Helicobacter pylori infection in intensive cave: Increased prevalence and a new nosocomial infection

Objective:The pathogenesis of acute gastric stress ulceration in the seriou sly ill is uncertain, and any role of Helicobacter pylori infection is unkn own. We aimed to assess the relationship between ii. pylori serological sta tus and stress ulceration in seriously ill patients, as well as H, pylori s erological status in intensive care nurses as a marker for nosocomial infec tion, Design: Prospective epidemiologic survey. Setting: Adult intensive care unit in a university teaching hospital. Patie nts: One hundred patients, 100 nurses, and 500 blood donors as community co ntrols. Interventions: H, pylori serological status was measured in patients, staff , and controls using a rapid whole blood test. Upper gastrointestinal bleed ing and risk factors for acute stress ulceration were recorded. Measurements and Main Results:ln seriously ill patients, ii, pylori seropos itivity (67%) was significantly higher than in the control group (39%) (p < .001). In patients, seropositivity was not related to age, country of birt h, diagnostic category, severity of illness, or risk score for stress ulcer ation. There was a trend toward increased macroscopic gastric bleeding in s eropositive patients. In intensive care nurses, ii. pylori seropositivity ( 40%) was significantly higher than in age-matched controls (19%) (P < .001) . Only duration of intensive care nursing was significantly associated with seropositivity (p = .02), Conclusions:The unexpectedly high H. pylori seropositivity rate in this ser iously ill cohort raises the possibility that under intensive care conditio ns, H. pylori Infection may modulate responses to illness and injury, with consequent clinical implications. Furthermore, the elevated seropositivity rate in intensive care nurses suggests that H, pylori can be nosocomially t ransmitted.