Hostname: page-component-6bf8c574d5-xtvcr Total loading time: 0 Render date: 2025-02-15T09:42:53.294Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors Related to Hospital Stay Among Patients With Nosocomial Infection Acquired in the Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Pedro M. Olaechea ,
Miguel-Angel Ulibarrena ,
Francisco Álvarez-Lerma ,
Jesús Insausti ,
Mercedes Palomar ,
Miguel-Angel De la Cal  and
ENVIN-UCI Study Group
Pedro M. Olaechea*
Affiliation:
Intensive Care Unit, Hospital de Galdakao, Bizkaia
Miguel-Angel Ulibarrena
Affiliation:
Intensive Care Unit, Hospital Santiago Apóstol, Vitoria, Alava
Francisco Álvarez-Lerma
Affiliation:
Intensive Care Unit, Hospital Universitario del Mar, Barcelona
Jesús Insausti
Affiliation:
Intensive Care Unit, Hospital de Navarra, Pamplona
Mercedes Palomar
Affiliation:
Intensive Care Unit, Hospital Vall d'Hebron, Barcelona
Miguel-Angel De la Cal
Affiliation:
Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain
*
Servicio de Urgencias y Medicina Intensiva, Hospital de Galdakao, Barrio de Labeaga s/n, E-48960 Galdakao, Bizkaia, Spain
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To assess the influence of nosocomial infection on length of stay in the intensive care unit (ICU) and to determine the relative effect of other factors on extra length of hospitalization associated with nosocomial infection.

Design:

Prospective cohort multicenter study in the context of the ENVIN-UCI project.

Setting:

Medical or surgical ICUs of 49 different hospitals in Spain.

Methods:

All consecutive patients (N = 6,593) admitted to ICUs of the participating hospitals who stayed for more than 24 hours during a 3-month period (from January 15 to April 15, 1996) were included. Length of ICU stay was compared between patients with and without nosocomial infections.

Results:

Uninfected patients (N = 5,868) had a median stay in the ICU of 3 days, whereas the median for infected patients (N = 725) was 17 days (P < .001). The median for infected patients with one episode of nosocomial infection was 13 days. The greatest length of stay (40 days) was among patients admitted to the ICU because of medical diseases, with an infection acquired before admission to the ICU, and with the largest number of nosocomial infection episodes. In extended stays, nosocomial infection was significantly associated with length of hospitalization (day 21; odds ratio, 22.38; 95% confidence interval, 16.6 to 30.4), whereas an effect of variables related to severity of illness on admission (Acute Physiology and Chronic Health Evaluation II score, urgent surgery, and infection prior to ICU admission) was not found.

Conclusions:

The presence of nosocomial infection and the number of infection episodes were the variables with the strongest association with prolonged hospital stay among ICU patients.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 3 , March 2003 , pp. 207 - 213
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Haley, RW, Schaberg, DR, Von Allmen, SD, McGowan, JE Jr. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis 1980;141:248–257.Google Scholar
2.Green, MS, Rubinstein, ER, Amit, P. Estimating the effect of nosocomial infections on the length of hospitalization. J Infect Dis 1982;145:667–672.Google Scholar
3.Wakefield, DS, Pfaller, M, Ludke, RL, Wenzel, RRMethods for estimating days of hospitalization due to nosocomial infections. Med Care 1992;30:373–376.Google Scholar
4.Erbaydar, S, Akgiin, A, Eksik, A, Erbaydar, T, Bilge, O, Bulut, A. Estimation of increased hospital stay due to nosocomial infections in surgical patients: comparison of matched groups. J Hosp Infect 1995;30:149–154.Google Scholar
5.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;157:1151–1158.Google Scholar
6.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. JAMA 1994;271:1598–1601.Google Scholar
7.Coello, R, Glenister, H, Fereres, J, et al.The cost of infection in surgical patients: a case-control study. J Hosp Infect 1993;25:239–250.Google Scholar
8.Papazian, L, Bregeon, F, Thirion, X, et al.Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91–97.Google Scholar
9.Heyland, DK, Cook, DJ, Griffith, L, Keenan, SP, Brun-Buisson, C, the Canadian Critical Care Trials Group. The attributable morbidity and mortality of ventilator-associated pneumonia in critically ill patients. Am J Respir Crit Care Med 1999;159:1249–1256.Google Scholar
10.Kappstein, I, Schulgen, G, Bayer, U, Geiger, K, Schumacher, W, Daoner, ED. Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit. Eur J Clin Microbiol Infect Dis 1992;11:504–508.Google Scholar
11.Asensio Vegas, A, Monge Jodra, V, Iizán Garda, M. Nosocomial infection in surgical wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993;9:504–510.CrossRefGoogle Scholar
12.Bjerke, HS, Leyerle, B, Shabot, MM. Impact of ICU nosocomial infections on outcome from surgical care. Am Surg 1991;57:798–802.Google Scholar
13.Dinkel, RH, Lebok, U. A survey of nosocomial infections and their influence on hospital mortality rates. J Hosp Infect 1994;28:297–304.Google Scholar
14.Herman, B, Wolff, MA, Pean, Y, Gertner, J, Millet, H. Risques infectieux liés au cathétérisme veineux et essai d'estimation de leur coût financier. Agressologie 1985;26:197–202.Google Scholar
15.Bueno Cavanillas, A, Delgado Rodríguez, M, López Luque, A, Schaffino Cano, S, Gálvez Vargas, R. Influence of nosocomial infection on mortality rate in an intensive care unit. Crit Care Med 1994;22:55–60.Google Scholar
16.Delgado Rodriguez, M, Lardelli Claret, P, López Gigosos, R, Cordero Moreno, A, Rodríguez-Contreras Pelayo, R, Gálvez Vargas, R. La estancia como modificador del efecto de otros factores de riesgo para la infección hospitalaria. Rev Clin Esp 1991;188:44–47.Google Scholar
17.Delgado-Rodríguez, M, Medina-Cuadros, M, Bueno-Cavanillas, A, Martínez-Gallego, G, Dierssen, T, Sillero-Arenas, M. Comparison of two procedures to estimate the hospital stay attributable to nosocomial infection: matched cohort study versus analysis of covariance of the total unmatched cohort. J Clin Epidemiol 1997;50:773–778.Google Scholar
18.Rentz, AM, Halpern, MT, Bowden, R. The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis 1998;27:781–788.Google Scholar
19.Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.Google Scholar
20.Alvarez-Lerma, F, de La Cal, MA, Palomar, M, Insausti, J, Olaechea, P, the ENVIN-UCI Spanish Study Group. Evolution of indicators of ICU-acquired infection (ENVIN-UCI) 1994-1999. Intensive Care Med 2000;26:S3–S254. Abstract.Google Scholar
21.Palomar, M, Alvarez Lerma, F, Olaechea, P, Insausti, J, De La Cal, MA, ENVIN Study Group ICU. Evolution of aetiology of ICU-acquired infection. Intensive Care Med 2001;27:S204. Abstract.Google Scholar
22.Insausti, J, Alvarez-Lerma, F, De La Cal, M, Palomar, M, Olaechea, P, the Spanish Study Group of Surveillance of ICU-Acquired Infection. Usage rates and trends of the recently introduced antimicrobials: evaluation of the 1996-2000 period. Intensive Care Med 2001;27:S2–S169.Google Scholar
23.Knaus, WA, Zimmerman, JE, Wagner, DP, Draper, EA. Laurence, DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 1981;9:591–597.Google Scholar
24.Le Gall, JR, Loirat, P, Alperovitch, A. A simplified acute physiology score for ICU patients. Crit Care Med 1985;13:818–829.Google Scholar
25.Emori, TG, Culver, DH, Horan, TC, et al.National Nosocomial Infection Surveillance System (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
26.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definition for nosocomial infection. Am J Infect Control 1988;16:128–140.Google Scholar
27.Martone, WJ, Jarvis, WR, Culver, DH, Haley, RW. Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett, JV, Brachman, PS, Sandord, JP, eds. Hospital Infections. Boston: Little Brown; 1992:577–596.Google Scholar
28.French, GL, Cheng, AFB. Measurements of the costs of hospital infection by prevalence surveys. J Hosp Infect 1991;18(suppl):65–72.CrossRefGoogle ScholarPubMed
29.Goff, DA, Sierawski, SJ, Fass, RJ. Cost analysis of candidemia infection among surgical intensive care unit patients. Clin Drug Invest 1996;12:176–180.Google Scholar
30.Weissman, C. Analyzing intensive care unit length of stay data: problems and possible solutions. Crit Care Med 1997;25:1594–1600.CrossRefGoogle ScholarPubMed
31.Wiley, MM, Tomas, R, Casas, M. A cross-national, case mix analysis of hospital length of stay for selected pathologies. European Journal of Public Health 1999;9:86–92.Google Scholar
32.Bueno Cavanillas, A, Delgado Rodríguez, M, Lardelli Claret, P, López Luque, A, Gálvez Vargas, R. Difficulties in assessing community-acquired infection as a risk factor for nosocomial infection at an intensive care unit. Eur J Epidemiol 1994;10:51–56.Google Scholar
33.Rebollo, MH, Bernal, JM, Llorca, J, Rabasa, JM, Revuelta, JM. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996;112:908–913.Google Scholar
34.Barie, PS, Hydo, LJ, Fisher, E. Utility of illness severity scoring for prediction of prolonged surgical critical care. J Trauma 1996;40:513–519.Google Scholar
35.Peña, C, Pujol, M, Pallares, R, et al.Estimación del coste atribuible a la infección nosocomial: prolongación de la estancia hospitalaria y cálculo de costes alternativos. Med Clin (Bare) 1996;106:441–444.Google Scholar
36.Jarvis, WR. Selected aspects of socioeconomics impact on nosocomial infections: morbidity, mortality, cost and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.Google Scholar