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Multiple nosocomial infections. An incidence study
R L Brawley1, D J Weber, G P Samsa
1Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill.
Abstract:
Prospective surveillance for nosocomial infections was performed for a five-year admission cohort (1980-1984) at North Carolina Memorial Hospital. One or more nosocomial infections developed in 2,662 patients (2.6%) from 102,206 patients at risk; greater than or equal to 2 nosocomial infections developed in 775 of these 2,662 patients (29.1%), and greater than or equal to 3 nosocomial infections in 304 of 775 patients with greater than or equal to 2 infections (39.2%). Hospital stay was significantly prolonged for infected compared with never-infected patients (38.1 vs. 7.9 days, p less than 0.0001) and for multiply-infected versus once-infected patients (57.9 vs. 30.0 days, p less than 0.0001). Total nosocomial infections numbered 4,031 with 2,144 multiple infections (53%); the average number of nosocomial infections per infected patient was 1.5 (4,031 infections in 2,662 patients). Among all nosocomial infections, 64% of bacteremias, 55% of respiratory infections, 55% of surgical wound infections, and 40% of urinary tract infections occurred in patients with multiple nosocomial infections. Surgical patients had 56% of multiple infections. Intensive care unit patients had significantly more multiple infections than non-intensive care unit patients. Nosocomial infections in intensive care unit patients were 71% multiple nosocomial infections. The probability of developing multiple infections was 11 times greater after the first infection occurred. This emphasizes the need to prevent initial nosocomial infections and to identify risk factors for multiple nosocomial infections. Determining risk factors for multiple nosocomial infections could focus infection control efforts on a subpopulation of patients who acquire over 50% of all nosocomial infections and who have significantly prolonged and costly hospital stays.
Insights
Preventing initial nosocomial infections is crucial, as patients developing multiple infections face significantly longer hospital stays. Identifying risk factors can target interventions to high-risk patients who account for over half of all hospital-acquired infections.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Public Health
Background:
- Nosocomial infections (NIs) represent a significant burden on healthcare systems.
- Understanding the patterns and impact of multiple NIs is essential for effective infection control.
Purpose of the Study:
- To analyze the incidence, characteristics, and impact of nosocomial infections, particularly multiple infections, in a large hospital cohort.
- To identify patient subpopulations at higher risk for developing multiple NIs.
Main Methods:
- Prospective surveillance of a five-year admission cohort (1980-1984) at North Carolina Memorial Hospital.
- Data collection on patient admissions, nosocomial infection development, and hospital stay duration.
- Statistical analysis to compare outcomes between infected and non-infected, and once-infected versus multiply-infected patients.
Main Results:
- Over 102,000 patients were monitored, with 2.6% developing at least one NI.
- 29.1% of infected patients acquired two or more NIs, and 39.2% of those acquired three or more.
- Multiply-infected patients experienced significantly prolonged hospital stays (57.9 days) compared to once-infected patients (30.0 days).
- 53% of total NIs were multiple infections, with bacteremias and respiratory infections being common in multiply-infected patients.
- Surgical and intensive care unit (ICU) patients had a higher burden of multiple NIs, with 71% of ICU NIs being multiple infections.
- The probability of developing multiple infections increased 11-fold after the first infection.
Conclusions:
- Initial prevention of nosocomial infections is paramount.
- Identifying risk factors for multiple NIs can focus infection control efforts on a high-risk subpopulation.
- Targeted interventions for high-risk patients could reduce the overall incidence and impact of nosocomial infections, leading to shorter hospital stays and reduced costs.