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Nosocomial infections and risk factors in intensive care unit of a university hospital

Year 2015, Volume: 6 Issue: 3, 233 - 239, 25.10.2015
https://doi.org/10.5799/ahinjs.01.2015.03.0525

Abstract

Objective: The aim of this study is to evaluate nosocomial infections (NIs) in intensive care unit (ICU) in terms of site of infection, distribution of pathogens and risk factors for developing infection.

Methods: 80 patients staying for more than 48 hours in the ICU were included in the study. Epidemiologic characteristics of the patients, invasive procedures and other risk factors were noted. Cultures, identification of isolates and antibiotic susceptibility tests were made by standard microbiologic methods.

Results: Of 56 patients who have developed NIs, 26 (50%) had pneumonia, 15 (28.8%) had bloodstream infections and 6 (11.5%) had urinary tract infections. Klebsiella pneumoniae (23.5%), Pseudomonas aeruginosa (19.6%), and Acinetobacter spp. (15.6%) were the most frequently isolated microorganisms, respectively. For Klebsiella pneumoniae isolates, extended spectrum beta lactamase (ESBL) rate was 91.6%, carbapenem resistance rate was 15.6% and for Pseudomonas aeruginosa and Acinetobacter spp. carbapenem resistance rates were 60% and 100% respectively. Hemodialysis, enteral nutrition, total parenteral nutrition and prolonged hospitalization for more than 10 days were determined as independent risk factors for developing NI. Additionally Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of ICU stay and lenght of hospital stay before ICU were found to be high in the NI group.

Conclusion: Pneumonia is the most common NI and carbapenem resistance in Gram-negative bacilli was remarkably high in our ICU. It was considered that infection control measures must be applied carefully, invasive procedures should be used in correct indications and we should avoid long-term hospitalization if unnecessary. J Clin Exp Invest 2015; 6 (3): 233-239

Key words: Intensive care unit, nosocomial infections, carbapenem resistance

References

  • 1. Trilla A. Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 1994;20:1-4.
  • 2. Fridkin SK, Welbel SF, Weinstein RA. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am 1997;11:479-496.
  • 3. Garner JS, Jarwis WR, Emori TG, et al. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-140
  • 4. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-644.
  • 5. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323-2329.
  • 6. Oliveira AC, Kovner CT, Silva RS. Nosocomial infection in an intensive care unit in a Brazilian University Hospital. Rev Latino-Am Enfermagem 2010;18:233-239.
  • 7. Ding JG, Sun QF, Li KC, et al. Retrospective analysis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007. BMC Infect Dis 2009;9:115-121.
  • 8. Buke C, Sipahi OR, Tasbakan M, et al. The evaluation of the infections developing in intensive care unit of the internal medicine department. Turk J Infect 2005;19:67–73.
  • 9. Erol S, Kürsat H, Özkurt Z, et al. Nosocomial infections in our reanimation unit. Hastane İnfeksiyonları Dergisi 2000;4:97-100.
  • 10. Palabiyikoglu I, Tulunay M, Oral M, Bengisun JS. Nosocomial infections observed in a reanimation unit: risk factors, causative agents and antimicrobial resistance. Hastane İnfeksiyonları Dergisi 2000;4:150-155.
  • 11. Celik I, Inci N, Denk A, et al. Prevalence of hospital acquired infections in anesthesiology intensive care unit. Fırat Tıp Derg 2005;10:132-135.
  • 12. Arslan H, Gurdogan K. Nosocomial Infections Detected in Intensive Care Units. Hastane İnfeksiyonları Dergisi 1999;3:165-170.
  • 13. Willke A, Baskan S, Palabiyikoglu I, et al. Hospital infections observed in Ibn-i Sina Hospital Between 1992-1998. Hastane İnfeksiyonları Dergisi 2001;5:31- 37.
  • 14. Meric M, Wilke A, Caglayan C, Toker K. Intensive care unit-acquired infections: Incidence, risk factors and associated mortality in a Turkish university hospital. Jpn J Infect Dis 2005;58:297–302.
  • 15. Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis 2004;36:144–148.
  • 16. Erbay H, Yalcin AN, Serin S, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 2003;29:1482–1488.
  • 17. Dasgupta S, Das S, Chawan NS, Hazra A. 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;19:14-20.
  • 18. Tüfek A, Tekin R, Dal T, et al. Evaluation of hospital infections developing in intensive care unit during a decade and reviewof literature. Dicle Med J 2012;39:492-498.
  • 19. Avci M, Genc V, Ozgenc O, et al. Infections in intensive care units in the aegean region: a cross-sectional investigation. Turk J Infect 2009;23:157-161.
  • 20. Bilman FB, Ayaydın Z, Turhanoğlu M, et al. Nonfermentative gram-negative microorganisms isolated from intensive care units and their resistance profiles in a training and research hospital. J Clin Exp Invest 2014;5:391-396.
  • 21. Yolbaş I, Tekin R, Gunes A, et al. Antibiotic susceptibility of Acinetobacter baumannii strains in a university hospital. J Clin Exp Invest 2013;4:318-321.
  • 22. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable motality and lenght of stay. Am J Infect Control 2003;31:291-295.
  • 23. Edwards JR, Peterson KD, Andrus ML, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2006;35:290-301.
  • 24. Jacobs S, Chang RWS, Lee B, Barlett FW. Continuous enteral feeding: A major cause of pneumonia among ventilated intensive care unit patients. J Parent Enteral Nutr 1990;14:353-356.
  • 25. Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med 2006;34:1007-1015.
  • 26. Kadamani I, Itani M, Zahran E, Taha N. Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition: A pseudo-randomised controlled trial. Aust Crit Care. 2014;27:188-193.
  • 27. Korten V. Hastane infeksiyonlarının epidemiyolojisi ve genel risk faktörleri. In: Akalın H, eds. Hastane İnfeksiyonları. 1th edn. Ankara: Güneş Kitabevi, 1993;34-44.
  • 28. Brawley RL, Weber DJ, Samsa GP, Rutala WA. Multiple nosocomial infections: An incidence study. Am J Epidemiol 1989;130:769-780.
  • 29. Akkus N, Biberoglu K, Tarhan O. Risk factors of the infections in intensive care units: Experience in Dokuz Eylul University Faculty of Medicine. Hastane İnfeksiyonları Dergisi 1997;1:101-105.
  • 30. Craven DE, Kunches LM, Lichtenberg DA, et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161-1168.
  • 31. Aygen B, Kayabas U, Guven M, et al. Surveillance of hospital infection in the ICU in Erciyes University Hospital: Epidemiology, risk and prognostic factors. Yoğun Bakım Dergisi 2001;1:122-130.
  • 32. Canbaz S, Peksen Y, Leblebicioglu H, et al. Evaluation of nosocomial infections in intensive care unit. J Exp Clin Med 2000;17:149-155.
  • 33. Ak O, Batirel A, Ozer S, Colakoglu S. Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: A prospective cohort study. Med Sci Monit 2011;17:29-34.
  • 34. Orsi GB, Scorzolini L, Franchi C, et al. Denditti M. Hospital-acquired infection surveillance in a neurosurgical intensive care unit. J Hosp Infect 2006;64:23-29.

Bir üniversite hastanesi yoğun bakım ünitesindeki hastane enfeksiyonları ve risk faktörleri

Year 2015, Volume: 6 Issue: 3, 233 - 239, 25.10.2015
https://doi.org/10.5799/ahinjs.01.2015.03.0525

Abstract

Amaç: Bu çalışmada yoğun bakım ünitesindeki (YBÜ) hastane enfeksiyonlarının (HE) enfeksiyon odağı, patojenlerin dağılımı ve risk faktörleri açısından değerlendirilmesi amaçlandı.Yöntemler: YBÜ’de 48 saatten fazla kalan 80 hasta çalışmaya dahil edildi. Hastaların epidemiyolojik özellikleri, invaziv girişimler ve diğer risk faktörleri kaydedildi. Kültürler, patojenlerin tanımlanması ve antibiyotik duyarlılık testleri standart mikrobiyolojik yöntemlerle yapıldı.Bulgular: HE gelişen 56 hastanın 26 (%50)’sında pnömoni, 15 (%28,8)’inde kan dolaşımı enfeksiyonu ve 6 (%11.5)’sında üriner sistem enfeksiyonu saptandı. Klebsiella pneumoniae (%23.5), Pseudomonas aeruginosa (%19,6) ve Acinetobacter spp. (%15,6) sırasıyla en sık saptanan etken mikroorganizmalar idi. Klebsiella pneumoniae izolatlarında genişlemiş spektrumlu beta laktamaz (GSBL) oranı %91,6, karbapenem direnci %15,6, Pseudomonas aeruginosa ve Acinetobacter spp. izolatları için de karbapenem direnci sırasıyla %60 ve %100 olarak saptandı. Hemodiyaliz, enteral beslenme, total parenteral beslenme, 10 günden uzun süreli yatış HE gelişimi açısından bağımsız risk faktörleri olarak saptandı. “Acute Physiology and Chronic Health Evaluation” (APACHE) II skoru, YBÜ’de yatış süresi ve YBÜ öncesi hastanede yatış süresi de HE gelişen grupta daha yüksek bulundu.Sonuç: Hastanemiz YBÜ’de pnömoni en sık görülen HE olarak saptandı ve Gram-negatif basillerdeki karbapenem direnci dikkat çekici ölçüde yüksek bulundu. Enfeksiyon kontrol önlemlerinin dikkatli bir şekilde uygulanması, invaziv girişimlerin doğru endikasyonlarda uygulanması ve gereksiz uzun dönem yatışlardan kaçınılması gerektiği düşünüldü

References

  • 1. Trilla A. Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 1994;20:1-4.
  • 2. Fridkin SK, Welbel SF, Weinstein RA. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am 1997;11:479-496.
  • 3. Garner JS, Jarwis WR, Emori TG, et al. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-140
  • 4. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-644.
  • 5. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:2323-2329.
  • 6. Oliveira AC, Kovner CT, Silva RS. Nosocomial infection in an intensive care unit in a Brazilian University Hospital. Rev Latino-Am Enfermagem 2010;18:233-239.
  • 7. Ding JG, Sun QF, Li KC, et al. Retrospective analysis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007. BMC Infect Dis 2009;9:115-121.
  • 8. Buke C, Sipahi OR, Tasbakan M, et al. The evaluation of the infections developing in intensive care unit of the internal medicine department. Turk J Infect 2005;19:67–73.
  • 9. Erol S, Kürsat H, Özkurt Z, et al. Nosocomial infections in our reanimation unit. Hastane İnfeksiyonları Dergisi 2000;4:97-100.
  • 10. Palabiyikoglu I, Tulunay M, Oral M, Bengisun JS. Nosocomial infections observed in a reanimation unit: risk factors, causative agents and antimicrobial resistance. Hastane İnfeksiyonları Dergisi 2000;4:150-155.
  • 11. Celik I, Inci N, Denk A, et al. Prevalence of hospital acquired infections in anesthesiology intensive care unit. Fırat Tıp Derg 2005;10:132-135.
  • 12. Arslan H, Gurdogan K. Nosocomial Infections Detected in Intensive Care Units. Hastane İnfeksiyonları Dergisi 1999;3:165-170.
  • 13. Willke A, Baskan S, Palabiyikoglu I, et al. Hospital infections observed in Ibn-i Sina Hospital Between 1992-1998. Hastane İnfeksiyonları Dergisi 2001;5:31- 37.
  • 14. Meric M, Wilke A, Caglayan C, Toker K. Intensive care unit-acquired infections: Incidence, risk factors and associated mortality in a Turkish university hospital. Jpn J Infect Dis 2005;58:297–302.
  • 15. Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis 2004;36:144–148.
  • 16. Erbay H, Yalcin AN, Serin S, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 2003;29:1482–1488.
  • 17. Dasgupta S, Das S, Chawan NS, Hazra A. 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;19:14-20.
  • 18. Tüfek A, Tekin R, Dal T, et al. Evaluation of hospital infections developing in intensive care unit during a decade and reviewof literature. Dicle Med J 2012;39:492-498.
  • 19. Avci M, Genc V, Ozgenc O, et al. Infections in intensive care units in the aegean region: a cross-sectional investigation. Turk J Infect 2009;23:157-161.
  • 20. Bilman FB, Ayaydın Z, Turhanoğlu M, et al. Nonfermentative gram-negative microorganisms isolated from intensive care units and their resistance profiles in a training and research hospital. J Clin Exp Invest 2014;5:391-396.
  • 21. Yolbaş I, Tekin R, Gunes A, et al. Antibiotic susceptibility of Acinetobacter baumannii strains in a university hospital. J Clin Exp Invest 2013;4:318-321.
  • 22. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable motality and lenght of stay. Am J Infect Control 2003;31:291-295.
  • 23. Edwards JR, Peterson KD, Andrus ML, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2006;35:290-301.
  • 24. Jacobs S, Chang RWS, Lee B, Barlett FW. Continuous enteral feeding: A major cause of pneumonia among ventilated intensive care unit patients. J Parent Enteral Nutr 1990;14:353-356.
  • 25. Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med 2006;34:1007-1015.
  • 26. Kadamani I, Itani M, Zahran E, Taha N. Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition: A pseudo-randomised controlled trial. Aust Crit Care. 2014;27:188-193.
  • 27. Korten V. Hastane infeksiyonlarının epidemiyolojisi ve genel risk faktörleri. In: Akalın H, eds. Hastane İnfeksiyonları. 1th edn. Ankara: Güneş Kitabevi, 1993;34-44.
  • 28. Brawley RL, Weber DJ, Samsa GP, Rutala WA. Multiple nosocomial infections: An incidence study. Am J Epidemiol 1989;130:769-780.
  • 29. Akkus N, Biberoglu K, Tarhan O. Risk factors of the infections in intensive care units: Experience in Dokuz Eylul University Faculty of Medicine. Hastane İnfeksiyonları Dergisi 1997;1:101-105.
  • 30. Craven DE, Kunches LM, Lichtenberg DA, et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161-1168.
  • 31. Aygen B, Kayabas U, Guven M, et al. Surveillance of hospital infection in the ICU in Erciyes University Hospital: Epidemiology, risk and prognostic factors. Yoğun Bakım Dergisi 2001;1:122-130.
  • 32. Canbaz S, Peksen Y, Leblebicioglu H, et al. Evaluation of nosocomial infections in intensive care unit. J Exp Clin Med 2000;17:149-155.
  • 33. Ak O, Batirel A, Ozer S, Colakoglu S. Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: A prospective cohort study. Med Sci Monit 2011;17:29-34.
  • 34. Orsi GB, Scorzolini L, Franchi C, et al. Denditti M. Hospital-acquired infection surveillance in a neurosurgical intensive care unit. J Hosp Infect 2006;64:23-29.
There are 34 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Zuhal Yesilbağ

Asli Karadeniz This is me

Seniha Başaran This is me

Fatih Kaya This is me

Publication Date October 25, 2015
Published in Issue Year 2015 Volume: 6 Issue: 3

Cite

APA Yesilbağ, Z., Karadeniz, A., Başaran, S., Kaya, F. (2015). Nosocomial infections and risk factors in intensive care unit of a university hospital. Journal of Clinical and Experimental Investigations, 6(3), 233-239. https://doi.org/10.5799/ahinjs.01.2015.03.0525
AMA Yesilbağ Z, Karadeniz A, Başaran S, Kaya F. Nosocomial infections and risk factors in intensive care unit of a university hospital. J Clin Exp Invest. November 2015;6(3):233-239. doi:10.5799/ahinjs.01.2015.03.0525
Chicago Yesilbağ, Zuhal, Asli Karadeniz, Seniha Başaran, and Fatih Kaya. “Nosocomial Infections and Risk Factors in Intensive Care Unit of a University Hospital”. Journal of Clinical and Experimental Investigations 6, no. 3 (November 2015): 233-39. https://doi.org/10.5799/ahinjs.01.2015.03.0525.
EndNote Yesilbağ Z, Karadeniz A, Başaran S, Kaya F (November 1, 2015) Nosocomial infections and risk factors in intensive care unit of a university hospital. Journal of Clinical and Experimental Investigations 6 3 233–239.
IEEE Z. Yesilbağ, A. Karadeniz, S. Başaran, and F. Kaya, “Nosocomial infections and risk factors in intensive care unit of a university hospital”, J Clin Exp Invest, vol. 6, no. 3, pp. 233–239, 2015, doi: 10.5799/ahinjs.01.2015.03.0525.
ISNAD Yesilbağ, Zuhal et al. “Nosocomial Infections and Risk Factors in Intensive Care Unit of a University Hospital”. Journal of Clinical and Experimental Investigations 6/3 (November 2015), 233-239. https://doi.org/10.5799/ahinjs.01.2015.03.0525.
JAMA Yesilbağ Z, Karadeniz A, Başaran S, Kaya F. Nosocomial infections and risk factors in intensive care unit of a university hospital. J Clin Exp Invest. 2015;6:233–239.
MLA Yesilbağ, Zuhal et al. “Nosocomial Infections and Risk Factors in Intensive Care Unit of a University Hospital”. Journal of Clinical and Experimental Investigations, vol. 6, no. 3, 2015, pp. 233-9, doi:10.5799/ahinjs.01.2015.03.0525.
Vancouver Yesilbağ Z, Karadeniz A, Başaran S, Kaya F. Nosocomial infections and risk factors in intensive care unit of a university hospital. J Clin Exp Invest. 2015;6(3):233-9.