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Nosocomial infections in a neurosurgery intensive care unit
M Dettenkofer1, W Ebner, F J Hans
1Institute of Environmental Medicine and Hospital Epidemiology, University Hospital Freiburg, Germany.
Abstract:
In order to identify overall and site-specific nosocomial infection (NI) rates in patients receiving neurosurgical intensive care therapy, a prospective study was started in February 1997 in the eight-bed neurosurgical ICU of the University Hospital of Freiburg, Germany. Case records were reviewed twice a week, all microbiology reports were reviewed and ward staff was consulted. NI were defined according to the CDC-criteria and were categorised into specific infection sites. Within 20 months, 545 patients with a total of 5,117 patient days were investigated (mean length of stay: 9.4 days). 113 NI were identified in 90 patients (72 pts. with one, 13 with two and 5 with three infections, respectively). A moderate to high overall incidence (20.7/100 pts.) and a moderate incidence density (22.1/1,000 patient days) of NI in the neurosurgical ICU could be documented; these figures are well within the range of published data. Site specific incidence rates and incidence densities were: 1 bloodstream infection per 100 patients (0.9 central line-associated BSIs per 1,000 central line-days), 9 pneumonias per 100 patients (15.1 ventilator-associated pneumonias per 1,000 ventilator-days), 7.3 urinary tract infections per 100 patients (8.5 urinary catheter-associated UTIs per 1,000 urinary catheter-days). Additionally, 1.1 cases of meningitis, 0.7 brain abscesses/ventriculitis, and 1.7 other infections (surgical site infection, bronchitis, catheter related local infection, diarrhoea) were documented per 100 patients, respectively. 14.6% of isolated pathogens were E. coli, 10.2% enterococci, 9.6% S. aureus, 6.4% CNS, 6.4% Klebsiella spp., 5% Enterobacter spp. and 5% Pseudomonas spp. In 11 cases of NI no pathogen could be isolated.
Insights
This study assessed nosocomial infection (NI) rates in a neurosurgical ICU, finding moderate to high overall incidence. Common infections included pneumonia and bloodstream infections, with E. coli as a frequent pathogen.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Neurosurgery
Background:
- Neurosurgical intensive care unit (ICU) patients are at high risk for nosocomial infections (NI).
- Understanding site-specific NI rates is crucial for targeted prevention strategies.
Purpose of the Study:
- To determine the overall and site-specific incidence rates of nosocomial infections in a neurosurgical ICU.
- To identify common pathogens associated with NI in this patient population.
Main Methods:
- Prospective study conducted over 20 months in an 8-bed neurosurgical ICU.
- Systematic review of patient records, microbiology reports, and consultation with ward staff.
- NI defined using CDC criteria and categorized by infection site.
Main Results:
- A total of 545 patients and 5,117 patient days were analyzed, with 113 NI identified in 90 patients.
- Overall NI incidence was 20.7/100 patients (22.1/1,000 patient days).
- Key site-specific rates included ventilator-associated pneumonia (15.1/1,000 ventilator-days) and central line-associated bloodstream infections (0.9/1,000 central line-days).
Conclusions:
- Neurosurgical ICUs experience moderate to high rates of nosocomial infections, consistent with published data.
- Ventilator-associated pneumonia and bloodstream infections are significant concerns.
- E. coli, enterococci, and S. aureus were the most frequently isolated pathogens.