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Healthcare associated infections in traumatology intensive care unit-where do we stand?

Aim. To determine the annual incidence of central venous catheter-associated bloodstream infections, ventilator-associated pneumonia, and catheter associated urinary tract infections, to determine causative microorganisms and their antibiotic susceptibility patterns, to establish trends in infection rates and isolated causative pathogens and to compare that to literature data. Surveillance enables epidemiological follow up and points targets for improvement of infection control measures. Important and challenging issues of healthcare-associated infections (HCAI) in Intensive Care Units are the emergence of multidrug resistant microorganisms, and narrowing selection of accessible antimicrobial therapy.

Methods. Prospective study of VAP, CVC bacteriaemia and UTI infections in patients hospitalised between 1 January 2010 and 31 December 2013 in the Intensive Care Unit at the Clinic of Traumatology at the University Hospital Centre Sestre milosrdnice (Zagreb, Croatia).

Case definitions and infection rates used were based on ECDC HAIICU protocol for the surveillance of HAI in ICUs.

Results. In a 4-year period, the annual incidence of CVC bloodstream infection was 4.75, 8.68, 9.63, 9.90 per 1000 catheter-days. Incidence of VAP was 27.09, 13.76, 11.88, 13.98 per 1000 ventilator-days. Incidence of UTI was 12.94, 7.14, 7.71, and 11.18 per 1000 catheter-days.

Causative microorganisms frequency differentiated depending on the infection site, showing different distribution in each study year. Most frequent isolated pathogens were Enterobacteriae species susceptible to the 3rd generation cephalosporins (33.90%), following ESBL producing Enterobacteriaceae species (17.34%), Pseudomonas aeruginosa (15.67%), carbapenem resistant Acinetobacter baumannii (14.70%) and MRSA (5.90%). In 2013, the first carbapenem-resistant enteobacteria was isolated (Enterobacter cloacae VIM).

Conclusion. The incidence of device-related healthcare infections in our ICU corresponds to literature data. VAP and UTI incidence are showing decreasing or steady rates. CVC related bloodstream infection incidence is increasing. This trend shows us the need to establish improved infection control practice, preferably CVC insertion and maintenance bundles of care.

Susceptibility patterns of isolated pathogens are changing, causing appearance of old species with new resistance mechanisms which requires additional effort in infection control practice and in antibiotic stewardship program. These complex tasks are demanding a multidisciplinary effort from intensive care medicine, clinical microbiology and infection control practitioners.

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