Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections
Matheus L Otero,1 Rodrigo C Menezes,2 Isabella B B Ferreira,3 Francine L Issa,4 Gabriel Agareno,1 Thomas Azevedo Carmo,1 María B Arriaga,4– 6 Kiyoshi F Fukutani,5,6 Licurgo Pamplona Neto,7 Sydney Agareno,7 Nivaldo M Filgueiras Filho,1,3,7,* Kevan M Akrami,8,* Bruno B Andrade1,4&...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-08-01
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| Series: | Infection and Drug Resistance |
| Subjects: | |
| Online Access: | https://www.dovepress.com/factors-associated-with-mortality-in-critically-ill-patients-diagnosed-peer-reviewed-article-IDR |
| _version_ | 1818470075136475136 |
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| author | Otero ML Menezes RC Ferreira IBB Issa FL Agareno G Carmo TA Arriaga MB Fukutani KF Pamplona Neto L Agareno S Filgueiras Filho NM Akrami KM Andrade BB |
| author_facet | Otero ML Menezes RC Ferreira IBB Issa FL Agareno G Carmo TA Arriaga MB Fukutani KF Pamplona Neto L Agareno S Filgueiras Filho NM Akrami KM Andrade BB |
| author_sort | Otero ML |
| collection | DOAJ |
| description | Matheus L Otero,1 Rodrigo C Menezes,2 Isabella B B Ferreira,3 Francine L Issa,4 Gabriel Agareno,1 Thomas Azevedo Carmo,1 María B Arriaga,4– 6 Kiyoshi F Fukutani,5,6 Licurgo Pamplona Neto,7 Sydney Agareno,7 Nivaldo M Filgueiras Filho,1,3,7,* Kevan M Akrami,8,* Bruno B Andrade1,4– 6,9,* 1Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil; 2Curso de Medicina, União Metropolitana Para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil; 3Universidade Do Estado Da Bahia (UNEB), Salvador, Bahia, Brazil; 4Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil; 5Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; 6Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil; 7Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil; 8Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA; 9Escola Bahiana De Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil*These authors contributed equally to this workCorrespondence: Bruno B AndradeLaboratório De Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Rua Waldemar Falcão No. 121, Candeal, Salvador, Bahia 40269-710, BrazilEmail bruno.andrade@fiocruz.brObjective: Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil.Methods: Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI.Results: A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23– 39.27, OR: 2.48, 95% CI 1.17– 5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality.Conclusion: Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.Keywords: hospital acquired infection, ICU, mortality, critical illness, septic shock, intensive care |
| first_indexed | 2024-04-13T21:33:27Z |
| format | Article |
| id | doaj.art-886c2984892c4071b54b9ff3aaf94bb7 |
| institution | Directory Open Access Journal |
| issn | 1178-6973 |
| language | English |
| last_indexed | 2024-04-13T21:33:27Z |
| publishDate | 2020-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Infection and Drug Resistance |
| spelling | doaj.art-886c2984892c4071b54b9ff3aaf94bb72022-12-22T02:29:05ZengDove Medical PressInfection and Drug Resistance1178-69732020-08-01Volume 132811281756199Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired InfectionsOtero MLMenezes RCFerreira IBBIssa FLAgareno GCarmo TAArriaga MBFukutani KFPamplona Neto LAgareno SFilgueiras Filho NMAkrami KMAndrade BBMatheus L Otero,1 Rodrigo C Menezes,2 Isabella B B Ferreira,3 Francine L Issa,4 Gabriel Agareno,1 Thomas Azevedo Carmo,1 María B Arriaga,4– 6 Kiyoshi F Fukutani,5,6 Licurgo Pamplona Neto,7 Sydney Agareno,7 Nivaldo M Filgueiras Filho,1,3,7,* Kevan M Akrami,8,* Bruno B Andrade1,4– 6,9,* 1Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil; 2Curso de Medicina, União Metropolitana Para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil; 3Universidade Do Estado Da Bahia (UNEB), Salvador, Bahia, Brazil; 4Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil; 5Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil; 6Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil; 7Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil; 8Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA; 9Escola Bahiana De Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil*These authors contributed equally to this workCorrespondence: Bruno B AndradeLaboratório De Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Rua Waldemar Falcão No. 121, Candeal, Salvador, Bahia 40269-710, BrazilEmail bruno.andrade@fiocruz.brObjective: Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil.Methods: Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI.Results: A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23– 39.27, OR: 2.48, 95% CI 1.17– 5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality.Conclusion: Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.Keywords: hospital acquired infection, ICU, mortality, critical illness, septic shock, intensive carehttps://www.dovepress.com/factors-associated-with-mortality-in-critically-ill-patients-diagnosed-peer-reviewed-article-IDRhospital acquired infectionicumortalitycritical illnessseptic shockintensive care |
| spellingShingle | Otero ML Menezes RC Ferreira IBB Issa FL Agareno G Carmo TA Arriaga MB Fukutani KF Pamplona Neto L Agareno S Filgueiras Filho NM Akrami KM Andrade BB Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections Infection and Drug Resistance hospital acquired infection icu mortality critical illness septic shock intensive care |
| title | Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections |
| title_full | Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections |
| title_fullStr | Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections |
| title_full_unstemmed | Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections |
| title_short | Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections |
| title_sort | factors associated with mortality in critically ill patients diagnosed with hospital acquired infections |
| topic | hospital acquired infection icu mortality critical illness septic shock intensive care |
| url | https://www.dovepress.com/factors-associated-with-mortality-in-critically-ill-patients-diagnosed-peer-reviewed-article-IDR |
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