Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Sep 21:15:125.
doi: 10.1186/s12871-015-0106-9.

Epidemiology, associated factors and outcomes of ICU-acquired infections caused by Gram-negative bacteria in critically ill patients: an observational, retrospective study

Cosimo Chelazzi  1 , Eleonora Pettini  2 , Gianluca Villa  3 , A Raffaele De Gaudio  4
Affiliations
Observational Study

Epidemiology, associated factors and outcomes of ICU-acquired infections caused by Gram-negative bacteria in critically ill patients: an observational, retrospective study

Cosimo Chelazzi et al. BMC Anesthesiol. .

Abstract

Background: Gram-negative bacteria are increasingly responsible for nosocomial infections, including ICU-acquired infections. Due to high virulence, rate of multi-drug resistance and limited availability of new agents, these infections create cumbersome clinical burdens, making it important to reduce the risk of their occurrence. The aim of the study was to assess epidemiology-related factors and outcomes of Gram-negative, ICU-acquired infections in a cohort of medical-surgical patients.

Methods: A retrospective survey was conducted on all patients admitted to a mixed ICU from January 2012 to December 2013. 'ICU-acquired infections' were defined as new infections acquired no less than 48 h after ICU admission. Diagnosis was made according to the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC/NHSN) criteria. Differences across patients who did and did not acquire a Gram-negative infection were tested regarding age, sex, body mass index, medical or surgical admission, cardiovascular comorbidities, chronic obstructive pulmonary disease, diabetes, end-stage renal failure, co-existing tumours and prophylactic anti-fungal treatment. Multivariate analysis was used to assess the independency of these associations. Finally, differences in ICU-mortality, ICU-length of stay and duration of mechanical ventilation were tested across patients with and without new, ICU-acquired, Gram-negative infections.

Results: Of 494 patients admitted to the ICU, 46 (9.3 %) acquired an infection 48 or more hours after admittance. In 30/46 patients (65.2 %) the isolated bacterium was Gram-negative. Univariate analysis showed that clinical factors associated with new ICU-acquired Gram-negative infections were medical admission (p < 0.001, 95 % CI 0.59 - 0.29, OR = 0.13), chronic kidney disease (p = 0.018, 95 % CI 1.20 - 7.34, OR = 2.98) and prophylactic antifungal therapy (p < 0.001, 95 % CI 1.91 - 9.79, OR = 4.33). At multivariate analysis, only medical admission and prophylactic antifungal therapy were significantly associated with ICU-acquired Gram-negative infections. Higher ICU-length of stay and longer duration of mechanical ventilation were associated with these infections while ICU-mortality did not significantly differ.

Conclusions: ICU-acquired Gram-negative infections were common in a cohort of mixed medical-surgical patients. Only medical admission and anti-fungal prophylaxis were found to be independently associated with these infections; they were not found to have a significant effect on ICU-mortality.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Primary ICU-acquired Gram-negative infections
Fig. 2
Fig. 2
Sites of primary ICU-acquired Gram-negative infections
See this image and copyright information in PMC

References

    1. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the Prevalence and Outcomes of Infection in Intensive Care Units. JAMA. 2009;302(21):2323–9. doi: 10.1001/jama.2009.1754. - DOI - PubMed
    1. Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care. 2011;1:47. doi: 10.1186/2110-5820-1-47. - DOI - PMC - PubMed
    1. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(1):1–12. doi: 10.1086/595011. - DOI - PubMed
    1. Fagon JY, Novara A, Stephan F, Girou E, Safar M. Mortality attributable to nosocomial infections in the ICU. Infect Control Hosp Epidemiol. 1994;15(7):428–34. doi: 10.2307/30148490. - DOI - PubMed
    1. Vosylius S, Sipylaite J, Ivaskevicius J. Intensive care unit acquired infection: a prevalence and impact on morbidity and mortality. Acta Anaesthesiol Scand. 2003;47:1132–7. doi: 10.1034/j.1399-6576.2003.00230.x. - DOI - PubMed

Publication types

Substances

LinkOut - more resources