Importance of medium time in case of device-associated infection

Abstract

Background: Intensive Therapeutic Units (ITUs) are unfortunately the epicenters of hospital acquired infection (HAIs). Limited data is available regarding the burden of HAIs in Indian ITU, especially median time of its detection, prevalent organisms and its resistance patterns. We conducted a prospective surveillance aimed to determine the occurrence of device associated infections (DAIs) rate, magnitude of device associated infection cases per 1000 bed days, incidence of infections per 1000 device days and median time for detection of DAIs. Study population was taken from a 25 bedded intensive therapeutic unit (ITU), of a government teaching hospital in India. Methods: A prospective cohort study was performed over two years duration from June 2011 to May 2013. Total 596 patients who were admitted in the ITU for more than 48 hours were followed until discharge. CDC/NNIS system definitions for DAIs were used and rates were calculated. Data were analyzed with descriptive statistics. Results: Cumulative incidence rate of HAIs was 23.15 (138/596) and isolated DAIs was 19.96 (119/596). There was high device utilization mainly for urinary catheter (.838) and IV catheter (.742) than ventilator (.310) but the incidence density was more in ventilator associated infection(VAP-7.38%) than catheter associated urinary tract infection (CAUTI-7.21%) and catheter related blood stream infection (CRBSI-5.37%). Chi-square value for MV(mechanical ventilation) was found 42.59 (<0.001) and ODD Ratio (OR) was 6.8 at CI 3.44-13.67. For urinary catheter(UC) and IVCatheter Chi-square value was 1.13 and 1.94. OR was 1.67 (0.61-4.93) and 4.71 (0.67-94.03). Median time of acquiring VAP, UTI, BSI were maximum in between (9 to 11 days), (17 to 20 days) and (12 to 14) days respectively; indicates requirement of regular follow up of devices within thisZ periods. Major pathogens for VAP Klebsiella (28%), Acinetobacter(26.3%) and Pseudomonus (21%). For CAUTI Staphylococcus aureus (18.7%), pseudomonas and Klebsiella (14.6%) each. CRBSI mainly by gram positive Staphylococcus aureus (24.2%) and Coagulase negative Staphylococcus (12.1%), Acinetobacter (18.2%) and Staphylococcus aureus (15.2%). Conclusion: Although the distribution of pathogens was similar to previous reports, a high rate of device associated infection in ITU can be prevented by regular follow-up of devices, early change of invasive devices within its median time of infection or to avoid unnecessarily prolong use.

Keywords

• Comorbid illness
• device-associated infection
• intensive therapeutic unit
• median time of infection