title: Epidemiology and risk factors of intensive care unit-acquired infections: a prospective multicentre cohort study in a middle-income country.
abstract: BACKGROUND
  This study aimed to determine the incidence and risk factors of infections among patients admitted to intensive care units (ICUs) in tertiary care hospitals in Turkey.
  
  
  METHODS
  Adult patients who were admitted to the ICUs of five tertiary care hospitals for over 48 hours between June and December 2007 were monitored daily. Potential risk factors such as age, gender, comorbidities, diagnosis at admission, severity of disease (Acute Physiology and Chronic Health Evaluation II scores), exposure to antibiotics, history of invasive procedures and significant medical interventions were evaluated. A multivariate analysis of these risk factors was carried out using Cox regression.
  
  
  RESULTS
  A total of 313 patients with a median ICU stay of 12 days were selected for the study. 236 infectious episodes (33.8/1,000 ICU-days) were diagnosed among 134 patients (42.8/100 patients) in this group. Multivariate analysis revealed that exposure to a cephalosporin antibiotic (hazard ratio [95% confidence interval] 1.55 [1.10-2.19]) was an independent risk factor, whereas having a tracheostomy cannula (0.53 [0.36-0.81]) or nasogastric tube (0.48 [0.33-0.70]) was protective. Patients admitted to the ICUs from surgical wards were significantly more exposed to cephalosporins.
  
  
  CONCLUSIONS
  ICU-associated infections, which are quite high in Turkey, are largely due to inadequate infrastructure and facilities and understaffing. Abuse of antibiotics, particularly in patients who have undergone surgery, and prolonged ICU stays are significant risk factors for such infections.
authors.affiliation: Department of Infectious Diseases & Clinical Microbiology, Kocaeli Universitesi Tip Fakultesi, Enfeksiyon Hst ve Klin Mikrobiyoloji AD, Umuttepe Kampusu, Kocaeli 41380, Turkey. drmelihameric@gmail.com
authors.forename: Meliha
authors.initials: M
authors.lastname: Meric
authors.forename: Nur
authors.initials: N
authors.lastname: Baykara
authors.forename: Suleyman
authors.initials: S
authors.lastname: Aksoy
authors.forename: Iclal Ozdemir
authors.initials: IO
authors.lastname: Kol
authors.forename: Gurdal
authors.initials: G
authors.lastname: Yilmaz
authors.forename: Nurhayat
authors.initials: N
authors.lastname: Beyazit
authors.forename: Birgul
authors.initials: B
authors.lastname: Mete
authors.forename: Haluk
authors.initials: H
authors.lastname: Vahaboglu
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014421:Turkey / Q000453:epidemiology