Skip to main content Accessibility help
×
Home

Risk factors for incidence and case-fatality rates of healthcare-associated infections: a 20-year follow-up of a hospital-based cohort

  • R.-F. WANG (a1) (a2) (a3), S.-H. SHEN (a1), A. M.-F. YEN (a1) (a4), T.-L. WANG (a2) (a3), T.-N. JANG (a3) (a5) (a6), S.-H. LEE (a6), J.-T. WANG (a7) (a8) and H.-H. CHEN (a1)...

Summary

Information is lacking on the integrated evaluation of mortality rates in healthcare-associated infections (HAIs). Our aim was to differentiate the risk factors responsible for the incidence from those for the case-fatality rates in association with HAIs. We therefore examined the time trends of both incidence and case-fatality rates over a 20-year period at a tertiary-care teaching medical centre in Taiwan and the mortality rate was expressed as the product of the incidence rate and the case-fatality rate. During the study period the overall mortality rate fell from 0·46 to 0·32 deaths/1000 patient-days and the incidence rate fell from 3·41 to 2·31/1000 patient-days, but the case-fatality rate increased marginally from 13·5% to 14·0%. The independent risk factors associated with incidence of HAIs were age, gender, infection site, admission type, and department of hospitalization. Significant prognostic factors for HAI case-fatality were age, infection site, intensive care, and clinical department. We conclude that the decreasing trend for the HAI mortality rate was accompanied by a significant decline in the incidence rate and this was offset by a slightly increasing trend in the case-fatality rate. This deconstruction approach could provide further insights into the underlying complex causes of mortality for HAIs.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Risk factors for incidence and case-fatality rates of healthcare-associated infections: a 20-year follow-up of a hospital-based cohort
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Risk factors for incidence and case-fatality rates of healthcare-associated infections: a 20-year follow-up of a hospital-based cohort
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Risk factors for incidence and case-fatality rates of healthcare-associated infections: a 20-year follow-up of a hospital-based cohort
      Available formats
      ×

Copyright

Corresponding author

* Author for correspondence: Professor Hsiu-Hsi Chen, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan. (Email: chenlin@ntu.edu.tw)

References

Hide All
1. Harbarth, S, Sax, H, Gastmeier, P. The preventable proportion of nosocomial infections: an overview of published reports. Journal of Hospital Infection 2003; 54: 258266; quiz 321.
2. National Nosocomial Infections Surveillance S. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 to June 2002, issued August 2002. American Journal of Infection Control 2002; 30: 458475.
3. Askarian, M. National nosocomial infection surveillance system-based study in Iran: Additional hospital stay attributable to nosocomial infections. American Journal of Infection Control 2003; 31: 465468.
4. Rossello-Urgell, J. Nosocomial infection surveillance and control activities in Spain under HELICS and NosoMed programs frame. Journal of Hospital Infection 2004; 56 Suppl 2: S5557.
5. Agodi, A, et al. Trends, risk factors and outcomes of healthcare-associated infections within the Italian network SPIN-UTI. Journal of Hospital Infection 2013; 84: 5258.
6. Gastmeier, P, et al. Reproducibility of the surveillance effect to decrease nosocomial infection rates. Infection Control and Hospital Epidemiology 2009; 30: 993999.
7. Haley, RW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. American Journal of Epidemiology 1985; 121: 182205.
8. Rioux, C, Grandbastien, B, Astagneau, P. Impact of a six-year control programme on surgical site infections in France: results of the INCISO surveillance. Journal of Hospital Infection 2007; 66: 217223.
9. Srinivasan, A, Craig, M, Cardo, D. The power of policy change, federal collaboration, and state coordination in healthcare-associated infection prevention. Clinical Infectious Diseases 2012; 55: 426431.
10. Luzzati, R, et al. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. European Journal of Clinical Microbiology & Infectious Diseases 2000; 19: 602607.
11. Colpan, A, et al. Evaluation of risk factors for mortality in intensive care units: a prospective study from a referral hospital in Turkey. American Journal of Infection Control 2005; 33: 4247.
12. Kaech, C, et al. Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre. Clinical Microbiology and Infection 2006; 12: 345352.
13. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control 2008; 36: 309332.
14. Garner, JS, et al. CDC definitions for nosocomial infections, 1988. American Journal of Infection Control 1988; 16: 128140.
15. Freire, MP, et al. Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients. European Journal of Clinical Microbiology & Infectious Diseases 2015; 34: 277286.
16. Sofair, AN, et al. Epidemiology of community-onset candidemia in Connecticut and Maryland. Clinical Infectious Diseases 2006; 43: 3239.
17. Poikonen, E, et al. Candidemia in Finland, 1995–1999. Emerging Infectious Diseases 2003; 9: 985990.
18. Guggenbichler, JP, et al. Incidence and clinical implication of nosocomial infections associated with implantable biomaterials – catheters, ventilator-associated pneumonia, urinary tract infections. GMS Krankenhaushygiene Interdisziplinar 2011; 6: Doc 18.
19. Raymond, J, Aujard, Y. Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infection Control and Hospital Epidemiology 2000; 21: 260263.
20. El Atrouni, WI, et al. Temporal trends in the incidence of Staphylococcus aureus bacteremia in Olmsted County, Minnesota, 1998 to 2005: a population-based study. ClinicalInfectious Diseases 2009; 49: e130138.
21. Alexopoulos, EC, et al. Wide range of point prevalences of healthcare-associated infections in Western Greece. Epidemiology and Infection 2011; 139: 17341739.
22. Halablab, MA, et al. Staphylococcus aureus nasal carriage rate and associated risk factors in individuals in the community. Epidemiology and Infection 2010; 138: 702706.
23. Mackintosh, CA, Hoffman, PN. An extended model for transfer of micro-organisms via the hands: differences between organisms and the effect of alcohol disinfection. Journal of Hygiene (London) 1984; 92: 345355.
24. Tsigrelis, C, et al. Decreases in case-fatality and mortality rates for invasive pneumococcal disease in Olmsted County, Minnesota, during 1995–2007: a population-based study. Clinical Infectious Diseases 2008; 47: 13671371.
25. Kanerva, M, et al. Estimating the annual burden of health care-associated infections in Finnish adult acute care hospitals. American Journal of Infection Control 2009; 37: 227230.
26. Laupland, KB, Ross, T, Gregson, DB. Staphylococcus aureus bloodstream infections: risk factors, outcomes, and the influence of methicillin resistance in Calgary, Canada, 2000–2006. Journal of Infectious Diseases 2008; 198: 336343.
27. Miller, M, et al. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clinical Infectious Diseases 2010; 50: 194201.
28. Deming, E. Transformation of western style of management. Interfaces 1985; 15: 6.
29. Vernaz, N, et al. Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile . Journal of Antimicrobial Chemotherapy 2008; 62: 601607.
30. Pittet, D, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infectious Diseases 2006; 6: 641652.
31. Yoshida, T, et al. Risk factors for hospital-acquired bacteremia. Internal Medicine 2005; 44: 11571162.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed