Abstract
The aim of this study was to evaluate the incidence of health care-associated infections (HAIs) in patients treated in Polish intensive care units (ICUs). This retrospective analysis was based on the results of active targeted surveillance, according to the recommendation of the ECDC (European Centre of Disease Control and Prevention, HAI-Net light protocol), conducted in 2013-2015 in seven ICUs for adults located in southern Poland (observational study). The incidence of HAI was 22.6% and 28.7/1000 person-days (pds). The incidence of pneumonia (PN) was 8.0%, bloodstream infections (BSIs) 7.2% and urinary tract infections (UTIs) 3.7%. The incidence per 1000 pds was as follows: PN 10.2, BSIs 9.2 and UTIs 4.7. PN was the most common source of secondary bloodstream infection (45%); the second was UTIs (22%). Mortality (directly and indirectly) associated with HAI was 10.8% and was related to the presence of PN or primary BSIs. HAIs were usually (69.2%) caused by Gram-negative bacteria; Klebsiella spp. and nonfermenting Gram-negative rods demonstrated very high antibiotic resistance. Despite the lack of widely implemented active targeted surveillance programmes and top-down incentives, it is possible to carry out effective surveillance of HAIs in ICUs in Poland. The results of this study are comparable with the ECDC data, but the results are alarmingly high in two fields: epidemiology of PN and BSIs and very high antibiotic resistance in Gram-negative rods, which indicate the need for intense control in this area and for further studies to clarify the source of the observed discrepancy.
Highlights
IntroductionAmong health care-associated infections (HAIs) (healthcare-associated infections) in the intensive care units (ICUs) (intensive care unit), one can distinguish forms dangerous to patient life, such as PN (pneumonia), bloodstream infections (BSIs) (bloodstream infection) and urinary tract infections (UTIs) (urinary tract infection)
Among health care-associated infections (HAIs) in the intensive care units (ICUs), one can distinguish forms dangerous to patient life, such as PN, bloodstream infections (BSIs) and urinary tract infections (UTIs)
The centralvenous catheter (CVC) utilization ratio measuring the presence of total patient-days with CVC and calculated by dividing the number of CVC days by the number of patient days was 0.89 The urinary catheter utilization ratio measuring the presence of total patient-days with urinary catheter and calculated by dividing the number of urinary catheter days by the number of patient days was 0.95
Summary
Among HAIs (healthcare-associated infections) in the ICU (intensive care unit), one can distinguish forms dangerous to patient life, such as PN (pneumonia), BSI (bloodstream infection) and UTI (urinary tract infection). HAI incidence may be associated with many risk factors, such as the use of invasive diagnostic and therapeutic procedures, the environment of treatment (including technological advancement), underlying diseases and comorbidities, which are the reasons for hospital treatment. Traumatic injuries are the current leading cause of hospitalization in intensive care units, they are associated with a high risk of hospital complications (including HAIs) and significantly increased risk of death[1,2]. The development of anaesthetic techniques has increased the age of patients as well as the number of those with serious coexisting diseases qualified for complex surgery and prolonged hospital treatment, which further elevates the risk of hospitalization in the ICU. It is important to conduct effective HAI surveillance, with a detailed analysis of HAI incidence in relation to the epidemiological situation of a given department, hospital, region and country
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