Infections in a surgical intensive care unit of a university hospital in Greece

Haridimos Markogiannakis, Nikoleta Pachylaki, Eleni Samara, Melpomeni Kalderi, Maria Minettou, Marina Toutouza, Konstantinos G Toutouzas, Dimitrios Theodorou, Stilianos Katsaragakis
International Journal of Infectious Diseases: IJID 2009, 13 (2): 145-53

OBJECTIVES: We aimed to evaluate the clinical and microbiological characteristics of the patients who developed an infection in our surgical intensive care unit (SICU).

METHODS: This was a prospective study of all patients who sustained an ICU-acquired infection from 2002 to 2004.

RESULTS: Among 683 consecutive SICU patients, 123 (18.0%) developed 241 infections (48.3 infections per 1000 patient-days). The mean age of patients was 66.7+/-3.8 years, the mean APACHE II score (acute physiology and chronic health evaluation) on SICU admission was 18.2+/-2.4, and the mean SOFA score (sepsis-related organ failure assessment) at the onset of infection was 8.8+/-2. Of the study patients, 51.2% were women. Infections were: bloodstream (36.1%), ventilator-associated pneumonia (VAP; 25.3%, 20.3/1000 ventilator-days), surgical site (18.7%), central venous catheter (10.4%, 7.1/1000 central venous catheter-days), and urinary tract infection (9.5%, 4.6/1000 urinary catheter-days). The most frequent microorganisms found were: Acinetobacter baumannii (20.3%), Pseudomonas aeruginosa (15.7%), Candida albicans (13.2%), Enterococcus faecalis (10.4%), Klebsiella pneumoniae (9.2%), Enterococcus faecium (7.9%), and Staphylococcus aureus (6.7%). High resistance to the majority of antibiotics was identified. The complication and mortality rates were 58.5% and 39.0%, respectively. Multivariate analysis identified APACHE II score on admission (odds ratio (OR) 4.63, 95% confidence interval (CI) 2.69-5.26, p=0.01), peritonitis (OR 1.85, 95% CI 1.03-3.25, p=0.03), acute pancreatitis (OR 2.27, 95% CI 1.05-3.75, p=0.02), previous aminoglycoside use (OR 2.84, 95% CI 1.06-5.14, p=0.03), and mechanical ventilation (OR 3.26, 95% CI: 2.43-6.15, p=0.01) as risk factors for infection development. Age (OR 1.16, 95% CI 1.01-1.33, p=0.03), APACHE II score on admission (OR 2.53, 95% CI 1.77-3.41, p=0.02), SOFA score at the onset of infection (OR 2.88, 95% CI 1.85-4.02, p=0.02), and VAP (OR 1.32, 95% CI 1.04-1.85, p=0.03) were associated with mortality.

CONCLUSIONS: Infections are an important problem in SICUs due to high incidence, multi-drug resistance, complications, and mortality rate. In our study, APACHE II score on admission, peritonitis, acute pancreatitis, previous aminoglycoside use, and mechanical ventilation were identified as risk factors for infection development, whereas age, APACHE II score on admission, SOFA score at the onset of infection, and VAP were associated with mortality.

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