Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium

被引:51
|
作者
Cuellar, Luis E. [3 ]
Fernandez-Maldonado, Eduardo [1 ]
Rosenthal, Victor D. [2 ]
Castaneda-Sabogal, Alex [4 ]
Rosales, Rosa [3 ]
Mayorga-Espichan, Manuel J. [1 ]
Camacho-Cosavalente, Luis A. [2 ]
Castillo-Bravo, Luis [3 ]
机构
[1] Clin San Pablo, Div Infect Control, Lima, Peru
[2] Coll Med, Dept Infect Control, Buenos Aires, DF, Argentina
[3] INEN, Div Infect Control, Lima, Peru
[4] Hosp Victor Lazarte Echegaray, Div Infect Control, Trujillo, Peru
关键词
bacterial infections; cross infection/epidemiology; drug resistance; bacterial; hospitals; infection control; intensive care units; length of stay; mortality; Peru;
D O I
10.1590/S1020-49892008000700002
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objectives. To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, and attributable mortality in intensive care units (ICUs) in hospitals in Peru that are members of the International Nosocomial Infection Control Consortium (INICC). Methods. Prospective cohort surveillance of DAIs was conducted in ICUs in four hospitals applying the definitions for nosocomial infections of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS) and National Healthcare Safety Network (NHSN). Results. From September 2003 to October 2007 1920 patients hospitalized in ICUs for an aggregate of 9 997 days acquired 249 DAIs, accounting for a rate of 13.0% and 24.9 DAIs per 1000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 31.3 per 1000 ventilator-days; the central venous catheter-associated bloodstream infections (CVC-BSI) rate was 7.7 cases per 1000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 5.1 cases per 1000 catheter-days. Extra mortality for VAP was 24.5% (RR 2.07, P < 0.001); for CVC-BSI the rate was 15.0% (RR 2.75, P = 0.028). Methicillin-resistant strains accounted for 73.5% of all Staphylococcus aureus DAIs; 40.5% of the Enterobacteriaceae were resistant to ceftriaxone, 40.8% were resistant to ceftazidime, and 32.0% were resistant to piperacillin-tazobactam. Sixty-five percent of Pseudomonas aeruginosa isolates were resistant to ciprofloxacin, 62.0% were resistant to ceftazidime, 29.4% were resistant to piperacillin-tazobactam, and 36.1% were resistant to imipenem. Conclusions. The high rates of DAIs in the Peruvian hospitals in this study indicate the need for active infection control. Programs consisting of surveillance of DAIs and implementation of guidelines for infection prevention can ensure improved patient safety in the ICUs and throughout hospitals.
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页码:16 / 24
页数:9
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