This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (49)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Bacterial Infections  • Critical Care/ Intensive Care Medicine  • Surgery  • Surgical Physiology  • Surgical Infections  • Prognosis/ Outcomes  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Stephan Harbarth, MD,MS; Karin Ferrière, MD; Stéphane Hugonnet, MD,MS; Bara Ricou, MD; Peter Suter, MD; Didier Pittet, MD,MS

Arch Surg. 2002;137:1353-1359.

Hypothesis  A set of clinical variables available at the bedside can be used to predict outcome in critically ill patients with bloodstream infection (BSI).

Design  A 3-year retrospective cohort study.

Setting  A surgical intensive care unit in Switzerland.

Patients  All patients with BSI were potentially eligible.

Main Outcome Measures  Clinical variables, organ dysfunctions, and outcome.

Results  Among 4530 admissions to the surgical intensive care unit, 224 clinically significant episodes of BSI were recorded (incidence, 4.9%), with a 28-day fatality of 36%. A total of 110 patients had primary bacteremia, of which 39 (35%) were catheter related. Although gram-positive organisms were the most frequently isolated pathogens (58% [159/275]), they were associated with lower case-fatality (30%) than BSI due to gram-negative bacteria (44%). Organ dysfunctions associated with the highest risk of death were neurologic dysfunction (hazard ratio [HR], 6.9; 95% confidence interval [CI], 3.3-14.5), hepatic dysfunction (HR, 3.9; 95% CI, 2.1-7.4), and disseminated intravascular coagulation (HR, 3.0; 95% CI, 1.5-6.1). By multivariate analysis, 2 independent predictors of mortality were the APACHE II (Acute Physiology and Chronic Health Evaluation II) score at onset of BSI (HR per 1-point increase, 1.08; 95% CI, 1.04-1.12) and the number of evolving organ dysfunctions (HR, 1.4; 95% CI, 1.2-1.7). Appropriate antimicrobial therapy was associated with improved outcome (HR, 0.4; 95% CI, 0.2-0.6).

Conclusions  Bloodstream infection in critically ill patients is a common and frequently fatal condition. Its outcome can be predicted by the severity of illness at onset of BSI and the number of organ dysfunctions evolving thereafter. Appropriate antimicrobial therapy is an important determinant for survival.

From the Infection Control Program (Drs Harbarth, Hugonnet, and Pittet) and the Departments of Internal Medicine (Drs Harbarth, Ferrière, and Pittet) and Anesthesiology, Pharmacology, and Surgical Intensive Care (Drs Ricou and Suter), University of Geneva Hospitals, Geneva, Switzerland.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Epidemiology and Prognostic Determinants of Bloodstream Infections in Surgical Intensive Care—Invited Critique
Ronald V. Maier
Arch Surg. 2002;137(12):1359.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Clinical implications of antimicrobial resistance for therapy
MacGowan and on behalf of the BSAC Working Parties on Resistanc
J Antimicrob Chemother 2008;62:ii105-ii114.
ABSTRACT | FULL TEXT  

Predictors of 30-Day Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: Impact of Delayed Appropriate Antibiotic Selection
Lodise et al.
Antimicrob. Agents Chemother. 2007;51:3510-3515.
ABSTRACT | FULL TEXT  

Health Care-Associated Pneumonia and Community-Acquired Pneumonia: a Single-Center Experience
Micek et al.
Antimicrob. Agents Chemother. 2007;51:3568-3573.
ABSTRACT | FULL TEXT  

Biofilm Production by Candida Species and Inadequate Antifungal Therapy as Predictors of Mortality for Patients with Candidemia
Tumbarello et al.
J. Clin. Microbiol. 2007;45:1843-1850.
ABSTRACT | FULL TEXT  

Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem
Pfaller and Diekema
Clin. Microbiol. Rev. 2007;20:133-163.
ABSTRACT | FULL TEXT  

Delaying the Empiric Treatment of Candida Bloodstream Infection until Positive Blood Culture Results Are Obtained: a Potential Risk Factor for Hospital Mortality
Morrell et al.
Antimicrob. Agents Chemother. 2005;49:3640-3645.
ABSTRACT | FULL TEXT  

Pseudomonas aeruginosa Bloodstream Infection: Importance of Appropriate Initial Antimicrobial Treatment
Micek et al.
Antimicrob. Agents Chemother. 2005;49:1306-1311.
ABSTRACT | FULL TEXT  

Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001-2002: the BSAC Bacteraemia Resistance Surveillance Programme
Reynolds et al.
J Antimicrob Chemother 2004;53:1018-1032.
ABSTRACT | FULL TEXT  

Treatment and outcome of Pseudomonas aeruginosa bacteraemia: an antibiotic pharmacodynamic analysis
Zelenitsky et al.
J Antimicrob Chemother 2003;52:668-674.
ABSTRACT | FULL TEXT  

Acute Respiratory Distress Syndrome after Bacteremic Sepsis Does Not Increase Mortality
Eggimann et al.
Am. J. Respir. Crit. Care Med. 2003;167:1210-1214.
ABSTRACT | FULL TEXT