Prognostic Factors and Cost Analysis of Central Line-Associated Bloodstream Infections in Intensive Care Unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HUANG Wei , LUO Yunshan , ZHOU Junfeng , ZHANG Jiuzhi , WAN Xianyao.

Department of General Intensive Care Unit, The First Affiliated Hospital, Dalian Medical University. Dalian, Liaoning,116011, ChinaCorresponding Author: HUANGWei, E-mail: huangwei9898@ 163. com;

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Keywords：

Nosocomial infection; Blood stream infections; Bacteremia; Prognostic factors; Intensive care

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Objective To investigate the prognostic factors and hospitalization cost in patients diagnosed as central line-associated bloodstream infection( CLABSI) in intensive care unit( ICU) .Methods A retrospective study was made to investigate the CLABSI epidemic data in ICU from June 2006 to June 2009. Clinical and physiological parameters were summarized and compared between these patients, which were divided into two groups based on the clinical outcome. Meanwhile, events including blood transfusion,mechanical ventilation, as well as cost of hospitalization were also reviewed. Logistic regression method was introduced to investigate the potential prognostic risk factors. Results There were 49 patients were diagnosed as nosocomial CLABSI, in which 19 cases( 38. 8% ) died in the hospital and 30( 61. 2% ) were
survival. In univariate analysis, differences in body temperature, central venous pressure, acute physiology and chronic health evaluation( APACHEⅡ ) score, blood transfusion amount, pH value, D-dimer, blood serum alanine transarninase, blood urea nitrogen level, serumcreatinine, serumpotassiumbetween the survivors and
the non-survivors were significant( P lt;0. 05) . However, no significant differences were observed between the two groups in in-hospital days, ICU days and hospitalization cost ( all P gt; 0. 05) . With multiple logistic regressions, higher APACHEⅡ score( OR 0. 78; 95% confidence interval: 0. 66-0. 94; P = 0. 007) , APTT
level( OR 0. 87; 95% confidence interval: 0. 77-0. 98; P = 0. 026) and serum potassium( OR 0. 09; 95% confidence interval: 0. 01-0. 80; P = 0. 031) were independent predictors of worse outcome. Conclusions Disease severity and coagulation situation may directly predict the prognosis of nosocomial CLABSI patients.But current investigation did not demonstrate significant differences in ICU length of stay and respective cost between the CLABSI patients with different prognosis.

Citation： HUANG Wei,LUO Yunshan,ZHOU Junfeng,ZHANG Jiuzhi,WAN Xianyao.. Prognostic Factors and Cost Analysis of Central Line-Associated Bloodstream Infections in Intensive Care Unit. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(3): 239-242. doi: Copy

1.	Vallés J, Ferrer R. Bloodstream infection in the ICU. Infect Dis Clin North Am, 2009, 23 : 557-569.
2.	Digiovine B, Chenoweth C, Watts C, et al. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med, 1999 , 160: 976 -981.
3.	Warren DK, Quadir WW, Hollenbeak CS, et al. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med, 2006, 34 : 2084 -2089.
4.	Renaud B, Brun-Buisson C, ICU-Bacteremia Study Group. Outcomes of primary and catheter-related bacteremia. A cohort and casecontrol study in critically ill patients. Am J Respir Crit Care Med,2001, 163: 1584-1590.
5.	Horan TC, Andrus M, Dudeck MA. CDC/ NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control,2008, 36: 309-332 .
6.	Suljagic V, Cobeljic M, Jankovic S, et al. Nosocomial bloodstream infections in ICU and non-ICU patients. Am J Infect Control, 2005,33: 333-340 .
7.	刘大鹰, 谢正福, 施焕中, 等. 重症监护病房与非重症监护病房中心静脉导管相关感染的对比研究. 中国呼吸与危重监护杂志, 2006, 5: 162 -167.
8.	Harbarth S, Ferrière K, Hugonnet S, et al. Epidemiology and prognostic determinants of bloodstream infections in surgical intensive care. Arch Surg, 2002, 137 : 1353 -1359.
9.	Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med, 2001, 344: 699-709.
10.	Marrie TJ, Wu L. Factors influencing in-hospital mortality in community-acquired pneumonia: a prospective study of patients not initially admitted to the ICU. Chest, 2005, 127 : 1260 -1270.
11.	Edmond MB, Wallace SE, McClish DK, et al. Nosocomial Bloodstream Infections in United States Hospitals: A Three-Year Analysis. Clin Infect Dis, 1999, 29: 239-244.
12.	Blot SI, Vandewoude KH, Hoste EA, et al. Outcome and Attributable Mortality in Critically Ill Patients With Bacteremia Involving Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus. Arch Intern Med, 2002, 162 : 2229 -2235 .

1. Vallés J, Ferrer R. Bloodstream infection in the ICU. Infect Dis Clin North Am, 2009, 23 : 557-569.
2. Digiovine B, Chenoweth C, Watts C, et al. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med, 1999 , 160: 976 -981.
3. Warren DK, Quadir WW, Hollenbeak CS, et al. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med, 2006, 34 : 2084 -2089.
4. Renaud B, Brun-Buisson C, ICU-Bacteremia Study Group. Outcomes of primary and catheter-related bacteremia. A cohort and casecontrol study in critically ill patients. Am J Respir Crit Care Med,2001, 163: 1584-1590.
5. Horan TC, Andrus M, Dudeck MA. CDC/ NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control,2008, 36: 309-332 .
6. Suljagic V, Cobeljic M, Jankovic S, et al. Nosocomial bloodstream infections in ICU and non-ICU patients. Am J Infect Control, 2005,33: 333-340 .
7. 刘大鹰, 谢正福, 施焕中, 等. 重症监护病房与非重症监护病房中心静脉导管相关感染的对比研究. 中国呼吸与危重监护杂志, 2006, 5: 162 -167.
8. Harbarth S, Ferrière K, Hugonnet S, et al. Epidemiology and prognostic determinants of bloodstream infections in surgical intensive care. Arch Surg, 2002, 137 : 1353 -1359.
9. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med, 2001, 344: 699-709.
10. Marrie TJ, Wu L. Factors influencing in-hospital mortality in community-acquired pneumonia: a prospective study of patients not initially admitted to the ICU. Chest, 2005, 127 : 1260 -1270.
11. Edmond MB, Wallace SE, McClish DK, et al. Nosocomial Bloodstream Infections in United States Hospitals: A Three-Year Analysis. Clin Infect Dis, 1999, 29: 239-244.
12. Blot SI, Vandewoude KH, Hoste EA, et al. Outcome and Attributable Mortality in Critically Ill Patients With Bacteremia Involving Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus. Arch Intern Med, 2002, 162 : 2229 -2235 .

Chinese Journal of Respiratory and Critical Care Medicine

Prognostic Factors and Cost Analysis of Central Line-Associated Bloodstream Infections in Intensive Care Unit

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