| Abstract |
INTRODUCTION: Infections related to healthcare facilities, (Health Care Acquired Infections-HCAIs) or shorter Hospital Acquired Infections (HAIs) are a serious risk factor for public health and are associated with an increase in morbidity and mortality rates. The increased HAI incidence in Intensive Care Unit (ICU) patients is a major issue for healthcare at national and global level. In addition, the use of broad spectrum antibiotics is documented as the most important factor in the development of antimicrobial resistance in ICUs, resulting in prolonged hospitalization and increased morbidity and mortality of hospitalized patients as well as the dispersion of resistant strains in other health care areas. An important weighted quality indicator in ICUs is HAI (health-related associated infections) surveillance associated with interventional devices (Device-Associated HAI, DA-HAIs). PURPOSE: The imprint of the incidence of infections associated with the use of devices in the ICU of the General Hospital of CHANIA and their relation with morbidity and mortality. The recording of the use of antibiotics and the microbial resistance of pathogenic microorganisms isolated from patients with HAI in the ICU. METHODOLOGY: The prospective study was carried out in the ICU G.H.CHANIA 7 beds between May and October 2018. The HAI-Net ICU protocol version 2.2 (ECDC, Stockholm, May 2017) was used. Patients with a minimum of 48 hours of hospitalization were followed and monitored until their discharge from ICU. The data collection concerned demographic data, the APACHE II index, cause of admission, antibiotic consumption, justification for administration and final outcome. Blood stream infections (BSI) have been studied, catheter-related infections BSΗ (CR-BSI), pneumonia associated with (endo) tracheal tube (PN )and urinary catheter-related urinary tract infections (CA-UTI). The time of exposure to these devices, the date of occurrence, the use of antibiotics and pathogenic microorganisms with the corresponding sensitivity to certain antimicrobial agents as defined in the protocol were recorded. In a separate form, the daily movement of ICU patients was recorded, the number of patients with CVC, with mechanical support of breathing and urinary catheter. Demographics, disease severity index, incidence of monitored infections were recorded and correlated with ICU hospitalization rates and outcome.
RESULTS: 104 patients were hospitalized during the study period, of which 84 met the study entry criteria. The median duration of hospitalization was 7 days (IQR, 4-16). The crude mortality was 38,1%. 17 (20,2%) patients had HAI, 5 (29,4%) out of
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17 had more than 1 HAI. Incidence indicators for DA-HAIs were: 6,6 CVC related infections per 1000 days of CVC use, 7,53 respiratory-related infections per 1000 days of intubation. No CAUTIs were recorded. Incidence of BSI was 12,1 per 1000 patient-days. HAI patients had longer ICU stay (21 days vs 6 days, p<,001) but no increased mortality. Most common pathogens isolated were: Klebsiella spp (51,6%) with a 100% resistance to 3rd generation cephalosporins, 87,5% to carbapenemes and 87,5% to colistin, with 75% of the detected strains being resistant to all antibiotics studied in the protocol. Acinetobacter baumani (16,1%) with 100% resistance to 3rd generation cephalosporins, 80% to carbapenems and 40% to colistin, Pseudomonas aeruginosa 12,9% without resistant strain to antipseudomonal penicillins, carbapenems and colistin. Staphylococcus aureus (19,4%) found with100% oxacillin resistance. Total duration of administration of antimicrobial agents was 2.704 days per 1000 patient days and was mainly given as empirical treatment in HAI (46,7%). A higher prescription was recorded in the following antibiotics: carbapenems, colistin, vancomycin, teicoplanin, 3rd generation cephalosporins and b-lactamase inhibitors with treatment days (DOT) 421, 410, 398, 372, 220, and 228 per 1000 patient days respectively. CONCLUSIONS: High incidence of HAIs in the ICU confirms the need for bundles based on international recommendations for prevention, monitor and decrease of infections at local and national level. High antibiotic consumption is associated with high levels of antimicrobial resistance. Implementable surveillance and rational use of antibiotics will lead to a reduction in ICUs consumption.
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Μελέτη επίπτωσης λοιμώξεων που συνδέονται με παροχή υπηρεσιών υγείας στη μονάδα εντατικής θεραπείας του γενικού νοσοκομείου Χανίων Κρήτης
