Pittet D, Tarara D, Wenzel R P
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City.
JAMA. 1994 May 25;271(20):1598-601. doi: 10.1001/jama.271.20.1598.
To determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients.
Pairwise-matched (1:1) case-control study.
Surgical intensive care unit (SICU) in a tertiary health care institution.
All patients admitted in the SICU between July 1, 1988, and June 30, 1990, were eligible. Cases were defined as patients with nosocomial bloodstream infection; controls were selected according to matching variables in a stepwise fashion.
Matching variables were primary diagnosis for admission, age, sex, length of stay before the day of infection in cases, and total number of discharge diagnoses. Matching was successful for 89% of the cohort; 86 matched case-control pairs were studied.
Crude and attributable mortality, excess length of hospital and SICU stay, and overall costs.
Nosocomial bloodstream infection complicated 2.67 per 100 admissions to the SICU during the study period. The crude mortality rates from cases and controls were 50% and 15%, respectively (P < .01); thus, the estimated attributable mortality rate was 35% (95% confidence interval, 25% to 45%). The median length of hospital stay significantly differed between cases and controls (40 vs 26 days, respectively; P < .01). When only matched pairs who survived bloodstream infection were considered (n = 41), cases stayed in the hospital a median of 54 days vs 30 days for controls (P < .01), and cases stayed in the SICU a median of 15 days vs 7 days for controls (P < .01). Thus, extra hospital and SICU length of stay attributable to bloodstream infection was 24 and 8 days, respectively. Extra costs attributable to the infection averaged $40,000 per survivor.
The attributable mortality from nosocomial bloodstream infection is high in critically ill patients. The infection is associated with a doubling of the SICU stay, an excess length of hospital stay of 24 days in survivors, and a significant economic burden.
确定重症患者医院血流感染所致的住院时间延长、额外费用及死亡率。
配对（1:1）病例对照研究。
一家三级医疗机构的外科重症监护病房（SICU）。
1988年7月1日至1990年6月30日期间入住SICU的所有患者均符合条件。病例定义为发生医院血流感染的患者；对照根据匹配变量逐步选取。
匹配变量为入院的主要诊断、年龄、性别、病例感染当天之前的住院时间以及出院诊断总数。89%的队列成功匹配；研究了86对匹配的病例对照。
粗死亡率和归因死亡率、医院和SICU住院时间延长以及总费用。
在研究期间，SICU每100例入院患者中有2.67例发生医院血流感染。病例组和对照组的粗死亡率分别为50%和15%（P<.01）；因此，估计归因死亡率为35%（95%置信区间，25%至45%）。病例组和对照组的中位住院时间有显著差异（分别为40天和26天；P<.01）。仅考虑血流感染存活的匹配对时（n = 41），病例组的中位住院时间为54天，对照组为30天（P<.01），病例组在SICU的中位住院时间为15天，对照组为7天（P<.01）。因此，血流感染所致的额外医院和SICU住院时间分别为24天和8天。感染所致的额外费用平均每位幸存者为40,000美元。
医院血流感染在重症患者中的归因死亡率很高。该感染与SICU住院时间加倍、幸存者住院时间延长24天以及重大经济负担相关。
