Risk factors for nosocomial sepsis: a case-control study

Background: The objective of this study was to identify the risk factors as sociated with the nosocomial sepsis syndrome according to the criteria of t he American College of Chest Physicians/Society of Critical Care Medicine C onsensus Conference. Patients and Method: A 1-year prospective case-control study matched for se x, age (+/- 5 years), and pre-infection hospital stay (+/- 1 day) was perfo rmed in a 1,200-bed university hospital. Cases were selected according to t he above criteria. Controls were randomly selected from the daily list of h ospitalized patients. Crude and adjusted odds ratios (OR) were determined. Results: 346 cases and 346 controls were included. Multivariate analysis id entified the following intrinsic risk factors: coma in the 48 hours before sepsis (OR: 15.1; CI 95%, 5.6-41.2), renal failure (OR: 3.4; CI 95%; 1.5-10 .8), neoplasm (OR: 2.4; CI 95%, 1.1-5.1), prosthesis material (OR: 2.7; CI 95%, 1.0-7.8), and serum albumin concentration at admission lower than 3.1 g/dl (OR: 5.3; CI 95%, 2.3-12.4). Main extrinsic risk factors were: previou s nosocomial infection (OR: 12.5; CI 95%, 1.61-96.3), intensive care unit ( ICU) stay (OR: 10.6; CI 95%, 3.1-36.2), naso-gastric tube (OR: 8.4; CI 95%, 2.3-31.3), indwelling urinary catheter (OR: 5.0; CI 95%, 1.4-18.9), H-2 bl ockers treatment (OR: 5.0; CI 95%, 1.6-15.2), and IV central line (OR: 4.1; CI 95%, 1.2-14.0). Conclusion: In our study, main risk factors for development of nosocomial s epsis were presence of coma in the 48 hours before sepsis, ICU stay, and pr ior cross infection during hospitalization.