title: Device-associated nosocomial infection rates in intensive care units at Cairo University hospitals: first step toward initiating surveillance programs in a resource-limited country.
abstract: BACKGROUND
  Device associated infections (DAIs) have major impact on patient morbidity and mortality.
  
  
  METHODS
  This study involved active prospective surveillance to measure the incidence of DAIs, evaluate microbiological profiles, and investigate excessive mortality in intensive care units (ICUs) in 3 hospitals of Cairo University applying the US Centers for Disease Control and Prevention's National Healthcare Safety Network case definitions for ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and central-line associated bloodstream infection (CLABSI). Data were collected between March 2009 and May 2010.
  
  
  RESULTS
  A total of 1,101 patients were hospitalized for a total of 10,869 days, had 4,734 device-days, and acquired 97 DAIs, with an overall rate of 20.5/1,000 ICU days. VAP was the most commonly identified infection (88.7%); followed by CLABSI (8.2%) and CAUTI (3.1%). Excess mortality was 48% (relative risk, 1.9; P < .001) for CAUTI, 12.9% (relative risk, 1.2; 95% confidence interval, 1.1-1.4; P < .05) for VAP, and 45.7% for CLABSI. Acinetobacter baumannii was the most frequently isolated pathogen (36.1%), followed by Klebsiella pneumoniae (29.2%) and Pseudomonas aeruginosa (22.2%). High antimicrobial resistance was identified, with 85% of A baumannii isolates resistant to ciprofloxacin and imipenem, 76% of K pneumoniae isolates were extended-spectrum β-lactamase producers, and 56.3% P aeruginosa isolates resistant to imipenem (56.3%).
  
  
  CONCLUSIONS
  High rates of DAI and antimicrobial resistance require strengthening infection control, instituting surveillance systems, and implementing evidence-based preventive strategies.
authors.affiliation: Infection Control Unit, Clinical Pathology and Pediatric Departments, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Amani
authors.initials: A
authors.lastname: El-Kholy
authors.forename: Tamer
authors.initials: T
authors.lastname: Saied
authors.forename: Mervat
authors.initials: M
authors.lastname: Gaber
authors.forename: Mariam A
authors.initials: MA
authors.lastname: Younan
authors.forename: Mona M A
authors.initials: MM
authors.lastname: Haleim
authors.forename: Hanan
authors.initials: H
authors.lastname: El-Sayed
authors.forename: Hanaa'a
authors.initials: H
authors.lastname: El-Karaksy
authors.forename: Hafez
authors.initials: H
authors.lastname: Bazara'a
authors.forename: Maha
authors.initials: M
authors.lastname: Talaat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D001419:Bacteria / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents