Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

Estuardo Salgado Yepez; Maria M Bovera; Victor D Rosenthal; Hugo A González Flores; Leonardo Pazmiño; Francisco Valencia; Nelly Alquinga; Vanessa Ramirez; Edgar Jara; Miguel Lascano; Veronica Delgado; Cristian Cevallos; Gasdali Santacruz; Cristian Pelaéz; Celso Zaruma; Diego Barahona Pinto

doi:10.4331/wjbc.v8.i1.95

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

World J Biol Chem. 2017 Feb 26;8(1):95-101. doi: 10.4331/wjbc.v8.i1.95.

Authors

Estuardo Salgado Yepez¹, Maria M Bovera¹, Victor D Rosenthal¹, Hugo A González Flores¹, Leonardo Pazmiño¹, Francisco Valencia¹, Nelly Alquinga¹, Vanessa Ramirez¹, Edgar Jara¹, Miguel Lascano¹, Veronica Delgado¹, Cristian Cevallos¹, Gasdali Santacruz¹, Cristian Pelaéz¹, Celso Zaruma¹, Diego Barahona Pinto¹

Affiliation

¹ Estuardo Salgado Yepez, Hugo A González Flores, Francisco Valencia, Vanessa Ramirez, Miguel Lascano, Cristian Cevallos, Cristian Pelaéz, Clínica la Merced, Quito 170401, Ecuador.

Abstract

Aim: To report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted in Quito, Ecuador.

Methods: A device-associated healthcare-acquired infection (DA-HAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units (ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) definitions and INICC methods.

Results: We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection (CLABSI) rate was 6.5 per 1000 central line (CL)-days, the ventilator-associated pneumonia (VAP) rate was 44.3 per 1000 mechanical ventilator (MV)-days, and the catheter-associated urinary tract infection (CAUTI) rate was 5.7 per 1000 urinary catheter (UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9 (CLABSI) and 5.3 (CAUTI)] and higher than NHSN rates [0.8 (CLABSI) and 1.3 (CAUTI)] - although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC (16.5) and NHSN's rates (1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI.

Conclusion: DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.

Keywords: Antibiotic resistance; Catheter-associated urinary tract infection; Central line-associated bloodstream infections; Developing countries; Healthcare-associated infection; Hospital infection; Intensive care unit; Surveillance; Ventilator-associated pneumonia.