Zasady prenumeraty miesięcznika Wiadomości Lekarskie na rok 2019 Zamówienia na prenumeratę przyjmuje Wydawnictwo Aluna

KEY WORDS: 
 
nosocomial
 
infection, antimicrobial resistance, intensive care unit
Wiad Lek 2019, 72, 5 cz. II, 963-969
PRACA ORYGINALNA
ORIGINAL ARTICLE

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Aidyn Salmanov et al. 
964
in 4 Kyiv city hospitals (2 general, 1 pediatric, and 1 women’s 
hospitals) that are similar in terms of medical equipment, 
personnel, laboratory facilities. The ICU type was classified 
according to the CDC/NHSN (National Healthcare Safety 
Network, CDC) criteria as a medical/surgical unit [11]. 
All eligible patients (642 patients) have been included in 
the surveillance. Patients who were transferred to the ICU 
from an outside hospital are also included. The exclusion 
criteria were patients with a community acquired infection, 
ICU stay for less than 48 h and death within 48 h of ICU 
admission. The follow-up of each patient was continued 
until discharge, referral, or death.
DEFINITIONS
A HAI was considered to be an infection developing during a 
hospitalization. Major and specific HAI site definitions were 
adapted from the CDC/NHSN case definitions [12]. Because 
of limitations in laboratory infrastructure, clinical sepsis 
was included among HAIs under surveillance in neonatal 
intensive care units (NICU). Surgical site infections were 
not monitored because surveillance focused on infections 
detected in ICU patients. An infection episode met HAI 
criteria when it occurred on or after the third calendar day 
in the ICU or within two calendar days of discharge from the 
ICU. In addition, institution of antimicrobial treatment by a 
physician was not considered to be sufficient for diagnosis of 
an HAI because of widespread use of empiric antimicrobial 
therapy. An infection was defined as device-associated (i.e., 
urinary catheter-, ventilator-, or central line-associated) 
if the corresponding device was in place on the date of 
infection or within two calendar days prior. ICU type was 
classified according to CDC/NHSN’s criteria.
ETHICS
The data was collected as a part of the hospital’s infection 
prevalence survey. According to the Health Research 
Act of Ukraine, quality assurance projects, surveys and 
evaluations that are intended to ensure that diagnosis and 
treatment actually produce the intended results do not 
need ethical committee approval and patient consent is not 
required. The research was carried out according to the plan 
of scientific investigations of the Shupyk National Medical 
Academy of Postgraduate Education, Kyiv, Ukraine.
DATA COLLECTION
Surveillance data on all ICU-acquired HAIs, both in patients 
with or without a device, and their causative pathogens 
were collected retrospective on a specifically designed 
form by the investigators using medical records comprising 
charts, daily flow sheets, laboratory (microbiology) results. 
The collected data included demographics; clinical signs; 
isolated pathogens with antibiogram results; and outcome 
on discharge from the ICU. All types of HAIs were recorded 
and analysed, including symptomatic urinary tract infection 
(UTI), pneumonia (PNEU), lower respiratory tract infection 
(LRTI), and blood stream infection (BSI). HAIs with only 
a few included cases such as skin, soft-tissue infections and 
gastrointestinal infections were analysed together as “other 
infections”. Patients with more than one type of infection 
simultaneously were analysed as a separate group. 
Up to four pathogens per HAI were recorded. For 
bloodstream infections specifically, “common commensal” 
organisms (e.g., coagulase-negative staphylococci, Bacillus 
spp.) were only considered pathogens if isolated from 
at least two blood cultures with signs or symptoms of a 
bloodstream infection, in accordance with CDC/NHSN 
criteria. The following variables were recorded for each 
patient: sex, age, season of admission, elective versus 
emergency admission, surgical procedure, use of urinary 
tract catheter (permanent and intermittent catheter).
MICROBIOLOGICAL SAMPLING
All samples (262) of isolates from HAI cases was sent to 
microbiology laboratory for identification and antimicrobial 
resistance testing. The identification and antimicrobial 
susceptibility of the cultures were determined, using automated 
microbiology analyzer Vitek 2 Compact (BioMerieux, France). 
Susceptibility to antibiotics was determined using AST cards 
(BioMerieux, France). Some antimicrobial sus ceptibility test 
used Kirby — Bauer antibiotic testing. Interpretative criteria 
were those suggested by the Clinical and Laboratory Standards 
Institute (CLSI) [13].
STATISTICAL ANALYSIS
HAIs were analysed as a binary exposure variable (no HAI, 
any HAI). We also analysed HAIs by type of infection 
(no HAI, UTI, PNEU, LRTI, BSI, other HAIs), which 
were mutually exclusive. The analysis of statistical data 
was performed using Microsoft Excel for Windows. 
Comparisons were carried out using the Student’s t-test, 
χ2. Statistical significance was defined as P < 0.05. 
RESULTS
During the surveillance period, among 642 patients, 148 
(23.1%) HAIs were observed. Death during hospitalization 
was reported in 20.1% HAI cases. The pooled mean incidence 
of HAI varied by ICU type (Table I). PNEU (47.3%), BSI 
(21.6%), and UTI (14.9) together accounted for 83.8% of all 
HAIs reported (Table II). Most PNEU, BSI, and UTI cases 
were device-associated. A minority of BSI (42%) were central 
line-associated. Of BSI 69% occurred in patients <1 year old, of 
which 83% were laboratory-confirmed BSI and the remainder 
(17%) clinical sepsis. The overall prevalence of HAIs was 
23.1% and the prevalence of the three most recorded types 
of infections was for PNEU 10.9 %, BSI 5.0%, and UTI 3.4%.
DEVICE-ASSOCIATED INFECTIONS
A total of 118 (79.7%) device-associated infections (DAIs) were 
found, of which 46.8% were ventilator associated pneumonia 

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HEALTHCARE-ASSOCIATED INFECTIONS IN INTENSIVE CARE UNITS
965
(VAPs), 43.2% central line-associated bloodstream infections 
(CLABSIs) and 9.3% catheter-associated urinary tract 
infections (CAUTIs). In the population, 56 out of 642 patients 
(6%) were affected by at least one episode of ICU-acquired 
pneumonia, and 72.7% of these were VAPs. The incidence 
rate of ICU-acquired pneumonia was 9 episodes per 1000 
patient-days and VAP incidence rate was 18.2 per 1000 MV 
days. On average, ICU-acquired BSIs occurred in 4.4% of 
patients staying in an ICU for more than 48 h. The incidence 
rate was 6.8 BSI episodes per 1000 patient-days. 89.5% of cases 
were CLABSIs with an incidence rate of 8.2 per 1000 CL days. 
The ICU-acquired urinary tract infections (UTIs) occurred in 
2.7% of patients staying in an ICU for more than 48 h., with 
84.6% of UTI episodes being associated with the use of a UC 
The incidence rate per ICU was 1.5 UTI episodes per 1000 
patient-days and a mean device-adjusted rate of 1.6 CAUTI 
episodes per 1000 UC – days. 
MICROORGANISMS CAUSING HAI IN ICUS
Among all 148 HAI, a total of 262 organisms were identified 
(Table III). Considering all HAI types together, 
Klebsiella 
pneumoniae
were most commonly reported, accounting 
for 21.8% of all organisms, followed by 
Acinetobacter 
baumanni
(14.3% of organisms), 
Pseudomonas aeruginosa
(12.4% of organisms) and 
Escherichia coli
(9.4% of 
organisms); these were the same organisms reported most 
commonly for pneumonia cases. Thirteen VAP episodes 
were non-microbiologically confirmed. All yeasts found 
were classified as 
Candida 
species. The most frequently 
isolated microorganisms in ICU-acquired CLABSI 
episodes were 
Staphylococcus aureus
and coagulase-
negative staphylococci (Staphylococcus epidermidis) 
(14.6%); among Gram-negative bacteria 
K. pneumoniae
and 
A.baumanni
spp. were the most frequent isolates. 
Candida
species (45.4%), 
K. pneumoniae
(18.1%) and 
P.aeruginosa
(13.4%) were the most frequently isolated 
microorganisms in CAUTI episodes.
ANTIMICROBIAL RESISTANCE
The antimicrobial-resistance in the isolates associated 
with ICU-acquired HAIs showed, among the Gram-
positive bacteria, that 59.8% and 6.6% of 
S.aureus