Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2025-01-01T00:39:40.247Z Has data issue: false hasContentIssue false
  • English
  • Français

Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals: Findings of the International Nosocomial Infection Control Consortium

Published online by Cambridge University Press:  21 June 2016

Carlos Álvarez Moreno ,
Victor D. Rosenthal ,
Narda Olarte ,
Wilmer Villamil Gomez ,
Otto Sussmann ,
Julio Garzon Agudelo ,
Catherine Rojas ,
Laline Osorio ,
Claudia Linares  and
Alberto Valderrama
...Show all authors
Carlos Álvarez Moreno
Affiliation:
Simon Bolivar Hospital, Bogata, Colombia San Ignacio Hospital, Pontificia Javeriana University, Bogata, Colombia
Victor D. Rosenthal
Affiliation:
Medical College of Buenos Aires, Argentina
Narda Olarte
Affiliation:
El Tunal ESE Hospital, Bogata, Colombia
Wilmer Villamil Gomez
Affiliation:
de la Sabana Medical Center, Sucre, Colombia Santa Maria Medical Center, Sucre, Colombia
Otto Sussmann
Affiliation:
La Nueva Medical Center, Bogata, Colombia Palermo Medical Center, Bogata, Colombia
Julio Garzon Agudelo
Affiliation:
Videlmédica Medical Center, Bogata, Colombia
Catherine Rojas
Affiliation:
del Olaya Medical Center, Bogata, Colombia
Laline Osorio
Affiliation:
Simon Bolivar Hospital, Bogata, Colombia
Claudia Linares
Affiliation:
San Ignacio Hospital, Pontificia Javeriana University, Bogata, Colombia
Alberto Valderrama
Affiliation:
El Tunal ESE Hospital, Bogata, Colombia
Patricia Garrido Mercado
Affiliation:
de la Sabana Medical Center, Sucre, Colombia
Patrick Hernán Arrieta Bernate
Affiliation:
de la Sabana Medical Center, Sucre, Colombia
Guillermo Ruiz Vergara
Affiliation:
Santa Maria Medical Center, Sucre, Colombia
Alberto Marrugo Pertuz
Affiliation:
Santa Maria Medical Center, Sucre, Colombia
Beatriz Eugenia Mojica
Affiliation:
La Nueva Medical Center, Bogata, Colombia
María del Pilar Torres Navarrete
Affiliation:
Palermo Medical Center, Bogata, Colombia
Ana Sofia Alonso Romero
Affiliation:
Department of Infection Control and Epidemiology, Bogota, Colombia
Daibeth Henríquez
Affiliation:
Department of Infection Control and Epidemiology, Bogota, Colombia
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium.

Methods.

We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days.

Results.

During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)–related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P = .002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P = .19).

Conclusion.

The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 4 , April 2006 , pp. 349 - 356
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470–485.Google Scholar
2.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in coronary care units in the United States. National Nosocomial Infections Surveillance System. Am J Cardiol 1998; 82:789–793.Google Scholar
3.Hughes, JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy 1988; 34:553–561.CrossRefGoogle Scholar
4.Reed, CS, Gorrie, G, Spelman, D. Hospital infection control in Australia. J Hosp Infect 2003; 54:267–271.Google Scholar
5.Cook, DJ, Walter, SD, Cook, RJ, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129:433–440.Google Scholar
6.Gastmeier, P, Hentschel, J, de Veer, I, Obladen, M, Ruden, H. Device-associated nosocomial infection surveillance in neonatal intensive care using specified criteria for neonates. J Hosp Infect 1998; 38:51–60.Google Scholar
7.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996; 17:552–557.Google Scholar
8.Fagon, JY, Chastre, J, Vuagnat, A, Trouillet, JL, Novara, A, Gibert, C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996; 275:866–869.CrossRefGoogle ScholarPubMed
9.Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999; 160:976–981.Google Scholar
10.Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002; 23:27–31.Google Scholar
11.Fagon, JY, Novara, A, Stephan, F, Girou, E, Safar, M. Mortality attributable to nosocomial infections in the ICU. Infect Control Hosp Epidemiol 1994; 15:428–434.CrossRefGoogle ScholarPubMed
12.Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991; 19:19–35.Google Scholar
13.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140.Google Scholar
14.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.Google Scholar
15.Pittet, D, Thievent, B, Wenzel, R, Li, N, Auckenthaler, R, Suter, P. Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med 1996; 153:684–693.Google Scholar
16.Safdar, N, Crnich, CJ, Maki, DG. Nosocomial infections in the intensive care unit associated with invasive medical devices. Curr Infect Dis Rep 2001; 3:487–495.Google Scholar
17.Diener, JR, Coutinho, MS, Zoccoli, CM. Central venous catheter-related infections in critically ill patients. Rev Assoc Med Bras 1996; 42:205–214.Google ScholarPubMed
18.Velasco, E, Thuler, LC, Martins, CA, Dias, LM, Goncalves, VM. Nosocomial infections in an oncology intensive care unit. Am J Infect Control 1997; 25:458–462.Google Scholar
19.Mittal, N, Nair, D, Gupta, N, et al. Outbreak of Acinetobacter spp septicemia in a neonatal ICU. Southeast Asian J Trop Med Public Health 2003; 34:365–366.Google Scholar
20.Villanova, P. Minimum Inhibitory Concentration Interpretive Standards. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. Document M7-A4.Google Scholar
21.Villamil Gómez, W, Ruíz Vergara, G, Marrugo Pertuz, A, Rosenthal, VD. Education and performance feedback effect on rates of central vascular catheter–associated bloodstream infections in new born intensive care units in a private hospital of Sucre, Colombia. In: Program and abstracts of the Association for Professional in Infection Control and Epidemiology 2005 Annual Conference; June 19-23, 2005; Baltimore, MD. Abstract 51829.Google Scholar
22.Freeman, R. Predictors for infection following open-heart surgery. J Hosp Infect 1991;18(Suppl):299–307.Google Scholar
23.Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977; 296:1305–1309.CrossRefGoogle ScholarPubMed
24.Higuera, F, Rosenthal, VD, Duarte, P, Ruiz, J, Franco, G, Safdar, N. The effect of process control on the incidence of central venous catheter–associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 2005; 33:2022–2027.Google Scholar
25.Pittet, D. Nosocomial pneumonia: incidence, morbidity and mortality in the intubated-ventilated patient. Schweiz Med Wochenschr 1994; 124:227–235.Google ScholarPubMed
26.Rosenthal, VD, Guzman, S, Migone, O, Crnich, CJ. The attributable cost, length of hospital stay, and mortality of central line–associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control 2003; 31:475–480.CrossRefGoogle ScholarPubMed
27.Rosenthal, VD, Guzman, S, Orellano, PW, Safdar, N. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003; 31:291–295.CrossRefGoogle ScholarPubMed
28.Orsi, GB, Di Stefano, L, Noah, N. Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol 2002; 23:190–197.Google Scholar
29.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994; 271:1598–1601.Google Scholar
30.Rosenthal, VD, Guzman, S, Migone, O, Safdar, N. The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: a prospective, matched analysis. Am J Infect Control 2005; 33:157–161.Google Scholar
31.Francisco Higuera, MR-F, Rosenthal, VD, Castanon, J, et al. The attributable cost, and length of hospital stay of central line–associated blood stream infection in intensive care units in Mexico: a prospective, matched analysis. In: Program and abstracts of the 15th Annual Society for Healthcare Epidemiology of America; April 9-12, 2005; Los Angeles, CA; 2005. Abstract 170.Google Scholar
32.Lopes, JM, Tonelli, E, Lamounier, JA, et al. Prospective surveillance applying the national nosocomial infection surveillance methods in a Brazilian pediatric public hospital. Am J Infect Control 2002; 30:1–7.CrossRefGoogle Scholar
33.Martinez-Aguilar, G, Anaya-Arriaga, MC, Avila-Figueroa, C. Incidence of nosocomial bacteremia and pneumonia in pediatric unit. Salud Publica Mex 2001; 43:515–523.Google Scholar
34.Rezende, EM, Couto, BR, Starling, CE, Modena, CM. Prevalence of nosocomial infections in general hospitals in Belo Horizonte. Infect Control Hosp Epidemiol 1998; 19:872–876.CrossRefGoogle ScholarPubMed
35.Tinoco, JC, Salvador-Moysen, J, Perez-Prado, MC, Santillan-Martinez, G, Salcido-Gutierrez, L. Epidemiology of nosocomial infections in a second level hospital. Salud Publica Mex 1997; 39:25–31.Google Scholar
36.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter–associated bloodstream infections. Infect Control Hosp Epidemiol 1996; 17:150–158.Google Scholar
37.Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 1997; 16:1045–1048.Google Scholar
38.Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999; 20:598–603.Google Scholar
39.Hugonnet, S, Harbarth, S, Sax, H, Duncan, RA, Pittet, D. Nursing resources: a major determinant of nosocomial infection? Curr Opin Infect Dis 2004; 17:329–333.Google Scholar
40.Guidelines for prevention of nosocomial pneumonia. Centers for Disease Control and Prevention. MMWR Recomm Rep 1997;46(RR-1):1–79.Google Scholar
41.O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002; 30:476–489.Google Scholar
42.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002; 30:1–46.Google Scholar
43.Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005; 33:392–397.Google Scholar
44.Rosenthal, VD, Guzman, S, Pezzotto, SM, Crnich, CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device–associated bloodstream infections in intensive care units in Argentina. Am J Infect Control 2003; 31:405–409.Google Scholar
45.Rosenthal, VD, McCormick, RD, Guzman, S, Villamayor, C, Orellano, PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31:85–92.Google Scholar
46.Rosenthal, VD, Maki, DG. Prospective study of the impact of open and closed infusion systems on rates of central venous catheter–associated bacteremia. Am J Infect Control 2004; 32:135–141.Google Scholar
47.Rosenthal, VD, Guzman, S, Safdar, N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol 2004; 25:47–50.CrossRefGoogle ScholarPubMed
48.Rosenthal, VD, Guzman, S, Crnich, C. Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control 2006; 34:58–63.CrossRefGoogle ScholarPubMed
49.Sobreyra Oropeza, M, Herrera Bravo, M, Rosenthal, VD. Nosocomial Infection global rates and central vascular catheter–associated bloodstream infections rates reduction in a new born intensive care unit of one Mexican public hospital. In: Program and abstracts of the 15th Annual Society for Healthcare Epidemiology of America; April 9-12, 2005; Los Angeles, CA; 2005. Abstract 254.Google Scholar
50.Salomao, R, Blecher, S, Maretti da Silva, MA, Vilins, M, Hilärio da Silva, E, Rosenthal, VD. Education and performance feedback effect on rates of central vascular catheter–associated bloodstream infections in adult intensive care units of one Brazilian hospital of Sao Paulo. In: Program and abstracts of the Association for Professional in Infection Control and Epidemiology 2005 Annual Conference; June 19-23,2005; Baltimore, MD. Abstract 51803.Google Scholar
51.Kurlat, I, Corral, G, Oliveira, F, Farinella, G, Alvarez, E. Infection control strategies in a neonatal intensive care unit in Argentina. J Hosp Infect 1998; 40:149–154.Google Scholar
52.Berg, DE, Hershow, RC, Ramirez, CA, Weinstein, RA. Control of nosocomial infections in an intensive care unit in Guatemala City. Clin Infect Dis 1995; 21:588–593.Google Scholar
53.Arias, CA, Reyes, J, Zuniga, M, et al. Multicentre surveillance of antimicrobial resistance in enterococci and staphylococci from Colombian hospitals, 2001-2002. J Antimicrob Chemother 2003; 51:59–68.CrossRefGoogle ScholarPubMed
54.Lemeshow, S, Le Gall, JR. Modeling the severity of illness of ICU patients: a systems update. JAMA 1994; 272:1049–1055.Google Scholar
55.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, Enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002; 136:834–844.Google Scholar