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Influence of Matching for Exposure Time on Estimates of Attributable Mortality Caused by Nosocomial Bacteremia in Critically Ill Patients

Published online by Cambridge University Press:  21 June 2016

Stijn Blot ,
Dirk De Bacquer ,
Eric Hoste ,
Pieter Depuydt ,
Koenraad Vandewoude ,
Jan De Waele ,
Dominique Benoit ,
Johan De Schuijmer ,
Francis Colardyn  and
Dirk Vogelaers
Stijn Blot*
Affiliation:
Intensive Care Department, Ghent University Hospital, Gent, Belgium
Dirk De Bacquer
Affiliation:
Department of Public Health, Ghent University, Gent, Belgium
Eric Hoste
Affiliation:
Intensive Care Department, Ghent University Hospital, Gent, Belgium
Pieter Depuydt
Affiliation:
Intensive Care Department, Ghent University Hospital, Gent, Belgium
Koenraad Vandewoude
Affiliation:
Intensive Care Department, Ghent University Hospital, Gent, Belgium
Jan De Waele
Affiliation:
Intensive Care Department, Ghent University Hospital, Gent, Belgium
Dominique Benoit
Affiliation:
Intensive Care Department, Ghent University Hospital, Gent, Belgium
Johan De Schuijmer
Affiliation:
Department of Infection Control, Ghent University Hospital, Gent, Belgium
Francis Colardyn
Affiliation:
Intensive Care Department, Ghent University Hospital, Gent, Belgium
Dirk Vogelaers
Affiliation:
Infectious Diseases Department, Ghent University Hospital, Gent, Belgium
*
Ghent University Hospital, Intensive Care Department, De Pintelaan 185, B-9000 Gent, Belgiumstijn.blot@UGent.be
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Abstract

Objective:

To evaluate the influence of matching on exposure time on estimates of attributable mortality of nosocomial bacteremia as assessed by matched cohort studies.

Design:

Two retrospective, pairwise-matched (1:2) cohort studies.

Setting:

A 54-bed intensive care unit (ICU) in a university hospital.

Patients:

Patients with nosocomial Escherichia coli bacteremia (n = 68) and control-patients without nosocomial bacteremia (n = 136 for each matched cohort study).

Intervention:

In both matched cohort studies, the same set of bacteremic patients was matched with control-patients using the APACHE II system. In the first study, control-patients were required to have an ICU stay at least as long as the respective bacteremic patient prior to onset of bacteremia (matching on exposure time). In the second study, control-patients were required to have an ICU stay shorter than the stay prior to the development of bacteremia in the respective bacteremic patient (no matching on exposure time).

Results:

For bacteremic patients, the mean ICU stay before onset of the bacteremia was 9 days (median, 6 days). In the first matched cohort study, hospital mortality was not different between bacteremic patients and control-patients (44.1% vs 43.4%; P = .999). In the second study, mortality of bacteremic patients and control-patients was also not different (44.1% vs 47.8%; P = .657). Mortality rates between control groups were not different (43.4% vs 47.8%; P = .543).

Conclusion:

Matching or not matching on exposure time did not alter the estimate of attributable mortality for ICU patients with E. coli bacteremia.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 4 , April 2005 , pp. 352 - 356
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.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
2.Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.Google Scholar
3.Wenzel, REThe mortality of hospital-acquired bloodstream infections: need for a new vital statistic? Int J Epidemiol 1988;17:225–227.Google Scholar
4.Costanza, MC. Matching. Prev Med 1995;24:425–433.Google Scholar
5.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
6.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Effects of nosocomial candidemia on outcomes of critically ill patients. Am J Med 2002;113:480–485.CrossRefGoogle ScholarPubMed
7.Blot, SI, Vandewoude, KH, Colardyn, FA. Clinical impact of nosocomial Klebsiella bacteremia in critically ill patients. Eur J Clin Microbiol Infect Dis 2002;21:471–473.Google Scholar
8.Blot, SI, Vandewoude, KH, Colardyn, FA. Evaluation of outcome in critically ill patients with nosocomial enterobacter bacteremia: results of a matched cohort study. Chest 2003;123:1208–1213.Google Scholar
9.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:2229–2235.Google Scholar
10.Blot, S, Vandewoude, K, Colardyn, F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med 2003;29:471–475.Google Scholar
11.Blot, S, Vandewoude, K, Hoste, E, Colardyn, F. Reappraisal of attributable mortality in critically ill patients with nosocomial bacteraemia involving Pseudomonas aeruginosa. J Hosp Infect 2003;53:18–24.Google Scholar
12.Smith, RL, Meixler, SM, Simberkoff, MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100:164–167.CrossRefGoogle ScholarPubMed
13.Relio, J, Ochagavia, A, Sabanes, E, et al.Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med 2000;162:1027–1030.Google Scholar
14.Hoste, EA, Blot, SI, Lameire, NH, Vanholder, RC, De Bacquer, D, Colardyn, FA. Effect of nosocomial bloodstream infection on the outcome of critically ill patients with acute renal failure treated with renal replacement therapy. J Am Soc Nephrol 2004;15:454–462.Google Scholar
15.Blot, S, Vandewoude, K, Hoste, E, et al.Absence of excess mortality in critically ill patients with nosocomial Escherichia coli bacteremia. Infect Control Hosp Epidemiol 2003;24:912–915.CrossRefGoogle ScholarPubMed
16.Renaud, B, Brun-Buisson, C. Outcomes of primary and catheter-related bacteremia: a cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 2001;163:1584–1590.CrossRefGoogle ScholarPubMed
17.Heyland, DK, Cook, DJ, Griffith, L, Keenan, SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient: the Canadian Critical Trials Group. Am J Respir Crit Care Med 1999;159:1249–1256.Google Scholar
18.Grimes, DA, Schulz, KF. Cohort studies: marching towards outcomes. Lancet 2002;359:341–345.Google Scholar
19.Girou, E, Stephan, F, Novara, A, Safar, M, Fagon, JY. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998;157:1151–1158.Google Scholar
20.Blot, S, Vandewoude, K, De Bacquer, D, Colardyn, F. Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clin Infect Dis 2002;34:1600–1606.CrossRefGoogle ScholarPubMed
21.Hurley, JC. Comparison of mortality associated with methicillin-susceptible and methicillin-resistant Staphylococcus aureus bacteremia: an ecological analysis. Clin Infect Dis 2003;37:866–868.Google Scholar
22.Valles, J, Relio, J, Ochagavia, A, Garnacho, J, Alcala, MA. Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival. Chest 2003;123:1615–1624.Google Scholar
23.Harbarth, S, Garbino, J, Pugin, J, Romand, JA, Lew, D, Pittet, D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003;115:529–535.Google Scholar
24.Kollef, MH, Sherman, G, Ward, S, Fraser, VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462–474.Google Scholar
25.Kollef, MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 2000;31 (suppl 4):S131–S138.CrossRefGoogle ScholarPubMed
26.Ibrahim, EH, Sherman, G, Ward, S, Fraser, VJ, Kollef, MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000;118:146–155.Google Scholar
27.Friedman, ND, Korman, TM, Fairley, CKFranklin, JC, Spelman, DW. Bacteraemia due to Stenotrophomonas maltophilia: an analysis of 45 episodes. J Infect 2002;45:47–53.Google Scholar
28.Blot, S, Vandewoude, K. Early detection of systemic infection. Acta Clin Belg 2004;59:20–23.Google Scholar