Surveillance of device associated infections and mortality in a major intensive care unit in the Republic of Cyprus
Tóm tắt
Device-associated health care-associated infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit. The aim of this study was to assess the incidence of DA-HAIs, mortality and crude excess mortality at a General Hospital’s Intensive Care Unit (ICU) in the Republic of Cyprus for 1 year period. A prospective cohort, active DA-HAIs surveillance study with the use of Health Acquired Infections (HAIs) ICU Protocol (v1.01 standard edition) as provided by ECDC/NHSN for the active DA-HAIs surveillance study was conducted. The study sample included 198 ICU patients admitted during the research period and hospitalized for over 48 h. The Ventilator-Associated Pneumonia (VAP), Central Line-Associated Bloodstream Infection (CLABSI), and Catheter-Associated Urinary Tract Infection (CAUTI) rates, length of stay (LOS), mortality, and crude excess mortality were calculated. CLABSI was the most frequent DA-HAI with 15.9 incidence rate per 1000 Central Venus Catheter (CVC) days. The VAP rate, was 10.1 per 1000 ventilator days and the CAUTI rate was 2.7 per 1000 urinary catheter days. Device associated infections were found to be significantly associated with the length of ICU stay (p < 0.001), the CVC days (p < 0.001), ventilator days (p < 0.001), and urinary catheter days (p < 0.001). The excess mortality was 22.1% for those who acquired a DA-HAI (95% CI, 2–42.2%) compared to the patients who remained DA-HAI free. Mortality of patients with VAP infection was 2.3 times higher (RR = 2.33 95% CI, 1.07–5.05) than those patients admitted without a HAI and subsequently did not acquire a DA-HAI. The most frequently isolated pathogen was Staphylococcus epidermidis (13.9%) and Candida albicans (13.9%). Higher DA-HAIs rates and device utilization than the international benchmarks were found in this study, calling into question the safety of preventative practices employed in this unit.
Tài liệu tham khảo
Fagan RP, Edwards JR, Park BJ, Fridkin SK, Magill SS. Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990-2010. Infect Control Hosp Epidemiol. 2013 [cited 2016 Aug 4];34:893–899. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23917902.
Rosenthal VD, Guzman S, Migone O, Crnich CJ. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: A prospective, matched analysis. Am. J. Infect. Control. Bernal Medical Center, Colegiales Medical Center, Department of Infectious Diseases, and Hospital Epidemiology, Buenos Aires, Argentina.; 2003;31:475–80.
Dima S, Kritsotakis EI, Roumbelaki M, Metalidis S, Karabinis A, Maguina N, et al. Device-associated nosocomial infection rates in intensive care units in Greece. Infect. Control Hosp Epidemiol. 2007;28:602–5.
Klevens RM, Edwards JR, Richards Jr CL, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Heal. reports (Washington, D.C. 1974). Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS A-24, Atlanta, GA 30333, USA.; 2007;122:160–6.
Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR. Morb. Mortal. Wkly. Rep. [Internet]. 2011 [cited 2016 Aug 4];60:243–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21368740.
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. [cited 2016 Nov 14];274:639–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7637145.
European Centre for Disease Prevention and Control. Annual epidemiological report 2014. Antimicrobial resistance and healthcare-associated infections [Internet]. 2014. Available from: http://ecdc.europa.eu/en/publications/publications/antimicrobial-resistance-annual-epidemiological-report.pdf.
Hansen S, Schwab F, Behnke M, Carsauw H, Heczko P, Klavs I, et al. National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project. J Hosp Infect. 2009 [cited 2016 Nov 16];71:66–73. Available from: www.elsevierhealth.com/journals/jhin.
ECDC-NHSN. Infections in Intensive Care Units HAI-ICU protocol [Internet]. Eur. Surveill. Heal. Infect. Intensive Care Units- ECDC HAIICU Protoc. 2010. p. 1–68. Available from: http://ecdc.europa.eu/en/aboutus/calls/ProcurementRelatedDocuments/5_ECDC_HAIICU_protocol_v1_1.pdf.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. [Internet]. Crit. Care Med. 1985 [cited 2016 Oct 23]. p. 818–29. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3928249.
Le Gall J-R, Lemeshow S, Saulnier F. Simplified acute physiology score ( SAPS II ) based on a European / north American multicenter study. JAMA. 1993 [cited 2016 Oct 23];270:2957–2963. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8254858.
R Development Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. URL http://www.R-project.org/. R Found Stat Comput. Vienna. 2015;2015.
Fay MP. Two-sided exact tests and matching confidence intervals for discrete data. R J. 2010;2:53–8. Available from: https://journal.r-project.org/archive/2010-1/RJournal_2010-1_Fay.pdf.
Ralph Scherer. Various confidence interval methods for proportions [Internet]. 2014. Available from: https://github.com/shearer/PropCIs.
Apostolopoulou E, Raftopoulos V, Filntisis G, Kithreotis P, Stefanidis E, Galanis P, et al. Surveillance of device-associated infection rates and mortality in 3 greek intensive care units. Am J Crit Care. Nursing Department, National and Kapodistrian University of Athens, Greece.; 2013 [cited 2016 Jan 4];22:e12-e20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23635940.
Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update:antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29:996–1011. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18947320.
Inan D, Saba R, Yalcin AN, Yilmaz M, Ongut G, Ramazanoglu A, et al. Device-associated nosocomial infection rates in Turkish medical-surgical intensive care units. Infect Control Hosp Epidemiol. 2006;27:343–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16622810.
Kübler A, Duszynska W, Rosenthal VD, Fleischer M, Kaiser T, Szewczyk E, et al. Device-associated infection rates and extra length of stay in an intensive care unit of a university hospital in Wroclaw, Poland: international Nosocomial infection control Consortium’s (INICC) findings. J Crit Care. 2012 [cited 2016 Nov 7];27:105.e5-105.e10. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0883944111002206.
Salomao R, Rosenthal VD, Grimberg G, Nouer S, Blecher S, Buchner-Ferreira S, et al. Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the international Nosocomial infection control consortium. Rev Panam Salud Publica. 2008 [cited 2016 Nov 7];24:195–202. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19115547.
Gikas A, Roumbelaki ÁM, Bagatzouni-Pieridou D, Alexandrou M, Zinieri V, Kritsotakis EI. Device-associated infections in the intensive care units of Cyprus: results of the first national incidence study. Infection. 2010;38:165–71.
Kanj S, Kanafani Z, Sidani N, Alamuddin L, Zahreddine N, Rosenthal V. International nosocomial infection control consortium findings of device-associated infections rate in an intensive care unit of a Lebanese university hospital. J Glob Infect Dis. 2012;4:15. Available from: http://www.jgid.org/text.asp?2012/4/1/15/93755.
Rosenthal VD. Device-associated infection and mortality rates, bacterial resistance, and length of stay in hospitals of Malaysia: international Nosocomial infection. Can J Infect Control. 2016;31:107–12.
Rosenthal VD, Bijie H, Maki DG, Mehta Y, Apisarnthanarak A, Medeiros EA, et al. International Nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am J Infect Control. 2012 [cited 2016 Nov 7];40:396–407. Available from: http://linkinghub.elsevier.com/retrieve/pii/S019665531100842X.
Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, et al. International Nosocomial infection control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control. 2014 [cited 2016 Nov 7];42:942–956. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0196655314008566.
Rosenthal VD, Maki DG, Mehta A, Álvarez-Moreno C, Leblebicioglu H, Higuera F, et al. International Nosocomial infection control consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control. 2008 [cited 2016 Nov 7];36:627–637. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0196655308001661.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.
Venkatram S, Rachmale S, Kanna B. Study of device use adjusted rates in health care–associated infections after implementation of “bundles” in a closed-model medical intensive care unit. J. Crit. Care. 2010;25:174.e11-174.e18. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19682846.
Haq A, Patil S, Parcells AL, Chamberlain RS. The Simplified Acute Physiology Score III Is Superior to the Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II in Predicting Surgical and ICU Mortality in the "Oldest Old". Curr. Gerontol. Geriatr. Res. 2014 [cited 2016 Nov 8];2014:934852. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24696680.
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.
Gould C V, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010 [cited 2016 Jan 4];31:319–326. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20156062.
Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect. Control Hosp. Epidemiol. Center for Evidence-Based Practice, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. [email protected]; 2011;32:101–14.
Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y, Higuera F, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006 [cited 2016 Nov 7];145:582–591. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17043340.
Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y, Higuera F, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006 [cited 2016 Aug 17];145:582–591. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17043340.
Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell G, Pollock DA, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am. J. Infect. Control. Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA 30329, USA. [email protected]; 2011;39:798–816.
Guanche-Garcell H, Requejo-Pino O, Rosenthal VD, Morales-Pérez C, Delgado-González O, Fernández-González D. Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings. Int J Infect Dis. 2011;15:e357–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21450505.
El-Kholy A, Saied T, Gaber M, Younan MA, Haleim MM, El-Sayed H, et al. Device-associated nosocomial infection rates in intensive care units at Cairo University hospitals: first step toward initiating surveillance programs in a resource-limited country. Am J Infect Control Infection Control Unit, Clinical Pathology and Pediatric Departments, Faculty of Medicine, Cairo University, Cairo, Egypt.; 2012;40:e216-e220.