Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

被引:40
作者
Januel, Jean-Marie [1 ,5 ]
Harbarth, Stephan [6 ]
Allard, Robert [7 ]
Voirin, Nicolas [1 ]
Lepape, Alain [2 ]
Allaouchiche, Bernard [2 ]
Guerin, Claude [2 ]
Lehot, Jean-Jacques [2 ]
Robert, Marc-Olivier [2 ]
Fournier, Gerard [2 ]
Jacques, Didier [2 ]
Chassard, Dominique [2 ]
Gueugniaud, Pierre-Yves [2 ]
Artru, Francois [2 ]
Petit, Paul [2 ]
Robert, Dominique [2 ]
Mohammedi, Ismael [2 ]
Girard, Raphaelle [3 ]
Cetre, Jean-Charles [3 ]
Nicolle, Marie-Christine [3 ]
Grando, Jacqueline [3 ]
Fabry, Jacques [1 ,4 ]
Vanhems, Philippe [1 ,4 ]
机构
[1] Univ Lyon 1, CNRS, UMR 5558, Lab Biometry & Evolutionary Biol, F-69365 Lyon, France
[2] Univ Hosp, Intens Care Units, Lyon, France
[3] Univ Hosp, Infect Control Units, Lyon, France
[4] Univ Hosp, Hosp Civils Lyon, Edouard Herriot Hosp, Dept Epidemiol Hyg & Prevent, Lyon, France
[5] Univ Lausanne, Univ Hosp Ctr Vaud, Inst Social & Prevent Med, Hlth Care Evaluat Unit, CH-1005 Lausanne, Switzerland
[6] Geneva Univ Hosp & Med Sch, Infect Control Program, Geneva, Switzerland
[7] Ctr Infect Dis, Dept Social & Prevent Med, Publ Hlth Unit, Montreal, PQ, Canada
关键词
CRITICALLY-ILL PATIENTS; RISK-FACTORS; EXPOSURE OPPORTUNITY; PROPORTION; SMOKING; COSTS;
D O I
10.1086/650754
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
BACKGROUND. The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. OBJECTIVE. To assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. SETTING. Eleven ICUs of a French university hospital. DESIGN. We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was defined as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. RESULTS. Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%-14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. CONCLUSIONS. ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.
引用
收藏
页码:388 / 394
页数:7
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