Robin Ohannessian1, Marie-Paule Gustin2, Thomas Bénet1,3, Solweig Gerbier-Colomban3, Raphaele Girard3, Laurent Argaud4,5, Thomas Rimmelé6,7, Claude Guerin8,9, Julien Bohé10, Vincent Piriou10, Philippe Vanhems1,3. 1. Laboratoire des Pathogènes Emergents, Equipe Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France. 2. Department of Public Health, Institute of Pharmacy, Université Lyon 1, Université de Lyon, Lyon, France. 3. Service d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France. 4. Service de Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 5. INSERM, UMR 1060, CarMeN, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France. 6. Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 7. EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-Induced Immunosuppression - PI3," Lyon, France. 8. Service de Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. 9. INSERM 955, Créteil, France. 10. Service de Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
Abstract
OBJECTIVES: The objective of the study was to estimate the length of stay of patients with hospital-acquired infections hospitalized in ICUs using a multistate model. DESIGN: Active prospective surveillance of hospital-acquired infection from January 1, 1995, to December 31, 2012. SETTING: Twelve ICUs at the University of Lyon hospital (France). PATIENTS: Adult patients age greater than or equal to 18 years old and hospitalized greater than or equal to 2 days were included in the surveillance. All hospital-acquired infections (pneumonia, bacteremia, and urinary tract infection) occurring during ICU stay were collected. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The competitive risks of in-hospital death, transfer, or discharge were considered in estimating the change in length of stay due to infection(s), using a multistate model, time of infection onset. Thirty-three thousand four-hundred forty-nine patients were involved, with an overall hospital-acquired infection attack rate of 15.5% (n = 5,176). Mean length of stay was 27.4 (± 18.3) days in patients with hospital-acquired infection and 7.3 (± 7.6) days in patients without hospital-acquired infection. A multistate model-estimated mean found an increase in length of stay by 5.0 days (95% CI, 4.6-5.4 d). The extra length of stay increased with the number of infected site and was higher for patients discharged alive from ICU. No increased length of stay was found for patients presenting late-onset hospital-acquired infection, more than the 25th day after admission. CONCLUSIONS: An increase length of stay of 5 days attributable to hospital-acquired infection in the ICU was estimated using a multistate model in a prospective surveillance study in France. The dose-response relationship between the number of hospitalacquired infection and length of stay and the impact of early-stage hospital-acquired infection may strengthen attention for clinicians to focus interventions on early preventions of hospital-acquired infection in ICU.
OBJECTIVES: The objective of the study was to estimate the length of stay of patients with hospital-acquired infections hospitalized in ICUs using a multistate model. DESIGN: Active prospective surveillance of hospital-acquired infection from January 1, 1995, to December 31, 2012. SETTING: Twelve ICUs at the University of Lyon hospital (France). PATIENTS: Adult patients age greater than or equal to 18 years old and hospitalized greater than or equal to 2 days were included in the surveillance. All hospital-acquired infections (pneumonia, bacteremia, and urinary tract infection) occurring during ICU stay were collected. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The competitive risks of in-hospital death, transfer, or discharge were considered in estimating the change in length of stay due to infection(s), using a multistate model, time of infection onset. Thirty-three thousand four-hundred forty-nine patients were involved, with an overall hospital-acquired infection attack rate of 15.5% (n = 5,176). Mean length of stay was 27.4 (± 18.3) days in patients with hospital-acquired infection and 7.3 (± 7.6) days in patients without hospital-acquired infection. A multistate model-estimated mean found an increase in length of stay by 5.0 days (95% CI, 4.6-5.4 d). The extra length of stay increased with the number of infected site and was higher for patients discharged alive from ICU. No increased length of stay was found for patients presenting late-onset hospital-acquired infection, more than the 25th day after admission. CONCLUSIONS: An increase length of stay of 5 days attributable to hospital-acquired infection in the ICU was estimated using a multistate model in a prospective surveillance study in France. The dose-response relationship between the number of hospitalacquired infection and length of stay and the impact of early-stage hospital-acquired infection may strengthen attention for clinicians to focus interventions on early preventions of hospital-acquired infection in ICU.
Authors: Nick Shryane; Maria Pampaka; Andrea Aparicio-Castro; Shazaad Ahmad; Mark J Elliot; Jihye Kim; Jennifer Murphy; Wendy Olsen; Diego Pérez Ruiz; Arkadiusz Wiśniowski Journal: Int J Popul Data Sci Date: 2021-03-03
Authors: Hugo Teixeira; Alberto Freitas; António Sarmento; Paulo Nossa; Hernâni Gonçalves; Maria de Fátima Pina Journal: Int J Environ Res Public Health Date: 2021-04-28 Impact factor: 3.390