• Jean-Marie Januel, Stephan Harbarth, Robert Allard, Nicolas Voirin, Alain Lepape, Bernard Allaouchiche, Claude Guerin, Jean-Jacques Lehot, Marc-Olivier Robert, Gérard Fournier, Didier Jacques, Dominique Chassard, Pierre-Yves Gueugniaud, François Artru, Paul Petit, Dominique Robert, Ismaël Mohammedi, Raphaëlle Girard, Jean-Charles Cêtre, Marie-Christine Nicolle, Jacqueline Grando, Jacques Fabry, and Philippe Vanhems.
• Laboratory of Biometry and Evolutionary Biology, CNRS, UMR 5558, Claude Bernard University of Lyon, Lyon, France. jean-marie.januel@chuv.ch
• Infect Control Hosp Epidemiol. 2010 Apr 1;31(4):388-94.

BackgroundThe strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.ObjectiveTo assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.SettingEleven ICUs of a French university hospital.DesignWe analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was defined as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.ResultsAmong 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%-14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection.ConclusionsICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed.

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