Device-associated nosocomial infections in 55 intensive care units of 8 developing countries.
BACKGROUND
Health care-associated infections from invasive medical devices in the intensive care unit (ICU) are a major threat to patient safety. Most published studies of ICU-acquired infections have come from industrialized western countries. In a Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance (NNIS) System report, the U.S. pooled mean rates of central venous catheter (CVC)-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections were 4.0 per 1000 CVC days, 5.4 per 1000 mechanical ventilator days, and 3.9 per Foley catheter days, respectively.


OBJECTIVE
To ascertain the incidence of device-associated infections in the ICUs of developing countries.


METHODS
Multicenter, prospective cohort surveillance of device-associated infection by using the CDC NNIS System definitions.


METHODS
55 ICUs of 46 hospitals in Argentina, Brazil, Colombia, India, Mexico, Morocco, Peru, and Turkey that are members of the International Nosocomial Infection Control Consortium (INICC).


METHODS
Rates of device-associated infection per 100 patients and per 1000 device days.


RESULTS
During 2002-2005, 21,069 patients who were hospitalized in ICUs for an aggregate 137,740 days acquired 3095 device-associated infections for an overall rate of 14.7% or 22.5 infections per 1000 ICU days. Ventilator-associated pneumonia posed the greatest risk (41% of all device-associated infections or 24.1 cases [range, 10.0 to 52.7 cases] per 1000 ventilator days), followed by CVC-related bloodstream infections (30% of all device-associated infections or 12.5 cases [range, 7.8 to 18.5 cases] per 1000 catheter days) and catheter-associated urinary tract infections (29% of all device-associated infections or 8.9 cases [range, 1.7 to 12.8 cases] per 1000 catheter days). Notably, 84% of Staphylococcus aureus infections were caused by methicillin-resistant strains, 51% of Enterobacteriaceae isolates were resistant to ceftriaxone, and 59% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones. The crude mortality rate for patients with device-associated infections ranged from 35.2% (for CVC-associated bloodstream infection) to 44.9% (for ventilator-associated pneumonia).


CONCLUSIONS
These initial data are not adequate to represent any entire country, and likely variations in the efficiency of surveillance and institutional resources may have affected the rates that were detected.


CONCLUSIONS
Device-associated infections in the ICUs of these developing countries pose greater threats to patient safety than in U.S. ICUs. Active infection control programs that perform surveillance of infection and implement guidelines for prevention can improve patient safety and must become a priority in every country.
Rosenthal
Victor D
VD
Medical College of Buenos Aires, Buenos Aires, Argentina. victor_rosenthal@inicc.org
Maki
Dennis G
DG
Salomao
Reinaldo
R
Moreno
Carlos Alvarez
CA
Mehta
Yatin
Y
Higuera
Francisco
F
Cuellar
Luis E
LE
Arikan
Ozay Akan
OA
Abouqal
Rédouane
R
Leblebicioglu
Hakan
H
D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000209:etiology*; D003906:Developing Countries; D004866:Equipment Contamination; D006801:Humans; D007362:Intensive Care Units; D018410:Pneumonia, Bacterial / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation; D018805:Sepsis / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology