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Difficulties in assessing community-acquired infection as a risk factor for nosocomial infection at an intensive care
A Bueno-Cavanillas1, M Delgado-Rodríguez, P Lardelli-Claret
1Departamento de Medicina Preventiva y Salud Pública, Hospital Universitario de Granada, Spain.
Objective:
To analyze the relationship between presentation with a community-acquired infection (CAI) and the risk of subsequent nosocomial infection, and the assessment of a likely diagnostic bias in this association.
Design:
A prospective cohort study. APACHE-II and TISS were used to assess severity and therapeutic intensity, respectively. Nosocomial infection (NI) was diagnosed according to SENIC and CDC diagnostic criteria. The relative risk and its 95% confidence interval were estimated.
Setting:
The intensive care unit (ICU) of the University of Granada Hospital (Spain). It is a ten-bed multidisciplinary unit.
Patients:
448 patients admitted to the intensive care unit (ICU) between December-1986 and April-1988 who stayed at the ICU for at least 24 hours were included in the study.
Results:
The crude analysis suggests that CAI may prevent NI. When data were stratified by other variables a previous infection acted as a preventive factor in patients admitted to the ICU from emergency room, in patients with lower severity level and in those with shorter stay lengths at ICU. Patients with a CAI showed higher severity; they were treated more aggressively, they had a longer stay at ICU before a NI was diagnosed and they remained at ICU longer. In multivariate analysis the NI risk in patients with a CAI compared with those not infected previously and controlling for other variables was of 0.36.
Conclusion:
The presence of a CAI may introduce a differential information bias in the study of NI.
Insights
Community-acquired infections (CAI) may reduce the risk of subsequent nosocomial infections (NI) in intensive care units. This association might be influenced by diagnostic bias, suggesting CAI could act as a protective factor in certain patient groups.
Area of Science:
- Infectious disease epidemiology
- Critical care medicine
Background:
- Community-acquired infections (CAI) are common among ICU admissions.
- The relationship between CAI and subsequent nosocomial infection (NI) risk requires clarification.
- Potential diagnostic biases in assessing this association need investigation.
Purpose of the Study:
- To analyze the association between community-acquired infection (CAI) at presentation and the risk of subsequent nosocomial infection (NI).
- To evaluate the potential for diagnostic bias in this relationship.
Main Methods:
- Prospective cohort study conducted in a multidisciplinary intensive care unit (ICU).
- Inclusion of 448 patients admitted between December 1986 and April 1988, with ICU stays of at least 24 hours.
- Utilized APACHE-II and TISS for severity and therapeutic intensity assessment, with NI diagnosed per SENIC and CDC criteria.
Main Results:
- Crude analysis suggested CAI may prevent NI.
- Stratified analysis indicated a preventive effect of prior infection in specific subgroups (emergency admissions, lower severity, shorter ICU stays).
- Multivariate analysis revealed a reduced NI risk (0.36) in patients with CAI compared to uninfected patients, after controlling for other variables.
Conclusions:
- The presence of community-acquired infection (CAI) may introduce a differential information bias when studying nosocomial infections (NI).
- Further research is needed to fully understand the complex interplay between CAI and NI risk in the ICU setting.