Skip to main content

Bloodstream Infection in the Intensive Care Unit

  • Chapter
  • 2124 Accesses

Abstract

Nosocomial infections occur in 5–10% of patients admitted to hospitals in the United States [1]. The endemic rates of nosocomial infections vary markedly between hospitals and between areas of the same hospital. Patients in intensive care units (ICUs), representing 8–15% of hospital admissions, suffer a disproportionately high percentage of nosocomial infections compared with patients in non-critical care areas [2–7]. Wenzel et al. [3] reported that patients admitted to ICUs account for 45% of all nosocomial pneumonias and bloodstream infections, although critical care units comprise only 5–10% of all hospital beds. Severity of underlying disease, invasive diagnostic and therapeutic procedures, contaminated life-support equipment, and the prevalence of resistant microorganisms are critical factors in the high rate of infection in ICUs [8].

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Wenzel RP (1990) Organization for infection control. In: Mandell GL, Douglas RG Jr, Bennett JE (eds) Principles and practice of infectious diseases, 3rd edn. Churchill Livingstone, New York, pp 2176–2180

    Google Scholar 

  2. Weinstein RA (1991) Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med 91(Suppl 3B):179S–184S

    Article  PubMed  CAS  Google Scholar 

  3. Wenzel RP, Thompson RL, Landry SM, et al. (1983) Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control 4:371–5

    PubMed  CAS  Google Scholar 

  4. Maki DG (1989) Risk factors for nosocomial infection in intensive care: “devices vs nature” and goals for the next decade. Arch Intern Med 149:30–35

    Article  PubMed  CAS  Google Scholar 

  5. Donowitz LG, Wenzel RP, Hoyt JW (1982) High risk of hospital-acquired infection in the ICU patient. Crit Care Med 10:355–7

    Article  PubMed  CAS  Google Scholar 

  6. Brown RB, Hosmer D, Chen HC, et al. (1985) A comparison of infections in the different ICUs within the same hospital. Crit Care Med 13:472–476

    Article  PubMed  CAS  Google Scholar 

  7. Daschner F (1985) Nosocomial infections in intensive care units. Intensive Care Med 11:284–287

    Article  PubMed  CAS  Google Scholar 

  8. Massanari RM, Hierholzer WJ Jr (1986) The intensive care unit. In: Bennett JV, Brachman PS (eds) Hospital infections, 2nd edn. Little, Brown and Company, Boston, pp 285–298

    Google Scholar 

  9. Trilla A, Gatell JM, Mensa J, et al. (1991) Risk factors for nosocomial bacteremia in a large Spanish teaching hospital: A case-control study. Infect Control Hosp Epidemiol 12:150–156

    Article  PubMed  CAS  Google Scholar 

  10. Ponce de León-Rosales S, Molinar-Ramos F, Domínguez-Cherit G, Rangel-Frausto S, Vázquez-Ramos V (2000) Prevalence of infections in intensive care units in Mexico: A multicenter study. Crit Care Med 28:1316–1321

    Article  PubMed  Google Scholar 

  11. Forgacs IC, Eykyn SJ, Bradley RD (1986) Serious infection in the intensive therapy unit: a 15-year study of bacteraemia. Q J Med 60:773–779

    PubMed  CAS  Google Scholar 

  12. Vallés J, Ochagavía A, Rué M, Díaz E, et al. (2000) Critically ill patients with community-acquired bacteremia: Characteristics and prognosis. Intensive Care Med 26(Suppl.3):S222

    Google Scholar 

  13. Reimer LG, Wilson ML, Weinstein MP (1997) Update on detection of bacteremia and fungemia. Clin Microbiol Rev 10:444–465

    PubMed  CAS  Google Scholar 

  14. Garner JS, Jarvis WR, Emori TG, et al. (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140

    Article  PubMed  CAS  Google Scholar 

  15. Friedman ND, Kaye KS, Stout JE, et al. (2002) Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections. Ann Intern Med 137:791–797

    PubMed  Google Scholar 

  16. Pittet D (1993) Nosocomial bloodstream infections. In: Wenzel RP (ed) Prevention and control of nosocomial infections, 2nd edn. Williams & Wilkins, Baltimore, MD, pp 512–555

    Google Scholar 

  17. Gatell JM, Trilla A, Latorre X, et al. (1988) Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis. Rev Infect Dis 10:203–210

    PubMed  CAS  Google Scholar 

  18. Rello J, Ricart M, Mirelis B, et al. (1994) Nosocomial bacteremia in a medical-surgical intensive care unit: epidemiologic characteristics and factors influencing mortality in 111 episodes. Intensive Care Med 20:94–98

    Article  PubMed  CAS  Google Scholar 

  19. Vallés J, León C, Alvarez-Lerma F, et al. (1997) Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Clin Infect Dis 24:387–395

    PubMed  Google Scholar 

  20. Towns ML, Quartey SM, Weinstein MP, et al. (1993) The clinical significance of positive blood cultures: a prospective, multicenter evaluation, abstr. C-232. In: Abstracts of the 93rd General Meeting of the American Society for Microbiology 1993. American Society for Microbiology, Washington, DC

    Google Scholar 

  21. Weinstein MP, Towns ML, Quartey SM, et al. (1997) The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 24:584–602

    PubMed  CAS  Google Scholar 

  22. Mirret S, Weinstein MP, Reimer LG, et al. (1994) Interpretation of coagulase-negative staphylococci in blood cultures: does the number of positive bottles help? Abstr. C-69. In: Abstracts of the 93rd General Meeting of the American Society for Microbiology 1994. American Society for Microbiology, Washington, DC

    Google Scholar 

  23. Martin MA, Pfaller MA, Wenzel RP (1989) Coagulase-negative staphylococci bacteremia. Mortality and hospital stay. Ann Intern Med 110:9–16

    PubMed  CAS  Google Scholar 

  24. Ponce de León S, Wenzel RP (1984) Hospital-acquired bloodstream infections with Staphylococcus epidermidis. Am J Med 77:639–644

    Article  PubMed  Google Scholar 

  25. Domínguez-de Villota E, Algora-Weber A, Millan I, et al. (1987) Early evaluation of coagulase-negative staphylococci in blood samples of intensive care unit patients. A clinically uncertain judgement. Intensive Care Med 13:390–394

    Article  PubMed  Google Scholar 

  26. Craven DE, Kunches LM, Lichtenberg DA, et al. (1988) Nosocomial infections and fatality in medical and surgical intensive care unit patients. Arch Intern Med 148:1161–1168

    Article  PubMed  CAS  Google Scholar 

  27. Constantini M, Donisi PM, Turrin MG, et al. (1987) Hospital-acquired infections surveillance and control in intensive care services. Results of an incidence study. Eur J Epidemiol 3:347–355

    Article  Google Scholar 

  28. Daschner FD, Frey P, Wolff G, et al. (1982) Nosocomial infections in intensive care wards: A multicenter prospective study. Intensive Care Med 8:5–9

    Article  PubMed  CAS  Google Scholar 

  29. Trilla A (1994) Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 20:S1–S4

    Article  PubMed  Google Scholar 

  30. Vincent JL, Bihari DJ, Suter PM, et al. (1995) The prevalence of nosocomial infection in intensive care units in Europe. JAMA 274:634–644

    Article  Google Scholar 

  31. Richards MJ, Edwards JR, Culver DH, et al. (1999) Nosocomial infections in medical intensive care units in the United States. Crit Care Med 27:887–892

    Article  PubMed  CAS  Google Scholar 

  32. Pittet D, Tarara D, Wenzel RP (1994) Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 271:1598–1601

    Article  PubMed  CAS  Google Scholar 

  33. Brun-Buisson C, Doyon F, Carlet J, et al. (1996) Bacteremia and severe sepsis in adults: A multicenter prospective survey in ICUs and wards of 24 hospitals. Am J Respir Crit Care Med 154:617–624

    PubMed  CAS  Google Scholar 

  34. Vallés J, Rello J, Ochagavía A, Garnacho J, Alcalá MA, and Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (2003) Community-acquired bloodstream infection in critically ill adult patients: Impact of shock and inappropriate antibiotic therapy on survival. Chest 123:1615–1624

    Article  PubMed  Google Scholar 

  35. Edgeworth JD, Treacher DF, Eykyn SJ (1999) A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med 27:1421–1428

    Article  PubMed  CAS  Google Scholar 

  36. Jamal WY, El-Din K, Rotimi VO, et al. (1999) An analysis of hospital-acquired bacteraemia in intensive care unit patients in a university hospital in Kuwait. J Hosp Infect 43:49–56

    Article  PubMed  CAS  Google Scholar 

  37. Bone RC, Balk RA, Cerra FB, et al. (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655

    Article  PubMed  CAS  Google Scholar 

  38. Wenzel RP (1995) Isolation of Candida species from sites other than the blood. Clin Infect Dis 20:1531–1534

    PubMed  CAS  Google Scholar 

  39. Díaz E, Villagrá A, Martínez M, et al. (1998) Nosocomial candidemia risk factors. Intensive Care Med 24(Suppl 1):S143

    Google Scholar 

  40. Leibovici L, Konisberger H, Pitlik SD (1992) Bacteremia and fungemia of unknown origin in adults. Clin Infect Dis 14:436–439

    PubMed  CAS  Google Scholar 

  41. Weinstein MP, Reller LB, Murphy JR, et al. (1983) The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bloodstream infection and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 5:35–53

    PubMed  CAS  Google Scholar 

  42. Wenzel RP (1988) The mortality of hospital-acquired bloodstream infections: need for a new vital statistic? Int J Epidemiol 17:225–227

    Article  PubMed  CAS  Google Scholar 

  43. Munford RS (1994) Sepsis and septic shock. In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL (eds) Harrison’s principles of internal medicine, 13rd edn. McGraw-Hill, New York, pp 511–515

    Google Scholar 

  44. Bueno-Cavanillas A, Delgado-Rodríguez M, López-Luque A, et al. (1994) Influence of nosocomial infection on mortality rate in an intensive care unit. Crit Care Med 22:55–60

    PubMed  CAS  Google Scholar 

  45. Crowe M, Ispahani P, Humphreys H, et al. (1998) Bacteraemia in the adult intensive care unit of a teaching hospital in Nottingham, UK, 1985–1996. Eur J Clin Microbiol Dis 17:377–384

    CAS  Google Scholar 

  46. Landry SL, Kaiser DL, Wenzel RP (1989) Hospital stay and mortality attributed to nosocomial enterococcal bacteremia: a controlled study. Am J Infect Control 17:323–329

    Article  PubMed  CAS  Google Scholar 

  47. Wey SB, Motomi M, Pfaller MA, et al. (1988) Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 148:2642–2645

    Article  PubMed  CAS  Google Scholar 

  48. Pittet D, Thiévent B, Wenzel RP, et al. (1993) Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 19:265–272

    Article  PubMed  CAS  Google Scholar 

  49. Pittet D, Thiévent B, Wenzel RP, et al. (1996) Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med 153:684–693

    PubMed  CAS  Google Scholar 

  50. Cartón JA, García-Velasco G, Maradona JA, Pérez F, Asensi V, Arribas JM (1988) Bacteriemia extrahospitalaria en adultos. Análisis prospectivo de 333 episodios. Med Clin (Barc) 90:525–530

    Google Scholar 

  51. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH (2000) The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118:146–155

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Valles, J. (2007). Bloodstream Infection in the Intensive Care Unit. In: Rello, J., Kollef, M., Díaz, E., Rodríguez, A. (eds) Infectious Diseases in Critical Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-34406-3_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-34406-3_28

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-34405-6

  • Online ISBN: 978-3-540-34406-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics