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Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Jean-Marie Januel ,
Stephan Harbarth ,
Robert Allard ,
Nicolas Voirin ,
Alain Lepape ,
Bernard Allaouchiche ,
Claude Guerin ,
Jean-Jacques Lehot ,
Marc-Olivier Robert  and
Gérard Fournier
...Show all authors
Jean-Marie Januel*
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France Health Care Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne, University Hospital Centre of Vaud, Lausanne, Switzerland
Stephan Harbarth
Affiliation:
Infection Control Program, Geneva University Hospitals and Medical School, Geneva, Switzerland
Robert Allard
Affiliation:
Department of Social and Preventive Medicine, Public Health Unit, Infectious Diseases Centre, Montreal, Quebec, Canada
Nicolas Voirin
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France
Alain Lepape
Affiliation:
Intensive Care Units, Lyon, France
Bernard Allaouchiche
Affiliation:
Intensive Care Units, Lyon, France
Claude Guerin
Affiliation:
Intensive Care Units, Lyon, France
Marc-Olivier Robert
Affiliation:
Intensive Care Units, Lyon, France
Gérard Fournier
Affiliation:
Intensive Care Units, Lyon, France
Didier Jacques
Affiliation:
Intensive Care Units, Lyon, France
Dominique Chassard
Affiliation:
Intensive Care Units, Lyon, France
Pierre-Yves Gueugniaud
Affiliation:
Intensive Care Units, Lyon, France
François Artru
Affiliation:
Intensive Care Units, Lyon, France
Paul Petit
Affiliation:
Intensive Care Units, Lyon, France
Dominique Robert
Affiliation:
Intensive Care Units, Lyon, France
Ismaël Mohammedi
Affiliation:
Intensive Care Units, Lyon, France
Raphaëlle Girard
Affiliation:
Infection Control Units, Lyon, France
Jean-Charles Cêtre
Affiliation:
Infection Control Units, Lyon, France
Marie-Christine Nicolle
Affiliation:
Infection Control Units, Lyon, France
Jacqueline Grando
Affiliation:
Infection Control Units, Lyon, France
Jacques Fabry
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France Department of Epidemiology, Hygiene and Prevention, Edouard Herriot Hospital, Hospices Civils of Lyon, University Hospital, Lyon, France
Philippe Vanhems
Affiliation:
Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, France Department of Epidemiology, Hygiene and Prevention, Edouard Herriot Hospital, Hospices Civils of Lyon, University Hospital, Lyon, France
*
Health Care Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne, University Hospital Centre of Vaud, 1005 Lausanne, Switzerland (jean-marie.januel@chuv.ch)
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Abstract

Background.

The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.

Objective.

TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.

Setting.

Eleven ICUs of a French university hospital.

Design.

We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.

Results.

Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%–6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%–3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%–2.5%) for bloodstream infection, and 0.0% (95% CI, –0.4% to 0.4%) for urinary tract infection.

Conclusions.

ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 4 , April 2010 , pp. 388 - 394
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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