title: Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system.
abstract: OBJECTIVE
  To examine the incidence of and risk factors for device-associated infections and associated mortality.
  
  
  METHODS
  Prospective surveillance-based study in ICUs of 19 hospitals in The Netherlands.
  
  
  METHODS
  The study included 2,644 patients without infection at admission during 1997-2000, staying in the ICU for at least 48 h.
  
  
  RESULTS
  The occurrence of ventilator-associated pneumonia (VAP), central venous catheter (CVC) related bloodstream infection (CR-BSI), urinary catheter-associated urinary tract infection (CA-UTI) and risk factors was monitored. Of the ventilated patients 19% developed pneumonia (25/1,000 ventilator days); of those with a central line 3% developed CR-BSI (4/1,000 CVC days,) and of catheterized patients 8% developed CA-UTI (9/1,000 catheter days). Longer device use increased the risk for all infections, especially for CR-BSI. Independent risk factors were sex, immunity, acute/elective admission, selective decontamination of the digestive tract, and systemic antibiotics at admission, dependent upon the infection type. Crude mortality significantly differed in patients with and without CR-BSI (31% vs. 20%) and CA-UTI (27% vs. 17%) but not for VAP (26% vs. 23%). Acquiring a device-associated infection was not an independent risk factor for mortality. Being in need of ventilation or a central line, and the duration of this, contributed significantly to mortality, after adjusting for other risk factors.
  
  
  CONCLUSIONS
  Device use was the major risk factor for acquiring VAP, CR-BSI and CA-UTI. Acquiring a device-associated infection was not an independent risk factor for mortality, but device use in itself was.
authors.affiliation: RIVM, Center for Infectious Disease Epidemiology, Bilthoven, The Netherlands. tjallie.van.der.kooi@rivm.nl
authors.forename: Tjallie I I
authors.initials: TI
authors.lastname: van der Kooi
authors.forename: Annette S
authors.initials: AS
authors.lastname: de Boer
authors.forename: Judith
authors.initials: J
authors.lastname: Manniën
authors.forename: Jan C
authors.initials: JC
authors.lastname: Wille
authors.forename: Mariëlle T
authors.initials: MT
authors.lastname: Beaumont
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mooi
authors.forename: Susan
authors.initials: S
authors.lastname: van den Hof
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000401:mortality; D011159:Population Surveillance / Q000379:methods*; D012307:Risk Factors; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology* / Q000401:mortality