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[The microbiological profile of nosocomial infection in a respiratory intensive care unit]
G Brum1, J T Monteiro, F Monteiro
1Serviço de Pneumologia, Hospital de Santa Maria, Lisboa.
Abstract:
In 1987, in the Respiratory Intensive Care Unit of Santa Maria Hospital we developed a nosocomial surveillance program with specially created software that provides knowledge of NI in the ICU at any moment. The information gathered along the time is particularly useful in the correlation of the risk factors, the most frequent microorganisms and in the institution of empiric antibiotic therapy. Out of 2528 patients admitted in our ICU for the last 6 years (87/92), 10% had bacteriologically identified NI. Almost (93%) of them had occurred in mechanically ventilated patients, which corresponds to 20.7% NI in those patients. The gram-negative appeared in 63.37%, with the predominance of Enterobacteriaceae. From the gram-positives the most frequent were Staphylococcus spp. Their meticiline resistance was worrisome. NI patients had significantly higher severity and therapeutic intervention scores. Mechanical ventilation period was 4 fold higher and mortality 2.5 times higher in the patients with this complication.
Insights
A nosocomial infection surveillance program in the ICU identified key risk factors and microorganisms. Mechanically ventilated patients faced higher rates of infection, prolonged ventilation, and increased mortality.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Context:
- Developed a specialized software for real-time nosocomial infection (NI) surveillance in an Intensive Care Unit (ICU).
- Utilized 6 years of data (1987-1992) from Santa Maria Hospital's Respiratory ICU.
- Focused on understanding the epidemiology and impact of NI in critically ill patients.
Purpose:
- To establish a continuous surveillance system for nosocomial infections (NI) in the ICU.
- To identify risk factors, prevalent microorganisms, and guide empiric antibiotic therapy.
- To analyze the clinical outcomes and mortality associated with NI.
Summary:
- 10% of 2528 ICU patients (1987-1992) had bacteriologically confirmed NI.
- NI predominantly affected mechanically ventilated patients (20.7% incidence).
- Gram-negative bacteria (Enterobacteriaceae) were most common (63.37%), followed by Staphylococcus spp. with concerning methicillin resistance.
Impact:
- NI patients exhibited higher severity and therapeutic intervention scores.
- Mechanical ventilation duration was fourfold longer in NI patients.
- Mortality rates were 2.5 times higher in patients with nosocomial infections.