Surveillance of device-associated infection rates and mortality in 3 Greek intensive care units

• Published in: American journal of critical care Vol. 22; no. 3; pp. e12 - e20
• Main Authors: Apostolopoulou, Eleni, Raftopoulos, Vasilios, Filntisis, Georgios, Kithreotis, Prokopis, Stefanidis, Evagelos, Galanis, Petros, Veldekis, Dimitrios
• Format: Journal Article
• Language: English
• Published: United States 01-05-2013
• Subjects: Aged; Catheter-Related Infections - epidemiology; Catheter-Related Infections - microbiology; Catheterization, Central Venous - adverse effects; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - microbiology; Drug Resistance, Microbial - drug effects; Equipment Contamination - statistics & numerical data; Female; Greece - epidemiology; Hospital Mortality; Humans; Intensive Care Units - statistics & numerical data; Male; Microbial Sensitivity Tests; Middle Aged; Nursing; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - microbiology; Population Surveillance; Prospective Studies; Urinary Tract Infections - epidemiology; Urinary Tract Infections - etiology; Urinary Tract Infections - microbiology; Ventilators, Mechanical - adverse effects; Ventilators, Mechanical - microbiology; Greece
• ISSN: 1062-3264; 1937-710X
• DOI: 10.4037/ajcc2013324

Several studies suggest that device-associated, health care-associated infections (DA-HAIs) affect the quality of care in intensive care units, increasing patients' morbidity and mortality and the costs of patient care.
To assess the DA-HAIs rates, microbiological profile, antimicrobial resistance, and crude excess mortality in 3 intensive care units in Athens, Greece.
A prospective cohort, active DA-HAI surveillance study was conducted in 3 Greek intensive care units from July 2009 to June 2010. The rates of mechanical ventilator-associated pneumonia (VAP), central catheter-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) were calculated along with microbiological profile, antimicrobial resistance, and crude excess mortality.
During 6004 days in intensive care, 152 of 294 patients acquired 205 DA-HAIs, an overall rate of 51.7% of patients or 34.1 DA-HAIs per 1000 days (95% CI, 29.3-38.6). The VAP rate was 20 (95% CI, 16.3-23.7) per 1000 ventilator-days, the CLABSI rate was 11.8 (95% CI: 9.2-14.8) per 1000 catheter-days, and the CAUTI rate was 4.2 (95% CI, 2.5-5.9) per 1000 catheter-days. The most frequently isolated pathogen was Acinetobacter baumannii among patients with CLABSI (37.8%) and Candida species among patients with CAUTI (66.7%). Excess mortality was 20.3% for VAP and CLABSI and 32.2% for carbapenem-resistant A baumannii CLABSI.
High rates of DA-HAIs, device utilization, and antimicrobial resistance emphasize the need for antimicrobial stewardship, the establishment of an active surveillance program of DA-HAIs, and the implementation of evidence-based preventive strategies.