Article

Risk of Mortality with a Bloodstream Infection Is Higher in the Less Severely Ill at Admission

Johns Hopkins University, Baltimore, Maryland, United States
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 04/2005; 171(6):616-20. DOI: 10.1164/rccm.200407-916OC
Source: PubMed

ABSTRACT

Health care-associated bloodstream infections are common in critically ill patients; however, investigators have had difficulty in quantifying the clinical impact of these infections given the high expected mortality among these patients.
To estimate the impact of health care-associated bloodstream infections on in-hospital mortality after adjusting for severity of illness at critical care admission.
A cohort of medical and surgical intensive care unit patients.
Severity of illness at admission, bloodstream infection, and in-hospital mortality.
Among the 2,783 adult patients, 269 developed unit-associated bloodstream infections. After adjusting for severity of illness, patients with a lower initial severity of illness who developed an infection had a greater than twofold higher risk for in-hospital mortality (hazard ratio [HR] = 2.42, 95% confidence interval [CI] 1.70, 3.44) when compared with patients without infection and with a similar initial severity of illness. In contrast, patients with a higher initial severity of illness who subsequently developed an infection did not have an increased risk for in-hospital mortality (HR = 0.96, 95%CI 0.76, 1.23) when compared with patients without infection but with a similar initial severity of illness.
These results suggest that these infections in less ill patients have a higher attributable impact on subsequent mortality than in more severely ill patients. Focusing interventions to prevent bloodstream infections in less severely ill patients would be expected to have a greater benefit in terms of mortality reduction.

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