Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Estuardo Salgado Yepez, Hugo A González Flores, Francisco Valencia, Vanessa Ramirez, Miguel Lascano, Cristian Cevallos, Cristian Pelaéz, Clínica la Merced, Quito 170401, Ecuador
Maria M Bovera, Leonardo Pazmiño, Nelly Alquinga, Edgar Jara, Veronica Delgado, Gasdali Santacruz, Celso Zaruma, Diego Barahona Pinto, Hospital de los Valles, Quito 170901, Ecuador
Victor D Rosenthal, International Nosocomial Infection Control Consortium, Buenos Aires 1429, Argentina
Author contributions: All authors were involved in study conception and design, drafting of the manuscript, provision of study patients, collection of data, critical revision of the manuscript for important intellectual content, and final approval of the manuscript; Rosenthal VD was responsible for software development, data assembly, analysis, and interpretation, epidemiologic analysis, statistical analysis and technical support.
Institutional review board statement: Every hospital’s Institutional Review Board agreed to the study protocol, and patient confidentiality was protected by codifying the recorded information, making it only identifiable to the infection control team.
Informed consent statement: All involved persons (subjects or legally authorized representative) gave their informed consent prior to study inclusion.
Conflict-of-interest statement: All authors report no conflicts of interest related to this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at victor_rosenthal@inicc.org.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Victor D Rosenthal, MD, Chairman, International Nosocomial Infection Control Consortium, 11 de Septiembre 4567, Floor 12, Apt 1201, Buenos Aires 1429, Argentina.
victor_rosenthal@inicc.org
Telephone: +54-11-47047227
Received: September 17, 2016
Peer-review started: September 19, 2016
First decision: November 14, 2016
Revised: December 31, 2016
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: February 26, 2017
Processing time: 161 Days and 14.9 Hours
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.
Core tip: This is a prospective, cohort, surveillance study on device-associated infection rates, mortality, length of stay and bacterial resistance conducted in intensive care units (ICUs) in Ecuador from October 2013 to January 2015. Device-associated healthcare-acquired infection rates in our ICUs from Ecuador are significantly higher than United States Centers for Disease Control and Prevention’s National Healthcare Safety Network’s rates and similar to International Nosocomial Infection Control Consortium’s international rates.
