| Abstract |
Introduction. 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). However, surveillance data concerning the epidemiology of ICU-acquired infections in Greece is limited.
The aim of this study was to assess the risk of ICU-acquired infections; to identify aspects for improvement in ICU of University Hospital of Heraklion by comparing observed incidence rates with international benchmarks; to specify the range of antimicrobial resistance of isolated microorganisms.
Material and method: This is a prospective 4-month surveillance study that took place at the ICU of the University Hospital of Heraklion, Crete. The latest HAI-Net ICU protocol, version 2.2 (ECDC, Stockholm, May 2017) was used. All patients hospitalized in ICU for more than 48 hours were included and followed until discharge. For each patient, demographics were collected and the APACHE II score (Acute Physiology and Chronic Health Assessment) during the patient’s entry was calculated. Furthermore, the cause of admission, any recent antibiotic receipt prior to ICU admission, immunodeficiency, and outcome were also recorded. As far as (HCAIs) criteria met the protocol definition, the following data was recorded: the type of infection, date of the onset, presence / absence of respiratory device, central venous catheter, urine catheter as well as the pathogenic microorganism and its sensitivity to specific antimicrobial drugs. A separate form was also completed, which included the total number of patients, the number of new admissions and the number of patients with central venous catheter, mechanical ventilation, urine bladder catheter, as well as patients receiving antimicrobial therapy, which constituted the denominators. Antimicrobial stewardship was also performed.
Results: During July - October 2017, 103 patients were included in the study. The median duration of hospitalization was 12.5 ± 1.05 days. Crude mortality was 24.2%. 27 (26.2%) patients showed a total of 42 (HCAIs) during their stay in the ICU with an incidence of 29.5 episodes of infection per 1,000 patient-days. The incidence markers for the presence of invasive devices were: 14 central venous catheter (CVC)-related blood stream infections (CR-BSIs) per 1000 CVC-days, 6.5 respiratory-related infections per 1000 intubation-days, and 0,7 infections associated with the use of a urinary catheter per 1000 urinary catheter days. The BSIs not related to CVCs was 9.8 per 1000 patient days. HCAIs- patients had prolonged hospitalization (p <0.001).
The most frequently isolated pathogens were the following: Acinetobacter baumanii (33,6%) with 93,3% resistance to 3rd generation cephalosporins, 93,3% to carbapenemes and 20% to polymixin.. Klebsiella spp (35,5%) with 62,5% resistance to 3rd generation cephalosporins, 62,5% to carbapenemes ,but no resistance to polymixin. Pseudomonas aeruginosa (13,3%) with 33,3% resistance to 3rd generation cephalosporins, 50% to carbapenemes. No resistance to polymixin was identified. Antibiotics were administered mostly as empirical treatment (69.9%) compared to documented treatment (22.1%). The most frequent indication of antimicrobial prescription was HCAI (58%).
Conclusions: The recorded incidence of infections associated with the provision of health services in the ICU of University Hospital of Heraklion Crete confirms the high incidence of HCAIs in Greek ICUs. The resistance of the predominant pathogenic micro-organisms emphasizes the microbial resistance problem in Greece. Results of the present study showed that HCAIs are associated with prolonged hospitalization in ICU. Appropriate prevention measures should be taken in order to reduce the HCAI rates in the ICU.
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Μελέτη επίπτωσης λοιμώξεων που συνδέονται με παροχή υπηρεσιών υγείας στη μονάδα εντατικής θεραπείας του ΠΑΓΝΗ
