title: Risk factors and outcomes of intensive care unit-acquired infections in a Tunisian ICU.
abstract: BACKGROUND
  ICU-acquired infections constitute an important world-wide health problem. Our aim was to determine the incidence, predictive factors and impact of ICU-AIs in ICU patients in Tunisia.
  
  
  METHODS
  We conducted a prospective observational cohort study over a 3 month period in the medical surgical intensive care unit of Habib Bourguiba University Hospital (Sfax-Tunisia).
  
  
  RESULTS
  During the study period 261 patients were surveyed; 44 of them (16.9%) developed 55 episodes of ICU-AI (34.7 ICU-AI/1000 days of hospitalization). The most frequently identified infections were ventilator-associated pneumoniae (58.2%), and primary bloodstream infection (18.2%). The most frequently isolated organisms were multidrug-resistant P. aeruginosa (44.7%), and A. baumannii (21.3%). The initial antibiotic prescription for ICU-AI was inadequate in 9 cases (16.4% of episodes of ICU-AI). At ICU discharge, overall mortality was 29.9%. Independent risk factors for acquiring infection in ICU were the use of central venous catheter (p=0.014) and antibiotic prescription on admission for more than 24 hours (p=0.025), those of mortality in ICU were SAPS II of more than 35 points (p<0.001) and ICU-AI (p=0.002), and those of mortality at 28 days after an episode of ICU-AI were septic shock (p=0.004) and inadequate initial antimicrobial treatment (p=0.011).
  
  
  CONCLUSIONS
  We conclude that the occurrence of ICU-AI is significantly related to increased mortality, and that focusing interventions on better use of antibiotics would have a benefit in terms of prevention and consequences of ICU-AI.
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax,Tunisie. Kallelhat@yahoo.fr
authors.forename: Hatem
authors.initials: H
authors.lastname: Kallel
authors.forename: Hassen
authors.initials: H
authors.lastname: Dammak
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.forename: Hichem
authors.initials: H
authors.lastname: Ksibi
authors.forename: Hedi
authors.initials: H
authors.lastname: Chelly
authors.forename: Chokri
authors.initials: C
authors.lastname: Ben Hamida
authors.forename: Noureddine
authors.initials: N
authors.lastname: Rekik
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult