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Outcomes of Nosocomial Bloodstream Infections in Adult Neutropenic Patients: A Prospective Cohort and Matched Case-Control Study

Published online by Cambridge University Press:  02 January 2015

Hilmar Wisplinghoff ,
Oliver A. Cornely ,
Susanne Moser ,
Ullrich Bethe ,
Hartmut Stützer ,
Bernd Salzberger ,
Gerd Fätkenheuer  and
Harald Seifert
Hilmar Wisplinghoff
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany Department of Internal Medicine, University of Cologne, Cologne, Germany
Oliver A. Cornely
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Susanne Moser
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
Ullrich Bethe
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Hartmut Stützer
Affiliation:
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
Bernd Salzberger
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Gerd Fätkenheuer
Affiliation:
Department of Internal Medicine, University of Cologne, Cologne, Germany
Harald Seifert*
Affiliation:
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
*
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935 Cologne, Germany
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Abstract

Objective:

To examine the clinical and epidemiologic features, excess length of stay, extra costs, and mortality attributable to bloodstream infection (BSI) in neutropenic patients with hematologic malignancies.

Design:

Prospective cohort and matched case-control study.

Patients:

All adult neutropenic patients with hematologic malignancies admitted to Cologne University Hospital between May 1, 1997, and April 30, 1998, were prospectively observed. Case-patients were defined as patients with nosocomial BSI; control-patients were selected among patients without BSI.

Results:

During the study period, the BSI rate in neutropenic patients was 14.3 per 100 neutropenic episodes. Eighty-four case-patients were included. Matching was successful for 96% of the cohort; 81 matched pairs were studied. The mean total length of stay was significantly longer for patients with BSI than for control-patients (37 vs 29 days; P = .002). Extra costs attributable to the infection averaged $3,200 (U.S.) per patient. The crude mortality rates of case-patients and control-patients were 16% and 4%, respectively (P = .013), with an attributable mortality of 12% (odds ratio, 11). Eighty-seven percent of patients met the criteria for sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine. Severe sepsis or septic shock occurred in 13% of patients and was correlated with mortality (55% vs 10% in patients without severe sepsis or septic shock; P =.01).

Conclusions:

Nosocomial BSI in neutropenic patients is significantly associated with an excess length of hospital stay, extra costs, and excess mortality. Severe sepsis and septic shock are closely correlated with an adverse outcome.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 905 - 911
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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