Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011).

OBJECTIVE: To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level. DESIGN: Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study. SETTING: Spanish ICU. PATIENTS: Patients admitted for over 24h. INTERVENTIONS: None. VARIABLES: Data for each of the participating hospitals and ICUs were recorded, as well as data that allowed to knowing the case-mix and the individual outcome of each patient. The study period was divided into two intervals, from 2006 to 2008 (period 1) and from 2009 to 2011 (period 2). Multilevel and multivariate models were used for the analysis of mortality and were performed in each stratum of severity level. RESULTS: The study population included 142,859 patients admitted to 188 adult ICUs. There was an increase in the mean age of the patients and in the percentage of patients >79 years (11.2% vs. 12.7%, P<0.001). Also, the mean APACHE II score increased from 14.35±8.29 to 14.72±8.43 (P<0.001). The crude overall intra-UCI mortality remained unchanged (11.4%) but adjusted mortality rate in patients with APACHE II score between 11 and 25 decreased modestly in recent years (12.3% vs. 11.6%, odds ratio=0.931, 95% CI 0.883-0.982; P=0.008). CONCLUSION: This study provides observational longitudinal data on case-mix of patients admitted to Spanish ICUs. A slight reduction in ICU mortality rate was observed among patients with intermediate severity level.

[Impact of primary and intravascular catheter-related bacteremia due to coagulase-negative staphylococci in critically ill patients]. / Impacto de la bacteriemia primaria y relacionada con catéter intravascular causada por Staphylococcus coagulasa negativo en pacientes críticos.

OBJECTIVE: To study the impact of coagulase-negative staphylococcal (CNS) primary and intravascular catheter-related bloodstream infection (PBSI/CRBSI) on mortality and morbidity in critically-ill patients. DESIGN: We performed a double analysis using data from the ENVIN-HELICS registry data (years 1997 to 2008): 1) We studied the clinical characteristics and outcomes of patients with CNS-induced PBSI/CRBSI and compared them with those of patients with PBSI/CRBSI caused by other pathogens; and 2) We analyzed the impact of CNS-induced PBSI/CRBSI using a case-control design (1:4) in patients without other nosocomial infections. SETTING: 167 Spanish Intensive Care Units. PATIENTS: Patients admitted to ICU for more than 24 hours. RESULTS: 2,252 patients developed PBSI/CRBSI, of which 1,133 were caused by CNS. The associated mortality for PBSI/CRBSI caused by non-CNS pathogens was higher than that of the CNS group (29.8% vs. 25.9%; P=.039) due exclusively to the mortality of patients with candidemia (mortality: 45.9%). In patients without other infections, PBSI/CRBSI caused by CNS (414 patients) is an independent risk factor for a higher than average length of ICU stay (OR: 5.81, 95% CI: 4.31-7.82; P<.001). CONCLUSION: Crude mortality of patients with CNS-induced BPSI/CRBSI is similar to that of patients with BPSI/CRBSI caused by other bacteria, but lower than that of patients with candidemia. Compared to patients without nosocomial infections, CNS-induced PBSI/CRBSI is associated with a significant increase in length of ICU stay.

A predictive model for the treatment approach to community-acquired pneumonia in patients needing ICU admission.

OBJECTIVE: To create a predictive model for the treatment approach to community-acquired pneumonia (CAP) in patients needing Intensive Care Unit (ICU) admission. DESIGN: Multicenter prospective study. SETTING: Twenty-six Spanish ICUs. PATIENTS: One hundred seven patients with CAP, all of them with accurate etiological diagnosis, divided in three groups according to their etiology in typical (bacterial pneumonia), Legionella and other atypical (Mycoplasma, Chlamydia spp. and virus). For the multivariate analysis we grouped Legionella and other atypical etiologies in the same category. METHODS: We recorded 34 variables including clinical characteristics, risk factors and radiographic pattern. We used a multivariate logistic regression analysis to find out a predictive model. RESULTS: We have the complete data in 70 patients. Four variables: APACHE II, (categorized as a dummy variable) serum sodium and phosphorus and "length of symptoms" gave an accurate predictive model (c = 0.856). From the model we created a score that predicts typical pneumonia with a sensitivity of 90.2% and specificity 72.4%. CONCLUSION: Our model is an attempt to help in the treatment approach to CAP in ICU patients based on a predictive model of basic clinical and laboratory information. Further studies, including larger numbers of patients, should validate and investigate the utility of this model in different clinical settings.

[Epidemiology and impact of nosocomial infections]. / Epidemiología e impacto de las infecciones nosocomiales.

Nosocomial infections are one of the most important problems occurring in Intensive Care Units. For this reason, the epidemiology and impact of these infections on critical patients must be known. Based on the data from the ENVIN-UCI study, the rates and etiology of the main nosocomial infections, such as ventilator-associated pneumonia, urinary tract infection and primary and secondary bloodstream infection, have been described. A review of the literature regarding the impact of different nosocomial infections on critically ill patients, particularly those caused by multidrug-resistant bacteria, was also performed.

Economic impact of Candida colonization and Candida infection in the critically ill patient.

The objective of the study presented here was to assess the economic impact of Candida colonization and Candida infection in critically ill patients admitted to intensive care units (ICUs). For this purpose, a prospective, cohort, observational, and multicenter study was designed. A total of 1,765 patients over the age of 18 years who were admitted for at least 7 days to 73 medical-surgical ICUs in 70 Spanish hospitals between May 1998 and January 1999 were studied. From day 7 of ICU admission to ICU discharge, samples of tracheal aspirates, pharyngeal exudates, gastric aspirates and urine were collected every week for culture. Prolonged length of stay was associated with severity of illness, Candida colonization or infection, infection by other fungi, antifungal therapy, treatment with more than one antifungal agent, and toxicity associated with this therapy. Compared to non-colonized, non-infected patients (n=720), patients with Candida colonization (n=880) had an extended ICU stay of 6.2 days (OR, 1.69; 95%CI, 1.53-1.87; P<0.001) and an extended hospital stay of 8.6 days (OR, 1.27; 95%CI, 1.16-1.40; P<0.001). The corresponding figures for patients with Candida infection (n=105) were 12.7 days for ICU stay (OR, 2.13; 95%CI, 1.72-2.64; P<0.001) and 15.5 days for hospital stay (OR, 1.23; 95%CI, 0.99-1.52; P=0.060). Candida colonization resulted in an additional 8,000 EUR in direct costs and Candida infection almost 16,000 EUR. Both Candida colonization and Candida infection had an important economic impact in terms of cost increases due to longer stays in both the ICU and in the hospital.