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Epidemiological Differences Between Sepsis Syndrome With Bacteremia and Culture-Negative Sepsis

Published online by Cambridge University Press:  02 January 2015

Concepción Fariñas-Álvarez ,
M. Carmen Fariñas ,
Carlos Fernández-Mazarrasa ,
Javier Llorca  and
Miguel Delgado-Rodríguez
Concepción Fariñas-Álvarez*
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
M. Carmen Fariñas
Affiliation:
Infectious Diseases Unit, Hospital Universitario “Marqués de Valdecilla,”, Santander, Spain
Carlos Fernández-Mazarrasa
Affiliation:
Service of Microbiology, Hospital Universitario “Marqués de Valdecilla,”, Santander, Spain
Javier Llorca
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
Miguel Delgado-Rodríguez
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
*
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Av Cardenal Herrera Oria s/n, 39011-Santander, Spain
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Abstract

Objective:

To explore the association of putative disease markers and potential risk factors with the nosocomial sepsis syndrome.

Design:

Prospective case-control study matched for gender, age, and length of preinfection hospital stay.

Setting:

1,200-bed tertiary-care center in Spain.

Patients:

Cases were selected using the sepsis syndrome criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference and were divided into three groups: sepsis with bacteremia (109 cases), sepsis with positive culture other than blood (122 cases), and sepsis with negative culture (115 cases without documented infection but with sepsis syndrome, clinically suspected infection, and empirical antibiotic treatment). Controls were randomly selected from the daily list of inpatients. Data were collected prospectively. Crude and multiple-risk-factor-adjusted odds ratios and their 95% confidence intervals were computed using conditional logistic regression analysis.

Results:

Presence of coma in the 48 hours before sepsis, intensive care unit (ICU) stay, and decreased serum albumin levels at admission were common epidemiological markers identified for the three groups of cases. Having a central venous catheter was the main healthcare-related risk factor for bacteremia. ICU stay and nasogastric tube were the main risk factors for sepsis with positive culture other than blood. Coma within 48 hours before sepsis and the need of intensive care were the only two markers identified for culture-negative sepsis.

Conclusion:

Culture-negative sepsis does not behave like culture-positive sepsis, and this may imply that implementation of preventive measures to decrease the risk of bacteremia may not decrease the risk of sepsis syndrome.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 10 , October 2000 , pp. 639 - 644
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1. Wenzel, RP, Pinsky, MR, Ulevitch, RJ, Young, L. Current understanding of sepsis. Clin Infect Dis 1996;22:407–412.Google Scholar
2. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guide-lines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–874.CrossRefGoogle Scholar
3. Rangel-Frausto, MS, Pittet, D, Costigan, M, Hwang, T, Davis, CS, Wenzel, RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 1995;273:117–123.CrossRefGoogle ScholarPubMed
4. Brun-Buisson, C, Doyon, F, Carlet, J, Dellamonica, P, Gouin, F, Lepoutre, A, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 1995;274:968–974.Google Scholar
5. Pittet, D, Rangel-Fausto, S, Li, N, Tarara, D, Costigan, M, Rempe, L, et al. Systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med 1995;21:302–309.Google Scholar
6. Salvo, I, de Cian, W, Musicco, M, Langer, M, Piadena, R, Wolfler, A, et al. The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock. Intensive Care Med 1995;21(suppl 2):S244–S249.Google Scholar
7. Jeljaszewicz, J. The epidemiology of the systemic inflammatory response syndrome. Curr Opin Infect Dis 1996;9:261–264.CrossRefGoogle Scholar
8. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infection. Am J Infect Control 1988;16:128–140.Google Scholar
9. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions for nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
10. McCabe, WR, Jackson, GG. Gram-negative bacteremia, II: clinical, laboratory, and therapeutic observations. Arch Intern Med 1962;110:856–864.Google Scholar
11. Sun, GW, Shook, TL, Kay, GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 1996;49:907–916.Google Scholar
12. Mickey, RM, Greenland, S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–137.Google Scholar
13. Thompson, WD. Statistical analysis of case-control studies. Epidemiol Rev 1994;16:33–50.Google Scholar
14. Trilla, A, Gatell, JM, Mensa, J, Latorre, X, Almela, M, Soriano, E, et al. Risk factors for nosocomial bacteremia in a large Spanish teaching hospital: a case-control study. Infect Control Hosp Epidemiol 1991;12:150–156.Google Scholar
15. Stroud, L, Srivastava, P, Culver, D, Bisno, A, Rimland, D, Simberkoff, M, et al. Nosocomial infections in HIV-infected patients: preliminary results from a multicenter surveillance system (1989-1995). Infect Control Hosp Epidemiol 1997;18:479–485.Google Scholar
16. Duggan, J, O'Conell, D, Heller, R, Ghosh, H. Causes of hospital-acquired septicaemia—a case control study. Q J Med 1993;86:479–483.Google Scholar
17. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
18. Meyers, BR, Sherman, E, Mendelson, MH, Velasquez, G, Sruleviteh-Chin, E, Hubbard, M, et al. Bloodstream infections in the elderly. Am J Med 1989;86:379–384.CrossRefGoogle ScholarPubMed
19. Torres, A, Aznar, R, Gatell, JM, Jimenez, P, Gonzalez, J, Ferrer, A, et al. Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523–528.Google Scholar
20. Craven, DE, Kunches, LM, Kilinsky, V, Lichtenberg, DA, Make, BJ, McCabe, WR, et al. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792–796.Google Scholar
21. Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.Google Scholar
22. Horan, TC, Culver, DH, Gaynes, RP, Jarvis, WR, Edwards, JR, Reid, CR. Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol 1993;14:73–80.Google Scholar
23. Anderson, CF, Moxness, K, Meister, J, Burritt, MF. The sensitivity and specificity of nutrition related variables in relationship to the duration of hospital stay and the rate of complications. Mayo Clin Proc 1984;59:477–483.Google Scholar
24. Rich, MW, Keller, AJ, Schechtman, KB, Marshall, WG Jr Kouchoukos, NT. Increased complications and prolonged hospital stay in elderly cardiac surgical patients with low serum albumin. Am J Cardiol 1989;63:714–718.Google Scholar
25. Hermann, FR, Safran, C, Levkoff, SE, Minaker, KL. Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med 1992;152:125–130.Google Scholar
26. Gorse, GJ, Messner, RL, Stephens, NC. Association of malnutrition with nosocomial infection. Infect Control Hosp Epidemiol 1994;10:194–204.Google Scholar
27. Beck-Sague, CM, Sinkowitz, RL, Chinn, RY, Vargo, J, Kaler, W, Jarvis, WR. Risk factors for ventilator-associated pneumonia in surgical intensive-care-unit patients. Infect Control Hosp Epidemiol 1996;17:374–376.CrossRefGoogle ScholarPubMed
28. Meares, EM Jr Current patterns in nosocomial urinary infections. Urology 1991;37(suppl 3):9S–12S.Google Scholar
29. Krieger, NJ, Kaiser, DL, Wenzel, RP. Urinary tract etiology of bloodstreams infections in hospitalized patients. J Infect Dis 1983;148:57–62.Google Scholar
30. Reed, CR, Sessle, CN, Glauser, FL, Phelan, BA. Central venous catheter infections: concepts and controversies. Intensive Care Med 1995;21:177–183.Google Scholar