The burden of nosocomial infection in the intensive care unit: Effects on organ failure, mortality and costs. A nested case-control study

BACKGROUND: Nosocomial infections increase mortality and costs in the intensive care units; however, few studies have addressed organ failure that developed in infected patients and their overall costs. The goal of this study was to measure the frequency of organ failure in nosocomial infection and the mortality and costs of these in critical care areas. METHODS: This was a nested 1:2 case-control study in a cohort of all consecutively hospitalized patients comparing those with and without nosocomial infections over a year in an institutional intensive care unit (ICU). Those patients who acquired an infection during hospitalization were considered cases. Controls were matched by hospital stay at least as long as the cases' time acquisition of nosocomial infection, age +/-5 years and APACHE II +/-5 points. RESULTS: Forty-three patients developed at least one nosocomial infection event (cases). The matching success was about 94%. Higher frequency and duration of organ failures was observed in the cases, as well as the number of devices and procedures (p < 0.05). Attributable mortality was 16.3% (p < 0.001). Attributable total cost of a nosocomial infection acquired in the ICU was 12,155 dollars. CONCLUSIONS: Nosocomial infection acquired in the ICU increases length of stay, frequency and duration of organ failures, mortality, and costs.     

Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer

Background

Recurrence occurs in up to 20% of patients with stage II colon cancer operated on for cure. Although postoperative intra-abdominal infection has been linked with an increased risk of recurrence, the association is controversial. The aim was to investigate the impact of postoperative intra-abdominal infection on disease-free survival and disease-specific survival in patients with stage II colon cancer.

Methods

Patients undergoing elective surgery for colon cancer stage II, between 2003 and 2014, were included. Patients with anastomotic leak or intra-abdominal abscess were included in the infection group. We used the Kaplan–Meier method to represent the distribution of survival and the Cox proportional hazards model to estimate the contribution of relevant clinicopathological factors with prognosis.

Results

Postoperative intra-abdominal infection was diagnosed in 37 of 363 (10.2%) patients. Perioperative blood transfusion was more frequent in patients with infection (p?=?0.008). Overall 5-year disease-free survival rate was 85.1%. Disease-free survival at 5 years was lower in patients with postoperative intra-abdominal infection (52.8 vs 88.7%; p < 0.001), perineural invasion (p?=?0.001), lymphovascular invasion (p?=?0.001), pT4 (p?=?0.013), and in patients with adjuvant chemotherapy (p?=?0.013). Multivariate analysis showed that postoperative intra-abdominal infection (HR 4.275; p?<?0.001), perineural invasion (HR 2.230; p?=?0.007), and lymphovascular invasion (HR 2.052; p?=?0.016) were all significant independent predictors of reduced disease-free survival. Regarding specific survival, independent significant prognostic factors were the number of lymph nodes, lymphovascular invasion, and postoperative intra-abdominal infection.

Conclusion

In this series of patients with stage II colon cancer, postoperative intra-abdominal infection has an independent negative impact on disease-free survival and disease-specific survival.