Risk factors for healthcare associated infections and in-hospital mortality in neurological intensive care unit in tertiary hospital in Belgrade, Serbia: A prospective cohort study

Abstract

Background /Aim. Patients in neurologic intensive care unit (ICU) are especially susceptible to healthcare-associated infections (HAIs). HAIs are cause of significant morbidity and mortality. Aim of this study was to assess the incidence of HAIs, to identify significant risk factors (RFs) and causative microorganisms for HAIs and to identify RFs for in-hospital mortality in neurological ICU. Methods. Prospective cohort study was conducted in a 6-bed Active surveillance on HAIs was performed by hospital infection control team, using methodologies of European Centre for Disease Prevention and Control and National Healthcare Safety Network/ Centres for Disease Prevention and Control. Results. 148 patients with a total of 2708 patient-days were enrolled. There were 49 HAIs in 39 patients during the study period. The incidence and incidence density of HAIs were 26.3% and 18.1 per 1000 patient-days, respectively. The most frequent HAIs were urinary tract infections (15.5%), pneumonia (10.1%) and bloodstream infections (4%). RFs independently associated with HAIs in neurological ICU were urinary catheter (RR: 5.6; 95% CI: 1.153 -27.632), urinary catheter-days (RR: 1.1; 95% CI: 1.057 -1.188), central-line days (RR: 1.1; 95% CI: 1.010 -1.150), mechanical ventilation (RR: 0.3; 95% CI: 0.079 -0.859). The most common microorganism was Klebsiella spp. RFs independently associated with in-hospital mortality in neurological ICU were mechanical ventilation (RR: 6.5; 95% CI: 2.868 -14.116), Glasgow Coma Score (RR: 2.7; 95% CI: 1.135 -6,396), and age (RR: 1.03; 95% CI: 1.005 -1.055). Conclusion. Usage of invasive procedures during ICU hospitalization carries significant risk for development of HAIs. HAIs in ICU setting are most often caused by Gram-negative bacteria with substantial antimicrobial resistance. These results stress the importance of infection prevention. Key words: intensive care unit, neurology, healthcareassociated infections.Apstrakt Uvod/Cilj. Pacijenti u neurološkim jedinicama intenzivnog lečenja (JIL) su u posebnom riziku za nastanak bolničkih infekcija (BI). BI uzrokuju značajan morbiditet i mortalitet. Cilj ovog istraživanja bio je da se utvrdi incidencija BI, identifikuju faktori rizika (FR) i uzročnici BI, kao i da se ustanove FR za smrtni ishod u neurološkim JIL. Metode. U šestokrevetnoj JIL Klinike za neurologiju, Vojnomedicinske akademije sprovedena je prospektivna kohortna studija od januara 2014. godine do decembra 2016. godine. Rezultati. U studiju je uključeno 148 pacijenata praćenih tokom 2708 pacijent-dana. Registrovano je ukupno 49 BI kod 39 pacijenata. Incidencija BI je bila 26.3%, a gustina incidencije 18.1 na 1000 pacijent -dana. Najčešće BI bile su: infekcije mokraćnog sistema (15.5%), pneumonija (10.1%) i sepsa (4%). FR povezani sa nastankom BI u neurološkoj JIL su primena urinarnog katetera (RR: 5.6; 95% CI: 1.153 -27.632), dani primene urinarnog katetera (RR: 1.1; 95% CI: 1.057 -1.188), dani primene centralnog vaskularnog katetera (RR: 1.1; 95% CI: 1.010 -1.150), primena mehaničke ventilaci...

Global prevalence of nosocomial infection: A systematic review and meta-analysis

“…Such infections are not limited to specific patients. They may occur to every patient or hospital employee and increase the mortality rate of hospitals [7].…”

Preventive Nurse Actions and Risk Factors Associated With Health Care Related Infections: A Narrative Review

“…Age over 64 corresponds to an intrinsic factor, highly associated with an increase in this infection rate. 29,30,31,21,32 Evidence shows that 80% of UTIs are related to the use of a urinary catheter, and its presence is already considered an important and independent risk factor for the development of HAIs. 29,30,31 The length of stay with this device is also a relevant risk factor for UTI, increasing the risk rate of infection by 5% each day the catheter is used.…”

“…29,30,31,21,32 Evidence shows that 80% of UTIs are related to the use of a urinary catheter, and its presence is already considered an important and independent risk factor for the development of HAIs. 29,30,31 The length of stay with this device is also a relevant risk factor for UTI, increasing the risk rate of infection by 5% each day the catheter is used. 29,31 Microorganisms found in the urinary tract of individuals who develop a UTI while in intensive care are the Candida sp and Klebsiella pneumoniae 29,33 and Acinetobacter baumannii.…”

“…29,30,31 The length of stay with this device is also a relevant risk factor for UTI, increasing the risk rate of infection by 5% each day the catheter is used. 29,31 Microorganisms found in the urinary tract of individuals who develop a UTI while in intensive care are the Candida sp and Klebsiella pneumoniae 29,33 and Acinetobacter baumannii. 21…”

“…IPCS are among the most common HAIs found in intensive care patients, with prevalence rates ranging from 4 to 49%. 34,35,31 . This variation depends on other associated risk factors, such as the presence of invasive devices, such as hemodialysis catheters., 35,36,32 Venoarterial Extracorporeal Membrane Oxygenation (ECMO -Extracorporeal Membrane Oxygenation) 37 ; central venous catheter 17,35,25,31,32 and arterial catheter.…”