INDICATORS OF INTENSIVE CARE UNIT-ACQUIRED INFECTIONS AND MORTALITY: TRENDS IN FIVE ICUs IN CATANIA

Abstract

Background: Hospital-acquired infections (HAIs) pose a significant clinical and economic burden worldwide. Surveillance has been associated with a reduction of HAI rates in Intensive Care Unit (ICU) patients, although the particular reasons for this decrease are still difficult to determine. The present study was conducted in order to report HAI surveillance data during an eight-year period in five ICUs in Catania. Methods: A patient-based HAI surveillance was conducted in the framework of the first four surveys of the Italian Nosocomial Infections Surveillance in ICUs network (SPIN-UTI) of the GISIO-SItI. Each survey consisted in a six-months surveillance conducted in: 2006-2007; 2008-2009; 2010-2011 and 2012-2013. During the study period, HAI cumulative incidence, incidence density and mortality were calculated overall and for each survey. Findings: From 2006 to 2013, a total of 2070 patients were admitted in the five participating ICUs and were included in the study. The cumulative incidences of infected patients in each survey were: 13.3, 17.0, 18.9 and 8.9 per 100 patients, respectively. Accordingly, the risk of ICU-acquired infections increased in the third survey compared with the first (RR: 1.43; 95%CI: 1.06-1.92) but it decreased in the fourth survey compared with the second (RR: 0.64; 95%CI: 0.47-0.86) and the third (RR: 0.57; 95%CI: 0.43-0.76). A similar trend was observed considering incidence of infections and incidence density. Although mortality did not show a significant trend between the four surveys, the risk of death increased for infected patients. Conclusions: The patient-based cohort design allowed us to analyze HAI indicators during an eight-years period, in five ICUs in Catania. Particularly, the risk of ICUacquired infections increased in the third survey compared with the first, whereas it decreased in the fourth survey compared with the second and the third surveys. Furthermore, mortality remained unchanged, however the risk of death significantly increased for infected patients, in each survey. Surveillance data are useful to support policymakers and leaders to make evidence-based decisions in the healthcare setting, to plan and improve programs, services and interventions for preventing, managing and treating HAI