title: Prevalence of nosocomial respiratory tract infections in the surgical intensive care units of a medical center.
abstract: BACKGROUND
  The intensive care unit (ICU) is one of the most common locations in the hospital for the development of nosocomial respiratory tract infections (RTIs). The purpose of this study was to better understand and compare the rate of nosocomial RTIs, their distribution and the frequency of infective organisms in three different adult surgical ICUs at a medical center in Taiwan.
  
  
  METHODS
  This retrospective study covered the period from 1991 to 1996, and targeted patients who had acquired nosocomial RTIs more than 72 hours after admission to the surgical, cardiovascular surgical, or neurosurgical ICU. Infection control nurses made routine weekly rounds to the units and conducted comprehensive patient-based surveys. Data collected were subjected to descriptive and deductive statistical analyses.
  
  
  RESULTS
  A total of 277 episodes of nosocomial RTIs were encountered (3.8 episodes per 1,000 patient-days of hospitalization). Neurosurgical ICU patients had the highest infection rate (4.8%) (p < 0.01). The median length of hospital stay of patients acquiring nosocomial RTIs was 61 days; the infection occurred 19 days (median) after admission to the ICU and the length of postinfection stay was 38 days (median). Pneumonia accounted for 91.3% of these infections. The overall mortality rate was 42.6%, with the surgical ICU having the highest mortality rate (61.5%), which was significantly higher compared with the other two ICUs studied. The majority of patients with nosocomial RTIs had medical catheters or devices in place. A total of 297 isolates were cultured from 277 infected patients. Pseudomonas aeruginosa was the predominant organism isolated (29.6%), followed by Staphylococcus aureus (26.6%), of which 88.2% were methicillin-resistant S aureus (MRSA).
  
  
  CONCLUSIONS
  The rate of nosocomial RTIs was significantly higher in neurosurgical ICU patients; the majority of infected patients had medical catheters or devices in place. S aureus played an increasingly important role as a nosocomial pathogen; hence, control of MRSA should be the focus of infection control policies.
authors.affiliation: Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.
authors.forename: F D
authors.initials: FD
authors.lastname: Wang
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chen
authors.forename: C Y
authors.initials: CY
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies