Jpn. J. Infect. Dis., 65 (2), 146-151, 2012
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Alterations in Bacterial Spectrum and Increasing Resistance Rates in Isolated Microorganisms from Device-Associated Infections in an Intensive Care Unit of a Teaching Hospital in Istanbul (2004–2010)
Asuman Inan1*, Asu Ozgultekin2, Seniha Senbayrak Akcay3, Derya Ozturk Engin1, Guldem Turan2, Nurgul Ceran1, Emine Dincer2, Sebahat Aksaray3, Pasa Goktas1, and Ilknur Erdem4
1Department of Infectious Diseases and Clinical Microbiology, 2Department of Anesthesiology and Reanimation, 3Department of Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul; and 4Department of of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey
(Received July 14, 2011. Accepted December 26, 2011)
*Corresponding author: Mailing address: Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Tibbiye Street 34668, Uskudar, Istanbul, Turkey. Fax: +90 216 347 52 01, E-mail: firstname.lastname@example.org
SUMMARY: The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical–surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp. and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum β-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed.
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