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Absence of Excess Mortality in Critically Ill Patients With Nosocomial Escherichia coli Bacteremia

Published online by Cambridge University Press:  02 January 2015

Stijn Blot ,
Koenraad Vandewoude ,
Eric Hoste ,
Jan De Waele ,
Kathleen Kint ,
Fanny Rosiers ,
Dirk Vogelaers  and
Francis Colardyn
Stijn Blot*
Affiliation:
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
Koenraad Vandewoude
Affiliation:
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
Eric Hoste
Affiliation:
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
Jan De Waele
Affiliation:
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
Kathleen Kint
Affiliation:
Department of Pharmacia, Ghent University Hospital, Ghent, Belgium
Fanny Rosiers
Affiliation:
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
Dirk Vogelaers
Affiliation:
Department of Infectious Diseases, Ghent University Hospital, Ghent, Belgium
Francis Colardyn
Affiliation:
Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
*
Intensive Care Department, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
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Abstract

Objective:

To evaluate excess mortality in critically ill patients with Escherichia coli bacteremia after adjustment for severity of illness.

Design:

Retrospective (1992-2000), pairwise-matched (1:2), risk-adjusted cohort study.

Setting:

Fifty-four-bed ICU in a university hospital including a medical and surgical ICU, a unit for care after cardiac surgery, and a burns unit.

Patients:

ICU patients with nosocomial E. coli bacteremia (defined as cases; n = 64) and control-patients without nosocomial bloodstream infection (n = 128).

Methods:

Case-patients were matched with control-patients on the basis of the Acute Physiology and Chronic Health Evaluation (APACHE) II system: an equal APACHE II score (± 2 points) and diagnostic category. In addition, control-patients were required to have an ICU stay at least as long as that of the respective case-patients prior to onset of the bacteremia.

Results:

The overall rate of appropriate antibiotic therapy in patients with E. coli bacteremia was high (93%) and such therapy was initiated soon after onset of the bacteremia (0.6 ± 1.0 day). ICU patients with E. coli bacteremia had more acute renal failure. No differences were noted between case-patients and control-patients in incidence of acute respiratory failure, hemodynamic instability, or age. No differences were observed in length of mechanical ventilation or length of ICU stay. In-hospital mortality rates for cases and controls were not different (43.8% and 45.3%, respectively; P = .959).

Conclusion:

After adjustment for disease severity and acute illness and in the presence of adequate antibiotic therapy, no excess mortality was found in ICU patients with E. coli bacteremia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 912 - 915
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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