Abstract
Objective
To determine epidemiology and risk factors for nosocomial infections in intensive care unit (ICU).
Design
Prospective incidence survey.
Setting
An adult general ICU in a university hospital in western Turkey.
Patients
All patients who stayed more than 48 h in ICU during a 2-year period (2000–2001).
Measurements and results
The study included 434 patients (7394 patient-days). A total of 225 infections were identified in 113 patients (26%). The incidence and infection rates were 56.8 in 1000-patient days and 51.8%, respectively. The infections were pneumonia (40.9%), bloodstream (30.2%), urinary tract (23.6%) and surgical site infections (5.3%). Pseudomonas aeruginosa (22.6%), methicillin-resistant Staphylococcus aureus (22.2%) and Acinetobacter spp. (11.9%) were frequently isolated micro-organisms. Median length of stay with nosocomial infection and without were 13 days (Interquartile range, IQR, 20) and 2 days (IQR, 2), respectively (P<0.0001). In logistic regression analysis, mechanical ventilation [odds ratio (OR): 16.35; 95% confidence interval (CI): 8.26–32.34; P<0.0001), coma (OR: 15.04; 95% CI: 3.41–66.33; P=0.0003), trauma (OR: 10.27; 95% CI: 2.34–45.01; P=0.002), nasogastric tube (OR: 2.94; 95% CI: 1.47–5.90; P=0.002), tracheotomy (OR: 5.77; 95% CI: 1.10–30.20; P=0.04) and APACHE II scores 10–19 (OR: 10.80; 95% CI: 1.10–106.01; P=0.04) were found to be significant risk factors for nosocomial infection. Rate of nosocomial infection increased with the number of risk factors (P<0.0001). Mortality rates were higher in infected patients than in non-infected patients (60.9 vs 22.1%; P<0.0001).
Conclusion
These data suggest that, in addition to underlying clinical conditions, some invasive procedures can be independent risk factors for nosocomial infection in ICU.
Similar content being viewed by others
References
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140
Yalcin AN, Hayran M, Unal S (1997) Economic analysis of nosocomial infections in a Turkish University Hospital. J Chemother 9:411–414
Evans TM, Ortiz CR, LaForce FM (1999) Prevention and control of nosocomial infection in the intensive care unit. In: Irwin RS, Cerra FB, Rippe JM (eds) Intensive care medicine, 4th edn. Lippincot-Raven, New York, pp 1074–1080
Gastmeier P, Kampf G, Wischnewski N, Hauer T, Schulgen G, Schumacher M, Daschner F, Rüden H (1998) Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 38:37–49
Pittet D, Harbarth S, Ruef C, Francioli P, Sudre P, Petignat C, Trampuz A, Widmer A (1999) Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 20:37–42
The French Prevalence Survey Study Group (2000) Prevalence of nosocomial infections in France: results of the nationwide survey in 1996. J Hosp Infect 46:186–193
Gikas A, Pediaditis J, Papadakis JA, Starakis J, Levidiotou S, Nikolaides P, Kioumis G, Maltezos E, Lazanas M, Anevlavis E, Roubelaki M, Tselentis Y, and The Greek Infection Control Network (2002) Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. J Hosp Infect 50:269–275
Hughes JM (1987) Nosocomial infection surveillance in the United States: historical perspective. Infect Control 8:450–453
Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, Hooton TM (1985) The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 121:182–205
Appelgren P, Hellstrom I, Weitzberg E, Soderlund V, Bindslev L, Ransjo U (2001) Risk factors for nosocomial intensive care infection: a long-term prospective analysis. Acta Anaesthesiol Scand 45:710–719
Legras A, Malvy D, Quinioux AI, Villers D, Bouachour G, Robert R, Thomas R (1998) Nosocomial infections: prospective survey of incidence in five French intensive care units. Intensive Care Med 24:1040–1046
Barsic B, Beus I, Marton E, Himbele J, Klinar I (1999) Nosocomial infections in critically ill infectious disease patients: results of a 7-year focal surveillance. Infection 27:16–22
Bouletreau A, Dettenkofer M, Forster DH, Babikir R, Hauer T, Schulgen G, Daschner FD (1999) Comparison of effectiveness and required time of two surveillance methods in intensive care patients. J Hosp Infect 41:281–289
Mertens R, Van den Berg JM, Veerman-Brenzikofer ML, Kurz X, Jans B, Klazinga N (1994) International comparison of results of infection surveillance: The Netherlands versus Belgium. Infect Control Hosp Epidemiol 15:574–578
Trilla A (1994) Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 20:S1–S4
Eggimann P, Pittet D (2001) Infection control in the ICU. Chest 120:2059–2093
Wenzel RP, Thompson RL, Landry SM, Russell BS, Miller PJ, Ponce de Leon S, Miller GB Jr (1983) Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control 4:371–375
Craven DE, Kunches LM, Lichtenberg DA, Kollisch NR, Barry MA, Heeren TC, McCabe WR (1988) Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 148:1161–1168
Urli T, Perone G, Acquarolo A, Zappa S, Antonini B, Ciani A (2002) Surveillance of infections acquired in intensive care: usefulness in clinical practice. J Hosp Infect 52:130–135
Stephan F, Cheffi A, Bonnet F (2001) Nosocomial infections and outcome of critically ill elderly patients after surgery. Anesthesiology 94:407–414
McCusker ME, Perisse AR, Roghmann MC (2002) Severity-of-illness markers as predictors of nosocomial infection in adult intensive care unit patients. Am J Infect Control 30:139–144
Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 27:887–892
Chen YC (2001) Risk factors for ICU mortality in critically ill patients. J Formos Med Assoc 100:656–661
Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474
Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA (1996) Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J Respir Crit Care Med 153:158–162
Chevret S, Hemmer M, Carlet J, Langer M (1993) Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia. Intensive Care Med 19:256–264
Richards MJ, Edwards JR, Culver DH, Gaynes RP (2000) Nosocomial infections in combined medical–surgical intensive care units in the United States. Infect Control Hosp Epidemiol 21:510–515
Ponce de Leon-Rosales SP, Molinar-Ramos F, Dominguez-Cherit G, Rangel-Frausto MS, Vazquez-Ramos VG (2000) Prevalence of infections in intensive care units in Mexico: a multicenter study. Crit Care Med 28:1316–1321
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. J Am Med Assoc 274:639–644
Torres A, El-Ebiary M, Rano A (1999) Respiratory infectious complications in the intensive care unit. Clin Chest Med 20:287–301
Akca O, Koltka K, Uzel S, Cakar N, Pembeci K, Sayan MA, Tutuncu AS, Karakas SE, Calangu S, Ozkan T, Esen F, Telci L, Sessler DI, Akpir K (2000) Risk Factors for early-onset, ventilator-associated pneumonia in critical care patients. Selected multiresistant versus nonresistant bacteria. Anaesthesiology 93:638–645
Edgeworth JD, Treacher DF, Eykyn SJ (1999) A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med 27:1421–1428
Yalcin AN, Bakir M, Bakici Z, Dokmetas I, Sabir N (1995) Postoperative wound infections. J Hosp Infect 29:305–309
Jarvis WR, Martone WJ (1992) Predominant pathogens in hospital infections. J Antimicrob Chemother 29:S19–S24
Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C (1996) Nosocomial pneumonia and mortality among patients in intensive care units. J Am Med Assoc 275:866–869
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Erbay, H., Yalcin, A.N., Serin, S. et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 29, 1482–1488 (2003). https://doi.org/10.1007/s00134-003-1788-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-003-1788-x