Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003

Omar M. AL-Rawajfah, Frank Stetzer, Jeanne Beauchamp Hewitt

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

background. Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported. objective. The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample. methods. This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and casefatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI. results. The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R2 was 0.22. conclusions. The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.

Original languageEnglish
Pages (from-to)1036-1044
Number of pages9
JournalInfection Control and Hospital Epidemiology
Volume30
Issue number11
DOIs
Publication statusPublished - Nov 2009

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Cross Infection
Incidence
Odds Ratio
Mortality
Inpatients
Infection
Sampling Studies
Central Venous Catheters
International Classification of Diseases
Artificial Respiration
Malnutrition
Renal Dialysis
Cross-Sectional Studies
Logistic Models
Wounds and Injuries

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003. / AL-Rawajfah, Omar M.; Stetzer, Frank; Hewitt, Jeanne Beauchamp.

In: Infection Control and Hospital Epidemiology, Vol. 30, No. 11, 11.2009, p. 1036-1044.

Research output: Contribution to journalArticle

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abstract = "background. Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported. objective. The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample. methods. This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and casefatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI. results. The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6{\%}. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R2 was 0.22. conclusions. The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.",
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