Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections

Matheus L Otero; Rodrigo C Menezes; Isabella B B Ferreira; Francine L Issa; Gabriel Agareno; Thomas Azevedo Carmo; María B Arriaga; Kiyoshi F Fukutani; Licurgo Pamplona Neto; Sydney Agareno; Nivaldo M Filgueiras Filho; Kevan M Akrami; Bruno B Andrade

doi:10.2147/IDR.S264276

Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections

Infect Drug Resist. 2020 Aug 12:13:2811-2817. doi: 10.2147/IDR.S264276. eCollection 2020.

Authors

Matheus L Otero¹, Rodrigo C Menezes², Isabella B B Ferreira³, Francine L Issa⁴, Gabriel Agareno¹, Thomas Azevedo Carmo¹, María B Arriaga^{4

5

6}, Kiyoshi F Fukutani^{5

6}, Licurgo Pamplona Neto⁷, Sydney Agareno⁷, Nivaldo M Filgueiras Filho^#^{1

3

7}, Kevan M Akrami^#⁸, Bruno B Andrade^#^{1

4

5

6

9}

Affiliations

¹ Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.
² Curso de Medicina, União Metropolitana Para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil.
³ Universidade Do Estado Da Bahia (UNEB), Salvador, Bahia, Brazil.
⁴ Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.
⁵ Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
⁶ Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil.
⁷ Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil.
⁸ Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA.
⁹ Escola Bahiana De Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil.

^# Contributed equally.

Abstract

Objective: Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil.

Methods: Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI.

Results: A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23-39.27, OR: 2.48, 95% CI 1.17-5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality.

Conclusion: Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.

Keywords: ICU; critical illness; hospital acquired infection; intensive care; mortality; septic shock.

Grants and funding

The study was supported by the Intramural Research Program from Hospital da Cidade and from the Fundação Oswaldo Cruz. The work of B.B.A. was supported by the the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; senior scientist fellowship). KFF received a fellowship from the Programa Nacional de Pós-Doutorado, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, finance code 001). MBA and TAC received research fellowships from Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.