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Colonization and infection in surgical intensive care patients--a prospective study
A J Kerver1, J H Rommes, E A Mevissen-Verhage
1Department of Surgery, University Hospital Utrecht, The Netherlands.
Abstract:
Nosocomial infections are a major problem in intensive care patients. Thirty-nine patients, requiring intensive care for 5 days or more (mean 15.8 days) were prospectively investigated, to determine the relation between colonisation and nosocomial infection. Thrice weekly, cultures from the oropharynx, respiratory and digestive tract were obtained. Colonization with aerobic gram-negative microorganisms of the oropharynx, respiratory and digestive tract significantly increased during the stay in the Intensive Care Unit. In 29 patients (74%) 78 nosocomial infections were diagnosed. The most frequent nosocomial infections were pneumonia (26 patients, 66.6%), catheter-related bacteraemia (11 patients, 28.2%), and wound infections (7 patients, 17.9%). In 59 instances (75.6%), colonization with the same potential pathogenic microorganism preceded the nosocomial infection. The overall mortality was 25.6% (10 patients), bacteraemia with aerobic gram-negative microorganisms being the cause of death in 7 patients.
Insights
Hospital-acquired infections are common in intensive care units. This study found that patient colonization with specific bacteria often precedes the development of these infections, increasing patient risk.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Nosocomial infections pose a significant threat to patients in intensive care units (ICUs).
- Understanding the relationship between microbial colonization and infection development is crucial for effective patient management.
Purpose of the Study:
- To investigate the link between microbial colonization and the incidence of nosocomial infections in ICU patients.
- To identify common pathogens and infection types in this vulnerable patient population.
Main Methods:
- Prospective study of 39 intensive care patients requiring prolonged stays (mean 15.8 days).
- Regular microbial cultures (thrice weekly) from oropharynx, respiratory, and digestive tracts.
- Analysis of colonization patterns and subsequent diagnosis of nosocomial infections.
Main Results:
- Significant increase in colonization with aerobic gram-negative microorganisms during ICU stay.
- Nosocomial infections diagnosed in 74% of patients, with pneumonia being most frequent (66.6%).
- In 75.6% of cases, microbial colonization preceded the diagnosed nosocomial infection.
Conclusions:
- Colonization with aerobic gram-negative microorganisms is a significant precursor to nosocomial infections in ICU patients.
- Preventive strategies targeting colonization may reduce infection rates and mortality.
- Bacteraemia caused by aerobic gram-negative microorganisms was a major cause of death.