| Abstract |
BACKGROUND
Nosocomial infections or Health-Care Acquired Infections (HCAIs) are a global public health concern, associated with high morbidity and mortality of patients suffering from an infection. In addition, the financial cost of hospitalizing these patients is high for hospitals, resulting in a financial blow to health and in general to global public health. Each year more than 4,000,000 patients in the European Union have HCAIs, and 37,000 patients have a fatal outcome. Surveillance of HCAIs in Intensive Care Unit (ICU) is a priority of the European Center for Disease Prevention and Control (ECDC). The reason for that is that the patients who are admitted in ICU are at 5 to 10 times more likely to get infections due to endogenous (e.g. immunosuppression) and exogenous factors (e.g. mechanical ventilation). Moreover, ICUs are the main area of the HCAIs and antimicrobial resistance in a hospital.
Aim of the study
The aim of this study was to assess the incidence of HCAIs in ICU of the General Hospital of Rethymnon (GΗR) based on the ECDC protocol ‘’SURVEILLANCE OF HEALTHCARE-ASSOCIATED INFECTIONS AND PREVENTION INDICATORS IN EUROPEAN INTENSIVE CARE UNITS HAI-Net ICU Protocol, version 2.2’’. To identify the risk factors for the occurrence of HCAIs, the antibiotic stewardship and the antimicrobial resistance in the ICU of GΗR. The present study helps to identify areas where preventive actions are needed so as to improve the quality of health care provision. The results of this study will have a broader implementation as it is part of a national study.
Methodology
This study lasted for 6 months, took place in the ICU of the GΗR and was based on the ECDC protocol, HAI-Net ICU Protocol, version 2.2. Surveillance was perspective and included all patients in the ICU of the GΗR stayed more than 2 days until their discharge. Enrolled patients were hospitalized more than 48 hours in ICU. Each infection was appraised
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according to protocol case definitions before being considered as HCAI, taking into account specific biological sample cultures, clinical signs, and laboratory and radiological workup of patients. The recorded infections included the central venous catheter-related (CR-CVC), respiratory device-related pneumonia (PN) and urinary (catheter-induced) tract infections (CA-UTI). Also, the time exposure to those devices, the use of antibiotics during ICU hospitalization and during stay was recorded. Moreover, the type of infections, the pathogen (with its antimicrobial resistance) and the specific justification for the use of antibiotics was recorded.
Results
The total number of patients who admitted in the ICU of the GHR was 132, 56 of whom were hospitalized over 48 hours. 75% of cases were general internal medicine cases. APACHE II score was 20.5 (14.25-29.5). The gross mortality was 10.7%.
Total number of enrolled patients with HCAIs was 12 while one of them had 2 HCAIs during the same hospitalization. The overall incidence of HCAIs for the surveillance period was 18.6 per 1000 patient-days. The incidence of CVC-associated bacteraemias was 12.2 infections per 1000 CVC- days, 14.5 pneumonias per 1000 intubation days, and 1.8 urinary tract infections per 1000 days of urinary catheterization. In addition, 2 episodes of primary bacteraemia (3.11 bacteraemia per 1000 patient-days) were recorded. No statistically significant correlation was found between HCAIs patients and mortality (p>0,05). The duration of hospitalization in the ICU was positively correlated with the presence of HCAIs (p<0,001 95% CI 7,32-12,74).
The isolated pathogens were as follow: Staphylococcus aureus (n = 3) and epidermidis (n = 2) with oxacillin resistance of 66% and 100% respectively. No resistance to glycopeptides was identified. Enterococcus (n = 1) was sensitive to oxacillin and glycopeptides. Klebsiella pneumonia (n = 2) was sensitive to all antibiotics tested and Pseudomonas aeruginosa (n = 3) had 66.6% resistance to β-lactamase inhibitors, ceftazidime and carbapenems and 33.3% to colistin. 3 Candida strains were isolated, but no resistance to antifungal agents was evaluated. Empiric antibiotic treatment was frequently administered (72%) compared to documented (19.2%) or as prophylaxis (8.8%). The main clinical indication for which 12
antibiotics were given were pneumonia (45.6%), clinical sepsis (15.2%), and intra-abdominal sepsis (13.6%), where 17.6% were administered for HCAIs.
Conclusions
This study highlights the high incidence of HCAIs associated with relevant devices in the ICU of GHR. Although the sample was limited, the results of the study are in concordance with other national ICUs, confirming the high incidence of HCAIs and increased antimicrobial resistance. It is necessary to organize urgently an active surveillance system at local and national level with strict infection control criteria. Changing practices within ICU sites based on predetermined bundles is necessary to reduce the incidence of HCAIs in these areas.
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