PURPOSE: Nosocomial infections (NI) are a serious health concern despite best practices to prevent them. Systemic inflammation and development of NI were examined.
METHODS: Retrospective pilot study. All patients admitted to the MICU/CICU for 6 weeks beginning 1/1/08 were screened for inclusion. All subjects with a CRP drawn within 24 hours of ICU admission were included. Baseline demographics, CRP, diagnoses, SIRS, APACHE II, MODS, infections, and invasive devices were recorded and all patients were followed through ICU discharge for the development of NI. Comparisons were made among those who did and did not develop NI.
RESULTS: Among the 27 patients included in this older (62.3 ± 12.9), male (96.3%) heterogeneous population, the mean APACHE II score was 17.8 ± 7.0; 25.9% required vasopressors, 59.6% had suspected or definitive baseline infections, 40.7% required mechanical ventilation, and the median baseline CRP level was 58.4 mg/dL with wide variation (range 3–548). Nine (33.3%) patients developed nosocomial infections (total of 15 infections) with bacteremia and UTI being most common. There were no significant differences in survival, baseline CRP, APACHE II, SIRS, MODS, or hospital length of stay in those who did and did not develop NI. There was a trend (p=0.10) towards development of a difference in ICU length of stay (10.4 vs 4.4) in those who developed new nosocomial infections versus those who did not, respectively. Patients with baseline infections were more likely to develop new nosocomial infections 8 (88.9%) compared to those who did not present with an infection 1(11.1%), p=0.04.
CONCLUSION: The finding of increased nosocomial infections in patients with prior infection was not expected. Host defense factors including genetic predisposition, and inflammation possibly predisposing the host to infection should be considered when examining NI. More research is needed in this area.
CLINICAL IMPLICATIONS: Future Medicare reimbursement policies should consider that the cause of NI in some cases is not related to quality of care and endogenous factors should be considered.
DISCLOSURE: Reba Umberger, No Financial Disclosure Information; No Product/Research Disclosure Information