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Impact of infection on admission and of the process of care on mortality of patients admitted to the Intensive Care Unit - The INFAUCI study.
Clin Microbiol Infect. 2014 Jun 27;
Authors: Gonçalves-Pereira J, Pereira JM, Ribeiro O, Baptista JP, Froes F, Paiva JA
Abstract
A prospective, cohort, clinical, observational study was performed in 14 Intensive Care Units (ICU) to evaluate the contemporary epidemiology, morbi-mortality and determinants of outcome of the population with an infection on admission. All 3766 patients admitted during a consecutive 12-month period were screened. Their median age was 63 [26-83], 61.1% were male and 69.8% had significant comorbidities. On admission to the ICU 1652 patients (43.9%) had an infection, community-acquired in 68.2% (one fifth with health-care associated criteria) ward-acquired in the others. Roughly half presented to the ICU with septic shock. As much as 488 patients with community-acquired infections were deemed stable enough to be first admitted to the ward, but had similar mortality as unstable patients directly admitted to the ICU (35.9% vs. 35.1%, p=0.78). Only 48.3% of this infected population had microbiological documentation and almost one quarter received inappropriate initial antibiotic therapy. This, along with comorbidities, was a main determinant of mortality. Overall infected patients on admission had higher mortality both in the ICU (28.0% vs. 19.9%, p<0.001), in the hospital (38.2% vs. 27.5%, p<0.001) and even after being discharged to the ward (14.2% vs. 9.6%, p<0.001). Besides, patients non infected on admission who acquired an infection in the ICU also had an increased risk of dying in the hospital (odds ratio 1.41 [1.12-1.83]). Consequently infection, regardless of its place of acquisition, was associated with increased mortality. Improving the process of care, especially first line antibiotic appropriateness and preventing ICU-acquired infections, may lead to better outcomes. This article is protected by copyright. All rights reserved.
PMID: 24975209 [PubMed - as supplied by publisher]