室（ＲＩＣＵ）及华山医院综合监护室（ＧＩＣＵ）１０８例医院获得性肺炎及同期各ＩＣＵ未发生肺为的５０例患为对象，采用回顾性病例对照分析，用ＳＰＳ软件，作Ｌｏｇｉｓｔｉｃ回归，筛选和分析ＩＣＵ相关危险因素。结果 综合分析医院内获得性肺炎（ＨＡＰ）发病     

Average daily risk range as a measure of glycemic risk is associated with mortality in the intensive care unit: a retrospective study in a burn intensive care unit

Background

Although tight glycemic control has been associated with improved outcomes in the intensive care unit (ICU), glycemic variability may be the influential factor in mortality. The main goal of the study was to relate blood glucose (BG) variability of burn ICU patients to outcomes using a sensitive measure of glycemic variability, the average daily risk range (ADRR).

Method

Data from patients admitted to a burn ICU were used. Patients were matched by total body surface area (TBSA) and injury severity score (ISS) to test whether increased BG variability measured by ADRR was associated with higher mortality risk and whether we could identify ADRR-based classifications associated with the degree of risk.

Results

Four ADRR classifications were identified: low risk, medium-low, medium-high, and high. Mortality progressively increased from 25% in the low-risk group to over 60% in the high-risk group (p < .001). In a post hoc analysis, age also contributed to outcome. Younger (age < 43 years) survivors and nonsurvivors matched by TBSA and ISS had no significant difference in age, mean BG or standard deviation of BG; however, nonsurvivors had higher ADRR (p < .01).

Conclusions

Independent of injury severity, glycemic variability measured by the ADRR was significantly associated with mortality in the ICU. When age was considered, ADRR was the only measure of glycemia significantly associated with mortality in younger patients with burns.     

Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality.

Demographic information, risk factors, therapy, and outcome for all patients who had candidemia at Barnes Hospital, St. Louis, between 1 September 1988 and 1 September 1989 were retrospectively reviewed. One hundred six candidemic patients were identified, representing 0.5% of all medical and surgical discharges and 0.33% of total patient discharges. These percentages represent a 20-fold increase in the incidence of candidemia at our hospital in comparison with that during 1976-1979. Candida albicans was the most frequently isolated species (63%), followed by Candida tropicalis (17%), Candida glabrata (13%), Candida parapsilosis (6.5%), and Candida krusei (0.9%). Overall mortality was 57%, and 14 (23%) of 60 deaths occurred within 48 hours of the detection of candidemia. Mortality was associated with higher APACHE II scores (25 for nonsurvivors vs. 16 for survivors; P = .0001), the presence of a rapidly fatal underlying illness (P = .0009), and sustained positivity of blood cultures (P = .02). In cases of sustained candidemia, the isolation of non-albicans Candida species also correlated with increased mortality (8 of 8 vs. 10 of 21; P = .005). Thirty candidemic patients (28%) did not receive any antifungal therapy, and 19 (63%) of these untreated patients died. Eleven untreated patients (37%) survived without sequelae. There has been a marked increase in the incidence of candidemia in our institution that is associated with a high overall mortality. Candidemia lasting less than 24 hours was associated with a lower mortality than was that of longer duration. Severity of illness and duration of candidemia should be used as stratifying factors in prospective studies to determine optimum therapy.     

Autoimmune rheumatic diseases in the intensive care unit: experience from a tertiary referral hospital and review of the literature

Autoimmune rheumatic diseases (AIRD) are not uncommon in the general population and up to one third of hospitalized patients with AIRD may need admission to intensive care unit (ICU). This paper describes the causes of admission, the clinical features and outcome of 24 AIRD patients admitted to a medical ICU from a third level hospital. Thirteen patients had systemic lupus erythematosus (54.2%), three rheumatoid arthritis (12.5%), three pulmonary renal syndrome (12.5%), two dermatopolymyositis (8.3%), two scleroderma (8.3%) and one antiphospholipid syndrome (4.2%). The main causes for ICU admission were rheumatic disease flare-up (37.5%), infection (37.5%) and complications derived from rheumatic disease (29.1%). Mortality during ICU stay was 16.7% (four patients). Excluding shock requiring vasopressor support, no statistical difference was found between survivors and nonsurvivors; although there was a trend to higher test severity scores (APACHE II, ODIN) in nonsurvivors. Our results reveal a lower mortality rate in AIRD patients admitted to the ICU than reported previously. Severity scores such as APACHE II are predictors of mortality in patients with AIRD in the ICU.