Trends of incidence of healthcare-associated infections in patients admitted to intensive care units of a French University Hospital between 2011 and 2016

Abstract

Background More than 20% patients in intensive care units (ICU) acquired healthcare-associated infection (HAI) in France. Pneumonia and bacteremia are of particular interest as they support significant morbidity and mortality. The objective of present study was to report the time course of patients’ characteristics, incidence of ICU-related HAI and bacteria isolated from these infections in a French university hospital between 2011 and 2016. Methods An active standardized surveillance of HAI in ICU was carried out in a university hospital totalizing 5362 beds (Lyon, France). The methodology was based on the national surveillance network of HAI in ICU. All ICU patients hospitalized > 48 h between 01/01/2011 and 31/12/2016 were included in the surveillance. Data on patient characteristics, invasive devices, outcome in the ICU and HAI were collected. HAI included bacteremia, pneumonia and ventilator-associated pneumonia (VAP). Only the first occurrence of infection per site was analyzed. Incidence rates (95% CI) were calculated per 1000 patient-days for bacteremia and pneumonia and per 1000 intubation-days for VAP. Adjusted incidence rate ratio (aIRR) were calculated using mixed-effects multivariate Poisson regression. Results Overall, 17,299 patients were hospitalized > 48 h in 8 ICU, accounting for 152,367 patients-days and 81,201 intubation-days. In 2011 and 2016, man/woman ratio was 1.82 and 1.49 (P Conclusion Patients admitted in ICU were older and more severe in 2011 compared to 2016. Decreases of incidence rates, even non-significant, were observed for nosocomial pneumonia. VAP and bacteremia rates were stable over time while severity of patients at admission increased. The observed decrease of MRSA-related proportion of nosocomial pneumonia is encouraging, although 3GCR-E-related remains relatively stable. Assessment and improvement of health care practices (ventilator bundle, appropriate use of antibiotics) might help to prevent HAI and to limit antibiotic resistance in the high-risk population of ICU patients.