Background: 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.
Objectives: To assess the DA-HAIs rates, microbiological profile, antimicrobial resistance, and crude excess mortality in 3 intensive care units in Athens, Greece. Methods 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.
Results: 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.
Conclusion: 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.
Written by:
Apostolopoulou E, Raftopoulos V, Filntisis G, Kithreotis P, Stefanidis E, Galanis P, Veldekis D Are you the author?
Eleni Apostolopoulou is a professor and Georgios Filntisis is an associate professor in the Nursing Department at National and Kapodistrian University of Athens, Greece. Vasilios Raftopoulos is head of the Mediterranean Research Center for Public Health and Quality of Care and an assistant professor in the Nursing Department at Cyprus University of Technology, Nicosia, Cyprus. Prokopis Kithreotis and Dimitrios Veldekis are physicians and Evagelos Stefanidis is a registered nurse in the intensive care unit at "SOTIRIA" General Hospital, Athens, Greece. Petros Galanisis a registered nurse in the Center for Health Services Management and Evaluation and a member of the nursing faculty at National and Kapodistrian University of Athens
Reference: Am J Crit Care. 2013 May;22(3):e12-e20.
doi: 10.4037/ajcc2013324
PubMed Abstract
PMID: 23635940
