• Maite Garrouste-Orgeas, Jean Francois Timsit, Muriel Tafflet, Benoit Misset, Jean-Ralph Zahar, Lilia Soufir, Thierry Lazard, Samir Jamali, Bruno Mourvillier, Yves Cohen, Arnaud De Lassence, Elie Azoulay, Christine Cheval, Adrien Descorps-Declere, Christophe Adrie, Marie-Alliette Costa de Beauregard, Jean Carlet, and OUTCOMEREA Study Group.
• Medical-Surgical Intensive Care Unit, Saint Joseph Hospital, Paris, France [corrected] mgarrouste@hopital-saint-joseph.org
• Clin. Infect. Dis. 2006 Apr 15;42(8):1118-26.

BackgroundOverall rates of bloodstream infection (BSI) are often used as quality indicators in intensive care units (ICUs). We investigated whether ICU-acquired BSI increased mortality (by > or = 10%) after adjustment for severity of infection at ICU admission and during the pre-BSI stay.MethodsWe conducted a matched, risk-adjusted (1:n), exposed-unexposed study of patients with stays longer than 72 h in 12 ICUs randomly selected from the Outcomerea database.ResultsPatients with BSI after the third ICU day (exposed group) were matched on the basis of risk-exposure time and mortality predicted at admission using the Three-Day Recalibrated ICU Outcome (TRIO) score to patients without BSI (unexposed group). Severity was assessed daily using the Logistic Organ Dysfunction (LOD) score. Of 3247 patients with ICU stays of >3 days, 232 experienced BSI by day 30 (incidence, 6.8 cases per 100 admissions); among them, 226 patients were matched to 1023 unexposed patients. Crude hospital mortality was 61.5% among exposed and 36.7% among unexposed patients (P<.0001). Attributable mortality was 24.8%. The only variable associated with both BSI and hospital mortality was the LOD score determined 4 days before onset of BSI (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03-1.16; P = .0025). The adjusted OR for hospital mortality among exposed patients (OR, 3.20; 95% CI, 2.30-4.43) decreased when the LOD score determined 4 days before onset of BSI was taken into account (OR, 3.02; 95% CI, 2.17-4.22; P<.0001). The estimated risk of death from BSI varied considerably according to the source and resistance of organisms, time to onset, and appropriateness of treatment.ConclusionsWhen adjusted for risk-exposure time and severity at admission and during the ICU stay, BSI was associated with a 3-fold increase in mortality, but considerable variation occurred across BSI subgroups. Focusing on BSI subgroups may be valuable for assessing quality of care in ICUs.

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