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Nosocomial Infections in a Respiratory Intensive Care Unit: An Indian Experience

Postgraduate Institute of Medical Education & Research, Chandigarh, India

PURPOSE: There is a paucity of data on nosocomial infections from India. We determined prevalence, pattern, risk factors and outcome of infections acquired in patients admitted to our Respiratory Intensive Care Unit (RICU).

METHODS: Data on RICU-acquired infection were collected prospectively over a 15-month period. The presence of risk factors such as the endotracheal intubation, surgical drains, invasive lines, renal failure, diabetes mellitus, malignancy and immunosuppressive therapy were evaluated in patients who developed infections using univariate and multivariate logistic regression analyses. The effect of infection on RICU stay was studied using survival analysis and log-rank test.

RESULTS: Of the 217 patients enrolled, 201 were included in the final analyses. Seventy-seven (38.5 %) patients developed one or the other infection. The most frequently acquired ICU infection was pneumonia (23%). The other infections were clinical sepsis (10.5%), bacteremia (7.5%), urinary tract infection (1.5%), catheter related bloodstream infection (1%) and Clostridium difficile colitis (1%). Positive cultures were obtained in 40 (51.9%) patients. The commonly identified organisms included the Acinetobacter species (34.8%), Pseudomonas aeruginosa (23.9%), and Escherichia coli (15.2%). Length of stay in RICU (OR = 1.22), renal failure (OR = 3.15) and presence of invasive intra-vascular lines (OR = 3.6) were the more significant risk factors for RICU-acquired infection. Increasing APACHE II scores (OR 1.11; 95% CI: 1.05-1.18) and presence of endotracheal tube (OR 4.11; 95%CI: 1.07-15.87) or invasive lines (OR 3.44; 95%CI: 1.03-11.5) contributed significantly to mortality; infection was not a significant factor (OR=1.88; 95%CI: 0.85-4.98). Median stay in patients with infection (13 days) was longer than in those without infection (4 days).

CONCLUSION: Infections acquired during hospitalization prolonged ICU stay but had no effect on ICU survival.

CLINICAL IMPLICATIONS: Identification of risk factors for and causative microorganisms of infections in RICU can help in formulating appropriate management and preventive strategies.

DISCLOSURE: D. Gupta, None.