Clinical and Economic Outcomes in Critically Ill Patients with Nosocomial Catheter-Related Bloodstream Infections
Stijn I. Blot,1,3 Pieter Depuydt,1 Lieven Annemans,4 Dominique Benoit,1 Eric Hoste,1,3 Jan J. De Waele,1 Johan Decruyenaere,1 Dirk Vogelaers,2 Francis Colardyn,1 and Koenraad H. Vandewoude1,3
1 Intensive Care Department and 2Department of Infectious Diseases, Ghent University Hospital, 3Hogeschool Gent, Health Care Department “Vesalius,” and 4Public Health, Ghent University, Ghent, Belgium
Background. Central venous catheters are universally used during the treatment of critically ill patients. Their use, however, is associated with a substantial infection risk, potentially leading to increased mortality and costs. We evaluate clinical and economic outcomes associated with nosocomial central venous catheter–related bloodstream infection (CR-BSI) in intensive care unit (ICU) patients. Methods. A retrospective (1992–2002), pairwise-matched (ratio of case patients to control subjects, 1:2 or 1: 1), risk-adjusted cohort study was performed at a 54-bed general ICU at a university hospital. ICU patients with microbiologically documented CR-BSI (n p 176 ) were matched with control subjects (n p 315 ) on the basis of disease severity, diagnostic category, and length of ICU stay (equivalent or longer) before the onset of CR-BSI in the index case patient. Clinical outcome was principally evaluated by in-hospital mortality. Economic outcome was evaluated on the basis of duration of mechanical ventilation, length of ICU and hospital stays, and total hospital costs, as derived from the patient’s hospital invoices. Results. The attributable mortality rate for CR-BSI was estimated to be 1.8% (95% conﬁdence interval, 6.4% to 10.0%); in-hospital mortality rates for patients with CR-BSI and matched control subjects were 27.8% and 26.0%, respectively. CR-BSI was associated with signiﬁcant excesses in duration of mechanical ventilation, duration of... [continues]
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