Reynvoet Emmelie, Vandijck Dominique M, Blot Stijn I, Dhondt Annemieke W, De Waele Jan J, Claus Stefaan, Buyle Franky M, Vanholder Raymond C, Hoste Eric A J
Department of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Crit Care Med. 2009 Jul;37(7):2203-9. doi: 10.1097/CCM.0b013e3181a03961.
OBJECTIVES: Critically ill patients with infection are at increased risk for developing acute renal failure (ARF), and ARF is associated with an increased risk for infection. Both conditions are associated with prolonged length of stay (LOS) and worse outcome; however, little data exist on the epidemiology of infection in this specific cohort. Therefore, we investigated the occurrence of infection in a cohort of critically ill patients with ARF treated with renal replacement therapy (RRT). In addition, we assessed whether this infection worsened outcome. DESIGN: Retrospective cohort study. SETTING: General intensive care unit (ICU) in an academic tertiary care center comprising a 22-bed surgical ICU, eight-bed cardiac surgery ICU, 14-bed medical ICU, and six-bed burn center. PATIENTS: Six hundred forty-seven consecutive critically ill patients with ARF treated with RRT, admitted between 2000 and 2004. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: total of 519 (80.2%), 193 (29.8%), 66 (10.2%), and ten (1.5%) patients developed one, two, three, and four episodes of infection, respectively. Of 788 episodes of infection observed, 364 (46.2%) occurred before, 318 (40.3%) during, and 106 (13.4%) after discontinuation of RRT. Pneumonia (54.3%) was most frequent, followed by intra-abdominal (11.9%) and urinary tract infections (9.7%). Infections were caused by Gram-negative organisms in 33.7%, Gram-positive organisms in 21.6%, and yeasts in 9.8%. Patients with infection had higher mortality (p = 0.04) and longer ICU and hospital LOS. They needed more vasoactive therapy and spent more time on mechanical ventilation and RRT (all p < 0.001) than patients without infection. After adjustment for potential confounders, Acute Physiology and Chronic Health Evaluation II score, age, mechanical ventilation, and vasoactive therapy were associated with worse outcome, but infection was not. CONCLUSIONS: Infection occurred in four fifths of critically ill patients with ARF treated with RRT and was in an unadjusted analysis associated with longer LOS and higher mortality. After correction for other covariates, infection was no longer associated with in-hospital mortality.
目的：感染的重症患者发生急性肾衰竭（ARF）的风险增加，而ARF又与感染风险增加相关。这两种情况均与住院时间延长（LOS）及更差的预后相关；然而，关于这一特定队列中感染的流行病学数据很少。因此，我们调查了接受肾脏替代治疗（RRT）的ARF重症患者队列中的感染发生率。此外，我们评估了这种感染是否会使预后恶化。 设计：回顾性队列研究。 地点：一所学术性三级医疗中心的综合重症监护病房（ICU），包括一个有22张床位的外科ICU、一个有8张床位的心脏外科ICU、一个有14张床位的内科ICU和一个有6张床位的烧伤中心。 患者：2000年至2004年间收治的647例连续接受RRT治疗的ARF重症患者。 干预措施：无。 测量指标及主要结果：分别有519例（80.2%）、193例（29.8%）、66例（10.2%）和10例（1.5%）患者发生了1次、2次、3次和4次感染发作。在观察到的788次感染发作中，364次（46.2%）发生在RRT停止前，318次（40.3%）发生在RRT期间，106次（13.4%）发生在RRT停止后。肺炎（5
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