acquired bloodstream infection in the intensive care unit incidence and attributable mortality在重症监护病房感染血液引起发病率和死亡率.pdfVIP

Prowle et al. Critical Care 2011, 15:R100 /content/15/2/R100 RESEARCH Open Access Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality 1 1 1 2 3 3 John R Prowle , Jorge E Echeverri , E Valentina Ligabo , Norelle Sherry , Gopal C Taori , Timothy M Crozier , 1 4 5 2 1,6* Graeme K Hart , Tony M Korman , Barrie C Mayall , Paul DR Johnson , Rinaldo Bellomo Abstract Introduction: To estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on hospital mortality. Methods: We retrospectively studied acquisition of BSI during admissions of 72 hours to adult ICUs from two university-affiliated hospitals. We obtained demographics, illness severity and co-morbidity data from ICU databases and microbiological diagnoses from departmental electronic records. We assessed survival at hospital discharge or at 90 days if still hospitalized. Results: We identified 6339 ICU admissions, 330 of which were complicated by BSI (5.2%). Median time to first positive culture was 7 days (IQR 5-12). Overall mortality was 23.5%, 41.2% in patients with BSI and 22.5% in those without. Patients who developed BSI had higher illness severity at ICU admission (median APACHE III score: 79 vs. 68, P 0.001). After controlling for illness severity and baseline demographics by Cox proportional-hazard model, BSI remained independently associated with risk of death (hazard ratio from diagnosis 2.89; 95% confidence interval 2.41-3.46; P 0.001). However, only 5% of the deaths in this model could be attributed to acquired-BSI,