Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India
Avijit Hazra, Sugata Dasgupta, Soumi Das, Neeraj S. Chawan
morbidity, mortality, nosocomial infection, risk factors,Intensive care unit
Citation Information :
Hazra A, Dasgupta S, Das S, Chawan NS. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med 2015; 19 (1):14-20.
Background: The increased morbidity and mortality associated with nosocomial infections in the intensive care unit (ICU) is a matter of serious concern today. Aims: To determine the incidence of nosocomial infections acquired in the ICU, their risk factors, the causative pathogens and the outcome in a tertiary care teaching hospital. Materials and Methods: This was a prospective observational study conducted in a 12 bedded combined medical and surgical ICU of a medical college hospital. The study group comprised 242 patients admitted for more than 48 h in the ICU. Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, infecting agent, length of ICU and hospital stay, and survival status and logistic regression analysis was done. Results: The nosocomial infection rate was 11.98% (95% confidence interval 7.89-16.07%). Pneumonia was the most frequently detected infection (62.07%), followed by urinary tract infections and central venous catheter associated bloodstream infections. Prior antimicrobial therapy, urinary catheterization and length of ICU stay were found to be statistically significant risk factors associated with nosocomial infection. Nosocomial infection resulted in a statistically significant increase in length of ICU and hospital stay, but not in mortality. Conclusion: Nosocomial infections increase morbidity of hospitalized patients. These findings can be utilized for planning nosocomial infection surveillance program in our setting.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128-40.
Ewans TM, Ortiz CR, LaForce FM. Prevention and control of nosocomial infection in the intensive care unit. In: Irwin RS, Cerra FB, Rippe JM, editors. Intensive Care Medicine. 4 th ed. New York: Lippincot-Ravan; 1999. p. 1074-80.
House of Commons Committee of Public Accounts. The management and control of hospital acquired infection in acute NHS trusts in England. Available from: http://www.publications.parliament.uk/pa/cm199900/cmpubacc/306/30603.htm. [Last accessed on 2003 Feb 19].
Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182-205.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Horan TC, Gaynes RP. Surveillance of nosocomial infections. In: Mayhall CG, editor. Hospital Epidemiology and Infection Control. 3 rd ed. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 1659-702.
CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types if infections in the acute care setting. Available from: http://www.cdc.gov/nhsn/PDFs/pscManual/17pscManual/17pscNosInfDef-current.pdf. [Last accessed on 2003 Feb 19].
Collee JG, Marr W. Culture of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology. 14 th ed. Philadelphia: Churchill Livingstone; 1999. p. 113-29.
Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology. 14 th ed. Philadelphia: Churchill Livingstone; 1999. p. 131-49.
Milne LJ. Fungi. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology. 14 th ed. Philadelphia: Churchill Livingstone; 1999. p. 695-717.
Gastmeier P, Sohr D, Just HM, Nassauer A, Daschner F, Rüden H. How to survey nosocomial infections. Infect Control Hosp Epidemiol 2000;21:366-70.
Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 2002;28:108-21.
Vincent JL, Rello J, Marshall J, Siva E, Anzueto A, Martin CD, et al. The extended prevalence of infection in the ICU study: EPIC II. JAMA 2009;302:2323-9.
Rebollo MH, Bernal JM, Llorca J, Rabasa JM, Revuelta JM. Nosocomial infections in patients having cardiovascular operations: A multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996;112:908-13.
Papia G, McLellan BA, El-Helou P, Louie M, Rachlis A, Szalai JP, et al. Infection in hospitalized trauma patients: Incidence, risk factors, and complications. J Trauma 1999;47:923-7.
Gaynes RP. Surveillance of nosocomial infections: A fundamental ingredient for quality. Infect Control Hosp Epidemiol 1997;18:475-8.
Erbay H, Yalcin AN, Serin S, Turgut H, Tomatir E, Cetin B, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: A 2-year survey. Intensive Care Med 2003;29:1482-8.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical infections surveillance system. Crit Care Med 1999;27:887-92.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510-5.
Vincent JL. Nosocomial infections in adult intensive-care units. Lancet 2003;361:2068-77.
Friedman G, Silva E, Vincent JL. Has the mortality of septic shock changed with time. Crit Care Med 1998;26:2078-86.
Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: A three-year analysis. Clin Infect Dis 1999;29:239-44.
Pittet D, Wenzel RP. Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177-84.
Edgeworth JD, Treacher DF, Eykyn SJ. A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med 1999;27:1421-8.
Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598-601.
Correa L, Pittet D. Problems and solutions in hospital-acquired bacteraemia. J Hosp Infect 2000;46:89-95.
Appelgren P, Hellström I, Weitzberg E, Söderlund V, Bindslev L, Ransjö U. Risk factors for nosocomial intensive care infection: A long-term prospective analysis. Acta Anaesthesiol Scand 2001;45:710-9.
Craven DE, Kunches LM, Lichtenberg DA, Kollisch NR, Barry MA, Heeren TC, et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161-8.
Rello J, Ochagavia A, Sabanes E, Roque M, Mariscal D, Reynaga E, et al. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med 2000;162:1027-30.
Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y, Higuera F, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145:582-91.
Torres A, Aznar R, Gatell JM, Jiménez P, González J, Ferrer A, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523-8.
Hanson LC, Weber DJ, Rutala WA. Risk factors for nosocomial pneumonia in the elderly. Am J Med 1992;92:161-6.
Ponce de León-Rosales SP, Molinar-Ramos F, Domínguez-Cherit G, Rangel-Frausto MS, Vázquez-Ramos VG. Prevalence of infections in intensive care units in Mexico: A multicenter study. Crit Care Med 2000;28:1316-21.