Impact of primary and intravascular catheter-related bacteremia due to coagulase-negative staphylococci in critically ill patients

Olaechea, P.M.; Álvarez-Lerma, F.; Palomar, M.; Insausti, J.; López-Pueyo, M.J.; Martínez-Pellús, A.; Cantón, M.L.

doi:10.1016/S2173-5727(11)70028-5

Article information

Abstract

Objective

To study the impact of coagulase-negative staphylococcal (CNS) primary and intravascular catheter-related bloodstream infection (PBSI/CRBSI) on mortality and morbidity in critically-ill patients.

Design

We performed a double analysis using data from the ENVIN-HELICS registry data (years 1997 to 2008): 1) We studied the clinical characteristics and outcomes of patients with CNSinduced PBSI/CRBSI and compared them with those of patients with PBSI/CRBSI caused by other pathogens; and 2) We analyzed the impact of CNS-induced PBSI/CRBSI using a case-control design (1:4) in patients without other nosocomial infections.

Setting

167 Spanish Intensive Care Units.

Patients

Patients admitted to ICU for more than 24 hours.

Results

2,252 patients developed PBSI/CRBSI, of which 1,133 were caused by CNS. The associated mortality for PBSI/CRBSI caused by non-CNS pathogens was higher than that of the CNS group (29.8% vs. 25.9%; P = .039) due exclusively to the mortality of patients with candidemia (mortality: 45.9%). In patients without other infections, PBSI/CRBSI caused by CNS (414 patients) is an independent risk factor for a higher than average length of ICU stay (OR: 5.81, 95% CI: 4.31–7.82; P<.001).

Conclusion

Crude mortality of patients with CNS-induced BPSI/CRBSI is similar to that of patients with BPSI/CRBSI caused by other bacteria, but lower than that of patients with candidemia. Compared to patients without nosocomial infections, CNS-induced PBSI/CRBSI is associated with a significant increase in length of ICU stay

Keywords:

Primary bacteremia

Catheter-related bacteremia

Coagulase-negative staphylococcus

Mortality

Morbidity

Resumen

Objetivo

Estudiar el impacto en la mortalidad y morbilidad en pacientes críticos de las bacteriemias primarias (BP) y relacionadas con catéteres intravasculares (BRC) causadas por Staphylococcus coagulasa negativo (SCN).

Diseño

Doble análisis con datos del registro ENVIN-HELICS (1997 a 2008): 1) analizar las características clínicas de pacientes con BP/BRC causadas por SCN, comparándolas con las de los pacientes con BP/BRC causadas por otros patógenos; y 2) analizar mediante un estudio casoscontroles (1:4) el impacto de BP/BRC por SCN en pacientes sin otras infecciones nosocomiales frente a pacientes sin ninguna infección nosocomial.

Ámbito

Ciento sesenta y siete UCI españolas.

Pacientes

Pacientes ingresados en UCI más de 24 horas.

Intervención

Ninguna.

Variables de interés

Estancia en UCI y mortalidad.

Resultados

Dos mil doscientos cincuenta y dos pacientes presentaron BP/BRC de los que 1.133 casos fueron por SCN. La mortalidad de los pacientes con BP/BRC causadas por patógenos distintos de SCN fue superior (29,8% vs. 25,9%; p = 0,039), debido exclusivamente a la mortalidad de pacientes con candidemia (mortalidad: 45,9%). En pacientes sin otras infecciones nosocomiales, la BP/BRC por SCN (414 pacientes) es un factor independiente de riesgo de tener una estancia superior a la media (OR 5,81; IC 95%: 4,31–7,82; p<0,001).

Conclusión

La mortalidad cruda de los pacientes que padecieron BP/BRC causada por SCN es similar a la de los pacientes con BP/BRC causada por otras bacterias, pero inferior a la de los pacientes con candidemia. Comparándolo con la estancia en UCI de pacientes sin infecciones nosocomiales, la BP/BRC por SCN es un factor apreciable de prolongación de estancia.

Palabras clave:

Bacteriemia primaria

Bacteriemia relacionada con catéter

Staphylococcus coagulas negativo

Mortalidad

Morbilidad

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References

[1.]

G.L. Archer.

Staphylococcus epidermidis and other coagulasenegative Staphylococci.

Mandell Douglas and Bennett's Principles and Practice of Infectious Diseases, 5th, pp. 2092-2100

[2.]

L.A. Mermel, M. Allon, E. Bouza, D.E. Craven, P. Flynn, N.P. O’Grady, et al.

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.

Clin Infect Dis, 49 (2009), pp. 1-45

http://dx.doi.org/10.1086/599376 | Medline

[3.]

M.A. Martin, M.A. Pfaller, R.P. Wenzel.

Coagulase-negative staphylococcal bacteremia. Mortality and hospital stay.

Ann. Intern. Med, 110 (1989), pp. 9-16

Medline

[4.]

M. Garrouste-Orgeas, J.F. Timsit, M. Tafflet, B. Misset, J.R. Zahar, L. Soufir, et al.

Excess risk of death from intensive care unitacquired nosocomial bloodstream infections: a reappraisal.

Clin Infect Dis, 42 (2006), pp. 1118-1126

http://dx.doi.org/10.1086/500318 | Medline

[5.]

P. Gastmeier, D. Sohr, C. Geffers, M. Behnke, H. Ruden.

Risk factors for death due to nosocomial infection in intensive care unit patients: findings from the Krankenhaus Infektions Surveillance System.

Infect Control Hosp Epidemiol, 28 (2007), pp. 466-472

http://dx.doi.org/10.1086/510810 | Medline

[6.]

C. Kassis, G. Rangaraj, Y. Jiang, R.Y. Hachem, I. Raad.

Differentiating culture samples representing coagulase-negative staphylococcal bacteremia from those representing contamination by use of time-to-positivity and quantitative blood culture methods.

J Clin Microbiol, 47 (2009), pp. 3255-3260

http://dx.doi.org/10.1128/JCM.01045-09 | Medline

[7.]

S.E. Beekmann, D.J. Diekema, G.V. Doern.

Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures.

Infect Control Hosp Epidemiol, 26 (2005), pp. 559-566

http://dx.doi.org/10.1086/502584 | Medline

[8.]

C.C. Lee, W.J. Lin, H.I. Shih, C.J. Wu, P.L. Chen, H.C. Lee, et al.

Clinical significance of potential contaminants in blood cultures among patients in a medical center.

J Microbiol Immunol Infect, 40 (2007), pp. 438-444

Medline

[9.]

P. Schuetz, B. Mueller, A. Trampuz.

Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative staphylococci.

Infection, 35 (2007), pp. 352-355

http://dx.doi.org/10.1007/s15010-007-7065-0 | Medline

[10.]

F. Alvarez-Lerma, M. Palomar, P. Olaechea, J.J. Otal, J. Insausti, E. Cerda.

Estudio Nacional de Vigilancia de Infección Nosocomial en Unidades de Cuidados Intensivos. Informe evolutivo de los años 2003–2005.

Med Intensiva, 31 (2007), pp. 6-17

Medline

[11.]

W.A. Knaus, E.A. Draper, D.P. Wagner, J.E. Zimmerman.

APACHE II: a severity of disease classification system.

Crit Care Med, 13 (1985), pp. 818-829

Medline

[12.]

J.R. Le Gall, S. Lemeshow, F. Saulnier.

A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.

JAMA, 270 (1993), pp. 2957-2963

Medline

[13.]

P. Gastmeier, K. Weist, H. Ruden.

Catheter-associated primary bloodstream infections: epidemiology and preventive methods.

Infection, 27 (1999), pp. S1-S6

Medline

[14.]

B. Digiovine, C. Chenoweth, C. Watts, M. Higgins.

The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit.

Am J Respir Crit Care Med, 160 (1999), pp. 976-981

http://dx.doi.org/10.1164/ajrccm.160.3.9808145 | Medline

[15.]

J.S. Garner, W.R. Jarvis, T.G. Emori, T.C. Horan, J.M. Hughes.

CDC definitions for nosocomial infections, 1988.

Am. J. Infect. Control, 16 (1988), pp. 128-140

Medline

[16.]

I.I. Siempos, P. Kopterides, I. Tsangaris, I. Dimopoulou, A.E. Armaganidis.

Impact of catheter-related bloodstream infections on the mortality of critically ill patients: a meta-analysis.

Crit Care Med, 37 (2009), pp. 2283-2289

http://dx.doi.org/10.1097/CCM.0b013e3181a02a67 | Medline

[17.]

J. Rello, A. Ochagavia, E. Sabanes, M. Roque, D. Mariscal, E. Reynaga, et al.

Evaluation of outcome of intravenous catheter-related infections in critically ill patients.

Am J Respir Crit Care Med, 162 (2000), pp. 1027-1030

http://dx.doi.org/10.1164/ajrccm.162.3.9911093 | Medline

[18.]

C. Suetens, I. Morales, A. Savey, M. Palomar, M. Hiesmayr, A. Lepape, et al.

European surveillance of ICU-acquired infections (HELICS-ICU): methods and main results.

J Hosp Infect, 65 (2007), pp. 171-173

http://dx.doi.org/10.1016/S0195-6701(07)60038-3 | Medline

[19.]

B. Renaud, C. Brun-Buisson.

Outcomes of primary and catheterrelated bacteremia. A cohort and case-control study in critically ill patients.

Am J Respir Crit Care Med, 163 (2001), pp. 1584-1590

http://dx.doi.org/10.1164/ajrccm.163.7.9912080 | Medline

[20.]

A. Topeli, S. Unal, M. Hayran, H.E. Akalin.

Septic shock as a predictor of mortality in bacteremia caused by coagulasenegative staphylococci.

Eur J Clin Microbiol Infect Dis, 16 (1997), pp. 411-416

Medline

[21.]

P.M. Olaechea, M.A. Ulibarrena, F. Alvarez-Lerma, J. Insausti, M. Palomar, M.A. De la Cal.

Factors related to hospital stay among patients with nosocomial infection acquired in the intensive care unit.

Infect Control Hosp Epidemiol, 24 (2003), pp. 207-213

http://dx.doi.org/10.1086/502191 | Medline

*

The list of responsibilities and hospitals corresponding to the members of the ENVIN-HELICS Group can be consulted at http://hws.vhebron.net/envin-helics/

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