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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2015 July;81(7):765-75
Epidemiology and clinical outcome of Healthcare-Associated Infections: a 4-year experience of an Italian ICU
Boncagni F. 1, Francolini R. 1, Nataloni S. 1, Skrami E. 2, Gesuita R. 2, Donati A. 1, Pelaia P. 1 ✉
1 Clinica di Rianimazione Generale, Respiratoria e del Trauma Maggiore, Università Politecnica delle Marche, Ancona, Italy;
2 Centro di Epidemiologia Biostatistica e Informatica Medica, Università Politecnica delle Marche, Ancona, Italy
BACKGROUND: Due to their impact on the outcome, hospital-acquired infections (HAIs) in ICUs represent a critical issue of patients’ assistance. This study describes microbiological and clinical findings of a surveillance program covering 4 years in an Italian ICU.
METHODS: Patients staying for >48 hours were prospectively followed until discharge or death. For each patient, infections after admissions, duration of device exposure and causal pathogens were noted. A multivariable logistic regression analysis concerning ICU mortality was made.
RESULTS: Incidence density rates were 23.14 VAPs, 6.6 CLABSIs and 5.45 CAUTIs (per 1000 device-days) with an increase in yearly rates during the study period (P<0.001). Use of invasive devices was significantly longer among infected patients (P<0.001, for each), whose proportion was higher among medical admissions (P=0.009). The most frequent source of infection was the lung (78%), followed by bloodstream (23%). MSSA was the most frequently isolated pathogen (26%) but Gram-negatives were found in 86.1% of infected patients, with a high degree of resistance to carbapenems (27.5% for Klebsiella pneumoniae). APACHE score, immunosuppression, duration of mechanical ventilation, surgical admission and abdominal infections were independent predictors of ICU mortality (P<0.001; P<0.001; P=0.006; P=0.027; P=0.006, respectively).
CONCLUSION: Our infection rates are higher than those reported by other studies. The use of devices and a medical admission share a significant relationship with infection presence. A greater degree of organ failure and the development of an abdominal sepsis are risk factors for mortality.