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Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals: Findings of the International Nosocomial Infection Control Consortium

Abstract
Objective.

To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium.

Methods.

We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days.

Results.

During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)–related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P = .002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P = .19).

Conclusion.

The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.

Copyright
Corresponding author
Medical Institute of General Hygiene and Environmental Health, University of Goettingen, Windausweg 2, D-37073 Goettingen, Germany (hdunkell@gwdg.de)
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1.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470485.

2. MJ Richards , JR Edwards , DH Culver , RP Gaynes . Nosocomial infections in coronary care units in the United States. National Nosocomial Infections Surveillance System. Am J Cardiol 1998; 82:789793.

3. JM Hughes . Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy 1988; 34:553561.

4. CS Reed , G Gorrie , D Spelman . Hospital infection control in Australia. J Hosp Infect 2003; 54:267271.

5. DJ Cook , SD Walter , RJ Cook , et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129:433440.

7. WR Jarvis . Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996; 17:552557.

8. JY Fagon , J Chastre , A Vuagnat , JL Trouillet , A Novara , C Gibert . Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996; 275:866869.

11. JY Fagon , A Novara , F Stephan , E Girou , M Safar . Mortality attributable to nosocomial infections in the ICU. Infect Control Hosp Epidemiol 1994; 15:428434.

13. JS Garner , WR Jarvis , TG Emori , TC Horan , JM Hughes . CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128140.

14. JL Vincent , DJ Bihari , PM Suter , et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995; 274:639644.

15. D Pittet , B Thievent , R Wenzel , N Li , R Auckenthaler , P Suter . Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med 1996; 153:684693.

16. N Safdar , CJ Crnich , DG Maki . Nosocomial infections in the intensive care unit associated with invasive medical devices. Curr Infect Dis Rep 2001; 3:487495.

18. E Velasco , LC Thuler , CA Martins , LM Dias , VM Goncalves . Nosocomial infections in an oncology intensive care unit. Am J Infect Control 1997; 25:458462.

23. DG Maki , CE Weise , HW Sarafin . A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977; 296:13051309.

24. F Higuera , VD Rosenthal , P Duarte , J Ruiz , G Franco , N Safdar . The effect of process control on the incidence of central venous catheter–associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 2005; 33:20222027.

26. VD Rosenthal , S Guzman , O Migone , CJ Crnich . The attributable cost, length of hospital stay, and mortality of central line–associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control 2003; 31:475480.

29. D Pittet , D Tarara , RP Wenzel . Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994; 271:15981601.

30. VD Rosenthal , S Guzman , O Migone , N Safdar . The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: a prospective, matched analysis. Am J Infect Control 2005; 33:157161.

32. JM Lopes , E Tonelli , JA Lamounier , et al. Prospective surveillance applying the national nosocomial infection surveillance methods in a Brazilian pediatric public hospital. Am J Infect Control 2002; 30:17.

33. G Martinez-Aguilar , MC Anaya-Arriaga , C Avila-Figueroa . Incidence of nosocomial bacteremia and pneumonia in pediatric unit. Salud Publica Mex 2001; 43:515523.

35. JC Tinoco , J Salvador-Moysen , MC Perez-Prado , G Santillan-Martinez , L Salcido-Gutierrez . Epidemiology of nosocomial infections in a second level hospital. Salud Publica Mex 1997; 39:2531.

41. NP O'Grady , M Alexander , EP Dellinger , et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002; 30:476489.

42. JM Boyce , D Pittet . Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002; 30:146.

43. VD Rosenthal , S Guzman , N Safdar . Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005; 33:392397.

45. VD Rosenthal , RD McCormick , S Guzman , C Villamayor , PW Orellano . Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31:8592.

46. VD Rosenthal , DG Maki . Prospective study of the impact of open and closed infusion systems on rates of central venous catheter–associated bacteremia. Am J Infect Control 2004; 32:135141.

47. VD Rosenthal , S Guzman , N Safdar . Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol 2004; 25:4750.

48. VD Rosenthal , S Guzman , C Crnich . Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control 2006; 34:5863.

51. I Kurlat , G Corral , F Oliveira , G Farinella , E Alvarez . Infection control strategies in a neonatal intensive care unit in Argentina. J Hosp Infect 1998; 40:149154.

52. DE Berg , RC Hershow , CA Ramirez , RA Weinstein . Control of nosocomial infections in an intensive care unit in Guatemala City. Clin Infect Dis 1995; 21:588593.

54. S Lemeshow , JR Le Gall . Modeling the severity of illness of ICU patients: a systems update. JAMA 1994; 272:10491055.

55. N Safdar , DG Maki . The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, Enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002; 136:834844.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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