title: Hospital infections in a neurological intensive care unit: incidence, causative agents and risk factors.
abstract: BACKGROUND
  Hospital infections (HIs), which are frequently associated with hospital treatment, increase morbidity, mortality and treatment costs. The aim of this study was to establish the incidence of HIs in a neurological intensive care unit (nICU), and to determine the most prevalent causative agents and risk factors for HIs.
  
  
  METHODS
  A cross-sectional study with nested case-control design was conducted between 1 July 2009 and 30 June 2010 at an 18-bed neurological intensive care unit at the Clinical Center Kragujevac, Serbia.
  
  
  RESULTS
  In total, 537 patients were enrolled in the study, with 6,549 patient-days. There were 89 patients with 101 HIs. The incidence of patients with HIs was 16.57%, and incidence of HIs was 18.81%, while density of HIs was 15.42 per 1,000 patient-days. The most frequent anatomical sites of HIs were urinary tract (73.27%), blood (10.89%), and skin and soft tissues (10.89%). The following risk factors were identified: co-morbidity (OR=3.9; 95% CI=1.9-7.9), surgical intervention in the last 30 days (OR=5.6; 95% CI=1.5-20.4), urinary bladder catheterization longer than seven days (OR=3.8; 95% CI=1.8-8.2), value of Glasgow coma scale ≤ 9 (OR=3.7; 95% CI=1-6.9), and longer hospital stay (OR=1.1; 95% CI=1.1-1.2).
  
  
  CONCLUSIONS
  Hospitalization in an nICU bears high risk of HIs, especially of urinary tract infections caused by Gram-negative bacteria, in patients with longer hospital stay or co-morbidities, and in those who have had surgical interventions or prolonged use of a urinary bladder catheter. Special attention should be paid to these patients to prevent HIs.
authors.affiliation: Department to Control Hospital Infections, Clinical Center Kragujevac, Serbia.
authors.forename: Zorana
authors.initials: Z
authors.lastname: Djordjevic
authors.forename: Slobodan
authors.initials: S
authors.lastname: Jankovic
authors.forename: Olgica
authors.initials: O
authors.lastname: Gajovic
authors.forename: Nela
authors.initials: N
authors.lastname: Djonovic
authors.forename: Nevena
authors.initials: N
authors.lastname: Folic
authors.forename: Zoran
authors.initials: Z
authors.lastname: Bukumiric
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000472:pathogenicity*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D016017:Odds Ratio; D011183:Postoperative Complications / Q000382:microbiology; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D012874:Skin Diseases, Infectious / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D013997:Time Factors; D062885:Urinary Catheters / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology