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Mortality Attributable to Nosocomial Infection: A Cohort of Patients With and Without Nosocomial Infection in a French University Hospital

Published online by Cambridge University Press:  02 January 2015

Pascale Fabbro-Peray ,
A. Sotto ,
C. Defez ,
M. Cazaban ,
L. Molinari ,
M. Pinède ,
A. Mahamat  and
J.P. Daurès
Pascale Fabbro-Peray*
Affiliation:
Département de l'Information Médicale, France Groupe hospitalier Carémeau, Nîmes, and Laboratoire de biostatistiques et d'épidémiologie, Institut Universitaire de Recherche Clinique, Université Montpellier I, Montpellier, France
A. Sotto
Affiliation:
Comité de Lutte contre les Infections Nosocomiales, France Groupe hospitalier Carémeau, Nîmes, and Laboratoire de biostatistiques et d'épidémiologie, Institut Universitaire de Recherche Clinique, Université Montpellier I, Montpellier, France
C. Defez
Affiliation:
Département de l'Information Médicale, France
M. Cazaban
Affiliation:
Equipe Opérationnelle d'Hygiène, France Groupe hospitalier Carémeau, Nîmes, and Laboratoire de biostatistiques et d'épidémiologie, Institut Universitaire de Recherche Clinique, Université Montpellier I, Montpellier, France
L. Molinari
Affiliation:
Département de l'Information Médicale, France
M. Pinède
Affiliation:
Département de l'Information Médicale, France
A. Mahamat
Affiliation:
Département de l'Information Médicale, France Groupe hospitalier Carémeau, Nîmes, and Laboratoire de biostatistiques et d'épidémiologie, Institut Universitaire de Recherche Clinique, Université Montpellier I, Montpellier, France
J.P. Daurès
Affiliation:
Département de l'Information Médicale, France Groupe hospitalier Carémeau, Nîmes, and Laboratoire de biostatistiques et d'épidémiologie, Institut Universitaire de Recherche Clinique, Université Montpellier I, Montpellier, France
*
Département de l'Information Médicale, CHU de Nîmes, Bâtiment polyvalent, Place du Pr Debré, 30029 NIMES Cedex 9, France ([email protected])
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Abstract

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Objective

To assess nosocomial infection (NI) as a risk factor for death and to estimate the population-attributable risk of death from NI.

Design.

A prospective cohort study of patients with and without NI.

Setting.

Nîmes University Hospital, Nîmes, France.

Patients.

Patients were recruited from May 7, 2001, to January 10, 2003. Patients in acute care and long-term care units who had NI were enrolled, and patients without NI were randomly selected and matched with patients with NI for age, sex, type of care (acute care vs. long-term care) and length of stay in hospital at study inclusion.

Outcome Measures.

Vital status within 60 days after study inclusion was assessed. We used conditional logistic regression to estimate the relative death risk from NI after adjusting for comorbidities, severity of the underlying disease, and all other confounding factors. The adjusted population-attributable risk was assessed using the Mantel-Haenszel method.

Results.

We recruited 1,914 patients with NI and 5,172 patients without NI. The median age of the patients with NI was 73 years; 1,045 (54.6%) were female. NI was associated with death within 60 days (adjusted odds ratio, 1.7 [95% confidence interval {CI}, 1.4—;2.2]; P-C.001). The adjusted population-attributable risk of death for all sites of infection was 1.7% (95% CI, 1.4-2.1). If we consider the NI incidence to be 3%-6% in French hospitals, the population-attributable risk of death from NI would range from 2.1% (95% CI, 1.7%-2.5%) to 4.0% (95% CI, 3.3%-4.9%).

Conclusion.

In this study, NI appeared to have a significant impact on mortality. Multicenter studies will be needed to confirm these results.

Type
Editorial
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 3 , March 2007 , pp. 265 - 272
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

References

1.Glynn, A, Ward, V, Wilson, J, et al. Hospital Acquired Infection: Surveillance Policies and Practice. London, England: Public Health Laboratory Service; 1997.Google Scholar
2.Galvez-Vargas, R, Bueno-Cavanillas, A, Garcia-Martin, M. Epidemiology, therapy and costs of nosocomial infection. Pharmacoeconomics 1995;7:128–140.CrossRefGoogle ScholarPubMed
3. Circulaire DGS/VS/VS2-DH/E01- N°17 du 19 avril 1995 relative à la lutte contre les infections nosocomiales dans les établissements de santé publics ou privés participant à 1' exécution du service public. 1995. Available at: http://www.sante.gouv.fr/htm/pointsur/nosoco/nosoco3-2-l.html. Accessed May 5, 2006.Google Scholar
4.Kaoutar, B, Joly, C, L'Heriteau, F, et al. Nosocomial infections and hospital mortality: a multicentre epidemiology study. J Hosp Infect 2004;58:268–275.CrossRefGoogle ScholarPubMed
5.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639–644.CrossRefGoogle Scholar
6.Fagon, JY, Chastre, J, Vuagnat, A, Trouillet, JL, Novara, A, Gibert, C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996;275:866–869.CrossRefGoogle ScholarPubMed
7.Pittet, D, Tarara, D, Wenzel, RRNosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
8.Soufir, L, Timsit, JF, Mahe, C, Carlet, J, Regnier, B, Chevret, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol 1999;20:396–401.CrossRefGoogle ScholarPubMed
9.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
10.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;160:976–81.CrossRefGoogle ScholarPubMed
11.Bercault, N, Boulain, T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med 2001;29:2303–2309.CrossRefGoogle Scholar
12.Kollef, MH, Silver, P, Murphy, DM, Trovillion, E. The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest 1995;108:1655–1662.CrossRefGoogle ScholarPubMed
13.Fagon, JY, Chastre, J, Domart, Y, Trouillet, JL, Gibert, C. Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species: assessment by quantitative culture of samples obtained by a protected specimen brush. Clin Infect Dis 1996;23:538–542.CrossRefGoogle ScholarPubMed
14.Leu, HS, Kaiser, DL, Mori, M, Woolson, RF, Wenzel, RP. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol 1989;129:1258–1267.CrossRefGoogle ScholarPubMed
15.White, MC. Mortality associated with nosocomial infections: analysis of multiple cause-of-death data. J Clin Epidemiol 1993;46:95–100.CrossRefGoogle ScholarPubMed
16.Comité Technique National des Infections Nosocomiales. 100 recommandations pour la surveillance et la prévention des infections nosocomiales. Paris, France: Secrétariat d'Etat à la santé et à l'action sociale; 1999. Available at: http://www.sante.gouv.fr/htm/pointsur/nosoco/nosoco3-l-2.html. Accessed May 22, 2006.Google Scholar
17.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
18.McCabe, WR, Jackson, GG. Gram-negative bacteremia. Arch Intern Med 1962;110:847–864.CrossRefGoogle Scholar
19.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
20.Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–1251.CrossRefGoogle ScholarPubMed
21. Centre interregional de coordination pour la lutte contre les infections nosocomiales Sud Est. Available at: http://cclin-sudest.chu-lyon.fr. Accessed February 8, 2007.Google Scholar
22.Dinkel, RH, Lebok, U. A survey of nosocomial infections and their influence on hospital mortality rates. J Hosp Infect 1994;28:297–304.CrossRefGoogle ScholarPubMed
23.Legras, B, Doveze, P, Weber, M. Evaluation of the mortality related to nosocomial infections: an approach by a homogeneous group of patients, from bacteriology and data of hospitalization (1989-1993) [in French]. Pathol Biol (Paris) 1996;44:269–274.Google Scholar
24.Salemi, C, Morgan, J, Padilla, S, Morrissey, R. Association between severity of illness and mortality from nosocomial infection. Am J Infect Control 1995;23:188–193.CrossRefGoogle ScholarPubMed
25.Breslow, NE, Day, NE. The Design and Analysis of Cohort Studies: Statistical Methods in Cancer Research. Vol II. Lyon, France: 1ARC; 1987. Publication 2.Google ScholarPubMed
26.Hosmer, WH, Lemeshow, S. Applied Logistic Regression. New York, NY: John Wiley & Sons; 1989.Google Scholar
27.Belsley, DA, Kuh, E, Welsch, RE. Regression Diagnostics. New York, NY: John Wiley & Sons; 1980.CrossRefGoogle Scholar
28.Benichou, J. Methods of adjustment for estimating the attributable risk in case-control studies: a review. Stat Med 1991;10:1753–1773.CrossRefGoogle ScholarPubMed
29.Abraham, C, Daures, JP, Momas, I. Utilisation de la proportion de cas attribuable: intérêts, limites, et applications à une étude sur le cancer de la vessie dans l'Hérault. 1997. Available at: http://www.sfds.asso.fr/publicat/somm97.htm. Accessed May 5, 2006.Google Scholar
30.Avril, JL, Carlet, J. Les infections nosocomiales et leur prévention. Paris, France: SA EM, 1998:687.Google Scholar
31.Poulsen, KB, Wachmann, CH, Bremmelgaard, A, Sorensen, AI, Raahave, D, Petersen, JV. Survival of patients with surgical wound infection: a case-control study of common surgical interventions. Br J Surg 1995;82:208–209.CrossRefGoogle ScholarPubMed
32.Kleinbaum, D, Kupper, LL, Morgenstern, H. Epidemiologic Research: Principles and Quantitative Methods. New York, NY: Van Nostrand Reinhold; 1982.Google Scholar
33.Garcia-Martin, M, Lardelli-Claret, P, Jimenez-Moleon, JJ, Bueno-Cavanillas, A, Luna-del-Castillo, JD, Galvez-Vargas, R. Proportion of hospital deaths potentially attributable to nosocomial infection. Infect Control Hosp Epidemiol 2001;22:708–714.CrossRefGoogle ScholarPubMed
34.Kuritz, SJ, Landis, JR. Attributable risk ratio estimation from matched-pairs case-control data. Am J Epidemiol 1987;125:324–328.CrossRefGoogle ScholarPubMed