RESUMEN
BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in intensive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors. METHODS: Between April and October 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient. RESULTS: Two hundred and four patients were included and 85 developed a nosocomial infection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 developed nosocomial infections at other sites. The CAUTI rate was 19.02 per 1000 catheter-days. A Cox proportional hazard model showed that in the presence of other site nosocomial infections, immune suppression (hazard ratio (HR) 3.73, 95% CI 1.47-9.46; p = 0.006), previous antibiotic usage (HR 2.06, 95% CI 1.11-3.83; p = 0.023), and the presence of a nosocomial infection at another site (HR 1.82, 95% CI 1.04-3.20; p = 0.037) were the factors associated with the acquisition of CAUTIs with or without a nosocomial infection at another site. When we excluded the other site nosocomial infections to determine if the risk factors differed depending on the presence of other nosocomial infections, female gender (HR 2.67, 95% CI 1.03-6.91; p = 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01-1.13; p = 0.019) were found to be the risk factors for the acquisition of CAUTIs alone. CONCLUSIONS: Our results showed that the presence of nosocomial infections at another site was an independent risk factor for the acquisition of a CAUTI and that their presence alters risk factors.
Asunto(s)
Infecciones Relacionadas con Catéteres/epidemiología , Coinfección/epidemiología , Infección Hospitalaria/complicaciones , Infección Hospitalaria/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Infecciones Urinarias/epidemiología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Relacionadas con Catéteres/complicaciones , Infecciones Relacionadas con Catéteres/microbiología , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/microbiología , Coinfección/microbiología , Infección Hospitalaria/microbiología , Femenino , Bacterias Gramnegativas/clasificación , Bacterias Gramnegativas/aislamiento & purificación , Hospitales Universitarios , Humanos , Incidencia , Masculino , Modelos de Riesgos Proporcionales , Factores de Riesgo , Staphylococcus/clasificación , Staphylococcus/aislamiento & purificación , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/métodos , Infecciones Urinarias/complicaciones , Infecciones Urinarias/microbiologíaRESUMEN
Atypical measles is characterized by high fever, headache, myalgia and atypical rash, in patients who were vaccinated against measles. In this report a 22 years old male patient presenting with severe cervical and shoulder muscles spasms, purpuric and petechial lesions on palm, sole and whole body, has been presented. The patient had not an underlying disease or immunosuppression, and he had experienced single dose of measles vaccine when he was nine months old. Diagnosis of atypical measles was based on the clinical and serological findings (by measles IgM and IgG positivity). The aim of the presentation of this case was to emphasize that atypical measles should be considered for differential diagnosis in the cases complaining of muscle spasms and atypical skin rashes even if vaccinated against measles.
