Nosocomial infections in medical intensive care units in the United States

Objective:To describe the epidemiology of nosocomial infections in combined medical-surgical (MS) intensive care units (ICUs) participating in the National Nosocomial Infection Surveillance (NNIS) System.Design:Analysis of surveillance data on 498,998 patients with 1,554,070 patient-days, collected between 1992 and 1998 from 205 MS ICUs following the NNIS Intensive Care Unit protocol, representing 152 participating NNIS hospitals in the United States.Results:Infections at three major sites represented 68% of all reported infections (nosocomial pneumonia, 31%; urinary tract infections (UTIs), 23%; and primary bloodstream infections (BSIs), 14%: 83% of episodes of nosocomial pneumonia were associated with mechanical ventilation, 97% of UTIs occurred in catheterized patients, and 87% of primary BSIs in patients with a central line. In patients with primary BSIs, coagulase-negative staphylococci (39%) were the most common pathogens reported; Staphylococcus aureus (12%) was as frequently reported as enterococci (11%). Coagulase-negative staphylococcal BSIs were increasingly reported over the 6 years, but no increase was seen in candidemia or enterococcal bacteremia. In patients with pneumonia, S aureus (17%) was the most frequently reported isolate. Of reported isolates, 59% were gram-negative bacilli. In patients with UTIs, Escherichia coli (19%) was the most frequently reported isolate. Of reported isolates, 31% were fungi. In patients with surgical-site infections, Enterococcus (17%) was the single most frequently reported pathogen. Device-associated nosocomial infection rates for BSIs, pneumonia, and UTIs did not correlate with length of ICU stay, hospital bed size, number of beds in die ICU, or season. Combined MS ICUs in major teaching hospitals had higher device-associated infection rates compared to all other hospitals with combined medical-surgical units.Conclusions:Nosocomial infections in MS ICUs at the most frequent infection sites (bloodstream, urinary, and respiratory tract) almost always were associated with use of an invasive device. Device-associated infection rates were die best available comparative rates between combined MS ICUs, but the distribution of device-associated rates should be stratified by a hospital's major teaching affiliation status.

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Comparison of rates of nosocomial infections in neonatal intensive care units in the United States

The American Journal of Medicine ◽

10.1016/0002-9343(91)90368-8 ◽

1991 ◽

Vol 91 (3) ◽

pp. S192-S196 ◽

Cited By ~ 80

Author(s):

Robert P. Gaynes ◽

◽

William J. Martone ◽

David H. Culver ◽

T.Grace Emori ◽

...

Keyword(s):

United States ◽

Intensive Care ◽

Intensive Care Units ◽

Nosocomial Infections ◽

Neonatal Intensive Care ◽

The United States ◽

Neonatal Intensive Care Units

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Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units—United States, 1990–2007

Infection Control and Hospital Epidemiology ◽

10.1086/660872 ◽

2011 ◽

Vol 32 (8) ◽

pp. 748-756 ◽

Cited By ~ 55

Author(s):

Deron C. Burton ◽

Jonathan R. Edwards ◽

Arjun Srinivasan ◽

Scott K. Fridkin ◽

Carolyn V. Gould

Keyword(s):

United States ◽

Intensive Care ◽

Urinary Tract ◽

Intensive Care Units ◽

Urinary Tract Infections ◽

Asymptomatic Bacteriuria ◽

The United States ◽

Symptomatic Urinary Tract Infection ◽

Prevention Guidelines ◽

Tract Infections

Background.Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.Objective.To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.Methods.Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.Results.Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.Conclusions.Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.

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