Scholarlink

Objectives <p>Intensive care unit (ICU) patients have an increased risk of bacteremia. We aimed to investigate the 5-year outcome of ICU-acquired infections comparing them with ICU patients without new infections. Our second aim was to compare the outcome of Gram-positive, Gram-negative and fungal ICU-acquired bloodstream infections (BSIs).</p> Methods <p>This single-center retrospective registry study occurred in an academic teaching hospital during 2000–2017 in a mixed adult ICU consisting of patients who stayed longer than 48&#xa0;h in the ICU. Data was retrieved from the ICU and hospital electronic data management systems. Three groups were included: no infection and no new antimicrobial treatment, a new ICU-acquired infection with negative blood cultures (BCs), and a new ICU-acquired BSI. A multivariable-adjusted Cox proportional hazards model was used to determine the impact of ICU-acquired infection on 5-year mortality.</p> Results <p>1857 had no infection and 768 developed an ICU-acquired infection with positive BCs in 195 cases (25.4%). The adjusted HR was 2.03 (95% CI from 1.76–2.35, p &lt; 0.001) for the impact of ICU-acquired infection on 5-year mortality. The highest median sequential organ failure assessment (SOFA) was 7.0 (5.0–8.0) for the no-infection group, 9.0 (7.0–10.0) for the BC-negative ICU-acquired infection group, and 12.0 (9.0–15.0) for the ICU-acquired BSI patients (p &lt; 0.001). The crude 30-day mortalities in the no-infection, the BC-negative, and the BSI groups were 98 (5.5%), 58 (10.1%), and 51 (26.0%), respectively (p &lt; 0.001). The highest median SOFA for Gram-positive BSIs was 11.0 (8.0–13.0), for Gram-negative BSIs 13.0 (11.0–16.0), and for fungal BSIs 12.5 (10.0–16.0) (p = 0.01). The need for RRT was 23.2% (19) in Gram-positive, 29.8% (14) in Gram-negative, and 48.1% (25) in fungal BSIs (p = 0.01). The crude ICU-mortalities were 12.2% (10) in Gram-positive BSIs, 31.9% (15) in Gram-negative BSIs, and 11.5% (6) in fungal BSIs (p = 0.008). Patients with fungal BSI had the worst 5-year outcome, whereas the long-term outcome did not differ between Gram-positive and Gram-negative BSIs.</p> Conclusions <p>Patients with ICU-acquired infections had three times higher 5-year mortality than non-infected ICU patients. ICU-acquired Gram-negative BSIs had the highest ICU mortality, whereas the long-term outcome did not differ between Gram-negative and Gram-positive ICU-acquired BSIs. Fungal BSI showed the worst long-term outcome.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Long-term outcomes of ICU-acquired infections with a focus on bloodstream infections: a single-center retrospective registry study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年8月13日

查看全文
  • Tero I. Ala-Kokko,
  • Jaana M. Karhu,
  • Pasi Lehto,
  • Sinikka Sälkiö,
  • Pasi Ohtonen,
  • Hannu Syrjälä

摘要

Objectives

Intensive care unit (ICU) patients have an increased risk of bacteremia. We aimed to investigate the 5-year outcome of ICU-acquired infections comparing them with ICU patients without new infections. Our second aim was to compare the outcome of Gram-positive, Gram-negative and fungal ICU-acquired bloodstream infections (BSIs).

Methods

This single-center retrospective registry study occurred in an academic teaching hospital during 2000–2017 in a mixed adult ICU consisting of patients who stayed longer than 48 h in the ICU. Data was retrieved from the ICU and hospital electronic data management systems. Three groups were included: no infection and no new antimicrobial treatment, a new ICU-acquired infection with negative blood cultures (BCs), and a new ICU-acquired BSI. A multivariable-adjusted Cox proportional hazards model was used to determine the impact of ICU-acquired infection on 5-year mortality.

Results

1857 had no infection and 768 developed an ICU-acquired infection with positive BCs in 195 cases (25.4%). The adjusted HR was 2.03 (95% CI from 1.76–2.35, p < 0.001) for the impact of ICU-acquired infection on 5-year mortality. The highest median sequential organ failure assessment (SOFA) was 7.0 (5.0–8.0) for the no-infection group, 9.0 (7.0–10.0) for the BC-negative ICU-acquired infection group, and 12.0 (9.0–15.0) for the ICU-acquired BSI patients (p < 0.001). The crude 30-day mortalities in the no-infection, the BC-negative, and the BSI groups were 98 (5.5%), 58 (10.1%), and 51 (26.0%), respectively (p < 0.001). The highest median SOFA for Gram-positive BSIs was 11.0 (8.0–13.0), for Gram-negative BSIs 13.0 (11.0–16.0), and for fungal BSIs 12.5 (10.0–16.0) (p = 0.01). The need for RRT was 23.2% (19) in Gram-positive, 29.8% (14) in Gram-negative, and 48.1% (25) in fungal BSIs (p = 0.01). The crude ICU-mortalities were 12.2% (10) in Gram-positive BSIs, 31.9% (15) in Gram-negative BSIs, and 11.5% (6) in fungal BSIs (p = 0.008). Patients with fungal BSI had the worst 5-year outcome, whereas the long-term outcome did not differ between Gram-positive and Gram-negative BSIs.

Conclusions

Patients with ICU-acquired infections had three times higher 5-year mortality than non-infected ICU patients. ICU-acquired Gram-negative BSIs had the highest ICU mortality, whereas the long-term outcome did not differ between Gram-negative and Gram-positive ICU-acquired BSIs. Fungal BSI showed the worst long-term outcome.