Are most ICU infections really nosocomial ? A prospective observational cohort study in mechanically ventilated patients.
A prospective cohort study was undertaken with two end points : (i) to compare the 48 h time cut-off with the carrier state criterion for classifying infections, and (ii) to determine a time cut-off more in line with the carrier state concept.
All patients admitted to the intensive care unit and expected to require mechanical ventilation for a period >= 3 days were enrolled.
Surveillance cultures of throat and rectum were obtained on admission and thereafter twice weekly to distinguish micro-organisms that were imported into the intensive care unit from those acquired during the stay in the unit.
A total of 117 patients with median age of 61 years and median Simplified Acute Physiology Score II of 42, were included in the study.
Of these patients, 48 (41%) developed a total of 74 infection episodes.
Using the 48 h cut-off point, 80% of all infections were classified as ICU-acquired.
According to the carrier state criterion, 44 infections (60%) were of primary endogenous development caused by micro-organisms imported into the intensive care unit.
Seventeen secondary endogenous (23%) and 13 exogenous (17%) infections were caused by bacteria acquired in the unit.
The carrier state classification allowed the transfer of 49% of infections from the ICU-acquired group into the import group.
A time cut-off of nine days was found to identify ICU-acquired infections better than two days. (...)
Mots-clés Pascal : Unité soin intensif, Ventilation mécanique, Surveillance, Culture microorganisme, Nasopharynx, Rectum, Infection nosocomiale, Homme, Prévention, Etude statistique, Colonisation, Exploration microbiologique, Etiologie, Contrôle, Hygiène
Mots-clés Pascal anglais : Intensive care unit, Mechanical ventilation, Surveillance, Microorganism culture, Nasopharynx, Rectum, Nosocomial infection, Human, Prevention, Statistical study, Colonization, Microbiological investigation, Etiology, Check, Hygiene
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0334526
Code Inist : 002B05A03. Création : 16/11/1999.