Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-23T10:28:54.005Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States

Published online by Cambridge University Press:  02 January 2015

Michael J. Richards ,
Jonathan R. Edwards ,
David H. Culver ,
Robert P. Gaynes  and
National Nosocomial Infections Surveillance System
Michael J. Richards
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David H. Culver
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert P. Gaynes*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, National Center for Infectious Diseases, Mail Stop E55, 1600 Clifton Rd NE, Centers for Disease Control and Prevention, Atlanta, GA30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe the epidemiology of nosocomial infections in combined medical-surgical (MS) intensive care units (ICUs) participating in the National Nosocomial Infection Surveillance (NNIS) System.

Design:

Analysis of surveillance data on 498,998 patients with 1,554,070 patient-days, collected between 1992 and 1998 from 205 MS ICUs following the NNIS Intensive Care Unit protocol, representing 152 participating NNIS hospitals in the United States.

Results:

Infections at three major sites represented 68% of all reported infections (nosocomial pneumonia, 31%; urinary tract infections (UTIs), 23%; and primary bloodstream infections (BSIs), 14%: 83% of episodes of nosocomial pneumonia were associated with mechanical ventilation, 97% of UTIs occurred in catheterized patients, and 87% of primary BSIs in patients with a central line. In patients with primary BSIs, coagulase-negative staphylococci (39%) were the most common pathogens reported; Staphylococcus aureus (12%) was as frequently reported as enterococci (11%). Coagulase-negative staphylococcal BSIs were increasingly reported over the 6 years, but no increase was seen in candidemia or enterococcal bacteremia. In patients with pneumonia, S aureus (17%) was the most frequently reported isolate. Of reported isolates, 59% were gram-negative bacilli. In patients with UTIs, Escherichia coli (19%) was the most frequently reported isolate. Of reported isolates, 31% were fungi. In patients with surgical-site infections, Enterococcus (17%) was the single most frequently reported pathogen. Device-associated nosocomial infection rates for BSIs, pneumonia, and UTIs did not correlate with length of ICU stay, hospital bed size, number of beds in die ICU, or season. Combined MS ICUs in major teaching hospitals had higher device-associated infection rates compared to all other hospitals with combined medical-surgical units.

Conclusions:

Nosocomial infections in MS ICUs at the most frequent infection sites (bloodstream, urinary, and respiratory tract) almost always were associated with use of an invasive device. Device-associated infection rates were die best available comparative rates between combined MS ICUs, but the distribution of device-associated rates should be stratified by a hospital's major teaching affiliation status.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 8 , August 2000 , pp. 510 - 515
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infections in critically ill patients. Excess length of stay, extra cost, and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
2.Bueno-Cavanillas, A, Delgado-Rodriguez, M, Lopez-Luque, A, Schaffino-Cano, S, Galvez-Vargas, R. Influence of nosocomial pneumonia on mortality rate in an intensive care unit. Crit Care Med 1994;22:55–60.CrossRefGoogle Scholar
3.Soufir, L, Timsit, JF, Mahe, C, Carlet, J, Regnier, B, Chevert, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients. Infect Control Hosp Epidemiol 1999;20:396–401.CrossRefGoogle ScholarPubMed
4.Fagon, JY, Chastre, J, Vuaagnet, A, Trouillet, JL, Novara, A, Gibert, C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996;275:866–869.CrossRefGoogle ScholarPubMed
5.Massanari, PM, Hierholzer, WJ. The intensive care unit. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. Boston, MA: Little Brown Co; 1986:258–298.Google Scholar
6.Stamm, WE, Weinstein, RA, Dion, RE. Comparison of endemic and epidemic nosocomial infections. Am J Med 1981;70:393–397.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance System Report. Data Summary From October 1986-April 1998. Am J Infect Control 1998;26;522–533.CrossRefGoogle Scholar
8.Emori, TG, Culver, DH, Horan, TC, Jarvis, WR, White, JW, Olson, DR, et al. National Nosocomial Infections Surveillance System. Description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
9.Gaynes, RP, Horan, TC. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996:1017–1031. Appendix A1.Google Scholar
10.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical ICUs in the United States. Crit Care Med 1999;27:887–892.CrossRefGoogle ScholarPubMed
11.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in pediatric ICUs in the United States. Pediatrics 1999;103:17.CrossRefGoogle ScholarPubMed
12.Roberts, JA, Fussek, EN, Kaack, MB. Bacterial adherence to urethral catheters. Journal of Urology 1990;144(2 part 1):264–269.CrossRefGoogle ScholarPubMed
13.Jarvis, WR, Edwards, JR, Culver, DH, Hughes, JM, Horan, T, Emori, TG, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med 1991;(suppl 3b):185S–191S.CrossRefGoogle ScholarPubMed
14.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understating in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150–158.Google Scholar
15.Emori, TG, Edwards, JR, Culver, DH, Sartor, C, Stroud, LA, Gaunt, EE, et al. Accuracy of reporting nosocomial infections in intensive care unit patients to the National Nosocomial Infections Surveillance System: a pilot study. Infect Control Hosp Epidemiol 1998;19:308–316.Google Scholar