Journal Article

Microbiological Factors Influencing the Outcome of Nosocomial Bloodstream Infections: A 6-Year Validated, Population-Based Model

Didier Pittet, Ning Li, Robert F. Woolson and Richard P. Wenzel

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 24, issue 6, pages 1068-1078
Published in print June 1997 | ISSN: 1058-4838
Published online June 1997 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/513640
Microbiological Factors Influencing the Outcome of Nosocomial Bloodstream Infections: A 6-Year Validated, Population-Based Model

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All patients (n = 1,745) with nosocomial bloodstream infection identified between 1986 and 1991 at a single 900-bed tertiary care hospital were studied to identify microbiological factors independently associated with mortality due to the infection. Patients were identified by prospective, case-based surveillance and positive blood cultures. Mortality rates were examined for secular trends. Prognostic factors were determined with use of univariate and multivariate analyses, and both derivation and validation sets were used. A total of 1,745 patients developed nosocomial bloodstream infection. The 28-day crude mortality was 22%, and crude in-hospital mortality was 35%. Factors independently (all P < .05) associated with increased 28-day mortality rates were older age, longer length of hospital stay before bloodstream infection, and a diagnosis of cancer or disease of the digestive system. After adjustment for major confounders, Candida species were the only organisms independently influencing the outcome of nosocomial bloodstream infection (odds ratio [OR] for mortality = 1.84; 95% confidence interval [CI], 1.22–2.76; P = .0035). The two additional microbiological factors independently associated with increased mortality were pneumonia as a source of secondary infection (OR = 2.74; 95% CI, 1.87–4.00; P < .0001) and polymicrobial infection (OR = 1.68; 95% CI, 1.22–2.32; P = .0014). Our data suggest that microbiological factors independently affect the outcome of nosocomial bloodstream infection.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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