Device-associated infections in the intensive care units of Cyprus: results of the first national incidence study

Background Surveillance of healthcare-associated infections (HCAIs) has become an integral part of infection control programs in several countries, especially in the intensive care unit (ICU) setting. In contrast, surveillance data on the epidemiology of ICU-acquired infections in Cyprus are limited...

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Published in:	Infection Vol. 38; no. 3; pp. 165 - 171
Main Authors:	Gikas, A, Roumbelaki, M, Bagatzouni-Pieridou, D, Alexandrou, M, Zinieri, V, Dimitriadis, I, Kritsotakis, E. I
Format:	Journal Article
Language:	English
Published:	Munchen Munchen : Urban and Vogel 01-06-2010 Urban and Vogel Springer Springer Nature B.V
Subjects:	Adult Antibiotic resistance Bacteremia - epidemiology Bacteremia - microbiology Benchmarks Biological and medical sciences Catheter-Related Infections - epidemiology Catheter-Related Infections - microbiology Clinical and Epidemiological Study Cohort Studies Cross Infection - epidemiology Cross Infection - microbiology Cyprus - epidemiology Device associated infection Drug Resistance, Bacterial Enterococcus Epidemiology Family Medicine General Practice Gram-Negative Bacteria Gram-Negative Bacterial Infections - epidemiology Gram-Negative Bacterial Infections - microbiology Gram-Positive Bacteria Gram-Positive Bacterial Infections - epidemiology Gram-Positive Bacterial Infections - microbiology Healthcare associated infection Hospitals Humans incidence Infectious Diseases Intensive care unit Intensive Care Units - statistics & numerical data Internal Medicine Medical instruments Medical sciences Medicine Medicine & Public Health Miscellaneous monitoring Nosocomial infection Pathogens Population Surveillance Pseudomonas aeruginosa Public health. Hygiene Public health. Hygiene-occupational medicine Risk assessment Staphylococcus aureus Statistics, Nonparametric Cyprus Healthcare associated infection Incidence rate Surveillance Cyprus Intensive care unit Device associated infection Nosocomial infection Pneumonia Methodology Catheter Risk Artificial ventilation Staphylococcus Incidence Bacteria Micrococcales Micrococcaceae Hospital Resuscitation Enterococcus Drug Urinary system disease Residence time Mortality Retrospective Infection Streptococcaceae Survey Sensitivity resistance Bacteriosis Medical device Hygiene
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Summary:	Background Surveillance of healthcare-associated infections (HCAIs) has become an integral part of infection control programs in several countries, especially in the intensive care unit (ICU) setting. In contrast, surveillance data on the epidemiology of ICU-acquired infections in Cyprus are limited. The aim of this study was to assess the risk of ICU-acquired infections and to identify areas for improvement in Cypriot hospitals by comparing observed incidence rates with international benchmarks and by specifying the microbiological and antibiotic resistance profiles of infecting organisms. Materials and methods An active surveillance protocol was introduced in the ICUs of the four major public hospitals in Cyprus, based on the methodology of the US National Nosocomial Infections Surveillance system. Results During February to December 2007, 2,692 patients who were hospitalized in ICUs for a mean length of stay of 5 days acquired 214 infections for an overall incidence rate of 15.8 infections per 1,000 patient-days [95% confidence interval (CI): 13.8-18.1]. Bloodstream infections, pneumonias and urinary tract infections accounted for 80.4% of all infections; of these, 87.8% were device-related. Central line-associated bloodstream infection (CL-BSI) posed the greatest risk (18.6 cases per 1,000 central line-days; 95% CI 14.9-22.9), followed by ventilator-associated pneumonia (VAP) (6.4 cases per 1,000 ventilator-days; 95% CI 4.5-8.8) and catheter-associated urinary tract infection (2.8 cases per 1,000 urinary catheter-days; 95% CI 1.9-4.1). Most frequently isolated pathogens included Pseudomonas aeruginosa (21.6% of all isolates), coagulase-negative Staphylococcus (11.7%), Enterococcus spp. (11.3%) and Staphylococcus aureus (9.2%). Overall, 29.8% of P. aeruginosa isolates were imipenem-resistant and 68.2% of S. aureus were methicillin-resistant. The crude excess mortality rate associated with ICU-acquired infections was 33.2% (95% CI 24.9-41.9%) and the mean post-infection stay in the ICUs was 21.6 days (95% CI 17.0-26.2). Conclusion In comparison to international benchmarks, the markedly high rate of CL-BSI, the high rate of VAP and the resistance patterns of major infecting pathogens identified in this study emphasize the need to improve current practices for appropriate use and management of invasive devices in Cypriot ICUs.
Bibliography:	http://dx.doi.org/10.1007/s15010-010-0007-2 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0300-8126 1439-0973
DOI:	10.1007/s15010-010-0007-2