Evaluation of Nosocomial Infections and Related Hospital Mortality in Coronary Intensive Care Unit

Year 2022, Volume: 25 Issue: 1, 95 - 101, 18.04.2022

Yeşim Uygun Kızmaz Şeyhmus Külahçıoğlu Hacer Ceren Tokgöz Özgür Yaşar Akbal Ali Karagöz

Abstract

Introduction: Mechanical/therapeutic technologies have resulted in an increased risk of infections including ventilator-associated pneumonia, central line-associated bloodstream infections, and potentially increased the risk of care process complications such as anesthesia/intubation/sedation complications; central line infections, stress ulcers, delirium, and the use of inappropriate or false medications in coronary intensive care units. These complications are associated with significantly increased in-hospital mortality, morbidity, length of stay, and/or healthcare costs and are potentially preventable. We aimed to evaluate the nosocomial infections developed in the coronary intensive care unit and the relationship between coronary intensive care unit infections and in-hospital mortality.

Patients and Methods: The data of 500 patients followed in the coronary intensive care unit more than 48 hours between 01.01.2019 and 31.12.2020 were retrospectively analyzed. Patient records were obtained from surveillance data obtained by infectious diseases and clinical microbiology specialists and infection control nurses through daily visits. The criteria determined by the Centers for Disease Control and Prevention were used in the diagnosis of nosocomial infections. Various clinical samples (blood, urine, endotracheal aspiration fluid) taken from the patients were processed in the microbiology laboratory using qualitative or quantitative methods.

Results: The most common detected infection type was catheter-related bloodstream infection (79.1%), followed by catheter-associated urinary tract infection (18.7%) and ventilator-associated pneumonia (6.25%) respectively. Gram-negative bacillus infections accounted for 70.8% of the causative agents, gram-positive cocci for 20.18%, and fungal infections for 12.5%. The most frequently detected microorganism species were Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) [7 (14.5%), 6 (12.5%)] respectively. Central venous catheter use was more common in non-infected group than infected group [45.0 (93.8%), 50.0 (73.5%) p= 0.005]. Continuous renal replacement therapy was more common in infected group compared to non-infected group [32 (66.7%), 21 (30.9%) p< 0.001]. The numbers of intubated days were higher in the infected group than in the non-infected group and this was statistically significant [mean (SD) 9.9 ± 9.2, 2.3 ± 2.9, P< 0.001]. In-hospital mortality rates were higher in infected group compared to non-infected group [28 (58.3%), 19 (27.9%), p= 0.001].

Conclusion: We found a significant relationship between nosocomial infections and in-hospital mortality in patients who were followed in coronary intensive care unit more than 48 hours [OR= 3.52 (1.30-9.53 CI= 95%) P= 0.01]. The most common sites of nosocomial infections are catheter-related bloodstream infections followed by catheter-associated urinary tract infections and ventilator-associated pneumonia. In multidisciplinary coronary intensive care units, daily visits with infectious diseases and clinical microbiology specialists and infection control nurses, close clinical and laboratory follow-up (detection of fever, elevation in procalcitonin and C-reactive protein (CRP) levels) are indispensable and more importantly nosocomial infections and infection-related mortality are preventable.

Keywords

Nosocomial infections, coronary care unit, catheter related infections

References

• 1. Wright MO, Decker SG, Allen-Bridson K, Hebden JN, Leaptrot D. Healthcare- associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: Location mapping. Am J Infect Control 2018;46(5):577-78.[Crossref]
• 2. Centers for Diseases Control and Prevention (CDC). Available from: https://www.cdc.gov/. (Accessed date: 21.09.2021).
• 3. Leclercq R, Cantón R, Brown DF, Giske CG, Heisig P, MacGowan AP, et al. EUCAST expert rules in antimicrobial susceptibility testing. Clin Microbiol Infect 2013;19(2):141-60. [Crossref]
• 4. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in coronary care units in the United States. National nosocomial infections surveillance system. Am J Cardiol 1998;82(6):789-93. [Crossref]
• 5. İnan D, Saba R, Keskin S, Öğünç D, Çiftci C, Günseren F, et al. Akdeniz Üniversitesi Hastanesi yoğun bakım ünitelerinde hastane infeksiyonları. Yoğun Bakım Dergisi 2002;2(2):129-35.
• 6. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302(21):2323-9. [Crossref]
• 7. van Diepen S, Sligl WI, Washam JB, Gilchrist IC, Arora RC, Katz JN. Prevention of critical care complications in the coronary intensive care unit: protocols, bundles, and insights from intensive care studies. Can J Cardiol 2017;33(1):101-09. [Crossref]
• 8. Stevens V, Geiger K, Concannon C, Nelson RE, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-lineassociated bloodstream infections. Clin Microbiol Infect 2014;20(5):O318-24. [Crossref]
• 9. van Diepen S, Fordyce CB, Wegermann ZK, Granger CB, Stebbins A, Morrow DA, et al. Organizational structure, staffing, resources, and educational initiatives in cardiac intensive care units in the united states: an American Heart Association Acute Cardiac Care Committee and American College of Cardiology Critical Care Cardiology Working Group cross-sectional survey. Circ Cardiovasc Qual Outcomes 2017;10(8):e003864. [Crossref]
• 10. Sinha SS, Sjoding MW, Sukul D, Prescott HC, Iwashyna TJ, Gurm HS, et al. Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States. Circ Cardiovasc Qual Outcomes 2017;10:e003616. [Crossref]
• 11. Jentzer JC, Murphree DH, Wiley B, Bennett C, Goldfarb M, Keegan MT, et al. Comparison of mortality risk prediction among patients ≥70 versus <70 years of age in a cardiac intensive care unit. Am J Cardiol 2018;122(10):1773-8. [Crossref]
• 12. Jentzer JC, van Diepen S, Barsness GW, Katz JN, Wiley BM, Bennett CE, et al. Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population. Am Heart J. 2019; 215:12-9. [Crossref]
• 13. Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson KD, et al; Society for Healthcare Epidemiology of America (SHEA). A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol 2014;35(8):967-77. [Crossref]
• 14. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(Suppl 2):S89-S107. [Crossref]
• 15. Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, et al. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 2014;35(Suppl 2):S155-S78. [Crossref]
• 16. Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(Suppl 2):S48-S65. [Crossref]