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

  • Stijn Blot (a1), Dirk De Bacquer (a2), Eric Hoste (a1), Pieter Depuydt (a1), Koenraad Vandewoude (a1), Jan De Waele (a1), Dominique Benoit (a1), Johan De Schuijmer (a3), Francis Colardyn (a1) and Dirk Vogelaers (a4)...
Abstract
AbstractObjective:

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.

Copyright
Corresponding author
Ghent University Hospital, Intensive Care Department, De Pintelaan 185, B-9000 Gent, Belgiumstijn.blot@UGent.be
References
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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;271:15981601.
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;160:976981.
3.Wenzel REThe mortality of hospital-acquired bloodstream infections: need for a new vital statistic? Int J Epidemiol 1988;17:225227.
4.Costanza MC. Matching. Prev Med 1995;24:425433.
5.Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.
6.Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Effects of nosocomial candidemia on outcomes of critically ill patients. Am J Med 2002;113:480485.
7.Blot SI, Vandewoude KH, Colardyn FA. Clinical impact of nosocomial Klebsiella bacteremia in critically ill patients. Eur J Clin Microbiol Infect Dis 2002;21:471473.
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;123:12081213.
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;162:22292235.
10.Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med 2003;29:471475.
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;53:1824.
12.Smith RL, Meixler SM, Simberkoff MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100:164167.
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;162:10271030.
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;15:454462.
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;24:912915.
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;163:15841590.
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;159:12491256.
18.Grimes DA, Schulz KF. Cohort studies: marching towards outcomes. Lancet 2002;359:341345.
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;157:11511158.
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;34:16001606.
21.Hurley JC. Comparison of mortality associated with methicillin-susceptible and methicillin-resistant Staphylococcus aureus bacteremia: an ecological analysis. Clin Infect Dis 2003;37:866868.
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;123:16151624.
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;115:529535.
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;115:462474.
25.Kollef MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 2000;31 (suppl 4):S131S138.
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;118:146155.
27.Friedman ND, Korman TM, Fairley CKFranklin JC, Spelman DW. Bacteraemia due to Stenotrophomonas maltophilia: an analysis of 45 episodes. J Infect 2002;45:4753.
28.Blot S, Vandewoude K. Early detection of systemic infection. Acta Clin Belg 2004;59:2023.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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