2.50
Hdl Handle:
http://hdl.handle.net/2336/41753
Title:
Risk factors and outcome in ICU-acquired infections
Authors:
Magnason, S; Kristinsson, K G; Stefansson, T; Erlendsdottir, H; Jonsdottir, K; Kristjansson, M; Jonmundsson, E; Baldursdottir, L; Sigvaldason, H; Gudmundsson, S
Citation:
Acta Anaesthesiol Scand. 2008, 52(9):1238-45
Issue Date:
1-Oct-2008
Abstract:
BACKGROUND: Nosocomial infections are common in intensive care units (ICU). The objectives of this study were to determine risk factors of ICU-acquired infections, and potential mortality attributable to such infections. METHODS: An observational study was performed in a 10-bed multidisciplinary ICU. For a period of 27 months, all patients admitted for >or=48 h were included. Infections were diagnosed according to Centers for Disease Control and Prevention definitions. Airway colonization was explored by molecular typing. Risk factors for infection were determined by multivariable logistic regression. Survival was analyzed with time-varying proportional hazards regression. RESULTS: Of 278 patients, 81 (29%) were infected: urinary tract infections in 39 patients (14%), primary bloodstream infections in 25 (9%), surgical site infections in 22 (8%) and pneumonia in 21 (8%). Of the total of 147 episodes, Gram-negative bacilli were isolated in 90, Gram-positive cocci in 49 and Candida sp. in 25. Risk factors for pneumonia were mechanical ventilation [odds ratio (OR=7.9, CI 1.8-35), lack of enteral nutriment (OR=8.0, CI 1.4-45) and length of time at risk (OR=1.8, CI 1.2-2.8), while gastric acid inhibitors did not affect the risk (OR=0.99, CI 0.32-3.0). Transmission of bacteria from the stomach to the airway was not confirmed. The risk of death was increased as patients were infected with pneumonia [hazard ratio (HR)=3.6; CI: 1.6-8.1], or primary bloodstream infection (HR=2.5; CI: 1.2-5.4), independent of age and disease severity. CONCLUSIONS: Mortality was increased by ICU-acquired pneumonia and primary bloodstream infections. Our findings did not support the gastro-pulmonary hypothesis of ICU-acquired pneumonia. The proposition that blood transfusions increase the risk of ICU-acquired nosocomial infections was not supported.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
Additional Links:
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Full metadata record

DC FieldValue Language
dc.contributor.authorMagnason, S-
dc.contributor.authorKristinsson, K G-
dc.contributor.authorStefansson, T-
dc.contributor.authorErlendsdottir, H-
dc.contributor.authorJonsdottir, K-
dc.contributor.authorKristjansson, M-
dc.contributor.authorJonmundsson, E-
dc.contributor.authorBaldursdottir, L-
dc.contributor.authorSigvaldason, H-
dc.contributor.authorGudmundsson, S-
dc.date.accessioned2008-12-03T09:21:02Z-
dc.date.available2008-12-03T09:21:02Z-
dc.date.issued2008-10-01-
dc.date.submitted2000-12-03-
dc.identifier.citationActa Anaesthesiol Scand. 2008, 52(9):1238-45en
dc.identifier.issn0001-5172-
dc.identifier.pmid18823463-
dc.identifier.doi10.1111/j.1399-6576.2008.01763.x-
dc.identifier.urihttp://hdl.handle.net/2336/41753-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: Nosocomial infections are common in intensive care units (ICU). The objectives of this study were to determine risk factors of ICU-acquired infections, and potential mortality attributable to such infections. METHODS: An observational study was performed in a 10-bed multidisciplinary ICU. For a period of 27 months, all patients admitted for >or=48 h were included. Infections were diagnosed according to Centers for Disease Control and Prevention definitions. Airway colonization was explored by molecular typing. Risk factors for infection were determined by multivariable logistic regression. Survival was analyzed with time-varying proportional hazards regression. RESULTS: Of 278 patients, 81 (29%) were infected: urinary tract infections in 39 patients (14%), primary bloodstream infections in 25 (9%), surgical site infections in 22 (8%) and pneumonia in 21 (8%). Of the total of 147 episodes, Gram-negative bacilli were isolated in 90, Gram-positive cocci in 49 and Candida sp. in 25. Risk factors for pneumonia were mechanical ventilation [odds ratio (OR=7.9, CI 1.8-35), lack of enteral nutriment (OR=8.0, CI 1.4-45) and length of time at risk (OR=1.8, CI 1.2-2.8), while gastric acid inhibitors did not affect the risk (OR=0.99, CI 0.32-3.0). Transmission of bacteria from the stomach to the airway was not confirmed. The risk of death was increased as patients were infected with pneumonia [hazard ratio (HR)=3.6; CI: 1.6-8.1], or primary bloodstream infection (HR=2.5; CI: 1.2-5.4), independent of age and disease severity. CONCLUSIONS: Mortality was increased by ICU-acquired pneumonia and primary bloodstream infections. Our findings did not support the gastro-pulmonary hypothesis of ICU-acquired pneumonia. The proposition that blood transfusions increase the risk of ICU-acquired nosocomial infections was not supported.en
dc.language.isoenen
dc.publisherBlackwell Munksgaarden
dc.relation.urlhttp://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=34275742&site=ehost-liveen
dc.subject.meshCommunity-Acquired Infectionsen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshIntensive Care Unitsen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshRisk Factorsen
dc.subject.meshSurvival Rateen
dc.subject.meshTime Factorsen
dc.subject.meshTreatment Outcomeen
dc.titleRisk factors and outcome in ICU-acquired infectionsen
dc.typeArticleen
dc.identifier.eissn1399-6576-
dc.contributor.departmentDepartment of Anesthesia, Landspitali University Hospital, Reykjavik, Iceland.en
dc.identifier.journalActa anaesthesiologica Scandinavicaen

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