Device-associated nosocomial infection rates in intensive care units at Cairo University hospitals: First step toward initiating surveillance programs in a resource-limited country

被引:35
作者
El-Kholy, Amani [2 ,3 ]
Saied, Tamer [1 ]
Gaber, Mervat [2 ,3 ]
Younan, Mariam A. [2 ,3 ]
Haleim, Mona M. A. [2 ,3 ]
El-Sayed, Hanan [2 ,3 ]
El-Karaksy, Hanaa'a [2 ,3 ]
Bazara'a, Hafez [2 ,3 ]
Talaat, Maha [1 ]
机构
[1] USN, Med Res Unit 3, Infect Control Unit, Global Dis Detect & Response Program, Cairo, Egypt
[2] Cairo Univ, Fac Med, Infect Control Unit, Dept Clin Pathol, Cairo, Egypt
[3] Cairo Univ, Fac Med, Infect Control Unit, Dept Pediat, Cairo, Egypt
关键词
Ventilator-associated pneumonia; Central line-associated bloodstream infection; Catheter-associated urinary tract infection; NETWORK NHSN REPORT; MORTALITY; CRITERIA;
D O I
10.1016/j.ajic.2011.12.010
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Device associated infections (DAIs) have major impact on patient morbidity and mortality. Methods: This study involved active prospective surveillance to measure the incidence of DAIs, evaluate microbiological profiles, and investigate excessive mortality in intensive care units (ICUs) in 3 hospitals of Cairo University applying the US Centers for Disease Control and Prevention's National Healthcare Safety Network case definitions for ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central-line associated bloodstream infection (CLABSI). Data were collected between March 2009 and May 2010. Results: A total of 1,101 patients were hospitalized for a total of 10,869 days, had 4,734 device-days, and acquired 97 DAIs, with an overall rate of 20.5/1,000 ICU days. VAP was the most commonly identified infection (88.7%); followed by CLABSI (8.2%) and CAUTI (3.1%). Excess mortality was 48% (relative risk, 1.9; P<.001) for CAUTI, 12.9% (relative risk, 1.2; 95% confidence interval, 1.1-1.4; P<.05) for VAP, and 45.7% for CLABSI. Acinetobacter baumannii was the most frequently isolated pathogen (36.1%), followed by Klebsiella pneumoniae (29.2%) and Pseudomonas aeruginosa (22.2%). High antimicrobial resistance was identified, with 85% of A baumannii isolates resistant to ciprofloxacin and imipenem, 76% of K pneumoniae isolates were extended-spectrum beta-lactamase producers, and 56.3% P aeruginosa isolates resistant to imipenem (56.3%). Conclusion: High rates of DAI and antimicrobial resistance require strengthening infection control, instituting surveillance systems, and implementing evidence-based preventive strategies. Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc
引用
收藏
页码:E216 / E220
页数:5
相关论文
共 33 条
[1]   Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis [J].
Allegranzi, Benedetta ;
Nejad, Sepideh Bagheri ;
Combescure, Christophe ;
Graafmans, Wilco ;
Attar, Homo ;
Donaldson, Liam ;
Pittet, Didier .
LANCET, 2011, 377 (9761) :228-241
[2]  
Tablan Ofelia C, 2004, MMWR Recomm Rep, V53, P1
[3]   National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004 [J].
Cardo, D ;
Horan, T ;
Andrus, M ;
Dembinski, M ;
Edwards, J ;
Peavy, G ;
Tolson, J ;
Wagner, D .
AMERICAN JOURNAL OF INFECTION CONTROL, 2004, 32 (08) :470-485
[4]  
[Centers for Disease Control and Prevention National Healthcare Safety Network], 2010, SURV DEF HEALTHC ASS
[5]   Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients [J].
Cook, DJ ;
Walter, SD ;
Cook, RJ ;
Griffith, LE ;
Guyatt, GH ;
Leasa, D ;
Jaeschke, RZ ;
Brun-Buisson, C .
ANNALS OF INTERNAL MEDICINE, 1998, 129 (06) :433-440
[6]   Models for hospital infection control - a view from the UK [J].
Cooke, EM .
CLINICAL MICROBIOLOGY AND INFECTION, 2000, 6 (08) :408-409
[7]   Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium [J].
Cuellar, Luis E. ;
Fernandez-Maldonado, Eduardo ;
Rosenthal, Victor D. ;
Castaneda-Sabogal, Alex ;
Rosales, Rosa ;
Mayorga-Espichan, Manuel J. ;
Camacho-Cosavalente, Luis A. ;
Castillo-Bravo, Luis .
REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH, 2008, 24 (01) :16-24
[8]   The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive cave unit [J].
DiGiovine, B ;
Chenoweth, C ;
Watts, C ;
Higgins, M .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1999, 160 (03) :976-981
[9]   National healthcare safety network (NHSN) report, data summary for 2006, issued June 2007 [J].
Edwards, Jonathan R. ;
Peterson, Kelly D. ;
Andrus, Mary L. ;
Tolson, James S. ;
Goulding, Joy S. ;
Dudeck, Margaret A. ;
Mincey, Randy B. ;
Pollock, Daniel A. ;
Horan, Teresa C. .
AMERICAN JOURNAL OF INFECTION CONTROL, 2007, 35 (05) :290-301
[10]   National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009 [J].
Edwards, Jonathan R. ;
Peterson, Kelly D. ;
Mu, Yi ;
Banerjee, Shailendra ;
Allen-Bridson, Katherine ;
Morrell, Gloria ;
Dudeck, Margaret A. ;
Pollock, Daniel A. ;
Horan, Teresa C. .
AMERICAN JOURNAL OF INFECTION CONTROL, 2009, 37 (10) :783-805