Device-Associated Infection Rates, Extra Length of Stay, Extra Mortality, Microorganism Profile, and Bacterial Resistance in an ICU of Macedonia: Findings of the International Nosocomial Infection Control Consortium (INICC)

Background: Device associated infections (DAI) are associated with morbidity and mortality. There are no previous data from Macedonia showing DAI rates, length of stay (LOS), mortality, microorganism profile and bacterial resistance collected using a standardized methodology and definitions.

Objective: To determine the rates and consequences of DAI in one intensive care unit (ICU) of a hospital member of the INICC in Macedonia.

Methods: A prospective cohort, active DAI surveillance study was conducted on adult patients admitted to one tertiary-care ICU in Macedonia. Methodology was developed by INICC. Data collection was done in the participating ICU. Data uploading and analysis were done at INICC headquarters on proprietary software. DAI rates were recorded by applying the definitions of the CDC NNIS/NHSN. We analyzed DAI (ventilator-associated pneumonia [VAP], central line associated bloodstream infection [CLAB], and catheter-associated urinary tract infection [CAUTI]) rates, microorganism profile, bacterial resistance, extra LOS and extra mortality.

Results:

From 11/06 to 9/09, we enrolled 1,558 patients, representing 7,311 bed days. The overall DAI rate was 2.1% (95% CI, 1.46 – 2.96) and 4.5 per 1000 bed days (95% CI, 3.11 – 6.34). The VAP rate was 6.58 per 1000 device days (95% CI, 4.01-10.1), CLAB rate was 1.47 per 1000 CL-days (95% CI, 0.7 – 2.71), and CAUTI rate was 0.45 per 1000 catheter days (95% CI, 0.09 – 1.31).

Overall 17.9% of all DAIs were caused by Candida sp.; 17.9% by Staphylococcus Aureus sp.—27.8% were MRSA—; 14.3% were caused by E.Coli sp.–36.7% resistant to ceftriaxone and 42.1% to ceftazidime-; 10.7% by Enterococcus sp.; 7.1% by Streptococcus sp; 7.1% by Coagulasa Negative Staphylococci–85.7% resistant to methicilin—; and 7.1% by Acinetobacter sp. –61.5% resistant to piperacilne-tazobactam.

The LOS of patients without DAI was 4.3 days; of patients with CLAB was 22.2 days (RR, 5.21; 95% CI, 4.56-5.95; P, 0.0001), (17.9 extra days). The LOS of patients with VAP was 23.0 days (RR, 5.40; 95% CI, 4.91-5.93; P, 0.0001), (4.1 extra days). The LOS of patients with CAUTI was 29.0 days (RR, 6.80, 95% CI 5.25 – 8.81, P, 0.0001).

A total of 36 out of 1524 (2.4%) patients without DAI died; 3 out of 10 patients with CLAB died (30%), the extra mortality being 28% (RR, 12.7, 95% CI 3.91 – 41.2, P, 0.0001); 9 out of 20 patients with VAP died (45.5%), the extra mortality being 43% (RR, 19.05, 95% CI 5.25 – 8.81, P, 0.0001).

Conclusions: VAP rate is higher than NHSN rates and lower than INICC rates, and CLAB and CAUTI rates are lower than the NHSN and INICC rates. Bacterial resistance rate to antibiotics is higher than NHSN rates. VAP, CLAB and CAUTI increased significantly the LOS and VAP. CLAB also increased significantly the mortality rate.