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Predictors of Nosocomial Bloodstream Infections Among Critically Ill Adult Trauma Patients

Published online by Cambridge University Press:  02 January 2015

Maher M. El-Masri ,
Tarek A. Hammad ,
Sandra W. McLeskey ,
Manjari Joshi  and
Denise M. Korniewicz
Maher M. El-Masri*
Affiliation:
University of Windsor, Faculty of Nursing, Windsor, Ontario, Canada
Tarek A. Hammad
Affiliation:
Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland
Sandra W. McLeskey
Affiliation:
University of Maryland School of Nursing and Greenebaum Cancer Center, Baltimore, Maryland
Manjari Joshi
Affiliation:
University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
Denise M. Korniewicz
Affiliation:
University of Miami, School of Nursing, Miami, Florida
*
University of Windsor, Faculty of Nursing, 401 Sunset, CHN Room G110, Windsor, Ontario, Canada, N9B 3P4
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Abstract

Objective:

To identify the independent predictors of nosocomial bloodstream infections (BSIs) among critically ill adult trauma patients.

Design:

A prospective, cohort design was used to study patients who met predetermined inclusion criteria. Basic descriptive and univariate statistical analyses were performed to identify unadjusted predictors. A forward stepwise multivariate logistic regression analysis was then conducted to identify independent predictors of nosocomial BSI.

Setting:

Level I university-affiliated shock trauma center.

Patients:

Three hundred sixty-one critically ill adult trauma patients, 55 of whom developed nosocomial BSIs (15.2%).

Results:

Data analysis of 45 variables indicated that only 9 were independent predictors of nosocomial BSI: presence of a chest tube, use of immunosuppressive agents, presence of microbial resistance, length of stay, presence of preexisting infection, percentage change of serum albumin levels, patient disposition, transfusion of 10 or more units of blood, and number of central venous catheters (CVCs) for patients who had 4 or more. The classification index of the final regression model at a cut-off point of 0.5 had a specificity of 97.4%, a sensitivity of 60%, a positive predictive value of 76.7%, a negative predictive value of 93%, and an overall precision of 91%.

Conclusion:

In this study, only 9 variables were independent predictors of nosocomial BSI. Our findings are specific to critically ill adult trauma patients and should be interpreted within the context of this particular population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 8 , August 2004 , pp. 656 - 663
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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