Original Paper

Nosocomial Infections in a Medical-Surgical Intensive Care Unit
Nasser Yehia A. Aly^{a, b}, Haifaa H. Al-Mousa^b, El Sayed M. Al Asar<sup>c

a</sup>Department of Tropical Medicine and Hygiene, Faculty of Medicine, University of Alexandria, Alexandria, Egypt;
^bDirectorate of Infection Control and
^cDepartment of Microbiology, Farwaniya Hospital, Ministry of Health, Kuwait

Address of Corresponding Author

Med Princ Pract 2008;17:373-377 (DOI: 10.1159/000141500)

  Key Words

• Nosocomial infection
• Intensive care unit
• Device-associated infection

  Abstract

Objective: We aimed to describe the pattern of nosocomial infections in an adult medical-surgical intensive care unit (ICU). Subjects and Methods: A 2-year prospective cohort study of nosocomial infection surveillance in a 15-bed adult combined medical and surgical ICU of Farwaniya Hospital, Kuwait, was carried out. Data were collected between January 2004 and December 2005 using the standard surveillance protocols and nosocomial infection site definitions of the National Nosocomial Infections Surveillance System's ICU surveillance component. Results: Of 1,173 patients hospitalized in the ICU for an aggregate duration of 6,855 days, 89 patients acquired a total of 140 nosocomial infections; 46 (33%) ventilator-associated pneumonia (VAP), 33 (24%) central-line-associated bloodstream infection and 15 (11%) catheter-associated urinary tract infection, 22 (16%) cutaneous infection and 24 (17%) other infections. The overall patient day rate was 20.6/1,000 patient days. The patient infection rate was 10.6/100 patients at risk. The mean VAP rate was 9.1/1,000 ventilator days (95% CI, 5-13.2), the central-line-associated bloodstream infection rate 5.5/1,000 central line days (95% CI, 3.2-7.8) and the catheter-associated urinary tract infection rate 2.3/1,000 catheter days (95% CI, 1.2-3.4). Of all nosocomial infections, 119 (85%) were culture-confirmed and 21 (15%) were clinically defined culture-negative infections. Of the culture-confirmed nosocomial infections, 81 (68%) were Gram-negative, 32 (27%) Gram-positive and 6 (5%) fungal. The most frequent organism was Pseudomonas aeruginosa (20, 17%), followed by Acinetobacter baumannii (15, 13%), Klebsiella spp. (13, 11%) and Escherichia coli (10, 8%). The crude mortality was 27% among ICU-infected patients. Conclusion: VAP was the most common nosocomial infection in our ICU. Gram-negative organisms were more commonly reported as etiologic agents of ICU infections.

Copyright © 2008 S. Karger AG, Basel

  References

1.

Gaynes RP, Horan TC: Surveillance of nosocomial infections; in Mayhall CG (ed): Hospital Epidemiology and Infection Control, ed 3. Philadelphia, Lippincott Williams & Wilkins, 1999, pp 1285-1318.

2.

Weinstein RA: Nosocomial infection update. Emerg Infect Dis 1998;4:416-420.

3.

Weber DJ, Raasch R, Pharm D, Rutala WA: Nosocomial Infections in the ICU: the growing importance of antibiotic-resistant pathogens. Chest 1999;115:S34-S41.

4.

Albrich WC, Angstwurm M, Bader L, Gartner R: Drug resistance in intensive care units. Infection 1999;27(suppl 2):S19-S23.

5.

Eggimann P, Pittet D: Infection control in the ICU. Chest 2001;120:2059-2093.

6.

Arya SC, Agarwal N, Agarwal S, George S, Singh K: Nosocomial infection: hospital infection surveillance and control. J Hosp Infect 2004;58:242-243.

7.

National Nosocomial Infections Surveillance System: National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470-485.

8.

Horan TC, Gaynes RP: Surveillance of nosocomial infections; in Mayhall CG (ed): Hospital Epidemiology and Infection Control, ed 3. Philadelphia, Lippincott Williams & Wilkins, 2004, pp 1659-1702.

9.

Emori TG, Culver DH, Horan TC, Jarvis WR, White JW, Olson DR, Banerjee S, Edwards JR, Martone WJ, Gaynes RP, Hughes JM: National Nosocomial Infections Surveillance (NNIS) System: Description of surveillance methodology. Am J Infect Control 1991;19:19-35.

10.

Barrow GI, Feltham RKA: Cowan and Steel's Manual for the Identification of Medical Bacteria, ed 3. Cambridge, Cambridge University Press, 1993.

11.

National Committee for Clinical Laboratory Standards: Performance Standards for Antimicrobial Disc Susceptibility Tests. Wayne, National Community for Clinical Laboratory Standards, 2000, NCCLS document, M2-A7.

12.

National Nosocomial Infections Surveillance System: Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609-612.

13.

Richard M, Thursky K, Buising K: Epidemiology, prevalence and sites of infections in intensive care units. Semin Respir Crit Care Med 2003;24:3-22.

14.

Richards MJ, Edwards JR, Culver DH, Gaynes RP; National Nosocomial Infections Surveillance System: Nosocomial infections in pediatric intensive care units in the United States. Pediatrics 1999;103:1-7.

15.

Roberts JA, Fussekk EN, Kaack MB: Bacterial adherence to urethral catheters. J Urol 1990;144:264-269.

16.

Fridkin SK, Welbel SF, Weinstein RA: Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am 1996;11:479-496.

17.

Rotimi VO, al-Sweih NA, Feteih J: The prevalence and antibiotic susceptibility pattern of Gram-negative bacterial isolates in two ICUs in Saudi Arabia and Kuwait. Diagn Microbiol Infect Dis 1998;30:53-59.

18.

Fridkin SK, Gaynes RP: Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20:303-316.

19.

Ballow CH, Schentag JH: Trends in antibiotic utilization and bacterial resistance: report of the National Nosocomial Resistance Surveillance group. Diagn Microbiol Infect Dis 1992;15(suppl 2):S375-S425.

20.

Pierson CL, Friedman BA: Comparison of susceptibility to beta-lactam antimicrobial agents among bacteria isolated from intensive care units. Diagn Microbiol Infect Dis 1992;15(suppl 2):S19-S30.

21.

Bueno-Cavanillas A, Delgado-Rodriguez M, Lopez-Luque A, Schaffino-Cano S, Galvez-Vargas R: Influence of nosocomial infection on mortality rate in an intensive care unit. Crit Care Med 1994;22:55-60.

22.

Ylipalosaari P, Ala-Kokko TI, Laurila J, Ohtonen P, Syrjälä1 H: Intensive care acquired infection is an independent risk factor for hospital mortality: a prospective cohort study. Crit Care 2006;10:R66.

23.

Girou E, Stephan F, Novara A, Safar M, Fagon JY: Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998;157:1151-1158.

  Author Contacts

Nasser Yehia A. Aly
Department of Infection Control, Farwaniya Hospital
Ministry of Health, PO Box 12414
71655 Al-Shamiya (Kuwait)
Tel. +965 488 8000, ext. 3816, Fax +965 488 2684, E-Mail nasseryehia@gmail.com

  Article Information

Received: July 15, 2007
Revised: November 6, 2007
Published online: August 06, 2008
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 3, Number of References : 23

  Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 17, No. 5, Year 2008 (Cover Date: August 2008)

Journal Editor: Owunwanne A. (Kuwait)
ISSN: 1011-7571 (Print), eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP

  Drug Dosage / Copyright

Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.