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. 2025 Aug 13.
doi: 10.1007/s15010-025-02621-w. Online ahead of print.

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

Tero I Ala-Kokko  1   2 , Jaana M Karhu  3   4 , Pasi Lehto  3   4 , Sinikka Sälkiö  3 , Pasi Ohtonen  4   5 , Hannu Syrjälä  3   4
Affiliations

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

Tero I Ala-Kokko et al. Infection. .

Abstract

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.

Keywords: ICU-acquired bacteremia; ICU-acquired infections; Long-term outcomes.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no competing interests. Ethical approval and consent to participate: The study protocol was accepted by the hospital administration (1/2019, 240/2023) and the Digital and Population Data Service Agency (DVV/5100/2023-3). Under Finnish law, a medical registry study does not require ethics committee approval because it involves the use of existing, anonymized data collected for clinical purposes, rather than direct interaction with patients or intervention in their care. According to the Medical Research Act (488/1999), ethical review is required for medical research involving intervention in the integrity of a person. Since registry studies do not involve such interventions, they are exempt from this requirement.

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