Chest
Excess Mortality in Critically III Patients with Nosocomial Bloodstream Infections
Section snippets
Setting
The Medical Service of the New York Veterans Administration Medical Center consists of 120 ward beds, six cardiac care unit beds, a 16-bed ward for care of patients with AIDS, and a 12-bed medical ICU. The medical ICU is staffed by three interns, two residents, a pulmonary fellow, and an attending physician, all of whom rotate at monthly intervals.
Data Collection
The study covered the period from July 1986, through June 1989. We identified 34 medical ICU patients from a computerized log maintained by the
Microbiology Data
The frequency of blood isolates is shown in Table 2. Of the six cases of C albicans fungemia, three were associated with total parenteral nutrition, and one each with acute myelogenous leukemia, an intracranial meningioma treated with glucocorticoids, and acquired immunodeficiency syndrome. Polymicrobial bloodstream infections were found in six (14.6 percent) cases; three cases of C albicans fungemia were polymicrobial, including Enterobacter cloacae (two) and Pseudomonas cepacia (one).
Mortality Data
The
Discussion
Bacteremia is the most frequently encountered nosocomial infection in critically ill patients.10 Prior studies have revealed that between 33 and 45 percent of nosocomial bacteremias occur in ICU patients who occupy less than 10 percent of hospital beds.11 This study was designed to determine the excess mortality attributable to nosocomial bloodstream infection in patients in our medical ICU. To overcome a problem found in other mortality studies, that is, the lack of an appropriate control
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Cited by (0)
Manuscript received October 8; revision accepted December 21.
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Instructor in Medicine, New York University Medical Center.
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Former Fellow in Pulmonary Disease and Critical Care Medicine, New York University Medical Center.
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Associate Professor of Medicine, New York University Medical Center.