title: Device-associated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the International Nocosomial Infection Control Consortium (INICC).
abstract: Device-associated health care-acquired infections (DA-HAIs) pose a threat to patient safety, particularly in the intensive care unit (ICU). However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections (CLABs) per 1000 central line-days, 7.88 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii, Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae and Enterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates. Resistance to oxacillin and imipenem was higher as well. Comparing device use, DA-HAI rates, and bacterial resistance for the primary isolated bacteria indicated a direct association between urinary catheter use and the rates of CAUTI.
authors.affiliation: Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Jahani-Sherafat
authors.affiliation: Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Razaghi
authors.affiliation: International Nosocomial Infection Control Consortium, Buenos Aires, Argentina.
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.affiliation: Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Elahe
authors.initials: E
authors.lastname: Tajeddin
authors.affiliation: Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Simasadat
authors.initials: S
authors.lastname: Seyedjavadi
authors.affiliation: Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.
authors.forename: Marjan
authors.initials: M
authors.lastname: Rashidan
authors.affiliation: Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.; Research Institute for Gastroenterology and Liver Diseases, Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: Masoud.alebouyeh@gmail.com.
authors.forename: Masoud
authors.initials: M
authors.lastname: Alebouyeh
authors.affiliation: Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Rostampour
authors.affiliation: Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Arezo
authors.initials: A
authors.lastname: Haghi
authors.affiliation: Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Sayarbayat
authors.affiliation: Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Farazmandian
authors.affiliation: Loghman Hakim hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Tahere
authors.initials: T
authors.lastname: Yarmohammadi
authors.affiliation: Mofid Children's' Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Fardokht K
authors.initials: FK
authors.lastname: Arshadi
authors.affiliation: Department of Health Assistance, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Mansouri
authors.affiliation: Department of Health Assistance, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Sarbazi
authors.affiliation: International Nosocomial Infection Control Consortium, Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Vilar
authors.affiliation: Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.; Research Institute for Gastroenterology and Liver Diseases, Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Zali
mesh_terms: D001419:Bacteria / Q000145:classification* / 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; D017053:Infection Control; D007492:Iran; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology
keywords: Bacterial resistance; Device-associated infection; Hospital infection; INICC; International Nosocomial Infection Consortium; Iran