Nosocomial bacteremia (NB) remains a challenge in critical care. Transfusion (TX) of red cells (pRBCs) is associated with nosocomial infection generally. Few data exist on the relationship between TX and NB.
We analyzed a multi-center prospective, observational study of TX practice in critical care (CRIT Trial). pRBC TX rates were prospectively tracked, as was the development of bacteremia. We defined NB as a new bacteremia arising after the subject had been in the intensive care unit (ICU) > 72 hrs. To limit confounding, we excluded patients who were bacteremic either on admission to the ICU or who had a positive blood culture reported during the first 72 hrs of ICU stay. Additional data collected included: demographics, ICU type, severity of illness (SOI), co-morbidities, use of antibiotics, and process of care. To determine if TX was associated with NB, we compared patients with NB to those not diagnosed with NB.
Of 4,892 patients enrolled, 3,501 received >72 hrs of ICU care, lacked bacteremia on admission, and remained free of bacteremia during the first 72 hrs of ICU hospitalization. NB developed in 117 subjects (3.3%). The duration of ICU stay prior to NB was 11.5 ± 5.7days. Approximately 76.1% of patients with NB received pRBCs prior to NB vs. 48.8% of controls (p<0.0001). Patients with NB also received a greater number of TXs (4.0 ± 4.6 u vs. 2.3 ± 4.3 u; p<0.0001) After controlling for confounders including SOI, the independent relationship between transfusion and NB remained significant as shown below.
TX is common in critically ill patients and is associated with an increased risk for NB.
Physicians need to reevaluate their approach to TX in ICU patients because of its association with nosocomial infection generally and NB specifically. Alternatives to TX are needed. Amount TransfusedAdjusted Odds Ratio for NB (95% CI)P1-2 u1.90 (1.10-3.28)0.02233-4 u2.36 (1.30-4.32)0.0051> 4 u2.47 (1.39-4.41)0.0021
A.F. Shorr, Ortho Biotech LLP