Intensive Care Unit-Acquired Infections and Association of These Infections with Mortality: A Prospective Study in a Turkish Tertiary Care Hospital

Yıl 2016, Cilt: 6 Sayı: 2 - J Microbiol Infect Dis 2016; 06(02) June Issue, 53 - 59, 01.06.2016

Bircan Kayaaslan Ayse But

https://doi.org/10.5799/jmid.328800

Öz

Objective: This study aimed to investigate epidemiological characteristics of infections and risk factors for mortality in
intensive care unit (ICU) patients.
Methods: A total of 164 patients hospitalized at Ankara Numune Education and Research Hospital in the medical and
surgical ICU over 48 hours were included in the study over a period of nine months. The patients were followed prospectively
until they died or were discharged from the ICU. Demographic characteristics of patients, underlying diseases,
history of surgical operations, Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission, usage
of invasive devices, nosocomial infections, isolated microorganisms, and outcome of cases were recorded on the standardized
patient forms.
Results: Of the patients, 96.3% (158) had at least one underlying disease, with neurological disorders being the most
frequent. The mean length of stay in the ICU was 20.3 ± 18.7 days, while the APACHE II score at admission was 16.8 ±
7.3. During follow-up, 105 infection episodes occurred in 65 patients. Pneumonia (41.0%) was the most frequent infection.
Acinetobacter baumannii was the most frequently isolated organism, and the most effective antimicrobials against
these strains were colistin (97.3%) and tigecycline (83.0%). Rude mortality rate was estimated at 30.5% (50 patients). In
multivariate logistic regression analysis, the APACHE II score was ≥15 at admission, surgical site infection acquired in
the ICU and infection caused by A. baumannii were found to be independent risk factors for mortality (p 0.039, 0.040
and 0.025, respectively).
Conclusion: Infections acquired in the ICU, especially those caused by A. baumannii, increase the mortality rate. Because
A. baumannii is resistant to most antibiotics, treatment becomes very difficult. Early empirical treatment against
A. baumannii may decrease the mortality rate in ICUs. J Microbiol Infect Dis 2016;6(2): 53-59  

Anahtar Kelimeler

Nosocomial infections, intensive care unit, mortality risk factors, A. baumannii

Kaynakça

• 1. Blot S. Limiting the attributable mortality of nosocomial infection and multidrug resistance in intensive care units. Clin Microbiol Infect 2008;14:5-13.
• 2. Katsaragakis S, Markogiannakis H, Samara E, et al. Predictors of mortality of Acinetobacte rbaumannii infections: A 2-year prospective study in a Greek surgical intensive care unit. Am J Infect Control 2010;38:631-635.
• 3. Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care 2011;1:47.
• 4. Sardan YC. Hastane Enfeksiyonları, Tanımlar, Sürveyans ve Epidemilere Yaklaşım. Enfeksiyon Hastalıkları ve Mikrobiyolojisi. Topcu AW, Soyletir G, Doğanay M. 3rd edition. Ankara: Nobel Tıp Kitapevleri, 2008;545-557.(in Turkish)
• 5. Meric M, Willke A, Caglayan C, et al. Intensive care unitacquired infections: incidence, risk factors and associated mortality in a Turkish university hospital Jpn J Infect Dis 2005;58:297-302.
• 6. Çevik MA, Yılmaz GR, Erdinç FŞ, et al. Nöroloji yoğun bakım ünitesinde mortalite ile ilişkili faktörler ve nozokomiyal infeksiyonla mortalite ilişkisi. Yoğun Bakım Dergisi 2001;1:47-55. (in Turkısh)
• 7. Appelgren P, Hellström I, Weitzberg E, et al. Risk factors for nosocomial intensive care infection: a long-term prospective analysis. Acta Anaesthesiol Scand 2001;45:710-719.
• 8. Craven DE, Kunches LM, Lichtenberg DA, et al. Nosocomial and fatality in medical surgical intensive care unit patients. Arch Intern Med 1988;148:1161-1168.
• 9. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639-644.
• 10. Garner JS, Jarvis WR, Emori TG, et al: CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-140.
• 11. National Committee for Clinical Laboratory Standards. Antimicrobial susceptibility tests. Approved Standard M100-S19. Wayne, PA. NCCLS, 2009
• 12. Çağatay AA, Özsüt H. Yoğun bakım ünitesi infeksiyonları ve antimikrobik tedavi. Yoğun Bakım Dergisi 2001;1:21-32. (in Turkısh)
• 13. Pradhan NP, Bhat SM, Ghadage DP. Nosocomial infections in the medical ICU: a retrospective study highlighting their prevalence, microbiological profile and impact on ICU stay and mortality. J Assoc Physicians India 2014;62:18-21.
• 14. Esen S, Leblebicioglu H. Prevalence of nosocomial infections at Intensive care units in Turkey: a multicentre 1-day point prevalence study Scan J Infect Dis 2004;36:144-148.
• 15. Ak O, Batirel A, Ozer S, Colakoglu S. Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: A prospective cohort study. Med Sci Monit 2011;17:29-34.
• 16. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcome of infection in intensive care units. JAMA 2009;302:2323-2329.
• 17. Yilmaz GR, Cevik MA, Erdinc FS, et al. The risk factors for infections acquired by cerebral hemorrhage and cerebral infarct patients in a neurology intensive care unit in Turkey. Jpn J Infect Dis2007;60:87-91.
• 18. Richards MJ, Edwards JR, Culver DH, et al. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-892.
• 19. Ursavaş A, Ege E, Yüksel EG, et al. Solunumsal Yoğun Bakım Ünitesinde Mortaliteyi Etkileyen Faktörlerin Değerlendirilmesi. Yoğun Bakım Dergisi 2006;6:43-48. (In Turkısh)
• 20. Ceylan E, İtil O, Arı G et al. İç hastalıkları yoğun bakım ünitesinde izlenmiş hastalarda mortalite ve morbiditeyi etkileyen faktörler. Toraks Dergisi 2001;2:6-12.(in Turkısh)
• 21. Günal H, Çalışır HC, Erol A, et al. Solunumsal yoğun bakım ünitesindeki mortalite. Solunum Hastalıkları 2001;12:260- 267.
• 22. Erbay H, Yalcin AN, Serin S, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 2003;29:1482-1488.
• 23. Ponce de LeónRosales SP, MolinarRamos F, DomínguezCherit G, et al. Prevalence of infections in intensive care units in Mexico: a multicenterstudy. Crit Care Med 2000;28:1316- 1321.
• 24. Caricato A, Montini L, Bello G, et al. Risk factors and outcome of Acinetobacter baumanii infection in severe trauma patients. Intensive Care Med 2009;35:1964-1969.
• 25. Karabay O, Yahyaoğlu M, Öğütlü A, et al. Factors associated with mortality in Acinetobacter baumannii infected intensive care unit patients. Mikrobiyol Bul 2012;46:335-337.
• 26. Kim SY, Jung JY, Kang YA, et al.Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit. J Korean Med Sci 2012; 27: 939-947.
• 27. Cevik MA, Yilmaz GR, Erdinc FS, et al. Relationship between nosocomial infection and mortality in a neurology intensive care unit in Turkey. J Hosp Infect 2005;59:324-330.
• 28. Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34:344-353.
• 29. Jang TN, Lee SH, Huang CH, et al. Risk factors and impact of nosocomial Acinetobacter baumannii bloodstream infections in the adult intensive care unit: a case-control study. J Hosp Infect 2009;73:143-150.
• 30. García-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, et al. Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients. Crit Care Med 1999;27:1794-1799.