title: Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010).
abstract: The aim of the present study was to determine the rate of device-associated infection (DAI)  and the change in profiles and antimicrobial resistance patterns of the causative microorganisms  in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new  nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In  this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs,  with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the  incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to  5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream  infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However,  ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days.  Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp.  and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum  β-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the  vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010  (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI  and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the  increasing prevalence of multidrug-resistant microorganisms indicate that further interventions  are urgently needed.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. asumaninan＠hotmail.com
authors.forename: Asuman
authors.initials: A
authors.lastname: Inan
authors.forename: Asu
authors.initials: A
authors.lastname: Ozgultekin
authors.forename: Seniha Senbayrak
authors.initials: SS
authors.lastname: Akcay
authors.forename: Derya Ozturk
authors.initials: DO
authors.lastname: Engin
authors.forename: Guldem
authors.initials: G
authors.lastname: Turan
authors.forename: Nurgul
authors.initials: N
authors.lastname: Ceran
authors.forename: Emine
authors.initials: E
authors.lastname: Dincer
authors.forename: Sebahat
authors.initials: S
authors.lastname: Aksaray
authors.forename: Pasa
authors.initials: P
authors.lastname: Goktas
authors.forename: Ilknur
authors.initials: I
authors.lastname: Erdem
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D014421:Turkey / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents