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

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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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*

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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