Prognostic factors for nosocomial bacteraemia outcome: a prospective study in a Greek teaching hospital

Epidemiological and clinical features were studied as potential prognostic factors for outcomes of bacteraemic patients in a tertiary care teaching hospital in Greece. The prospective study was conducted over 12 months and enrolled 153 consecutive hospital-acquired bacteraemic episodes in 137 patients. The crude in-hospital mortality rate was 27% (37/137). The mean lengths of stay and of antimicrobial treatment were significantly longer for patients with a fatal outcome than for survivors (P<0.0001 and P=0.001, respectively). Needs for mechanical ventilation, urinary catheters and parenteral nutrition before or during the onset of episodes were significantly associated with fatalities [odds ratio (OR)=5.54, 95% confidence intervals (CI) 2.22-14.0, P<0.0001; OR=0.70, 95% CI 0.63-0.79, P=0.021; OR=5.03, 95% CI 1.88-13.95, P<0.0001, respectively]. Also, in logistic regression analysis, mechanical ventilation (OR=5.5, 95% CI 1.2-7.9, P=0.02) and parenteral nutrition (OR=8.8, 95% CI 3.8-11.4, P=0.003) were independent predictors of mortality. No differences between fatalities and survivors were found in sex, age, smoking habit, intensive care unit hospitalization, need for a nasogastric catheter and previous surgery. Neutropenia was associated with a fatal outcome (OR=3.65, 95% CI 1.24-10.91, P=0.006). None of the bacterial pathogens were significantly associated with an adverse outcome, whereas Staphylococcus aureus was recovered more frequently from survivors (P=0.02). Fatalities were more often associated with an intravascular catheter origin (P=0.002), whereas bacteraemias in survivors were associated with a skin/soft tissue origin (P=0.02). Various prognostic factors were associated with outcome in our bacteraemic population, and can be employed to identify bacteraemic patients at risk of death and to develop local strategies for its prevention.