title: Epidemiology and clinical outcome of Healthcare-Associated Infections: a 4-year experience of an Italian ICU.
abstract: BACKGROUND
  Due to their impact on the outcome, hospital-acquired infections (HAIs) in ICUs represent a critical issue of patients' assistance. This study describes microbiological and clinical findings of a surveillance program covering 4 years in an Italian ICU.
  
  
  METHODS
  Patients staying for >48 hours were prospectively followed until discharge or death. For each patient, infections after admissions, duration of device exposure and causal pathogens were noted. A multivariable logistic regression analysis concerning ICU mortality was made.
  
  
  RESULTS
  Incidence density rates were 23.14 VAPs, 6.6 CLABSIs and 5.45 CAUTIs (per 1000 device-days) with an increase in yearly rates during the study period (P<0.001). Use of invasive devices was significantly longer among infected patients (P<0.001, for each), whose proportion was higher among medical admissions (P=0.009). The most frequent source of infection was the lung (78%), followed by bloodstream (23%). MSSA was the most frequently isolated pathogen (26%) but Gram-negatives were found in 86.1% of infected patients, with a high degree of resistance to carbapenems (27.5% for Klebsiella pneumoniae). APACHE score, immunosuppression, duration of mechanical ventilation, surgical admission and abdominal infections were independent predictors of ICU mortality (P<0.001; P<0.001; P=0.006; P=0.027; P=0.006, respectively).
  
  
  CONCLUSIONS
  Our infection rates are higher than those reported by other studies. The use of devices and a medical admission share a significant relationship with infection presence. A greater degree of organ failure and the development of an abdominal sepsis are risk factors for mortality.
authors.affiliation: Clinica di Rianimazione Generale, Respiratoria e del Trauma Maggiore, Università Politecnica delle Marche, Ancona, Italy - simasca@libero.it.
authors.forename: F
authors.initials: F
authors.lastname: Boncagni
authors.forename: R
authors.initials: R
authors.lastname: Francolini
authors.forename: S
authors.initials: S
authors.lastname: Nataloni
authors.forename: E
authors.initials: E
authors.lastname: Skrami
authors.forename: R
authors.initials: R
authors.lastname: Gesuita
authors.forename: A
authors.initials: A
authors.lastname: Donati
authors.forename: P
authors.initials: P
authors.lastname: Pelaia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome