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Identifier

000415137

Title

Μελέτη επίπτωσης λοιμώξεων που συνδέονται με παροχή υπηρεσιών υγείας στην μονάδα εντατικής θεραπείας του Γ.Ν. Ρόδου

Alternative Title

Surveillance of healthcare-associated infections in the intensive care unit of general hospital of Rhodes

Author

Πάχου, Μαρία

Thesis advisor

Μπριασούλης, Γεώργιος

Reviewer

Γκίκας, Αχιλλέας
Γεωργόπουλος, Δημήτριος
Ηλία, Σταυρούλα

Abstract

Background: Infections related to health care or hospital infections (HAIs) tend to be a serious risk factor for patients as they contribute significantly to increasing their morbidity and mortality rates and multiplying the cost of hospitalization. The increased incidence of HAI in ICU patients demands a systematic surveillance and an immediate implementation of measures for their prevention and control. The present study of HAI incidence in the intensive care unit of General Hospital of Rhodes based on the European Centre for Disease Prevention and Control (ECDC) EUROPEAN SURVEILLANCE OF HEALTHCAREASSOCIATED INFECTIONS IN INTENSIVE CARE UNITS protocol focuses on these axes. The purpose of the study is to: 1) apply surveillance to the General District Hospital of Rhodes in order to gain experience in the implementation of the ECDC protocols 2) evaluate the instructions for recording, data collection and familiarization with the recording protocols, analyzing the results and drawing conclusions; 3) identify the problems of HAI and finally designing interventions to solve them. This study will also be the basis for the implementation of national-level records. Methodology: The study was conducted at the Adult Intensive Care Unit of General Hospital of Rhodes for six consecutive months. The ECDC protocol HAI ICU Protocol v2.2 was used. Surveillance was performed for all ICU patients stayed more than two days until discharge from the unit. Three classes of HAI, pneumonia (PN), bacteremia (BSI) and urinary tract infections (UTI) and their association with relevant devices (respiratory devices, central intravascular catheters, urine catheters) were studied. The frequencies of pathogens identified as causative agents of HAI growth in ICU Rhodes were recorded, as well as their resistance. Antibiotic stewardship was also performed for the surveillance time period. ΦΕΒΡΟΥΑΡΙΟΣ 2018 [ΠΡΟΓΡΑΜΜΑ ΜΕΤΑΠΤΥΧΙΑΚΩΝ ΣΠΟΥΔΩΝ ΕΠΕΙΓΟΥΣΑ ΚΑΙ ΕΝΤΑΤΙΚΗ ΘΕΡΑΠΕΙΑ ΠΑΙΔΩΝ ΚΑΙ ΕΦΗΒΩΝ] 15 Results: 52.9% of the HAI recorded were blood stream infections (BSI), 23.5% were catheter-related BSI (CR-BSI), 11.8% were catheterassociated urinary tract infections and 11.8% intubation devices related pneumonia episodes. The incidence rate was 2.44 episodes of pneumonia per 1000 intubation days, 9,5 episodes of BSIs per 1000 patient days, 4.22 CR-BSIs per 1000 central venous catheter days and 2.1 urinary infections per 1000 urine catheter days. The gross mortality was 39.3%. The most frequent identified pathogens were: Acinetobacter baumanii (17.6%) Klebsiella pneumoniae (58.8%) and Pseudomonas aeruginosa (17.6%) with carbapenemes resistance 100%, 67%, and 67% respectively. Of the antibiotics used, 14.3% was used as causative therapy, 85.1 %% as empirical therapy and 0.6 % as pharmaceutical prophylaxis. The most frequently used antibiotic groups were: carbapenemes (17.5%), β-lactamase inhibitors (7.1%), cephalosporins (11%), quinolones (5.2%) and colistin (10.7%). Conclusions: This study demonstrates that an actual incidence of HAIrelated devices cannot be substantiated. HAI prolong the ICU length of stay but are not independently related to mortality. In our single-center series, HAIs are associated with high rates of multivalent pathogens Klebsiella and Acinetobacter and an extensive use of empirical antibiotic treatment. Prevention measures, continued surveillance, and implementation of bundles are urgently needed

Language

Greek

Subject

Antibiotic resistance

Bloodstrem infection

ΜΕΘ

Μικροβιαιμία

Μικροβιακή αντοχή

Νοσοκομειακές λοιμώξεις

Ουρολοίμωξη

Πνευμονία

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