Nosocomial Infections in a Neurosurgery Intensive Care Unit

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.

Surveillance Study of Healthcare-Associated Infections in a Pediatric Neurosurgery Unit in Italy

“…In our surveillance study, the incidence density (11.0/ 1,000 patient days) and the incidence rate (13.8/100 patients) of HAIs were relatively low compared to previously published data [2,3,4,5]. Such a discrepancy may be accounted for both the differences in the study setting and in the baseline characteristics of the study population.…”

“…Partly for the same reasons, we recorded lower device utilization ratios of urinary catheters and tracheal tubes [2,3,4,6]. Compared to data reported by the National Nosocomial Infections Surveillance System and other studies, device-associated infection rates were similar for CVCs and tracheal tubes and slightly higher for urinary catheters, suggesting the need for targeted implementation strategies [3,4,6]. The EVD utilization ratio and EVD-associated infection rate were slightly lower than those reported by the only previously published study [7] (table 3).…”

Nosocomial Pneumonia After Acute Stroke

“…21 Etiological agents for bacterial pneumonia vary by type of hospital, patient population at risk, diagnostic methods, and the microbial flora in the ICU. 6 In general, Gram-negative bacilli have been implicated in 40% to 60%, Staphylococcus aureus in 20% to 40%, and anaerobic bacteria in 0% to 35% of cases.…”

Indikationen und Outcome beatmeter Patienten einer neurologischen Intensivstation

“…Ein Faktor, der einerseits möglicher-weise zu verlängerter Intensivdauer führt und andererseits ein erhöhtes Risiko für die Mortalität birgt, ist die nosokomiale Infektion und die Sepsis [7]. Vacca et al sowie Dettenkofer et al konnten eine Inzidenz von 20,7% nosokomialer Infektionen auf einer neurochirurgischen Intensivstation nachweisen [7,27].…”