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Transfusion: A Risk Factor for Nosocomial Bacteremia in the Intensive Care Unit
October 2004, Vol 126, No. 4_MeetingAbstracts Abstract: Slide Presentations | October 2004
Transfusion: A Risk Factor for Nosocomial Bacteremia in the Intensive Care Unit Andrew F. Shorr, MD*; Kathy M. Kelly, MD; Marin H. Kollef, MD Walter Reed Army Medical Center, Washington, DC Chest Chest. 2004;126(4_MeetingAbstracts):763S. doi:10.1378/chest.126.4.1337
Abstract PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: TX is common in critically ill patients and is associated with an increased risk for NB. CLINICAL IMPLICATIONS: 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. DISCLOSURE: A.F. Shorr, Ortho Biotech LLP Tuesday, October 26, 2004 2:30 PM- 4:00 PM
Transfusion: A Risk Factor for Nosocomial Bacteremia in the Intensive Care Unit Andrew F. Shorr, MD*; Kathy M. Kelly, MD; Marin H. Kollef, MD Walter Reed Army Medical Center, Washington, DC Chest Chest. 2004;126(4_MeetingAbstracts):763S. doi:10.1378/chest.126.4.1337
Abstract PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: TX is common in critically ill patients and is associated with an increased risk for NB. CLINICAL IMPLICATIONS: 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. DISCLOSURE: A.F. Shorr, Ortho Biotech LLP Tuesday, October 26, 2004 2:30 PM- 4:00 PM