Incidence of Device Associated-Healthcare Associated Infections from a Neurosurgical Intensive Care Unit of a Tertiary Care Center: A Retrospective Analysis.

Abstract

Background:Deviceassociated infections (DAIs) increase the morbidity and mortality in the intensive care unit (ICU). Studies from the neurosurgical ICU in developing countries are sparse.Aims:The aim of this study was to assess the incidence of device-associated healthcare associated infections, pathogens isolated, antibiotic resistance, and mortality in neurosurgical ICU.Settings and Design:A retrospective study was conducted in the neurosurgical ICU of a tertiary care centerMaterials and Methods:This study was done by analyzing data of patients admitted in a neurosurgical ICU with one or more devices during the period from January 2011 to July 2017.Statistical Analysis:Quantitative variables were expressed as mean and standard deviation; qualitative variables were expressed as frequency and percentage.Results:During this period, 6788 patients with devices were admitted in the ICU, and 316 patients developed DAI. Two hundred and forty-eight patients had catheter-associated urinary tract infection (CAUTI), 78 had ventilator-associated pneumonia (VAP), and 53 had central line-associated bloodstream infection (CLABSI). The incidence rate for CAUTI was 17.83, VAP – 16.83, and CLABSI – 4.39 per 1000 device days. The device utilization ratio was highest for urinary catheter – 0.76, followed by central line – 0.66 and ventilator – 0.25. Predominant pathogens were Klebsiella – 90, Escherichia coli – 77, Pseudomonas – 40, Candida – 39, Acinetobacter – 30, and Enterobacter – 21. Carbapenem resistance was found in Acinetobacter (73.4%), Pseudomonas (45%), and Enterobacter (38%). S. aureus isolated in six cases; four being MRSA (66.7%). Multidrug resistance was found in Acinetobacter (80%), Pseudomonas (60%), Enterobacter (52.3%), Klebsiella (42.3%), and E. coli (33.7%). No colistin resistant Gram negative bacilli or vancomycin resistant enterococci were isolated. During this period 124 patients with DAI died, of which 52 patients had sepsis. The crude mortality rate was 1.83%.Conclusion:The DAI with the highest incidence was CAUTI, followed by VAP and CLABSI. With the implementation of insertion bundles and adherence to aseptic precautions, the DAI rate had come down.