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[Monitoring infection at the intensive care unit--a multicenter pilot study]
F Lackner1, G Wewalka, M Rotter
1Universitätsklinik für Anästhesie und allgemeine Intensivmedizin, Wien, Osterreich.
Abstract:
During a period of 3 months an infection survey was carried out in 4 intensive care units (ICUs), 2 in Vienna, Austria, and one each in Ulm and Münster, Federal Republic of Germany, using a common protocol. A total of 329 patients was monitored prospectively. This pilot study was performed to evaluate the usefulness of parameters included in the monitoring form. It was attempted to characterize the patient populations of the four units. Mean duration of stay (1-12 days), mortality (8-26%), leading diagnosis upon admission, intubation rate (41-91%) and use of pulmonary artery catheter (12-35%) were distinctly different. The rate of patients admitted already with an infection was 9-43%, septicemia was diagnosed in up to 27% of the diseased. The rate of infection acquired in the unit was between 12 and 37%, the most frequent types were bronchopneumonia, septicemia and urinary tract infection. When septicemia patients were compared to non-septicemia patients who had been admitted for more than 3 days, it appeared that the latter stayed significantly shorter at the ICU and showed less frequently bronchopneumonia or urinary tract infection at the time of admission. Septicemia patients acquired more frequently additional infections like broncho-pneumonia or urinary tract infection while staying at the ICU. The median day of onset of septicemia was the fifth day and only in a quarter of cases diagnosis could be supported by a positive blood culture. The use of antibiotics in the 4 ICUs is compared and shows marked differences. Based upon experience with this type of infection survey a new modified protocol is introduced, which displays the time course of documented events.
Insights
This pilot study surveyed infections in four intensive care units (ICUs), revealing significant differences in patient populations and infection rates. Findings highlight variations in acquired infections and antibiotic use, informing improved monitoring protocols.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Context:
- A 3-month prospective infection survey was conducted across four intensive care units (ICUs) in Austria and Germany.
- The study involved 329 patients, aiming to evaluate monitoring parameters and characterize patient populations.
- Significant variations were observed in patient demographics, including duration of stay, mortality, intubation rates, and pulmonary artery catheter use.
Purpose:
- To evaluate the utility of parameters within a novel infection monitoring form for intensive care units.
- To characterize and compare patient populations across four distinct intensive care units.
- To identify differences in infection acquisition rates, types, and onset within ICUs.
Summary:
- The survey identified substantial differences in patient populations and clinical characteristics among the four ICUs.
- Infection rates varied, with 9-43% of patients admitted with existing infections and 12-37% acquiring infections during their ICU stay.
- Common acquired infections included bronchopneumonia, septicemia, and urinary tract infections, with septicemia patients experiencing higher rates of additional infections and a median onset on day five.
Impact:
- The study revealed marked differences in antibiotic usage across the ICUs.
- Findings underscore the need for standardized infection surveillance and highlight variations in critical care practices.
- The experience gained led to the development of a modified monitoring protocol to better track the timeline of documented events.