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Volume 2020, Issue 2
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Deliberate self-harm (DSH) is an important cause for intensive care admission in developing countries. The evaluation of incidence and risk factors for nosocomial infection development in DSH with its impact on the outcome is not clearly elucidated. Demographic, infection, and outcome data were collected in this retrospective study of 2 years. Factors associated with infection and mortality were explored using bivariate and multivariate logistic regression analyses, which were expressed as odds ratio (OR) with 95% confidence interval (CI). Of the 3274 admissions, 302 (9.2%) were due to DSH, whereas the majority (n = 178, 58.9%) were due to organophosphorus (OP) compounds, with the mean (SD) APACHE-II score of 14.7 (6.0); 278 (92.1%) patients were ventilated. 55 (18.2%) patients developed a nosocomial infection, accounting for 15.6 infections per 1000 hospital days, with an overall mortality of 14.2%. Mortality was significantly ( < 0.001) higher in those who developed an infection (30.9% vs. 10.5%). Multivariate logistic regression analysis demonstrated that DSH due to OP compounds (OR 2.9; 95%CI 1.1–7.1) and ventilation duration (OR 1.1; 95%CI 1.1–1.3) were independently associated with nosocomial infection development. APACHE-II score, nosocomial infection, and the need for dialysis significantly ( < 0.001) associated with mortality. In the DSH setting, acquiring nosocomial infection during intensive care admission impacts mortality. DSH due to OP compounds and duration of ventilation were independent risk factors for the development of infection.

© 2020 D'Sa, Chacko, Sudarsan, Mani, Paul, Victor, Iyyadurai, Das, Koshy, Peter, licensee HBKU Press.
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2021-02-03
2023-03-31
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References

  1. Vijayakumar L. Suicide and its prevention: The urgent need in India. Indian J Psychiatry. 2007; 49: 81–4.
     [Google Scholar]
  2. Peter JV, Jerobin J, Nair A, Bennett A, Samuel P, Chrispal A, et al. Clinical profile and outcome of patients hospitalized with dimethyl and diethyl organophosphate poisoning. Clin Toxicol (Phila). 2010; 48: 916–23.
     [Google Scholar]
  3. Davies JO, Eddleston M, Buckley NA. Predicting outcome in acute organophosphorus poisoning with a poison severity score of the Glasgow coma scale. QJM. 2008; 101: 371–9.
     [Google Scholar]
  4. Peter JV, Jerobin J, Nair A, Bennett A. Is there a relationship between the WHO hazard classification of organophosphate pesticide and outcomes in suicidal human poisoning with commercial organophosphate formulations? Regul Toxicol Pharmacol. 2010; 57: 99–102.
     [Google Scholar]
  5. Chacko B, Thomas K, David T, Paul H, Jeyaseelan L, Peter JV. Attributable cost of a nosocomial infection in the intensive care unit: a prospective cohort study. World J Crit Care Med. 2017; 6: 79–84.
     [Google Scholar]
  6. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control. 2003; 31: 291–5.
     [Google Scholar]
  7. van Vught LA, Klein Klouwenberg PM, Spitoni C, Scicluna BP, Wiewel MA, Horn J, et al. Incidence, risk factors and attributable mortality of secondary infections in the intensive care unit after admission for sepsis. JAMA. 2016; 315: 1469–79.
     [Google Scholar]
  8. Ylipalosaari P, Ala-Kokko TI, Laurila J, Ohtonen P, Syrjala H. Intensive care acquired infection is an independent risk factor for hospital mortality: a prospective cohort study. Crit Care. 2006; 10: R66.
     [Google Scholar]
  9. Hermanowicz A, Kossman S. Neutrophil function and infectious disease in workers occupationally exposed to phosphoorganic pesticides: role of mononuclear-derived chemotactic factor for neutrophils. Clin Immunol Immunopathol. 1984; 33: 12–22.
     [Google Scholar]
  10. Queiroz ML, Fernandes MD, Valadares MC. Neutrophil function in workers exposed to organophosphate and carbamate insecticides. Int J Immunopharmacol. 1999; 21: 263–70.
     [Google Scholar]
  11. Fernandes MD, Queiroz ML. Measurement of the respiratory burst and chemotaxis in polymorphonuclear leucocytes from anti-ChE insecticides- exposed workers. Immunopharmacol Immunotoxicol. 1999; 21: 621–33.
     [Google Scholar]
  12. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36: 309–32.
     [Google Scholar]
  13. Schoenfeld DA, Bernard GR, ARDS Network. Statistical evaluation of ventilator-free days as an efficacy measure in clinical trials of treatment for acute respiratory distress syndrome. Crit Care Med. 2002; 30: 1772–7.
     [Google Scholar]
  14. World Health Organization. Health care-associated infections fact sheet [Internet]. [Accessed March 2019]. Available from: https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf .
  15. Pradhan NP, Bhat SM, Ghadage DP. Nosocomial infections in the medical ICU: a retrospective study highlighting their prevalence, microbiological profile and impact on ICU stay and mortality. J Assoc Physicians India. 2014; 62: 18–21.
     [Google Scholar]
  16. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med. 2015; 19: 14–20.
     [Google Scholar]
  17. Mythri H, Kashinath K. Nosocomial infections in patients admitted in intensive care unit of a tertiary health center,India. Ann Med Health Sci Res. 2014; 4: 738–41.
     [Google Scholar]
  18. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011; 377: 228–41.
     [Google Scholar]
  19. Suka M, Yoshida K, Uno H, Takezawa J. Incidence and outcomes of ventilator-associated pneumonia in Japanese intensive care units: the Japanese nosocomial infection surveillance system. Infect Control Hosp Epidemiol. 2007; 28: 307–28.
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2020.12
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Nosocomial infection acquired during intensive care admission impacts mortality in patients admitted with deliberate self-harm
Journal of Emergency Medicine, Trauma and Acute Care 2020, 12 (2021); https://doi.org/10.5339/jemtac.2020.12
/content/journals/10.5339/jemtac.2020.12
/content/journals/10.5339/jemtac.2020.12
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  • Article Type: Research Article
Keyword(s): infection, intensive care, outcome and pesticide

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