Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium.
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).


CONCLUSIONS
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.
Moreno
Carlos Alvarez
CA
Simon Bolivar Hospital, Bogata, Columbia.
Rosenthal
Victor D
VD
Olarte
Narda
N
Gomez
Wilmer Villamil
WV
Sussmann
Otto
O
Agudelo
Julio Garzon
JG
Rojas
Catherine
C
Osorio
Laline
L
Linares
Claudia
C
Valderrama
Alberto
A
Mercado
Patricia Garrido
PG
Bernate
Patrick Hernan Arrieta
PH
Vergara
Guillermo Ruiz
GR
Pertuz
Alberto Marrugo
AM
Mojica
Beatriz Eugenia
BE
Navarrete
Maria del Pilar Torres
Mdel P
Romero
Ana Sofia Alonso
AS
Henriquez
Daibeth
D
D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000382:microbiology; D003105:Colombia / Q000453:epidemiology; D003428:Cross Infection / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D024881:Drug Resistance, Bacterial; D004864:Equipment and Supplies / Q000009:adverse effects* / Q000382:microbiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment; D018571:Sentinel Surveillance; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D012122:Ventilators, Mechanical / Q000382:microbiology