Community- and hospital-acquired infections necessitating ICU admission: spectrum, co-morbidities and outcome.

OBJECTIVES: To evaluate the spectrum of infections, co-morbidities and outcome of patients admitted into an intensive care unit (ICU) due to community- (CAI) or hospital-acquired infections (HAI).
METHODS: A 14-month prospective study in a medical-surgical ICU in a tertiary level teaching hospital.
RESULTS: Three hundred and thirty-five patients were included, of whom 74.9% had an infection on admission; 59.3% had CAI and 40.7% HAI, while 84 patients did not have any infection (NI). The most common infections in the CAI and HAI groups (G) were pneumonia and gastrointestinal infections. Secondary bacteremia (p<0.001), severe sepsis and septic shock (p=0.048) were more prevalent in CAIG, while histories of transient ischaemic attack or stroke (p=0.03), immunosuppressive medications (p=0.009) or malignancies (p<0.001) were more common in HAIG. APACHE II scores and ICU or hospital mortalities did not differ between the groups. The median hospital stay was longer in HAIG (24 days) than in CAIG (15) or NIG (17.5), p<0.001.
CONCLUSIONS: Patients in CAIG had more often secondary bacteremia or severe sepsis or septic shock, whereas HAIG patients had more often a history of cerebrovascular problems, malignancies and immunosuppressive treatments. Eighty percent of these infection patients requiring ICU treatment survived.