High prevalence rate of multidrug resistance among nosocomial pathogens in the respiratory care center of a tertiary hospital.
OBJECTIVE
There is an increasing need for respiratory care centers (RCCs) for patients who require prolonged mechanical ventilation after intensive care unit (ICU) stay. Nosocomial infections occur at a high rate in ICUs, but there have been few studies of nosocomial infections in RCCs in Taiwan.


METHODS
The infection rates, sources, and pathogens of nosocomial infections in the RCC of a tertiary hospital were retrospectively analyzed from January 2001 to December 2002. Nosocomial infections were defined in accordance with the recommendations of the Centers for Disease Control in the United States.


RESULTS
There were 398 nosocomial infections in 265 patients (1.5 episodes for each patient). The incidence density of nosocomial infection was 27.3%. The mean age +/- standard deviation of patients was 74.5 +/- 12.8 years. The mean duration of infection from the day of patient transfer to the RCC was 13 days (range, 2-78 days). Urinary tract infection was most common (53.8%), followed by bloodstream infection (31.2%), skin and soft tissue infection (6.0%), and lower respiratory tract infection (5.5%). 481 strains of microorganisms were isolated, 12.8% of which were Staphylococcus aureus (all methicillin-resistant), 11.1% were Klebsiella pneumoniae (69.1% of which were the extended spectrum beta-lactamase [ESBL] phenotype), and 10.6% were Escherichia coli (31.4% of which were the ESBL phenotype).


CONCLUSIONS
The infection incidence density in the RCC was similar to previous findings for ICUs during the same period. However, there were differences in the distribution of sites and pathogens. Multiple drug resistance rates were high.
Lee
Chun-Ming
CM
Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan. leecm@ms2.mmh.org.tw
Yeh
Shu-Chen
SC
Lim
Hwee-Kheng
HK
Liu
Chang-Pan
CP
Tseng
Hsiang-Kuang
HK
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013624:Taiwan; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult