JSTOR: Infection Control and Hospital Epidemiology, Vol. 20, No. 6 (June 1999), pp. 396-401

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Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America

Article DOI: 10.1086/501639

Stable URL: http://www.jstor.org/stable/10.1086/501639

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Original Articles

Attributable Morbidity and Mortality of Catheter‐Related Septicemia in Critically Ill Patients: A Matched, Risk‐Adjusted, Cohort Study

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Abstract(back to top)

OBJECTIVE. To determine the attributable risk of death due to catheter‐related septicemia (CRS) in critically ill patients when taking into account severity of illness during the intensivecare unit (ICU) stay but before CRS.

DESIGN. Pairwise‐matched (1:2) exposed‐unexposed study.

SETTING. 10‐bed medical‐surgical ICU and an 18‐bed medical ICU.

PATIENTS. Patients admitted to either ICU between January 1, 1990, and December 31, 1995, were eligible. Exposed patients were defined as patients with CRS; unexposed controls were selected according to matching variables.

METHODS. Matching variables were diagnosis at ICU admission, length of central catheterization before the infection, McCabe Score, Simplified Acute Physiologic Score (SAPS) II at admission, age, and gender. Severity scores (SAPS II, Organ System Failure Score, Organ Dysfunction and Infection Score, and Logistic Organ Dysfunction System) were calculated four times for each patient: the day of ICU admission, the day of CRS onset, and 3 and 7 days before CRS. Matching was successful for 38 exposed patients. Statistical analysis was based on nonparametric tests for epidemiological data and on Cox’s models for the exposed‐unexposed study, with adjustment on matching variables and prognostic factors of mortality.

RESULTS. CRS complicated 1.17 per 100 ICU admissions during the study period. Twenty (53%) of the CRS cases were associated with septic shock. CRS was associated with a 28% increase in SAPS II. Crude ICU mortality rates from exposed and unexposed patients were 50% and 21%, respectively. CRS remained associated with mortality even when adjusted on other prognostic factors at ICU admission (relative risk [RR], 2.01; 95% confidence interval [CI₉₅], 1.08‐3.73; P=.03). However, after adjustment on severity scores calculated between ICU admission and 1 week before CRS, the increased mortality was no longer significant (RR, 1.41; CI₉₅, 0.76‐2.61; P=.27).

CONCLUSION. CRS is associated with subsequent morbidity and mortality in the ICU, even when adjusted on severity factors at ICU admission. However, after adjustment on severity factors during the ICU stay and before the event, there was only a trend toward CRS‐attributable mortality. The evolution of patient severity should be taken into account when evaluating excess mortality induced by nosocomial events in ICU patients.

Bibliographic Information(back to top)

Attributable Morbidity and Mortality of Catheter‐Related Septicemia in Critically Ill Patients: A Matched, Risk‐Adjusted, Cohort Study
Lilia Soufir , MD, Jean‐François Timsit , MD, Cédric Mahe , MD, Jean Carlet , MD, Bernard Regnier , MD and Sylvie Chevret , MD, PhD
Infection Control and Hospital Epidemiology
Vol. 20, No. 6 (June 1999) (pp. 396-401)

Author Information(back to top)

Lilia Soufir , MD; Jean‐François Timsit , MD; Cédric Mahe , MD; Jean Carlet , MD; Bernard Regnier , MD; Sylvie Chevret , MD, PhD

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Notes

From the Clinique de réanimation des maladies infectieuses (Drs. Timsit and Regnier), Hôpital Universitaire Bichat Claude‐Bernard; Service de réanimation polyvalente (Drs. Soufir, Timsit, and Carlet), Hôpital Saint‐Joseph; Département de Biostatistique et Informatique Médicale (Drs. Mahe and Chevret), Hôpital Universitaire Saint‐Louis, Paris, France.Address reprint requests to J‐F Timsit, Réanimation polyvalente, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France.98‐OA‐135. Soufir L, Timsit J‐F, Mahe C, Carlet J, Regnier B, Chevret S. Attributable morbidity and mortality of catheter‐related septicemia in critically ill patients: a matched, risk‐adjusted, cohort study. Infect Control Hosp Epidemiol 1999;20:396‐401.

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