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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2010 January;76(1):13-23
Epidemiology of Nosocomial Infection in 125 Italian Intensive Care Units
Malacarne P. 1, Boccalatte D. 2, Acquarolo A. 3, Agostini F. 4, Anghileri A. 5, Giardino M. 5, Giudici D. 6, Langer M. 7, Livigni S. 8, Nascimben E. 9, Rossi C. 5, Bertolini G. 5 ✉
1 Department of Anesthesiology, Resuscitation and Emergency, S. Chiara Hospital, Pisa, Italy;
2 Department of Anesthesiology and Resuscitation, Hospital of Lucca, Lucca, Italy;
3 II Department of Anesthesiology, Resuscitation, Spedali Civili, Brescia, Italy;
4 II Unit of Anesthesiology and Resuscitation, Department of Neurosciences, San Giovanni Battista Le Molinette Hospital, Turin, Italy;
5 Laboratory of Clinical Epidemiology, “Mario Negri” Research Institute, Ranica, Bergamo, Italy;
6 Department of Anesthesiology and Resuscitation, San Raffaele IRCCS Hospital, Milan, Italy;
7 University of Milan and National Cancer Institute, Milan, Italy;
8 Department of Anesthesiology and Resuscitation, San Giovanni Bosco Hospital, Turin, Italy;
9 II Unit of Anesthesiology and Resuscitation, Regional Hospital Ca’ Foncello, Treviso, Italy
AIM: A continuous infection surveillance program was conducted by GiViTI throughout 2006 in Intensive Care Units (ICUs).
METHODS: This was a prospective epidemiological study carried out in 125 Italian intensive care units. All patients have been included in the study. Aside from the detailed clinical information collected for all patients, in cases of infection upon ICU admission and for the first site-specific episode that occurred during the patient’s stay, the following data were collected: severity upon admission, micro-organisms and their antibiotic resistance patterns, subsequent multiple episodes in the same site, origin of infections and maximum severity reached. The diagnostic criteria for all infections are explicitly stated.
RESULTS: A total of 34472 patients entered the study. Infection upon admission was present in 12.6% of patients, with a high level of ICU and hospital mortality (29.4% and 38.7%, respectively). In 3148 patients one or more infections were reported as ICU-acquired with an overall incidence of 9.1% and an ICU and hospital mortality of 27.2% and 35.1%, respectively. Out of the device-related infections, ventilator-associated pneumonia was the most frequently diagnosed (8.9/1000 days on ventilator). Catheter-related blood stream infection was reported with a low incidence (1.9/1000 central venous catheter days). Nearly 20% of more than 5000 isolated microorganisms were classified as multi-drug resistant, with methicillin-resistant Staphylococcus aureus as the most frequently reported bug.
CONCLUSIONS: The ad hoc expanded GiViTI software “Margherita2” allows continuous infection surveillance in Italian ICUs, annually providing an extensive and updated database. Interventions to improve infection prevention and patient safety should be tailored to accommodate these data.