RESUMEN
Aim: Secondary bloodstream infections (SBSIs) are caused by another infection and differ from primary bloodstream infections (PBSIs) in terms of prevention and treatment strategies. The aim of this study was to determine the risk factors for bloodstream infections which were secondary to the most common healthcare-associated infections caused by the most common microorganisms in intensive care units (ICUs) and to examine whether extended-spectrum beta lactamase (ESBL) production and carbapenem resistance is related to the higher risk or not. Methods: The study population consisted of patients in ICUs with ventilator-associated pneumonia (VAP), ventilator-associated event (VAE) or catheter-associated urinary tract infection (CAUTI) caused by E. coli, K. pneumoniae, P. aeruginosa or A. baumannii between 2014 and 2019. The data were obtained through the National Healthcare-associated Infections Surveillance Network. Multivariate logistic regression analysis was performed separately for VAP/VAE and CAUTI to determine the risk factors for the development of SBSI. Results: Microorganism, ICU type, bed capasity and carbapenem resistance were found to be risk factors for SBSI for both types of infection. For VAPs/VAEs, female gender and hospital type were also identified as risk factors. The highest risk was in K.pneumoniae and in emergency ICUs. Among the hospitals, the highest risk in VAPs/VAEs was found in government education and research hospitals. ESBL production for K. pneumoniae and E. coli increased the risk in patients with VAP/VAE; however, it did not increase in patients with CAUTI. Discussion: By using the risk factors, it may be possible to recognize SBSIs earlier, especially in patients with CAUTIs or VAPs/VAEs caused by carbapenem-resistant or ESBL-producing K. pneumoniae.
RESUMEN
BACKGROUND: The prevalence of healthcare associated infection (HAI) is generally higher in countries with limited resources than developed countries. To address the high prevalence of HAI, Turkish Ministry of Health introduced a national infection control program in 2005. METHODS: Device associated (DA)-HAIs routinely surveyed included ventilator associated events, urinary catheter associated urinary tract infection and central line associated blood stream infection. Rates in DA-HAI were examined from 2008 to 2017 by type of hospitals, bed capacity, and geographic location of hospitals. RESULTS: All DA-HAIs declined significantly from 2008 to 2017 nationally for ventilator associated events from 16.69 to 4.86 per 1,000 device days (IRRâ¯=â¯0.29, P < .0001), catheter associated urinary tract infection from 4.98 to 1.59 per 1,000 catheter days (IRRâ¯=â¯0.31, P < .0001) and central line associated blood stream infection from 5.65 to 2.82 per 1,000 catheter days (IRRâ¯=â¯0.47, P < .0001). The rates for DA-HAIs declined significantly in hospitals with ≥200 beds and <200 bed capacity and in all 4 type of hospitals. By 2017 all DA-HAI had significantly improved across all regions. CONCLUSIONS: The introduction of a new national surveillance system supported by a national infection control program has significantly reduced 3 major DA-HAIs that are associated with risk of treatment failure and death. The next critical step in sustaining this crucial improvement will require timely feedback to hospitals using technology and continued buy-in from clinicians for their commitment to safety associated with DA-HAIs using aspirational DA-HAI rates.