Outcome Intensive Care Unit of Patients Discharged with Nosocomial Infections
DOI:
https://doi.org/10.18004/Keywords:
Nosocomial infections, Intensive care, Outcome, ParaguayAbstract
Introduction: 5 to 30% of infected patients in intensive care develop complications, pass away in the common hospital rooms or are readmitted.
Objectives: To determine mortality, complications, risk of mortality in this group of patients at discharge from intensive care. Materials and methods: Descriptive and case-control study, between July 1999 - December 2004. Including patients with nosocomial infections, transferred to common hospital rooms. Analysis of cases and controls for risk factors of mortality. Results in percentages and means with OR, DE, p <0.05 significant. Results: Evaluated 71 patients, presenting 110 infections. Complications in common hospital rooms (41) in 37 patients (52.1%), 43.9% occurring before day 5th. Infectious complications 24 (58.5%): pneumonies 29%, urinary tract infections 29%. Non-infectious complications 17 (42%): respiratory 32.3%, cardiovascular 23.5%. 10 patients were readmitted (14.1%). Of 61 patients not readmitted, 8 (13.1%) passed away, 37.5%. before the 4th day. The most frequent cause of death (n = 8) were infections (75%). Risk factor of mortality: ≥ 65 years, OR 8.12 (1.28 to 65.21), p = 0.009. Conclusions: Complications in patients with intensive care nosocomial infections transferred to common hospital rooms, are frequent, precocious and predominantly infectious. Low mortality and readmissions. Advanced age is a risk factor related to mortality.
References
1. Richards MJ, Edwards JR, Culver DH, Gaynes RP and National Nosocomial Infections Surveillance System. Critical Care Medicine 1999; 27:887-96
2. Reanis. Guide pour la Prevention Des Infeactions Nosocomiales en Reanimation. Definitions des Infecciotiones Nosocomiales. Paris: EDICK 1999; 240-50
3. Vicent JL, Bihari DJ, Bruining HA, White J, Nicolas-Chanoin M, Wolff M et al. The Prevalence of Nosocomial Infection in Intesive Care (EPIC) Study. JAMA 1995; 274:639-44
4. Fridkin SK, Welbel SF,Weinstein RA. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am 1997; 11: 479
5. Kim J.M, Park E, Jeong J, Kim K, Kim J, Oh H, et al. Multicenter surveillance study for nosocomial infections in major hospitals in Korea. American Journal of Infection Control 2000; 28: 454-58
6. Báez S, Bueno E, Yanes L, Bianco H. Evolución hospitalaria de pacientes de la Unidad de Cuidados Intensivos Adultos. Anales de la Sociedad Paraguaya de Medicina Interna. 2001; 5: 15-19
7. Vicen J, Bihari D, Bruining S, White J, Chanoin N, Wolf M, et al. The Prelalence of Nosocomial Infection in Intensive Care Units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA 1995; 274: 639-44
8. Azoulay E, Adrie C, De Lassence A, Pochard F, Moreau D, Thiery G, et al. Determinants of postintensive care unit mortality: a prospective multicenter study. Crit Care Med. 2003; 31: 428-32
9. Hughes M, Evans H, Chong T, Smith R, Raymond D, Pelletier S, et al. Effect of an intensive care unit rotating empiric antibiotic schedule on the development of hospital-adquired infections on the non-intensive care unit ward. Critical Care Medicine 2004; 32: 53-60
10. Azoulay E, Alberti C, Legendre I, Brun Buisson C, Le Gall JR for the European Sepsis Group. Post-ICU mortality in critically ill infected patients: an international study. Intensive Care Med 2005; 31: 56-63
11. Garner J, Jarvis W, Emori T, Horan T, Hughes J. CDC definitions for nosocomial infections. Am J Infect Control 1988; 16: 128-40
12. Knaus W, Drapper E, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Critical Care Medicine 1986; 10: 828-29
13. Chiavone P, Alves Y. Evaluation of APACHE II system among intensive care patients at a teaching hospital. Sao Paulo Med J 2003; 121: 53-7
14. Mc Cabe WR, Jackson GG. Gram negative bacteremia, etiology and ecology. Arch Intern Med 1962; 110: 845
15. Brivet F. Les Indices Therapeutiques. In: Evaluation en Reanimation. Le Gall JR, Loirat Ph. Editorial Masson 1994; 109-25
16. Durban C.G, Koper R.F. A case-control study of patients readmitted to the Intensive Care Unit. Critical Care Medicine. Octuber 1993; 21: 1547-53.
