Hostname: page-component-7bb8b95d7b-wpx69 Total loading time: 0 Render date: 2024-09-12T05:49:00.621Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors Affecting Mortality Outcome and Risk of Developing Nosocomial Bloodstream Infection

Published online by Cambridge University Press:  02 January 2015

Silom Jamulitrat ,
Ubolrat Meknavin  and
Somchit Thongpiyapoom
Silom Jamulitrat*
Affiliation:
Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hadyai, Songkla 90112, Thailand
Ubolrat Meknavin
Affiliation:
Infection Control Unit, Songklanagarind Hospital, Hadyai, Songkla 90112, Thailand
Somchit Thongpiyapoom
Affiliation:
Infection Control Unit, Songklanagarind Hospital, Hadyai, Songkla 90112, Thailand
*
Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hadyai, Songkla 90112, Thailand
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To identify factors associated with developing nosocomial bloodstream infection (NBI) and to identify factors associated with fatal outcome of NBI.

Design:

Prospective matched and unmatched case-control studies.

Seting:

Songklanagarind Hospital, a 640-bed medical school and referral center in Songkla, Thailand.

Patients:

During a two-year study period, 277 patients of 17,829 total admissions in the hospital services of medicine, surgery, pediatrics, and orthopedics acquired bloodstream infections during hospitalization. For the purpose of identifying factors associated with mortality attributed to NBI, patients who died from NBI were assigned as cases; patients who survived the infections were assigned as controls. For the purpose of identifying risk factors for acquisition of NBI, patients with NBI were considered as cases; patients with the same primary diagnosis as a case but without NBI were eligible to be case-matched controls.

Results:

Case fatality rate was 37.2% based on deaths attributed specifically to bloodstream infection. Patients who died from NBI, compared with those who survived such infections, were associated with inappropriate antibiotic treatment, infection caused by Klebsiella pneumoniae, and the medicine service. When comparison was made between 239 patients with bloodstream infections and 598 diagnosis-matched controls with no bloodstream infection, infection was found to be associated with old age, number of comorbidities, number of prior infections, neutropenia, duration of immunosuppressive drugs, and duration of indwelling intravenous catheter.

Conclusion:

Awareness of the factors predisposing to NBI may permit better surveillance and better care. Although most of the factors associated with development of NBI or death from NBI are not subject to control, some factors are duration of immunosuppressive drugs, duration of indwelling intravenous lines, and choice of antibiotic treatment.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 3 , March 1994 , pp. 163 - 170
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159–167.CrossRefGoogle Scholar
2. Maki, DG. Nosocomial bacteremia: an epidemiologic overview. Am J Med 1981;70:719–732.CrossRefGoogle ScholarPubMed
3. Banerjee, SN, Emori, TG, Culver, DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989 National Nosocomial Infections Surveillance System. Am J Med 1991;91(3B):86S–89S.Google Scholar
4. Freeman, J, Platt, R, Epstein, ME Smith, NE, Sidebottom, DG, Goldmann, DA Birth weight and length of stay as determinants of nosocomial coagulase-nagative staphylococcal bacteremia in neonatal intensive care unit population: potential for confounding. Am J Epidemiol 1990;132:1130–1140.Google Scholar
5. Townsend, TR, Wenzel, RR Nosocomial bloodstream infections in a newborn intensive care unit: a case-matched control study of morbidity, mortality and risk. Am J Epidemiol 1981;114:73–80.CrossRefGoogle Scholar
6. International Classification of Diseases: Ninth Revision. Geneva, Switzerland: World Health Organization; 1977.Google Scholar
7. Haley, RW, Quade, D, Freeman, HE, Bennett, JV. Study on the efficacy of nosocomial infection control: summary of study design. Am J Epidemiol 1980;111:472–485.CrossRefGoogle Scholar
8. McCabe, WR, Jackson, GG. Gram-negative bacteremia, II: clinical, laboratory and therapeutic observations. Arch Intern Med 1962;110:856–864.Google Scholar
9. Uzun, O, Akalin, HE, Hayran, M, Unal, S. Factors influencing prognosis in bacteremia due to gram-negative organisms: evaluation of 448 episodes in a Turkish university hospital. Clin Infect Dis 1992;15:866–873.Google Scholar
10. Trilla, A, Gatell, JM, Mensa, J, et al. Risk factors for nosocomial bacteremia in a large Spanish teaching hospital: a case-control study. Infect Control Hosp Epidemiol 1991;12:150–156.CrossRefGoogle Scholar
11. Gransden, WR. Predictors for bacteremia. J Hosp Infect 1991;18(suppl A):308–316.Google Scholar
12. Gross, PA, DeMauro, PJ, Antwerpen, CV, Wallenstein, S, Chiang, S. Number of comorbidities as a predictor of nosocomial infection acquisition. Infect Control Hosp Epidemiol 1988;9:497–500.CrossRefGoogle ScholarPubMed
13. Britt, MR, Schleupner, CJ, Matsumiya, S. Severity of disease as a predictor of nosocomial infections: utility in the control of nosocomial infections. JAMA 1978;2398:1047–1051.CrossRefGoogle Scholar
14. Tager, IB, Ginsberg, MB, Ellis, SE, et al. An epidemiologic study of the risks associated with peripheral intravenous catheters. Am J Epidemiol 1983;118:839–851.Google ScholarPubMed
15. Michael, L, McMichan, JC, Bachy, JL. Microbial colonization of indwelling central venous catheters: statistical evaluation of potential contaminating factors. Am J Surg 1979;137:745–748.Google Scholar
16. Bjornson, HS, Colley, R, Bower, RH, Duty, VP, Schwatz-Fulton, JT, Fisher, JE. Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery 1982;92:720–727.Google ScholarPubMed
17. Wistbacka, JO, Nuutinen, LS. Catheter-related complications of total parenteral nutrition (TPN): a review. Acta Anaesth Scand 1985:29:84–88.Google Scholar