ICU医院感染死亡归因评估（翻译有奖）
Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care UnitsInfect Control Hosp Epidemiol 2010;31:388–394
Background.The strength of the association between intensive care unit (ICU)–acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken.
Objective.To assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients.
Setting.Eleven ICUs of a French university hospital.
Design.We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was defined as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis.
Results.Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval , 14.4%–14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%–6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%–3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%–2.5%) for bloodstream infection, and 0.0% (95% CI, −0.4% to 0.4%) for urinary tract infection.
Conclusions.ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed. population-attributable fraction (PAF)，人群归因分值，指总人群发病率中归因于暴露的部分。 结果：在8068名患者中，一共有1725名死亡病例与1725名对照病例配对成功。在病人出ICU之前因医院感染死亡的调整的人群归因分值是14.6%（95%置信区间为14.4%-14.8%）。采用感染类型分层，因肺感染的人群归因分值为6.1%（95%置信区间5.7%-6.5%)，因中心静脉导管感染的人群归因分值为3.2%（95%置信区间2.8%-3.5%），因血流感染的人群归因分值为1.7%（95%置信区间0.9%-2.5%）和因尿道感染的0.0%（95%置信区间-0.4%-0.4%）
结论：icu医院感染对死亡率有重要的影响。然而，基于人群归因分值来调查icu医院感染和死亡率的统计学关系的研究结果比基于估计相对危险度研究的结果更少的被报道。因此，当医院感染负担需要评估的时候方法的选择尤为重要。
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