NOSOCOMIAL BACTEREMIA IN CRITICALLY ILL PATIENTS - A MULTICENTER STUDY EVALUATING EPIDEMIOLOGY AND PROGNOSIS

A total of 590 consecutive episodes of nosocomial bacteremia were pros pectively followed in 30 intensive care units (ICUs) over a 9-month pe riod. The crude and directly related mortality rates were 41.6% and 19 %, respectively. The predominant pathogens were coagulase-negative sta phylacocci (24.4%) and coagulase-positive staphylococci (17.5%). The m ost frequent sources of infection were intravenous catheters (37.1%). Multivariate analysis defined seven variables as independently influen cing crude mortality: adult respiratory distress syndrome (ARDS), sept ic shock, multiorgan failure (MOF), mechanical ventilation, chronic he patic failure, acute renal failure, and APACHE II scope of greater tha n or equal to 15 at diagnosis. Variables associated with a higher dire ctly related mortality were septic shock, ARDS, acute renal failure, M OF, gram-negative or candidal bacteremia, source of bacteremia other t han intravascular catheter, and severe sepsis. We conclude that preven ting catheter colonization is crucial in reducing the incidence of bac teremia in an ICU, while improving outcome depends on better managemen t of septic shock and associated complications.