| Abstract |
Background Healthcare-associated infections (HAIs) are very common, potentially life-threatening complications in hospitalized patients. The incidence of HAIs is remarkably high in Intensive Care Units (ICUs). Some of the major factors that are linked to high HAI incidence in ICUs are the multiple comorbidities of ICU patients, the prolonged use of invasive devices, the use of multiple broad spectrum antibiotics and the spread of various resistant pathogens in ICUs worldwide. HAIs caused by resistant pathogens can delay proper antibiotic treatment in ICU patients and might be difficult or impossible to control. These concerns have led to the development of various strategies in order to achieve HAI surveillance and prevention.
Objective The aim of this study is the surveillance of HAI incidence in the ICU of “Korgialenio-Benakio Red Cross” General Hospital in Athens and their relationship with patient morbidity and outcome. In addition, the frequency and resistance of isolated pathogens, as well as antimicrobial consumption, are also recorded.
Methods This is a single center, prospective surveillance study which was carried out in the mixed ICU of Korgialenio-Benakio Red Cross General Hospital in Athens. The surveillance lasted six months (01/06/2020-30/11/2020). All data were completed according to the HAI-Net ICU protocol (version 2.2), which was provided by the European Center of Disease Prevention and Control (ECDC). Patients who were hospitalized at least for 48 hours in the ICU were enrolled in the study. Patient demographics, type of admission and disease severity index APACHE II score were recorded. Invasive device use (central venous catheters, respiratory devices, urinary catheters) and antimicrobial consumption were also recorded for each patient. HAI identification criteria were provided by the HAI-Net ICU protocol. In patients with confirmed HAI, the type and source of infection, as well as the isolated pathogens and their antimicrobial resistance, were recorded. Patients’ length of stay and outcome were evaluated in relation to the presence of HAIs. All data were extracted from the patients’ medical files, the imaging files digital viewer and the laboratory results provided by the hospital’s microbiology department, while patients’ anonymity and privacy were maintained. All information collected were imported and coded in the HelicsWin.Net platform.
Results During the surveillance period, 117 patients were admitted in the ICU, 84 of whom met the inclusion criteria. 68 patients were finally enrolled in the study. Patients’ average age was 59±17 years. 51,5% of total number of admissions were medical and 49,5% were surgical admissions. The mean APACHE II score was 21±7 points. The mean length of stay was 15±13 days. Length of stay was longer in patients with HAIs (27±17 days, p<0,001). Patients’ mortality in the ICU was estimated as 48,5%. Mortality rate was higher in patients with medical causes of admission (63,6%, p=0,021), in older patients (64±17 years, p=0,024), in patients with higher APACHE II score (25±7,p<0,001) and in patients with HAIs (68,4%,p=0,04).Central venous catheter use was recorded at 81%, intratracheal device use was recorded at 79% and urinary catheter use was recorded at 88%.
Nineteen of the 68 patients developed HAIs. 12 patients developed 1 HAI,2 patients developed 2 HAIs and 5 patients developed more than 2 HAI episodes. In total, 38 HAI episodes were recorded. The incidence of endotracheal device-associated pneumonia was 20 PN per 1000 ETT-days. The incidence of CR-BSI was 10,9 CR-BSI per 1000 CVC-days, respectively. Moreover, CAUTI incidence was 1,1 CAUTI per 1000 catheter-days. BSI incidence was 11,8 BSI per 1000 patient-days.
In this study, 43 pathogens were isolated in 38 HAI episodes. The vast majority of these isolated pathogens were identified as Gram-negative bacteria (33 out of 43). 17 of these pathogens were Enterobacteriaceae species, which were 94% resistant to broad-spectrum Penicillins, 88% resistant to 3rd generation cephalosporins and 76% resistant to carbapenems. 10 Acinetobacter baumanii strains were also isolated, which were 100% resistant to the types of antibiotics mentioned above, whereas they were 90% sensitive to colistin. In addition, 6 Pseudomonas aeruginosa strains were found, which were 50% resistant to the aforementioned antibiotics and 100% sensitive to colistin. Five coagulase-negative Staphylococci species and 2 Enterococci species were also isolated. Finally, Candida species were isolated in 3 cases.
During the surveillance period, 254 antimicrobial agents were prescribed, which equated to 2028 DOTs (days of treatment) and 1997 DOTs per 1000 patient-days, meaning that every patient received on average 2 antibiotics on a daily basis.
Conclusion In this study, the presence of HAIs was significantly correlated with patients’ length of stay and outcome. The majority of reported HAIs were device-associated lower respiratory tract and bloodstream infections. Most of the isolated pathogens were Gram negative bacteria, highly resistant to many broad-spectrum types of antibiotics. Use of antibiotics was high, both in agents with Gram-positive and Gram-negative spectrum. Active surveillance and recording of HAIs can be an important aspect in HAI prevention and control.
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