Skip to main content
×
Home
    • Aa
    • Aa

Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States

  • Michael J. Richards (a1), Jonathan R. Edwards (a1), David H. Culver (a1) and Robert P. Gaynes (a1)
Abstract
Objective:

To describe the epidemiology of nosocomial infections in combined medical-surgical (MS) intensive care units (ICUs) participating in the National Nosocomial Infection Surveillance (NNIS) System.

Design:

Analysis of surveillance data on 498,998 patients with 1,554,070 patient-days, collected between 1992 and 1998 from 205 MS ICUs following the NNIS Intensive Care Unit protocol, representing 152 participating NNIS hospitals in the United States.

Results:

Infections at three major sites represented 68% of all reported infections (nosocomial pneumonia, 31%; urinary tract infections (UTIs), 23%; and primary bloodstream infections (BSIs), 14%: 83% of episodes of nosocomial pneumonia were associated with mechanical ventilation, 97% of UTIs occurred in catheterized patients, and 87% of primary BSIs in patients with a central line. In patients with primary BSIs, coagulase-negative staphylococci (39%) were the most common pathogens reported; Staphylococcus aureus (12%) was as frequently reported as enterococci (11%). Coagulase-negative staphylococcal BSIs were increasingly reported over the 6 years, but no increase was seen in candidemia or enterococcal bacteremia. In patients with pneumonia, S aureus (17%) was the most frequently reported isolate. Of reported isolates, 59% were gram-negative bacilli. In patients with UTIs, Escherichia coli (19%) was the most frequently reported isolate. Of reported isolates, 31% were fungi. In patients with surgical-site infections, Enterococcus (17%) was the single most frequently reported pathogen. Device-associated nosocomial infection rates for BSIs, pneumonia, and UTIs did not correlate with length of ICU stay, hospital bed size, number of beds in die ICU, or season. Combined MS ICUs in major teaching hospitals had higher device-associated infection rates compared to all other hospitals with combined medical-surgical units.

Conclusions:

Nosocomial infections in MS ICUs at the most frequent infection sites (bloodstream, urinary, and respiratory tract) almost always were associated with use of an invasive device. Device-associated infection rates were die best available comparative rates between combined MS ICUs, but the distribution of device-associated rates should be stratified by a hospital's major teaching affiliation status.

Copyright
Corresponding author
Hospital Infections Program, National Center for Infectious Diseases, Mail Stop E55, 1600 Clifton Rd NE, Centers for Disease Control and Prevention, Atlanta, GA30333
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

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

2. A Bueno-Cavanillas , M Delgado-Rodriguez , A Lopez-Luque , S Schaffino-Cano , R Galvez-Vargas . Influence of nosocomial pneumonia on mortality rate in an intensive care unit. Crit Care Med 1994;22:5560.

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

6. WE Stamm , RA Weinstein , RE Dion . Comparison of endemic and epidemic nosocomial infections. Am J Med 1981;70:393397.

7.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance System Report. Data Summary From October 1986-April 1998. Am J Infect Control 1998;26;522533.

8. TG Emori , DH Culver , TC Horan , WR Jarvis , JW White , DR Olson , et al. National Nosocomial Infections Surveillance System. Description of surveillance methods. Am J Infect Control 1991;19:1935.

10. MJ Richards , JR Edwards , DH Culver , RP Gaynes . Nosocomial infections in medical ICUs in the United States. Crit Care Med 1999;27:887892.

11. MJ Richards , JR Edwards , DH Culver , RP Gaynes . Nosocomial infections in pediatric ICUs in the United States. Pediatrics 1999;103:17.

13. WR Jarvis , JR Edwards , DH Culver , JM Hughes , T Horan , TG Emori , et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 1991;(suppl 3b):185S191S.

14. SK Fridkin , SM Pear , TH Williamson , JN Galgiani , WR Jarvis . The role of understating in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150158.

15. TG Emori , JR Edwards , DH Culver , C Sartor , LA Stroud , EE Gaunt , et al. Accuracy of reporting nosocomial infections in intensive care unit patients to the National Nosocomial Infections Surveillance System: a pilot study. Infect Control Hosp Epidemiol 1998;19:308316.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 25 *
Loading metrics...

Abstract views

Total abstract views: 727 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd June 2017. This data will be updated every 24 hours.