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Wilke M, Worf K, Preisendörfer B, Heinlein W, Kast T, Bodmann KF. Potential savings through single-dose intravenous Dalbavancin in long-term MRSA infection treatment - a health economic analysis using German DRG data. GMS INFECTIOUS DISEASES 2019; 7:Doc03. [PMID: 31728264 PMCID: PMC6839362 DOI: 10.3205/id000043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Complicated infections such as osteomyelitis, skin and soft tissue infections or endocarditis often require antibiotic therapies that can last up to several weeks. The prolonged hospital length of stay (LOS) leads to a dramatic increase in costs. Single-dose intravenous Dalbavancin is a novel antimicrobial agent for the treatment of acute bacterial skin, skin structure and soft tissue infections (ABSSSI) that allows an earlier discharge of patients, resulting in potential savings. Joint, bone and prostheses infections (JBPI) are also related with long LOS. The aim of this study is to determine the economic effects of single-dose intravenous Dalbavancin in suitable patients with Methicillin-resistant Staphylococcus aureus infections in Germany. For this purpose, an analysis with real-world patient treatment data was performed, which was subsequently validated in a large German hospital. In total, ABSSSI patients with MRSA infections could stay 6.45 days shorter and 2,865 € could be saved while JBPI patients could be discharged eventually 10.6 days earlier and 3,909 € could be saved. Single-dose intravenous Dalbavancin is thus an option for patients with ABSSSI and JBPI who are eligible for discharge.
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Djuric O, Markovic-Denic L, Jovanovic B, Bumbasirevic V. High incidence of multiresistant bacterial isolates from bloodstream infections in trauma emergency department and intensive care unit in Serbia. Acta Microbiol Immunol Hung 2019; 66:307-325. [PMID: 30786727 DOI: 10.1556/030.66.2019.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We investigated the incidence of bloodstream infections (BSIs) in trauma emergency department (ED) and intensive care unit (ICU), to assess ED- and ICU-related predictors of BSI and to describe the most common bacteria causing BSI and their antimicrobial resistance markers. A prospective study was conducted in two trauma ICUs of the ED of Clinical Center of Serbia. Overall, 62 BSIs were diagnosed in 406 patients, of which 13 were catheter-related BSI (3.0/1,000 CVC-days) and 30 BSIs of unknown origin, while 15% were attributed to ED CVC exposure. Lactate ≥2 mmol/L and SOFA score were independent ED-related predictors of BSI, while CVC in place for >7 days and mechanical ventilation >7 days were significant ICU-related predictors. The most common bacteria recovered were Acinetobacter spp., Klebsiella spp., and Pseudomonas aeruginosa. All Staphylococcus aureus and coagulase-negative staphylococci isolates were methicillin-resistant, whereas 66% of Enterococcus spp. were vancomycin-resistant. All isolates of Enterobacteriaceae were resistant to third-generation cephalosporins, whereas 87.5% of P. aeruginosa and 95.8% of Acinetobacter spp. isolates were resistant to carbapenems. ED BSI contributes substantially to overall ICU incidence of BSI. Lactate level and SOFA score can help to identify patients with higher risk of developing BSI. Better overall and CVC-specific control measures in patients with trauma are needed.
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Affiliation(s)
- Olivera Djuric
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- 2 Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Markovic-Denic
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- 2 Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bojan Jovanovic
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- 3 Center for Anaesthesiology, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Vesna Bumbasirevic
- 1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- 3 Center for Anaesthesiology, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia
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Concannon C, van Wijngaarden E, Stevens V, Dumyati G. The Effect of Multiple Concurrent Central Venous Catheters on Central Line–Associated Bloodstream Infections. Infect Control Hosp Epidemiol 2016; 35:1140-6. [DOI: 10.1086/677634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveThe current central line–associated bloodstream infection (CLABSI) surveillance rate calculation does not account for multiple concurrent central venous catheters (CVCs). The presence of multiple CVCs creates more points of entry into the bloodstream, potentially increasing CLABSI risk. Multiple CVCs may be used in sicker patients, making it difficult to separate the relative contributions of multiple CVCs and comorbidities to CLABSI risk. We explored the relative impact of multiple CVCs, patient comorbidities, and disease severity on the risk of CLABSI.DesignCase-control study.SettingA total of 197 case patients and 201 control subjects with a CVC inserted during hospitalization at a tertiary care academic medical center from January 1, 2008, to December 31, 2010.MethodsMultiple CVCs was the exposure of interest; the primary outcome was CLABSI. Multivariable logistic regression was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) describing the association between CLABSI and multiple CVCs with and without controlling for Acute Physiology and Chronic Health Evaluation (APACHE) II and Charlson comorbidity index (CCI) scores as measures of disease severity and patient comorbidities, respectively.ResultsPatients with multiple CVCs (n = 78) showed a 4.2 (95% CI, 2.2–8.4) times greater risk of CLABSI compared with patients with 1 CVC after adjusting for CLABSI risk factors. When including APACHE II and CCI scores, multiple CVCs remained an independent risk factor for CLABSI (OR, 3.4 [95% CI, 1.7–6.9]).ConclusionsMultiple CVCs is an independent risk factor for CLABSI even after adjusting for severity of illness. Adjustment for this risk may be necessary to accurately compare rates between hospitals.Infect Control Hosp Epidemiol 2014;35(9):1140-1146
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Andreasen JJ, Sørensen GV, Abrahamsen ER, Hansen-Nord E, Bundgaard K, Bendtsen MD, Troelsen P. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Eur J Cardiothorac Surg 2015; 49:288-92. [DOI: 10.1093/ejcts/ezv005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/06/2015] [Indexed: 11/14/2022] Open
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Hurley JC. Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis. BMC Infect Dis 2014; 14:714. [PMID: 25551776 PMCID: PMC4300056 DOI: 10.1186/s12879-014-0714-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/11/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Among methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT's) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT's versus the broader evidence base. METHODS Bacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence. RESULTS Within SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 - 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT's versus benchmark groups with data available. CONCLUSIONS The topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates.
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Ozkardesler S, Avkan-Oguz V, Akan M, Unek T, Ozbilgin M, Meseri R, Cimen M, Karademir S. Effects of blood products on nosocomial infections in liver transplant recipients. EXP CLIN TRANSPLANT 2013; 11:530-6. [PMID: 23901878 DOI: 10.6002/ect.2012.0286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Infection is the most severe complication after an organ transplant. Blood cell transfusion is an independent risk factor for adverse events, including infection in the recipient. This study sought to evaluate the effect of blood product transfusions on nosocomial infections in liver transplant patients. MATERIALS AND METHODS Patients who underwent a liver transplant at our hospital between 2003 and 2010 were recruited for this study. Exclusion criteria were incomplete records, patients who were hospitalized for more than 48 hours during the 4 weeks before transplant, and pediatric transplants. Incidence of nosocomial infections, which were defined as infections occurring within 30 days after transplant was the primary endpoint. RESULTS The incidence of nosocomial infections was 28.7%. The number of transfusions of packed red blood cells and fresh frozen plasma was significantly higher in patients with nosocomial infection compared with patients without nosocomial infection (P = .018 and P = .039). Blood products dose-dependently contributed to nosocomial infections. Transfusions of ≥ 7.5 units of red blood cells (odds ratio: 2.8) or ≥ 12.5 units of fresh frozen plasma (odds ratio: 3.27) were associated with nosocomial infections (P = .042 and P = .015). The infection-related mortality rate was 10.3%. CONCLUSIONS Blood product transfusions are associated with an increased rate of nosocomial infections, which contributes to higher morbidity and mortality.
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Affiliation(s)
- Sevda Ozkardesler
- Department of Anesthesiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Jeon CY, Neidell M, Jia H, Sinisi M, Larson E. On the role of length of stay in healthcare-associated bloodstream infection. Infect Control Hosp Epidemiol 2012; 33:1213-8. [PMID: 23143358 DOI: 10.1086/668422] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
DESIGN We conducted a retrospective cohort study to examine the role played by length of hospital stay in the risk of healthcare-associated bloodstream infection (BSI), independent of demographic and clinical risk factors for BSI. PATIENTS We employed data from 113,893 admissions from inpatients discharged between 2006 and 2008. SETTING Large tertiary healthcare center in New York City. METHODS We estimated the crude and adjusted hazard of BSI by conducting logistic regression using a person-day data structure. The covariates included in the fully adjusted model included age, sex, Charlson score of comorbidity, renal failure, and malignancy as static variables and central venous catheterization, mechanical ventilation, and intensive care unit stay as time-varying variables. RESULTS In the crude model, we observed a nonlinear increasing hazard of BSI with increasing hospital stay. This trend was reduced to a constant hazard when fully adjusted for demographic and clinical risk factors for BSI. CONCLUSION The association between longer length of hospital stay and increased risk of infection can largely be explained by the increased duration of stay among those who have underlying morbidity and require invasive procedures. We should take caution in attributing the association between length of stay and BSI to a direct negative impact of the healthcare environment.
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Affiliation(s)
- Christie Y Jeon
- Columbia University School of Nursing, New York, New York, USA.
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El-Masri MM, Oldfield MP. Exploring the influence of enforcing infection control directives on the risk of developing healthcare associated infections in the intensive care unit: a retrospective study. Intensive Crit Care Nurs 2011; 28:26-31. [PMID: 22055396 PMCID: PMC7134889 DOI: 10.1016/j.iccn.2011.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/10/2011] [Accepted: 10/06/2011] [Indexed: 01/24/2023]
Abstract
Background Although strict adherence to infection control strategies is recognised as the simplest and most cost effective method to prevent the spread of healthcare associated infections (HAIs), measurement of the direct impact that such adherence may have on the risk of developing such infections has always been a challenge. Purpose The purpose of this study was to compare the risk of HAIs before and during the SARS outbreak. Such comparison is intended to provide a surrogate measure of the influence that strict enforcement of infection control strategies during the SARS outbreak may have had on the risk of HAIs. Methods A retrospective chart review was conducted on the medical records of 400 intensive care patients who were admitted to the ICU three months before and during the 2003 SARS outbreak. Results The rate of HAIs was higher in the pre-SARS period than the SARS period. Specifically, 61.7% of all reported infections were diagnosed in the pre-SARS period. The rate of HAIs in the pre-SARS period was 14.5% as opposed to 9% during the SARS period. Adjusted logistic regression analysis suggested that the odds of HAIs were 2.2 times higher in the pre-SARS period as compared to the SARS period (OR = 2.2; 95%CI = 1.08–4.49). Conclusion Our findings suggest that strict enforcement of infection control strategies may have a positive impact on the efforts to minimise the risk of HAIs. These findings carry a clinical significance that shall not be ignored with regard to our overall efforts to minimise the risk of developing HAIs in the ICU.
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Affiliation(s)
- Maher M El-Masri
- University of Windsor, Faculty of Nursing, 401 Sunset, Health Education Center, and Hotel Dieu Grace Hospital, Room 328, Windsor, Ontario N9B 3P4, Canada.
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Parsons EC, Hough CL, Seymour CW, Cooke CR, Rubenfeld GD, Watkins TR. Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shock. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R221. [PMID: 21936902 PMCID: PMC3334766 DOI: 10.1186/cc10458] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/25/2011] [Accepted: 09/21/2011] [Indexed: 01/08/2023]
Abstract
Introduction In this study, we sought to determine the association between red blood cell (RBC) transfusion and outcomes in patients with acute lung injury (ALI), sepsis and shock. Methods We performed a secondary analysis of new-onset ALI patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial (2000 to 2005) who had a documented ALI risk factor of sepsis or pneumonia and met shock criteria (mean arterial pressure (MAP) < 60 mmHg or vasopressor use) within 24 hours of randomization. Using multivariable logistic regression, we examined the association between RBC transfusion and 28-day mortality after adjustment for age, sex, race, randomization arm and Acute Physiology and Chronic Health Evaluation III score. Secondary end points included 90-day mortality and ventilator-free days (VFDs). Finally, we examined these end points among the subset of subjects meeting prespecified transfusion criteria defined by five simultaneous indicators: hemoglobin < 10.2 g/dL, central or mixed venous oxygen saturation < 70%, central venous pressure ≥ 8 mmHg, MAP ≥ 65 mmHg, and vasopressor use. Results We identified 285 subjects with ALI, sepsis, shock and transfusion data. Of these, 85 also met the above prespecified transfusion criteria. Fifty-three (19%) of the two hundred eighty-five subjects with shock and twenty (24%) of the subset meeting the transfusion criteria received RBC transfusion within twenty-four hours of randomization. We found no independent association between RBC transfusion and 28-day mortality (odds ratio = 1.49, 95% CI (95% confidence interval) = 0.77 to 2.90; P = 0.23) or VFDs (mean difference = -0.35, 95% CI = -4.03 to 3.32; P = 0.85). Likewise, 90-day mortality and VFDs did not differ by transfusion status. Among the subset of patients meeting the transfusion criteria, we found no independent association between transfusion and mortality or VFDs. Conclusions In patients with new-onset ALI, sepsis and shock, we found no independent association between RBC transfusion and mortality or VFDs. The physiological criteria did not identify patients more likely to be transfused or to benefit from transfusion.
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Affiliation(s)
- Elizabeth C Parsons
- Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA.
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Abstract
OBJECTIVES In children with severe sepsis or septic shock, the optimal red blood cell transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis and transfusion requirements in a pediatric intensive care unit study to determine the impact of a restrictive vs. liberal transfusion strategy on clinical outcome. DESIGN Subgroup analysis of a prospective, multicenter, randomized, controlled trial. SETTING Multicenter pediatric critical care units. PATIENTS Stabilized critically ill children (mean systemic arterial pressure >2 sd below normal mean for age and cardiovascular support not increased for at least 2 hrs before enrollment) with a hemoglobin ≤ 9.5 g/dL within 7 days after pediatric critical care unit admission. INTERVENTIONS One hundred thirty-seven stabilized critically ill children with sepsis were randomized to receive red blood cell transfusion if their hemoglobin decreased to either <7.0 g/dL (restrictive group) or 9.5 g/dL (liberal group). MEASUREMENTS AND MAIN RESULTS In the restrictive group (69 patients), 30 patients did not receive any red blood cell transfusion, whereas only one patient in the liberal group (68 patients) never underwent transfusion (p < .01). No clinically significant differences were found for the occurrence of new or progressive multiple organ dysfunction syndrome (18.8% vs. 19.1%; p = .97), for pediatric critical care unit length of stay (p = .74), or for pediatric critical care unit mortality (p = .44) in the restrictive vs. liberal group. CONCLUSIONS In this subgroup analysis of children with stable sepsis, we found no evidence that a restrictive red cell transfusion strategy, as compared to a liberal one, increased the rate of new or progressive multiple organ dysfunction syndromes. Furthermore, a restrictive transfusion threshold significantly reduced exposure to blood products. Our data suggest that a hemoglobin level of 7.0 g/dL may be safe stabilized for children with sepsis, but further studies are required to support this recommendation.
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Glance LG, Stone PW, Mukamel DB, Dick AW. Increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 2011; 146:794-801. [PMID: 21422331 PMCID: PMC3336161 DOI: 10.1001/archsurg.2011.41] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To explore the clinical impact and economic burden of hospital-acquired infections (HAIs) in trauma patients using a nationally representative database. DESIGN Retrospective study. SETTING The Healthcare Cost and Utilization Project Nationwide Inpatient Sample. PATIENTS Trauma patients. MAIN OUTCOME MEASURES We examined the association between HAIs (sepsis, pneumonia, Staphylococcus infections, and Clostridium difficile- associated disease) and in-hospital mortality, length of stay, and inpatient costs using logistic regression and generalized linear models. RESULTS After controlling for patient demographics, mechanism of injury, injury type, injury severity, and comorbidities, we found that mortality, cost, and length of stay were significantly higher in patients with HAIs compared with patients without HAIs. Patients with sepsis had a nearly 6-fold higher odds of death compared with patients without an HAI (odds ratio, 5.78; 95% confidence interval, 5.03-6.64; P < .001). Patients with other HAIs had a 1.5- to 1.9-fold higher odds of mortality compared with controls (P < .005). Patients with HAIs had costs that were approximately 2- to 2.5-fold higher compared with patients without HAIs (P < .001). The median length of stay was approximately 2-fold higher in patients with HAIs compared with patients without HAIs (P < .001). CONCLUSIONS Trauma patients with HAIs are at increased risk for mortality, have longer lengths of stay, and incur higher inpatient costs. In light of the preventability of many HAIs and the magnitude of the clinical and economic burden associated with HAIs, policies aiming to decrease the incidence of HAIs may have a potentially large impact on outcomes in injured patients.
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Affiliation(s)
- Laurent G Glance
- Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY 14642, USA.
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Niven D, Fick G, Kirkpatrick A, Grant V, Laupland K. Cost and outcomes of nosocomial bloodstream infections complicating major traumatic injury. J Hosp Infect 2010; 76:296-9. [DOI: 10.1016/j.jhin.2010.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 06/10/2010] [Indexed: 11/29/2022]
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Are red blood cell transfusions associated with nosocomial infections in pediatric intensive care units? Pediatr Crit Care Med 2010; 11:464-8. [PMID: 20081555 DOI: 10.1097/pcc.0b013e3181ce708d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether red blood cell transfusion is similarly associated with nosocomial infections in pediatric intensive care unit patients and whether reduced lymphocyte numbers is a possible mechanism. In adult studies, red blood cell transfusions are associated with nosocomial infections. DESIGN Historical cohort study. SETTING Single-center, mixed medical-surgical, closed pediatric intensive care unit of a tertiary university-affiliated children's hospital. PATIENTS All patients < or = 18 yrs old admitted to the pediatric intensive care unit during a 6-month period from January 1 to July 3, 2005. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Nosocomial infections (respiratory, urinary tract, and bloodstream infections) were the primary outcome measure and were defined as post transfusion if occurring within 14 days after red blood cell transfusion. Of the 209 subjects enrolled, 32 (15%) acquired nosocomial infections and 45 (22%) received red blood cell transfusions. Patients with versus without nosocomial infections had received red blood cell transfusions significantly more often (odds ratio, 18.0; 95% confidence interval, 7.6-45.9; p < .001). In a dose-dependence analysis, we found that patients receiving > or = 3 red blood cell transfusions had a similar prevalence of nosocomial infections compared with those receiving one to two red blood cell transfusions (61% vs. 44%, p = .365), but greater mortality (22% vs. 0%, p = .04). In a multiple logistic regression analysis controlling for gender, age, pediatric intensive care unit length of stay, presence of an invasive catheter, mechanical ventilation, and surgery, red blood cell transfusion remained independently associated with risk of nosocomial infection (odds ratio, 3.73; 95% confidence interval, 1.19-11.85, p = .023). Transfused subjects had lower absolute lymphocyte counts compared with nontransfused subjects (1605 vs. 2054/microL, p = .041), but similar total white blood cell counts (10.4 vs. 11.4 x 10/microL, p = .52). CONCLUSION Red blood cell transfusion in pediatric intensive care unit patients is associated with an increased risk of nosocomial infections.
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Al-Rawajfah OM, Stetzer F, Hewitt JB. Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. Infect Control Hosp Epidemiol 2010; 30:1036-44. [PMID: 19780675 DOI: 10.1086/606167] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported. OBJECTIVE The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample. METHODS This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and case-fatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI. RESULTS The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R(2) was 0.22. CONCLUSIONS The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.
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Duggan JM. Gastrointestinal hemorrhage: should we transfuse less? Dig Dis Sci 2009; 54:1662-6. [PMID: 19034655 DOI: 10.1007/s10620-008-0561-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 09/26/2008] [Indexed: 01/05/2023]
Abstract
Although blood transfusion has an established place in the conventional management of acute upper gastrointestinal (GI) hemorrhage, there is growing evidence of adverse side effects of transfusion, both acute and later. An Ovid Medline literature search was performed to evaluate the significance and importance of these effects. Evidence of impaired hemostasis with repletion of blood volume in the acute phase was found in multiple studies and in uncontrolled studies in combat casualties. There are multiple large studies of a so-called immunosuppressive effect of transfused blood leading to increased infection rates and mortality dependent both on dose and on the age of the stored blood. In view of evidence of increased bleeding with early blood volume restoration and the growing evidence of so-called immunosuppressive effects of stored blood, there is a need to consider trials using a conservative utilization of blood in acute GI bleeding.
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Affiliation(s)
- John M Duggan
- Division of Clinical Practice and Population Health, Faculty of Health Sciences, Newcastle University, Newcastle, 2308, Australia.
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Examining the association between chest tube-related factors and the risk of developing healthcare-associated infections in the ICU of a community hospital: a retrospective case-control study. Intensive Crit Care Nurs 2008; 25:38-44. [PMID: 18693112 DOI: 10.1016/j.iccn.2008.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 06/05/2008] [Accepted: 07/01/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The study examined the association between chest tube-related factors and the risk for developing healthcare-associated infections (HAI). RESEARCH METHODOLOGY A case-control retrospective chart review was performed on 120 intensive care patients. Eligible patients were 18 years of age or older, had been in the intensive care unit (ICU) for 48 h or more, and had one or more chest tubes. SETTING A 20-bed medical-surgical intensive care unit (ICU) of a community hospital in south-western Ontario, Canada. MAIN OUTCOME MEASURES Documented diagnosis of hospital-acquired pneumonia or bloodstream infection. RESULTS The variable chest tube days was the only chest tube-related factor that was independently associated with HAI (OR = 5.78; p = 0.013). Mechanical ventilation (OR = 4.88; p = 0.002) and outcome length of stay (OR = 0.72; p < or = 0.001) were also independently associated with HAI. CONCLUSIONS The risk of infection among patients with chest tubes increases as the number of chest tube days increases. Infection is likely to happen early during admission, which necessitates stringent adherence to infection control strategies, especially during that time frame.
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Abstract
PURPOSE OF REVIEW To evaluate recent literature describing the potential relation between transfusion practice in the intensive care unit and the subsequent risk for nosocomial infection. RECENT FINDINGS Multiple studies have documented that patients in the intensive care unit often receive transfusions of packed red blood cells while in the intensive care unit. Although the safety of the blood supply has increased substantially over the last decade, nosocomial infection is emerging as an unappreciated potential consequence of transfusion. Research now suggests that transfusion alters the host's immune system. Clinically, this may lead to relative immunosuppression and result in nosocomial infection. Supporting this hypothesis, an association between infection and transfusion has been shown in various settings and for several different types of infections. In both postoperative and medical intensive care unit subjects, administration of packed red blood cell consistently raises the risk for infection. Similarly, transfusion rates correlate with two major nosocomial complications in the intensive care unit: pneumonia and bloodstream infection. Proof of causation remains elusive because of study design issues. Nonetheless, the weight of the evidence favors adding nosocomial infection to the list of potential risks related to packed red blood cell transfusion. SUMMARY Packed red blood cell transfusion may substantially increase the risk for nosocomial infection. The likely link between transfusion practice and nosocomial infection should factor into the provider's decision when determining when to transfuse.
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Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine Section, Washington Hospital Center, Washington, DC 20010, USA.
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El-Masri MM, Hammad TA, Fox-Wasylyshyn SM. Predicting Nosocomial Bloodstream Infections Using Surrogate Markers of Injury Severity. Nurs Res 2005; 54:273-9. [PMID: 16027570 DOI: 10.1097/00006199-200507000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Injury severity indices are numerical scores that are utilized to predict nosocomial bloodstream infections (BSI) in critically ill patients. However, surrogate markers of injury severity (SMIS) may be more clinically meaningful than these commonly used numerical injury severity indices with respect to the control and prevention of nosocomial BSI. OBJECTIVE The purpose of this study was to demonstrate the clinical and research implications of using the SMIS in predicting nosocomial BSI. METHOD A prospective nonexperimental cohort study was conducted on 361 critically ill trauma patients. Three logistic regression models were examined for their clinical relevance and statistical parsimony. The first model included the Injury Severity Score (ISS) and 5 other independent predictors, and excluded the SMIS. The second model included all study variables. The third model excluded the ISS. RESULTS The analysis suggested that number of blood units transfused, number of central venous catheters inserted, and use of chest tube(s) were the SMIS. The ISS was found to be an independent predictor of nosocomial BSI only when the SMIS were not included in the model. The model that included the SMIS and excluded the ISS explained the highest variance in nosocomial BSI and had the best negative predictive value (93%). DISCUSSION Clinicians can use knowledge of SMIS to develop interventions that minimize the risk of nosocomial BSI. Hence, the SMIS can serve not only as a prediction tool but also as a way to enhance control and prevention strategies for BSI.
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Affiliation(s)
- Maher M El-Masri
- University of Windsor, Faculty of Nursing, Windsor, Ontario, Canada.
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