NOSOCOMIAL BACTEREMIA IN A MEDICAL-SURGICAL INTENSIVE-CARE UNIT - EPIDEMIOLOGIC CHARACTERISTICS AND FACTORS INFLUENCING MORTALITY IN 111 EPISODES

Objective: To analyze the epidemiology and factors influencing mortali ty of ICU-acquired bacteremia. Design: Prospective clinical study. Set ting: A medical-surgical ICU in an university hospital. Patients: We r ecorded variables from 111 consecutive ICU-acquired episodes for a 3-y ear period. Results: The attack rate was 1.9 episodes per 100 patient- days. The commonest isolates were coagulase-negative staphylococci, St aphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Int ravascular catheters were the most frequent source of infection. Overa ll mortality was 31.5%, and 65.7% of all deaths were directly attribut able to infection. Bacteremia from intra-abdominal, lower respiratory tract or unknown origin were associated with a poor prognosis. A logis tic regression analysis defined intraabdominal origin (p = 0.01, OR = 15.7) and presence of shock (p = 0.04, OR = 3.3) as independently infl uencing the risk of death. No significant differences were found for t he remaining variables studied. Conclusions: Epidemiology and etiology of ICU-acquired bacteremia does not differ seriously in respect to no socomial bacteremia among unselected populations, although it is assoc iated with a greater incidence and overall mortality. Presence of shoc k is the most important modificable variable affecting the outcome.