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Invited Critique
December 2002

Epidemiology and Prognostic Determinants of Bloodstream Infections in Surgical Intensive Care—Invited Critique

Arch Surg. 2002;137(12):1359. doi:10.1001/archsurg.137.12.1359

This study by a group of renowned experts in the field is, indeed, welcomed. Bloodstream infection in critically ill patients portends excessive morbidity and mortality throughout the world.

The epidemiologic characteristics of bloodstream infection is remarkably similar in Switzerland compared with the rest of the world. The authors confirm the same determinants of outcome identified in several other excellent studies, including older age, comorbidity as defined by APACHE II (Acute Physiology and Chronic Health Evaluation II) and Simplified Acute Physiology scores, and sequential organ failure. The presence of gram-negative vs gram-positive, or polymicrobial vs monomicrobial, infection is also linked to increased mortality. The improved survival trend in the injured patient is likely owing to youthfulness, while the enhanced mortality trend in those with underlying gastrointestinal disease is presumably owing to a higher incidence of fungemia with significantly increased mortality. In contrast, the presence of systemic inflammatory response syndrome adds little and confirms the lack of usefulness of this nondescript inflammation as a discriminator of outcome. In contrast to all other organs, the onset of acute lung injury or acute respiratory distress syndrome seems overly sensitive and has no predictive value.