Gender impact on the outcomes of critically ill patients with nosocomial infections
Gender impact on the outcomes of critically ill patients with nosocomial infections
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DOI：
10.1097/ccm.0b013e3181a569df
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发表时间：
2009-09-01
影响因子：
8.8
通讯作者：
Chastre, Jean
中科院分区：
文献类型：
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作者：
Combes, Alain;Luyt, Charles-Edouard;Chastre, Jean
目标.研究性别对在内科-外科重症监护室住院的大型患者队列中发生的严重院内感染（肺炎、菌血症、导管相关血流感染、胸骨切开术后纵隔炎、尿路感染）结局的影响。高度争议的数据存在严重的院内感染的结果与性别有关的差异，反映了潜在的混杂因素有关的情况下混合或异质性的populationsevaluated.Design：回顾性研究的患者入住我们的重症监护病房。多变量逻辑回归分析用于控制性别对重症监护病房院内感染后死亡影响的混杂因素。一所教学医院的18个床位的三级转诊内外科重症监护病房。重症监护病房发生医院感染的混合人群：测量和主要结果。从1995年到2004年，我们的重症监护室收治了5081名患者，其中1341名（34%为女性）发生了医院感染。肺炎和纵隔炎在男性中更常见（分别为51% vs. 44%，p = 0.01和29% vs. 22%，p = 0.01），而尿路感染在女性中占主导地位（46% vs. 24%，p <0.001）。机械通气和重症监护室停留的持续时间和治疗强度在性别之间没有差异。然而，重症监护病房死亡率女性较高（37% vs. 32%，p = 0.06），在控制重症监护病房死亡的其他独立风险因素后，这种超额死亡率具有统计学意义（比值比= 1.50，95%置信区间= 1.11-2.03）。与相同亚组的男性相比，患肺炎的女性的ICU粗死亡率显著更高，
Objectives. To investigate gender impact on the outcomes of severe nosocomial infections (pneumonia, bacteremia, catheter-related bloodstream infections, poststernotomy mediastinitis, urinary infections) occurring in a large cohort of patients hospitalized in a medical-surgical intensive care unit. Highly controversial data exist regarding gender-related differences in outcomes of severe nosocomial infections, reflecting potential confounders related to case-mixes or heterogeneity of populations evaluated.Design: Retrospective study of patients admitted to our intensive care unit. Multivariable logistic regression-analysis was used to control for confounders in the evaluation of gender impact on intensive care unit death post nosocomial infections.Setting. An 18-bed tertiary referral medical-surgical intensive care unit in a teaching hospital.Patients. Mixed population of patients who developed nosocomial infections in the intensive care unit.Measurements and Main Results. Among the 5081 patients admitted to our intensive care unit from 1995 to 2004, 1341 (34% women) developed nosocomial infections. Pneumonia and mediastinitis were more frequent in men (51% vs. 44%, p = .01 and 29% vs. 22%, p = .01, respectively) whereas urinary infections predominated for women (46% vs. 24%, p < .001). Durations of mechanical ventilation and intensive care unit stays and treatment intensity did not differ between genders. However, intensive care unit mortality was higher for women (37% vs. 32%, p = .06) and this excess mortality was statistically significant (odds ratio = 1.50, 95% Confidence Interval = 1.11-2.03), after controlling for other independent risk factors of intensive care unit death. Compared with those observed for men of the same subgroup, crude ICU death rates were significantly higher for women who developed pneumonia, who were