title: Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection Control Consortium.
abstract: OBJECTIVE
  To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, extra length of stay, and attributable mortality in intensive care units (ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection Control Consortium (INICC).
  
  
  METHODS
  Prospective cohort surveillance of DAIs was conducted in five ICUs in three city hospitals in Brazil by applying the definitions of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS).
  
  
  RESULTS
  Between April 2003 and February 2006, 1 031 patients hospitalized in five ICUs for an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8% or 29.8 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the rate for central venous catheter-associated bloodstream infections (CVC-BSI) was 9.1 per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 9.6 per 1 000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone in 96.7% of cases, resistant to ceftazidime in 79.3% of cases, and resistant to piperacillin-tazobactam in 85.7% of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin in 71.3% of cases, resistant to ceftazidime in 75.5% of cases, and resistant to imipenem in 27.7% of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented extra mortality rates of 15.3% (RR 1.79, P = 0.0149) for VAP, 27.8% (RR 2.44, P = 0.0004) for CVC-BSI, and 10.7% (RR 1.56, P = 0.2875) for CAUTI.
  
  
  CONCLUSIONS
  The DAI rates were high in the ICUs of the Brazilian hospitals included in this study. Patient safety can be improved through the implementation of an active infection control program comprising surveillance of DAIs and infection prevention guidelines. These actions should become a priority in every country.
authors.affiliation: Division of Infection Control, Santa Marcelina Hospital, São Paulo, Brazil.
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Salomao
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Gorki
authors.initials: G
authors.lastname: Grimberg
authors.forename: Simone
authors.initials: S
authors.lastname: Nouer
authors.forename: Sergio
authors.initials: S
authors.lastname: Blecher
authors.forename: Silvia
authors.initials: S
authors.lastname: Buchner-Ferreira
authors.forename: Rosa
authors.initials: R
authors.lastname: Vianna
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Maretti-da-Silva
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002408:Catheters, Indwelling / Q000382:microbiology* / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007391:International Cooperation; D053831:Surgical Fixation Devices / Q000382:microbiology* / Q000706:statistics & numerical data*