Case-fatality and risk factors for death in adult patients with nosocomial infection caused by multi-drug resistant organisms in Hungary, 2007-2009

Background: Nosocomial infections (NIs) due to multidrug-resistant organisms (MDROs) are associated with longer hospital stay, worse outcome and costly therapies. In Hungary, patients with NI caused by a MDRO are notified to the National Nosocomial Surveillance System (NNSS) since 2004. We aimed to determine risk factors for death in patients infected with a MDRO.

Methods: We conducted a retrospective cohort study including all adult patients with NI caused by a MDRO notified to NNSS in 2007-2009. Case-fatality ratios (CFRs) within seven and 30 days of microbiological diagnosis were calculated, and stratified by sex, age group, site of infection and pathogen. We obtained hazard ratios (HRs) and 95% confidence intervals (CIs) for death using Cox proportional hazards models.

Results: Overall, 2,437 patients (58.9% males, median age 67) were included. Seven- and 30-day CFRs were 19.8% and 40.0%, respectively. Seven-day CFRs were higher in patients ≥75 years (23.6%;p=0.01), in those with respiratory (35.5%;p<0.01) or bloodstream (23.6%;p=0.04) infection, and in those infected with multidrug-resistant Pseudomonas aeruginosa (31.6%;p<0.01) or Acinetobacter baumannii (26.6%;p=0.01). Independent risk factors for death were malnutrition (HR 1.94, 95% CI 1.35-2.79), endotracheal tube (HR 1.47, 95% CI 1.25-1.74), central venous catheter (HR 1.43, 95% CI 1.20-1.71), underlying cardiovascular (HR 1.27, 95% CI 1.10-1.47) or chronic respiratory (HR 1.20, 95% CI 1.02-1.42) disease. Patients transferred to an infectious diseases (ID) department had better prognosis (HR 0.56, 95% CI 0.36-0.85).

Conclusions: Risk of death varies according to patient characteristics, site of infection and pathogen, and procedures during hospital stay. Clinicians and infection control practitioners should be aware of specific high-risk groups, and, as soon as a MDRO is diagnosed, an ID specialist should be consulted to tailor interventions and patient care. 

Year: 
2010
Author (s): 

Saverio Caini, Á. Hajdu, A. Kurcz, K. Böröcz

Presenter (s): 
Caini
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