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Nosocomial Infection After Septic Shock Among Intensive Care Unit Patients

Published online by Cambridge University Press:  02 January 2015

Caroline Landelle ,
Alain Lepape ,
Adrien Français ,
Eve Tognet ,
Hélène Thizy ,
Nicolas Voirin ,
Jean François Timsit ,
Guillaume Monneret  and
Philippe Vanhems
Caroline Landelle
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Grenoble, France Hospices Civils de Lyon, and the Epidémiologie et de Santé Publique, Laboratoire de Biométrie et Biologie Evolutive, UMR5558, CNRS, Université Lyon 1, Université de Lyon, Grenoble, France
Alain Lepape
Affiliation:
Service de Réanimation Chirurgicale, Grenoble, France
Adrien Français
Affiliation:
Epidémiologie Pronostique des Cancers et Affections Graves, Inserm U823, Centre de Recherche Institut Albert Bonniot, Grenoble, France
Eve Tognet
Affiliation:
Service de Réanimation Médicale, Grenoble, France
Hélène Thizy
Affiliation:
Hôpital Edouard Herriot, and the Centre d'Investigation Clinique de Lyon, CIC201, Inserm, Hôpital Louis Pradel, Grenoble, France
Nicolas Voirin
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Grenoble, France Hospices Civils de Lyon, and the Epidémiologie et de Santé Publique, Laboratoire de Biométrie et Biologie Evolutive, UMR5558, CNRS, Université Lyon 1, Université de Lyon, Grenoble, France
Jean François Timsit
Affiliation:
Lyon, and the Service de Réanimation Médicale, CHU de Grenoble, Grenoble, France Epidémiologie Pronostique des Cancers et Affections Graves, Inserm U823, Centre de Recherche Institut Albert Bonniot, Grenoble, France
Guillaume Monneret
Affiliation:
Centre Hospitalier de Lyon Sud, and the Laboratoire d'Immunologie, Grenoble, France
Philippe Vanhems*
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Grenoble, France Hospices Civils de Lyon, and the Epidémiologie et de Santé Publique, Laboratoire de Biométrie et Biologie Evolutive, UMR5558, CNRS, Université Lyon 1, Université de Lyon, Grenoble, France
*
Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon F-69437, France (philippe.vanhems@chu-lyon.fr)
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Abstract

Objectives.

To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.

Design.

Prospective cohort study.

Setting.

TWO intensive care units (ICUs) of a French university hospital.

Patients and Methods.

The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.

Results.

Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).

Conclusions.

The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 11 , November 2008 , pp. 1054 - 1065
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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