A prospectic nosocomial infection – survey in a medical department in Italy

Abstract number: 1135_87

Tosti A., Fiorio M., Marmotta S., Bellini M., Miele N.

Objectives:  

Measuring the incidence of nosocomial infections and microbial isolates in an Internal Medicine 23 bed-Unit in a 100-bed hospital.

Methods:  

Data were collected according to the NNIS protocol using a dedicated software from Epinfo program.

Results:  

From October 2002 to December 2003 (for a 14-month term), 1920 patients were enrolled (55% male and 45% female, median age: 76) for a total of 8530 patient-days; 78% of the patients had one or more comorbidities. The infections were 36 in 33 patients (1.71% of the total cases): 20 Urinary tract infections (UTI), 18 of which were catheter-related, 10 pneumonia, 5 blood stream infections (BSI), 1 of which Central Line Catheter-associated, 1 case of Pseudomembranous colitis. The device-utilization ratios were: 1.2% for CVC with an average catheterization of 7 days (103 central line-days); 19.9% for urinary catheter with an average catheterization of 5 days (1702 urinary catheter-days). A Central Line Catheter-associated BSI developed in 8% of patients exposed to CVC with a central line-associated BSI rate of 9.7 ‰. An UTI developed in 6.1% of patients exposed to a urinary catheter with an urinary catheter-associated UTI rate of 10.5 ‰. One patient died because of nosocomial pneumonia (0.9% attributable mortality), 7 patients died having been diagnosed a nosocomial infection. The microbial etiologies of UTIs were: Gram negative in 11 cases, Gram positive in 10 cases, Candida albicans in 3 cases (4 patients showed two contemporary pathogens isolated); BSIs Staphilococci in 3 cases, Gram negative in 1 case, 1 case of Clinical Sepsis.

Conclusions:  

Our study, comparing NNIS data, shows that nosocomial infections may be a problem also in Hospital Units not usually considered at high risk, probably due to advanced age and multiple comorbidities of the patients admitted. Despite a urinary catheter-utilization ratio within the norm, we observed a high incidence of UTI, which however showed an approximate 10% decrease during the period of our research.