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Risk Factors for Nosocomial Bacteremia in a Large Spanish Teaching Hospital: A Case-Control Study

Published online by Cambridge University Press:  21 June 2016

Antoni Trilla ,
Josep M. Gatell ,
Josep Mensa ,
Xavier Latorre ,
Manuel Almela ,
Eladio Soriano ,
Maria T. Jimenez de Anta  and
Juan Garcia San Miguel
Antoni Trilla*
Affiliation:
Infectious Diseases Unit, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
Josep M. Gatell
Affiliation:
Infectious Diseases Unit, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
Josep Mensa
Affiliation:
Infectious Diseases Unit, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
Xavier Latorre
Affiliation:
Infectious Diseases Unit, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
Manuel Almela
Affiliation:
Microbiology Laboratory, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
Eladio Soriano
Affiliation:
Infectious Diseases Unit, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
Maria T. Jimenez de Anta
Affiliation:
Microbiology Laboratory, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
Juan Garcia San Miguel
Affiliation:
Infectious Diseases Unit, Hospital Clinic, University of Barcelona School of Medicine, Barcelona (Spain)
*
Infectious Diseases Unit (G044), Hospital Clinic, Villarroel 170, 08036-Barcelona (Spain)
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Abstract

Objective:

Identify independent risk factors associated with the development of nosocomial bacteremia.

Design:

Exploratory, unmatched, case-control study.

Setting:

A 970-bed Spanish university hospital.

Patients:

All non-neutropenic adult patients with nosocomial bacteremia admitted during a 12-month period were eligible as cases. All adult non-neutropenic patients without nosocomial bacteremia were eligible as controls.

Results:

The incidence of bacteremia in the study population was 6.9/1000 admissions/ year. One hundred eighty cases and 180 controls were analyzed. Multivariate analysis (stepwise logistic regression techniques) identified seven risk factors independently associated with nosocomial bacteremia: age above 65 years; prior admission (within six months) to the hospital; underlying diseases that were ultimately or rapidly fatal; indwelling urethral catheter in place for more than three days; intravenous central lines or peripheral venous lines (if in place for more than four days); “high-risk surgery” (i.e., lower abdominal, cardiac or thoracic); and admission to an intensive care unit.

Conclusions:

Although five variables are not modifiable, the remaining two relate to the use and duration of devices. Our data give strong support for the value of testing strict guidelines for limiting vascular catheters and evaluating the need for prolonged urethral catheterization. If effective infection control measures are identified, we could target hospital-wide surveillance to patients whose risk factors are amenable to intervention.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 3 , March 1991 , pp. 150 - 156
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Freeman, J, McGowan, JE. Risk factors for nosocomial infection. J Infect Dis. 1978;138:811–819.CrossRefGoogle ScholarPubMed
2. Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infections. Am J Epidemiol. 1985;121:206–215.CrossRefGoogle Scholar
3. Wenzel, RP, Thompson, RL, Landry, SM, et al. Hospital acquired infections in intensive care unit patients: an overview with emphasis in epidemics. Infect Control. 1983;4:371–375.CrossRefGoogle ScholarPubMed
4. Bouza, E, Cosin, J. Estudio de prevalencia de infection hospitalaria y consumo de antimicrobianos. Med Clin (Barc). 1986:87:353–358.Google Scholar
5. Grupo de Trabajo EPINCAT. Prevalencia de las infecciones nosocomiales en Catalunya (I). Infecciones y factores de rieseo. Med Clin (Barc). 1990;95:41–52.Google Scholar
6. Gatel l, JM, Trilla, A, Latorre, X, et al. Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis. Rev Infect Dis. 1988;10:203–210.CrossRefGoogle Scholar
7. Wenzel, RI? Towards a global perspective of nosocomial infections. Eur J Clin Microbiol. 1987;6:341–343.CrossRefGoogle ScholarPubMed
8. Freeman, J, McGowan, JE. Methodologic issues in hospital epidemiology: rates, case-finding and interpretation. Rev Infect Dis. 1981;3:658–667.CrossRefGoogle ScholarPubMed
9. Aronson, MD, Bor, DH. Blood cultures. Ann Intern Med. 1987;106:246–253.CrossRefGoogle ScholarPubMed
10. Bryan, CS. Clinical implications of positive blood cultures. Clin Microbiol Rev. 1989;2:329–353.CrossRefGoogle ScholarPubMed
11. Gross, PA. Collection of data documenting risk factors: safe guards in conducting case-control studies. Am J Med. 1984;76:28–33.CrossRefGoogle Scholar
12. Hayden, GE, Kramer, MS, Horwitz, RI. The case-control study: a practical review for the clinician. JAMA. 1982;247:326–331.CrossRefGoogle ScholarPubMed
13. Haley, RW, Quade, D, Freeman, H, et al. Study on the efficacy of nosocomial infection control (SENIC project): summary of study design. AM J Epidemiol. 1980;111:635–643.CrossRefGoogle Scholar
14. National Nosocomial Infections Study Site Definitions Manual. Atlanta. Ga: Centers for Disease Control; 1972.Google Scholar
15. McCabe, WR, Jackson, GG. Gram-negative bacteremia; II. Clinical, laboratory and therapeutic observations. Arch Intern Med. 1962;110:856–864.CrossRefGoogle Scholar
16. Isenberg, HD, Schoenknecht, FD, Graevenitz, A. Collection and processing of bacteriological specimens. In: Rubin, SJ, ed. Cumitech 9; Collection and Processing of Bacteriological Specimens. Washington DC: American Society of Microbiology; 1979.Google Scholar
17. Freiman, JA, Chalmers, TC, Smith, H, Kuebler, RR. The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial. N Engl J Med. 1978;299:690–694.CrossRefGoogle ScholarPubMed
18. Simon, R. Confidence intervals for reporting results of clinical trials. Ann Intern Med. 1986;105:429–435.CrossRefGoogle ScholarPubMed
19. Cupples, LA, Heeren, T, Schatzkin, A, Colton, T. Multiple testing of hypotheses in comparing two groups. Ann Intern Med. 1984;100:122–129.CrossRefGoogle ScholarPubMed
20. Kleinbaum, DG, Kupper, L, Muller, KE. Applied Regression Analysis and Other Multivariate Methods. 2nd ed. Boston, Mass: PWS-Kent Publishing Co; 1988.Google Scholar
21. Mayo, JW, Wenzel, RI? Rates of hospital-acquired bloodstream infections in patients with specific malignancy. Cancer. 1982;50:187–190.10.1002/1097-0142(19820701)50:1<187::AID-CNCR2820500134>3.0.CO;2-Y3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
22. Townsend, TR, Wenzel, RP. Nosocomial bloodstream infections in a newborn intensive care unit: a case-matched control study of morbidity, mortality and risk. Am J Epidemiol. 1981;114:73–80.CrossRefGoogle Scholar
23. Centers for Disease Control. Nosocomial infection surveillance; 1984. MMWR. 1986;35:17–29.Google Scholar
24. Schesselman, JJ. Case-Control Studies. NewYork, NY: Oxford University Press; 1982.Google Scholar
25. Fedson, DS, Chiarello, LA. Previous hospital care and pneumococcal bacteremia; importance for pneumococcal immunization. Arch Intern Med. 1983;143:885–889.CrossRefGoogle ScholarPubMed
26. Pallares, R, Gudiol, F, Linares, J, et al. Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med. 1987;317:18–22.CrossRefGoogle ScholarPubMed
27. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals. Am J Epidemiol. 1985;121:182–205.CrossRefGoogle Scholar
28. Meyers, RB, Sherman, E, Mendelson, MH, et al. Bloodstream infections in the elderly. Am J Med. 1989;86:379–384.CrossRefGoogle ScholarPubMed
29. Gross, PA, Rapuano, C, Andrignolo, A, Shaw, B. Nosocomial infections; decade-specific risk. Infect Control. 1983;4:145–147.CrossRefGoogle ScholarPubMed
30. Centers for Disease Control. Increase in national hospital discharge survey rates for septicemia: U.S., 1979-1987. MMWR. 1990;39:31–34.Google Scholar
31. Sheckler, WE. Septicemia in a community hospital: 1970 through 1973. JAMA. 1977;237:1437–1442.Google Scholar
32. Britt, MR, Scheleupner, CJ, Matsumiya, S. Severity of underlying disease as a predictor of nosocomial infection: utility in the control of nosocomial infection. JAMA. 1978;239:1047–1051.CrossRefGoogle ScholarPubMed
33. Krieger, JW, Kaiser, DL, Wenzel, RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis. 1983;148:57–62.10.1093/infdis/148.1.57CrossRefGoogle ScholarPubMed
34. Bryan, CS, Reynolds, KL. Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol. 1984; 132:494–498.CrossRefGoogle ScholarPubMed
35. Turck, M, Stamm, W. Nosocomial infection of the urinary tract. Am J Med. 1981;70:651–654.CrossRefGoogle ScholarPubMed
36. McGowan, JE, Parrott, PL, Duty, VP. Nosocomial bacteremia: potential for prevention of procedure-related cases. JAMA. 1977;237:2727–2729.CrossRefGoogle ScholarPubMed
37. Donowitz, LG, Wenzel, RP, Hoyt, JW. High risk of hospital acquired infection in the ICU patient. Crit Cure Med. 1982; 10:355–357.CrossRefGoogle ScholarPubMed
38. Wenzel, RP, Osterman, CA, Donowitz, LG, et al. Identification of procedure-related nosocomial infections in high-risk patients. Rev Infect Dis. 1981;3:701–707.CrossRefGoogle ScholarPubMed
39. Craven, DE, Kunches, LM, Lichtenberg, DA, et al. Nosocomial infection and fatality in medical and surgical intensive care units patients. Arch Intern Med. 1988;148:1161–1168.CrossRefGoogle Scholar
40. Wenzel, RP, The mortality of hospital-acquired bloodstream infections: need for a new vital statistic. Int J Epidemiol. 1988;17:225–227.CrossRefGoogle ScholarPubMed
41. Rose, R, Hunting, KJ, Townsend, TR, Wenzel, RP. Morbidity/mortality and economics of hospital-acquired bloodstream infections: a controlled study. South Med J. 1977;70:1267–1269.CrossRefGoogle ScholarPubMed
42. Spengler, RF, Greenough, WB. Hospital costs and mortality attributed to nosocomial bacteremias. JAMA. 1978;240:2455–2458.CrossRefGoogle ScholarPubMed
43. Trilla, A, Miro, JM. El control de la infection nosocomial. Quien?, Como? y Cuanto Cuesta? Med Clin(Barcelona). 1989;92:217–219.Google Scholar
44. Hooton, TM, Haley, RW, Culver, DH, White, JW, Morgan, WM, Carroll, RJ. The joint associations of multiple risk factors with the occurrence of nosocomial infection. Am J Med. 1981:70:960–970.CrossRefGoogle ScholarPubMed
45. Broderick, A, Mori, M, Nettleman, MD, Streed, SA, Wenzel, RP. Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk. Am J Epidemiol. 1990; 131:734–742.CrossRefGoogle ScholarPubMed