Impact of bloodstream infection on outcomes among infected surgical inpatients
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D P Raymond1, S J Pelletier, T D Crabtree
1Surgical Infectious Disease Laboratory, Department of Surgery, University of Virginia Medical School, Charlottesville, Virginia, USA. dpr4w@virginia.edu
Objective:
To assess the importance of bloodstream infection (BSI) to outcomes among infected surgical patients.
Background:
Bloodstream infection complicating infection is thought to connote a more serious condition compared with a primary infection alone. The authors recently reported, however, that BSI does not alter outcomes with central venous catheter colonization in the presence of sepsis. The significance of BSI with other infections has been incompletely evaluated.
Methods:
Data on all episodes of infection among surgical patients were collected prospectively during a 38-month period at a single hospital, then analyzed retrospectively to determine the independent prognostic value of BSI for all infections by logistic regression analysis, and for abdominal infections and pneumonia using matched control groups.
Results:
During the study period, 2,076 episodes of infection occurred, including 363 with BSI. Patients with BSI had a greater severity of illness and a greater death rate. After logistic regression, however, BSI did not independently predict death. After matching patients with abdominal infections and pneumonia with BSI to patients without BSI but with a similar site of infection, severity of illness, age, and causative organism, no difference in outcome was seen.
Conclusions:
Bloodstream infection is associated with critical illness and death but appears to be a marker of severe primary disease rather than an independent predictor of outcome.
Insights
Bloodstream infection (BSI) in surgical patients is linked to severe illness and higher death rates. However, BSI appears to indicate underlying disease severity rather than independently predicting patient outcomes.
Area of Science:
- Infectious Diseases
- Surgical Outcomes
- Critical Care Medicine
Background:
- Bloodstream infection (BSI) is often considered to worsen patient prognosis compared to localized infections.
- Previous research indicated BSI did not impact outcomes in central venous catheter colonization with sepsis.
- The independent prognostic significance of BSI in other surgical infections remained unclear.
Purpose of the Study:
- To evaluate the independent impact of bloodstream infection (BSI) on outcomes in surgical patients.
- To determine if BSI is a predictor of mortality in various surgical infections.
Main Methods:
- Prospective data collection of all infection episodes in surgical patients over 38 months.
- Retrospective analysis using logistic regression to assess BSI's prognostic value.
- Matched control groups for abdominal infections and pneumonia to compare outcomes with and without BSI.
Main Results:
- A total of 2,076 infection episodes were analyzed, with 363 involving BSI.
- Patients with BSI exhibited higher illness severity and mortality rates.
- Logistic regression and matched analyses revealed BSI did not independently predict death.
Conclusions:
- Bloodstream infection (BSI) is associated with critical illness and mortality in surgical patients.
- BSI appears to be a marker of underlying disease severity, not an independent prognostic factor.
- The presence of BSI does not independently worsen outcomes for specific infections like abdominal infections or pneumonia.
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