title: A monthly systematic bacteriological report improves accuracy of identification of hospital-acquired infections in an ICU.
abstract: A prospective cohort study with retrospective validation was initiated in order to assess whether a monthly bacteriological report improves the accuracy in detecting hospital-acquired infections (HAI). The setting was a 14-bed medical intensive care unit (ICU) in a 821 bed French university affiliated hospital. One thousand, six hundred and two patients were admitted during the two-year study period, the mean age was 58+/-19 years, the mean Simplified Acute Physiology Score 2 (SAPS 2) was 34+/-21, and ICU mortality was 14%. The microbiology laboratory sent monthly bacteriological reports of urine samples and central venous catheter (CVC) tips back to the intensive-care unit physician in charge of the HAI surveillance programme. This enabled a comparison to be made between prospectively and retrospectively diagnosed hospital-acquired urinary tract infections (HAUTI) and CVC-related infections (HACVCI), HAUTI were prospectively identified in 51 cases (incidence density=10.03/1,000 days) and 23 more cases were found after receiving the monthly bacteriological report (final HAUTI incidence density=14.6/1,000 days, P<0.05). HACVCI were prospectively recognized in 13 cases (incidence density=4/1,000 days) and eight more cases were discovered (final HACVCI incidence density=6.52/1,000 days,P >0.1). All retrospectively diagnosed HAI occurred during the last 48 h of the patients' ICU stay. We conclude that the routine HAI surveillance programme is reliable, except for the last 48 h in the ICU. The monthly bacteriological report improved the accuracy of the HAI reporting rate.
authors.affiliation: Service de Réanimation Médicale, Hôpital Saint Antoine, Assistance Publique, Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75 571 Paris Cedex 12, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Baudel
authors.forename: M
authors.initials: M
authors.lastname: Alzieu
authors.forename: F
authors.initials: F
authors.lastname: Barbut
authors.forename: J
authors.initials: J
authors.lastname: Guglielminotti
authors.forename: E
authors.initials: E
authors.lastname: Maury
authors.forename: B
authors.initials: B
authors.lastname: Guidet
authors.forename: G
authors.initials: G
authors.lastname: Offenstadt
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D003625:Data Collection; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology