Health and economic outcomes of nosocomial catheter-related candidaemia in critically ill patients
Abstract number: 902_p864
Because of severity of underlying disease, multiple venous accesses, parenteral nutrition and often increased length of stay, intensive care unit (ICU) patients are at increased risk for catheter-related candidemia (CRC). We investigated health and economic outcomes in ICU patients with CRC.
In a retrospective matched cohort study (19922002) attributable mortality and excess length of stay for CRC was investigated. Matching was (1:2 ratio) based on severity of underlying disease and acute illness (APACHE II score and admission diagnosis) and length of ICU stay prior to the onset of the candidemia. As expected mortality can be derived from APACHE II; this matching procedure results in an equal prognosis for cases and control subjects. Attributable mortality is determined by subtracting the hospital mortality rate of the controls from this of the candidemic cases. Excesses in length of ICU stay and hospitalisation were determined by subtracting the median length of stay of the controls from this of the cases.
During the study period 21 ICU patients developed a microbiologically documented CRC (out of a total of 83 candidemic patients). Nineteen catheters were removed within 24 h. Cases (n = 21) and controls (n = 42) had an equal age (resp. 49 ± 20 vs. 53 ± 19 year; P = 0.470), APACHE II score (resp. 23 ± 8 vs. 23 ± 8; P = 0.754) and incidence of respiratory failure (95 vs. 86%; P = 0.479), acute renal failure (33 vs. 14%; P = 0.153) and haemodynamic instability (76 vs. 69%; P = 0.767). The excess length of ICU stay was 11 days (median 31 vs. 20 days; P = 0.002). Although patients with CRC had a longer length of hospital stay this difference was not significant (52 vs. 30 days; P = 0.508). The attributable mortality of CRC was 19.1% (95% CI: -6 to 44%) as hospital mortality rates in cases and controls were 42.9 and 23.8%, respectively (P = 0.207).
Our data revealed that, after careful adjustment for severity of underlying disease and acute illness, CRC is not associated with a significantly higher mortality in ICU patients. It is, however, associated with a significant excess in length of ICU stay, thereby representing an important economic burden."
|Session name:||XXIst ISTH Congress|
|Back to top|