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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES CRITICAL AND INTENSIVE THERAPY
Minerva Anestesiologica 2001 September;67(9):647-52
Prevalence of nosocomial infections in Intensive Care Units in Triveneto area, Italy
Luzzati R., Antozzi L., Bellocco R. *, Del Bravo P., Mirandola M., Procaccio F. **, Cirillo F. M. **, Romiti P. **, Sarti A. **, Manani G. **, Concia E., Italic Study Group ***
Istituto di Malattie Infettive Università ed Azienda Ospedaliera - Verona
*Department of Medical Epidemiology Karolinska Institute - Stockholm (Sweden)
**Collegio dei Primari di Anestesia e Rianimazione del Triveneto Gruppo di Studio «Le infezioni in terapia intensiva»
Background. Nosocomial infection is one of the most common complications affecting patients admitted in intensive care units (ICU). The aim of this study is to evaluate rates of ICU-acquired infections, potential risk factors for these infections, causative microrganisms and antibiotic resistance patterns.
Methods. A 1-day point-prevalence study was conducted in 39 ICUs in Triveneto area (Italy) in November 1998. The overall study population included 188 patients with mean age of 61.4±19.3 years; the mean SAPS II score at entry into the ICU was 44.4±16.8 and the median duration of hospitalization was 9 days (range 2-636).
Results. A total of 59 patients (31.4%) had 79 episodes of ICU-acquired infections; pneumonia (45.5%), bloodstream infection (30.4%), and urinary tract infection (11.4%) were the most frequent types of infection. The leading causative microrganisms were S. aureus (24.4%, 77% of them were resistant to methicillin), Enterobacteriaceae (24.4%), P. aeruginosa (23.2%), fungi (12.2%), coagulase-negative staphylococci (7.3%) and Enterococcus spp (4.9%). Independent risk factors for nosocomial infections were duration of hospitalization >7 days (OR 4.29, 95% CI 1.82-10.1), SAPS II score >30 (OR 3.34, 95% CI 1.0-11.18), total parenteral nutrition (OR 2.69, 95% CI 1.19-6.07) and tracheostomy (OR 1.88, 95% CI 0.84-4.20).
Conclusions. Nosocomial infections are relatively frequent in Triveneto area ICUs. The predominance of pneumonia and bloodstream infection, and the high frequency of antibiotic-resistant pathogens indicate that resources had to be assigned towards the implementation of control programs of those infections, monitoring of antibiotic resistance and prescription, and antibiotic therapy guidelines.