Nosocomial Bloodstream Infection in Critically III Patients

Abstract

<h3>Objective.</h3> —To determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients. <h3>Design.</h3> —Pairwise-matched (1:1) case-control study. <h3>Setting.</h3> —Surgical intensive care unit (SICU) in a tertiary health care institution. <h3>Patients.</h3> —All patients admitted in the SICU between July 1,1988, and June 30, 1990, were eligible. Cases were defined as patients with nosocomial bloodstream infection; controls were selected according to matching variables in a stepwise fashion. <h3>Methods.</h3> —Matching variables were primary diagnosis for admission, age, sex, length of stay before the day of infection in cases, and total number of discharge diagnoses. Matching was successful for 89% of the cohort; 86 matched case-control pairs were studied. <h3>Main Outcome Measures.</h3> —Crude and attributable mortality, excess length of hospital and SICU stay, and overall costs. <h3>Results.</h3> —Nosocomial bloodstream infection complicated 2.67 per 100 admissions to the SICU during the study period. The crude mortality rates from cases and controls were 50% and 15%, respectively (<i>P</i>&lt;.01); thus, the estimated attributable mortality rate was 35% (95% confidence interval, 25% to 45%). The median length of hospital stay significantly differed between cases and controls (40 vs 26 days, respectively;<i>P</i>&lt;.01). When only matched pairs who survived bloodstream infection were considered (n=41), cases stayed in the hospital a median of 54 days vs 30 days for controls (<i>P</i>&lt;.01), and cases stayed in the SICU a median of 15 days vs 7 days for controls (<i>P</i>&lt;.01). Thus, extra hospital and SICU length of stay attributable to bloodstream infection was 24 and 8 days, respectively. Extra costs attributable to the infection averaged $40 000 per survivor. <h3>Conclusions.</h3> —The attributable mortality from nosocomial bloodstream infection is high in critically ill patients. The infection is associated with a doubling of the SICU stay, an excess length of hospital stay of 24 days in survivors, and a significant economic burden. (<i>JAMA</i>. 1994;271:1598-1601)