Bloodstream Infections Tied to Excess Mortality in ICU

Pneumonia also greatly increases mortality, but antimicrobial resistance does not up length of stay

WEDNESDAY, Dec. 1 (HealthDay News) -- Health-care-associated bloodstream infections and pneumonia appear to be strongly associated with increased mortality among patients admitted to intensive care units (ICUs), according to a study published online Dec. 1 in The Lancet Infectious Diseases.

Using data collected prospectively from ICUs that reported according to the European standard protocol for surveillance of health-care-associated infections, Marie-Laurence Lambert, M.D., of the Scientific Institute for Public Health in Brussels, Belgium, and colleagues evaluated excess mortality and length of stay in ICUs from bloodstream infections and pneumonia. The investigators collected data for 119,699 patients who were admitted for more than two days to 537 ICUs in 10 countries between Jan. 1, 2005, and Dec. 31, 2008.

The researchers found that excess risk of death for pneumonia in the fully adjusted model ranged from a hazard ratio of 1.7 for drug-sensitive Staphylococcus aureus to 3.5 for drug-resistant Pseudomonas aeruginosa. The excess risk for bloodstream infections ranged from a hazard ratio of 2.1 for drug-sensitive S. aureus to 4.0 for drug-resistant P. aeruginosa. For a combination of all four microorganisms assessed, the risk of death associated with antimicrobial resistance was 1.2 for both pneumonia and bloodstream infections. Antimicrobial resistance did not significantly increase length of hospital stay.

"On the basis of previously published work, no definite conclusions could be made about the outcomes of health-care-related infections and antimicrobial resistance in ICUs," the authors write. "However, in our study we noted a high excess mortality associated with bloodstream infections and pneumonia and excess length of stay for pneumonia acquired in the ICU with the most common pathogens."

Two authors disclosed financial relationships with multiple pharmaceutical and medical device companies.

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