Epidemiology, clinical aspects, outcomes and prognostic factors associated with Trichosporon fungaemia: results of an international multicentre study carried out at 23 medical centres.

BACKGROUND: Trichosporon fungaemia (TF) episodes have increased in recent years and mortality rates remain high despite the advances in the management of sepsis. New concepts about its clinical course, treatment and microbiology need to be investigated for the better management of this infection. OBJECTIVES: To describe the aetiology, natural history, clinical management and prognostic factors of TF. METHODS: TF episodes documented between 2005 and 2018 in 23 South American centres were retrospectively investigated by using a standard clinical form. Molecular identification, antifungal susceptibility testing and biofilm production were also performed. RESULTS: Eighty-eight TF episodes were studied. Patients had several underlying conditions, including haematological diseases (47.7%), post-operative status (34%), solid organ transplants (n = 7, 7.9%), among others. Seventy-three (82.9%) patients had a central venous catheter (CVC) at TF diagnosis. The 30 day mortality rate was 51.1%. Voriconazole-based therapy was given to 34 patients (38.6%), with a 30 day mortality rate of 38.2%. Multivariate predictors of 30 day mortality were age (OR 1.036), mechanical ventilation (OR 8.25) and persistent neutropenia (OR 9.299). CVC removal was associated with over 75% decreased risk of 30 day mortality (OR 0.241). Microbiological analyses revealed that 77.7% of the strains were identified as Trichosporon asahii, and voriconazole showed the strongest in vitro activity against Trichosporon spp. Most of the strains (63%) were considered medium or high biofilm producers. CONCLUSIONS: Older age, mechanical ventilation and persistent neutropenia were associated with poor prognosis. CVC may play a role in the pathogenicity of TF and its removal was associated with a better prognosis.

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: findings of the International Nosocomial Infection Control Consortium.

OBJECTIVES: The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units. DESIGN: A prospective active surveillance before-after study. The study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance. SETTING: Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey. PATIENTS: A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals. INTERVENTIONS: The International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: 1) bundle of infection-control interventions; 2) education; 3) outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6) performance feedback of infection-control practices. MEASUREMENTS: The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention. MAIN RESULT: During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study. CONCLUSION: The implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries.

Clinicopathological Features and Mortality in Patients With Kaposi Sarcoma and HIV: A Retrospective Analysis of a Thirty-Year Study From a Peruvian Oncologic Center.

PURPOSE: Kaposi's sarcoma (KS) is a multifocal angioproliferative disease. In Peru, the implementation of the highly active antiretroviral treatment (HAART) program was in 2005, the model for treating patients with HIV-positive KS shifted to a potential cure. In this study, we aim to compare clinicopathological characteristics and prognostic factors associated with outcomes in patients with HIV-positive KS. METHODS: We developed a retrospective cohort study that includes patients with HIV/AIDS and KS seen in the Instituto Nacional de Enfermedades Neoplasicas between 1987 and 2017. Patients were divided into two groups according to the implementation of HAART in our country: the non-HAART group and those treated with HAART after 2005. Multivariate analysis for overall survival (OS) was performed with the Cox proportional hazard regression model. RESULTS: There was a greater visceral compromise and more extensive oral cavity involvement in the non-HAART group (60% 31.7%, P < .01). Regarding the immune status, there was a significant difference from the CD4 count at 1-year follow-up (73 v 335, P = .01). The CD4/CD8 rate were significant different before QT (0.23 v 0.13, P = .01) and at 1-year follow-up (0.12 v 0.32, P = .03.). The estimated 5-year OS rate was significantly lower (P = .0001) for the non-HAART group (41.7%; 95% CI, 25.9 to 56.9) compared with the HAART group (79.3%; 95% CI, 66.8 to 87.5). In the multivariate model for OS, full-HAART regimen and previous diagnosis of HIV/AIDS (P < .01) were significantly associated with longer survival. CONCLUSION: Clinical and demographic characteristics of our patients are compatible with the literature, but we report a higher rate of gastrointestinal involvement. Furthermore, our findings provide evidence for the importance of HAART and its ability to reduce KS-related mortality.

Listeria bacteremia in patients from a peruvian oncologic institute, 2005-2015. / Bacteriemia por listeria en pacientes de un instituto oncológico peruano, 2005-2015.

Listeriosis infection is a severe disease, with high morbidity and mortality in the immunocompromised patient, especially with disseminated and fatal presentations in cancer patients. A descriptive study was developed to describe the clinical and epidemiologic characteristics in oncologic patients with listeriosis in the Instituto Nacional de Enfermedades Neoplásicas between the years 2005-2015. A total of 29 patients were included; 23 (79.3%) of the listeriosis cases showed up in patients with hematological neoplasia, of which 52.1% was acute lymphatic leukemia and 39.1% non-Hodgkin's lymphoma. The 72.4% of the isolated species correspond to Listeria monocytogenes. Twenty-seven (93.1%) patients met sepsis criteria and twenty-four (82.7%) had neurologic affection. Bacteremia was the most common presentation, followed by meningoencephalitis (20.6%). Global mortality was 75.8%. In conclusion in cancer patients, listeriosis implies high morbidity and mortality. Therefore, the suspicion of this entity is mandatory in onco-hematologic patients with sepsis and acute neurologic symptoms.

La listeriosis es una infección severa de elevada morbimortalidad en el paciente inmunocomprometido, existen formas diseminadas y fatales en el paciente oncológico. Se realizó un estudio descriptivo de las características clínico-epidemiológicas de los pacientes oncológicos con listeriosis atendidos en el Instituto Nacional de Enfermedades Neoplásicas entre 2005 y 2015. Se incluyeron 29 pacientes, 23 (79,3%) casos de listeriosis se presentaron en pacientes con neoplasia hematológica, de los cuales el 52,3% fueron leucemia linfática aguda y 39,1% linfoma no Hodgkin. Listeria monocytogenes representó el 72,4% de las especies aisladas. Veintisiete (93,1%) tuvieron criterios de sepsis y veinticuatro (82,7%) compromiso neurológico al ingreso. La presentación más común fue la bacteriemia, seguida de la meningoencefalitis (20,6%). La mortalidad global fue del 75,8%. Se concluye que la listeriosis conlleva elevada morbimortalidad en el paciente oncohematológico, por lo que debe sospecharse en el paciente admitido con sepsis y/o compromiso neurológico agudo.

Device-associated nosocomial infections in 55 intensive care units of 8 developing countries.

BACKGROUND: Health care-associated infections from invasive medical devices in the intensive care unit (ICU) are a major threat to patient safety. Most published studies of ICU-acquired infections have come from industrialized western countries. In a Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance (NNIS) System report, the U.S. pooled mean rates of central venous catheter (CVC)-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections were 4.0 per 1000 CVC days, 5.4 per 1000 mechanical ventilator days, and 3.9 per Foley catheter days, respectively. OBJECTIVE: To ascertain the incidence of device-associated infections in the ICUs of developing countries. DESIGN: Multicenter, prospective cohort surveillance of device-associated infection by using the CDC NNIS System definitions. SETTING: 55 ICUs of 46 hospitals in Argentina, Brazil, Colombia, India, Mexico, Morocco, Peru, and Turkey that are members of the International Nosocomial Infection Control Consortium (INICC). MEASUREMENTS: Rates of device-associated infection per 100 patients and per 1000 device days. RESULTS: During 2002-2005, 21,069 patients who were hospitalized in ICUs for an aggregate 137,740 days acquired 3095 device-associated infections for an overall rate of 14.7% or 22.5 infections per 1000 ICU days. Ventilator-associated pneumonia posed the greatest risk (41% of all device-associated infections or 24.1 cases [range, 10.0 to 52.7 cases] per 1000 ventilator days), followed by CVC-related bloodstream infections (30% of all device-associated infections or 12.5 cases [range, 7.8 to 18.5 cases] per 1000 catheter days) and catheter-associated urinary tract infections (29% of all device-associated infections or 8.9 cases [range, 1.7 to 12.8 cases] per 1000 catheter days). Notably, 84% of Staphylococcus aureus infections were caused by methicillin-resistant strains, 51% of Enterobacteriaceae isolates were resistant to ceftriaxone, and 59% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones. The crude mortality rate for patients with device-associated infections ranged from 35.2% (for CVC-associated bloodstream infection) to 44.9% (for ventilator-associated pneumonia). LIMITATIONS: These initial data are not adequate to represent any entire country, and likely variations in the efficiency of surveillance and institutional resources may have affected the rates that were detected. CONCLUSIONS: Device-associated infections in the ICUs of these developing countries pose greater threats to patient safety than in U.S. ICUs. Active infection control programs that perform surveillance of infection and implement guidelines for prevention can improve patient safety and must become a priority in every country.

Bacteriemia por listeria en pacientes de un instituto oncológico peruano, 2005-2015 / Listeria bacteremia in patients from a peruvian oncologic institute, 2005-2015

RESUMEN La listeriosis es una infección severa de elevada morbimortalidad en el paciente inmunocomprometido, existen formas diseminadas y fatales en el paciente oncológico. Se realizó un estudio descriptivo de las características clínico-epidemiológicas de los pacientes oncológicos con listeriosis atendidos en el Instituto Nacional de Enfermedades Neoplásicas entre 2005 y 2015. Se incluyeron 29 pacientes, 23 (79,3%) casos de listeriosis se presentaron en pacientes con neoplasia hematológica, de los cuales el 52,3% fueron leucemia linfática aguda y 39,1% linfoma no Hodgkin. Listeria monocytogenes representó el 72,4% de las especies aisladas. Veintisiete (93,1%) tuvieron criterios de sepsis y veinticuatro (82,7%) compromiso neurológico al ingreso. La presentación más común fue la bacteriemia, seguida de la meningoencefalitis (20,6%). La mortalidad global fue del 75,8%. Se concluye que la listeriosis conlleva elevada morbimortalidad en el paciente oncohematológico, por lo que debe sospecharse en el paciente admitido con sepsis y/o compromiso neurológico agudo.

ABSTRACT Listeriosis infection is a severe disease, with high morbidity and mortality in the immunocompromised patient, especially with disseminated and fatal presentations in cancer patients. A descriptive study was developed to describe the clinical and epidemiologic characteristics in oncologic patients with listeriosis in the Instituto Nacional de Enfermedades Neoplásicas between the years 2005-2015. A total of 29 patients were included; 23 (79.3%) of the listeriosis cases showed up in patients with hematological neoplasia, of which 52.1% was acute lymphatic leukemia and 39.1% non-Hodgkin's lymphoma. The 72.4% of the isolated species correspond to Listeria monocytogenes. Twenty-seven (93.1%) patients met sepsis criteria and twenty-four (82.7%) had neurologic affection. Bacteremia was the most common presentation, followed by meningoencephalitis (20.6%). Global mortality was 75.8%. In conclusion in cancer patients, listeriosis implies high morbidity and mortality. Therefore, the suspicion of this entity is mandatory in onco-hematologic patients with sepsis and acute neurologic symptoms.

Bacteriemia por listeria en pacientes de un instituto oncológico peruano, 2005-2015 / Listeria bacteremia in patients from a peruvian oncologic institute, 2005-2015

RESUMEN La listeriosis es una infección severa de elevada morbimortalidad en el paciente inmunocomprometido, existen formas diseminadas y fatales en el paciente oncológico. Se realizó un estudio descriptivo de las características clínico-epidemiológicas de los pacientes oncológicos con listeriosis atendidos en el Instituto Nacional de Enfermedades Neoplásicas entre 2005 y 2015. Se incluyeron 29 pacientes, 23 (79,3%) casos de listeriosis se presentaron en pacientes con neoplasia hematológica, de los cuales el 52,3% fueron leucemia linfática aguda y 39,1% linfoma no Hodgkin. Listeria monocytogenes representó el 72,4% de las especies aisladas. Veintisiete (93,1%) tuvieron criterios de sepsis y veinticuatro (82,7%) compromiso neurológico al ingreso. La presentación más común fue la bacteriemia, seguida de la meningoencefalitis (20,6%). La mortalidad global fue del 75,8%. Se concluye que la listeriosis conlleva elevada morbimortalidad en el paciente oncohematológico, por lo que debe sospecharse en el paciente admitido con sepsis y/o compromiso neurológico agudo.

ABSTRACT Listeriosis infection is a severe disease, with high morbidity and mortality in the immunocompromised patient, especially with disseminated and fatal presentations in cancer patients. A descriptive study was developed to describe the clinical and epidemiologic characteristics in oncologic patients with listeriosis in the Instituto Nacional de Enfermedades Neoplásicas between the years 2005-2015. A total of 29 patients were included; 23 (79.3%) of the listeriosis cases showed up in patients with hematological neoplasia, of which 52.1% was acute lymphatic leukemia and 39.1% non-Hodgkin's lymphoma. The 72.4% of the isolated species correspond to Listeria monocytogenes. Twenty-seven (93.1%) patients met sepsis criteria and twenty-four (82.7%) had neurologic affection. Bacteremia was the most common presentation, followed by meningoencephalitis (20.6%). Global mortality was 75.8%. In conclusion in cancer patients, listeriosis implies high morbidity and mortality. Therefore, the suspicion of this entity is mandatory in onco-hematologic patients with sepsis and acute neurologic symptoms.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module.

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach over 13 years in 51 cities of 19 limited-resource countries from Latin America, Asia, the Middle East, and Europe.

OBJECTIVE: To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance. DESIGN: An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period. SETTING: Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey. PARTICIPANTS: Healthcare workers at 99 ICU members of the INICC. METHODS: A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. Observations were made for hand hygiene compliance in each ICU, during randomly selected 30-minute periods. RESULTS: A total of 149,727 opportunities for hand hygiene were observed. Overall hand hygiene compliance increased from 48.3% to 71.4% ([Formula: see text]). Univariate analysis indicated that several variables were significantly associated with poor hand hygiene compliance, including males versus females (63% vs 70%; [Formula: see text]), physicians versus nurses (62% vs 72%; [Formula: see text]), and adult versus neonatal ICUs (67% vs 81%; [Formula: see text]), among others. CONCLUSIONS: Adherence to hand hygiene increased by 48% with the INICC approach. Specific programs directed to improve hand hygiene for variables found to be predictors of poor hand hygiene compliance should be implemented.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009.

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia).

Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive care units of 15 developing countries.

BACKGROUND: The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership. METHODS: Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data. RESULTS: During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95% confidence interval, 0.33-0.63]; P < .001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P < .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted chlorhexidine for antisepsis increased from 7% to 27% (P < .001), and that sought to remove unneeded catheters increased from 37% to 83% (P < .001); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001). CONCLUSIONS: Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.

Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium.

OBJECTIVES: To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, and attributable mortality in intensive care units (ICUs) in hospitals in Peru that are members of the International Nosocomial Infection Control Consortium (INICC). METHODS: Prospective cohort surveillance of DAIs was conducted in ICUs in four hospitals applying the definitions for nosocomial infections of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS) and National Healthcare Safety Network (NHSN). RESULTS: From September 2003 to October 2007 1 920 patients hospitalized in ICUs for an aggregate of 9 997 days acquired 249 DAIs, accounting for a rate of 13.0% and 24.9 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 31.3 per 1 000 ventilator-days; the central venous catheter-associated bloodstream infections (CVC-BSI) rate was 7.7 cases per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 5.1 cases per 1 000 catheter-days. Extra mortality for VAP was 24.5% (RR 2.07, P < 0.001); for CVC-BSI the rate was 15.0% (RR 2.75, P = 0.028). Methicillin-resistant strains accounted for 73.5% of all Staphylococcus aureus DAIs; 40.5% of the Enterobacteriaceae were resistant to ceftriaxone, 40.8% were resistant to ceftazidime, and 32.0% were resistant to piperacillin-tazobactam. Sixty-five percent of Pseudomonas aeruginosa isolates were resistant to ciprofloxacin, 62.0% were resistant to ceftazidime, 29.4% were resistant to piperacillin-tazobactam, and 36.1% were resistant to imipenem. CONCLUSIONS: The high rates of DAIs in the Peruvian hospitals in this study indicate the need for active infection control. Programs consisting of surveillance of DAIs and implementation of guidelines for infection prevention can ensure improved patient safety in the ICUs and throughout hospitals.

International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008.

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from 2002 through 2007 in 98 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance System (NNIS) definitions for device-associated health care-associated infection, we collected prospective data from 43,114 patients hospitalized in the Consortium's hospital ICUs for an aggregate of 272,279 days. Although device utilization in the INICC ICUs was remarkably similar to that reported from US ICUs in the CDC's National Healthcare Safety Network, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infections (CLABs) in the INICC ICUs, 9.2 per 1000 CL-days, is nearly 3-fold higher than the 2.4-5.3 per 1000 CL-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia was also far higher, 19.5 vs 1.1-3.6 per 1000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 6.5 versus 3.4-5.2 per 1000 catheter-days. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (80.8% vs 48.1%), Enterobacter species to ceftriaxone (50.8% vs 17.8%), and Pseudomonas aeruginosa to fluoroquinolones (52.4% vs 29.1%) were also far higher in the Consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 14.3% (CLABs) to 27.5% (ventilator-associated pneumonia).

Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium / Tasas de infección asociadas a aparatos y mortalidad en unidades de cuidados intensivos de hospitales peruanos: datos del Consorcio Internacional para el Control de las Infecciones Nosocomiales

OBJECTIVES: To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, and attributable mortality in intensive care units (ICUs) in hospitals in Peru that are members of the International Nosocomial Infection Control Consortium (INICC). METHODS: Prospective cohort surveillance of DAIs was conducted in ICUs in four hospitals applying the definitions for nosocomial infections of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS) and National Healthcare Safety Network (NHSN). RESULTS: From September 2003 to October 2007 1 920 patients hospitalized in ICUs for an aggregate of 9 997 days acquired 249 DAIs, accounting for a rate of 13.0 percent and 24.9 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 31.3 per 1 000 ventilator-days; the central venous catheter-associated bloodstream infections (CVC-BSI) rate was 7.7 cases per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 5.1 cases per 1 000 catheter-days. Extra mortality for VAP was 24.5 percent (RR 2.07, P < 0.001); for CVC-BSI the rate was 15.0 percent (RR 2.75, P = 0.028). Methicillin-resistant strains accounted for 73.5 percent of all Staphylococcus aureus DAIs; 40.5 percent of the Enterobacteriaceae were resistant to ceftriaxone, 40.8 percent were resistant to ceftazidime, and 32.0 percent were resistant to piperacillin-tazobactam. Sixty-five percent of Pseudomonas aeruginosa isolates were resistant to ciprofloxacin, 62.0 percent were resistant to ceftazidime, 29.4 percent were resistant to piperacillin-tazobactam, and 36.1 percent were resistant to imipenem. CONCLUSIONS: The high rates of DAIs in the Peruvian hospitals in this study indicate the need for active infection control. Programs consisting of surveillance of DAIs and implementation of guidelines for infection prevention can ensure improved patient...

OBJETIVOS: Determinar las tasas de infecciones asociadas a aparatos (IAA), sus perfiles microbiológicos y la resistencia bacteriana, así como la mortalidad atribuible a estas infecciones en unidades de cuidados intensivos (UCI) de hospitales de Perú, miembros del Consorcio Internacional para el Control de las Infecciones Nosocomiales (INICC). MÉTODOS: Se hizo un seguimiento retrospectivo de cohorte de las IAA en las UCI de cuatro hospitales, según las definiciones de infección nosocomial del Sistema Nacional de Vigilancia de Infecciones Nosocomiales de los Centros para el Control y la Prevención de Enfermedades (CDC-NNIS) y de la Red Nacional de Seguridad Sanitaria (NHSN), de los Estados Unidos de América. RESULTADOS: De septiembre de 2003 a octubre de 2007, 1 920 pacientes hospitalizados en las UCI, con un total de 9 997 días, adquirieron 249 IAA, para una tasa de 13,0 por paciente (24,9 IAA por 1 000 días-UCI). La tasa de neumonía asociada a respiradores (NAR) fue de 31,3 casos por 1 000 días-ventilador; la tasa de infecciones circulatorias asociadas con cateterismo venoso central (IC-CVC) fue de 7,7 casos por 1 000 díascatéter; y la tasa de infecciones urinarias asociadas con el uso de catéteres (IUAC) fue de 5,1 casos por días-catéter. La mortalidad adicional por NAR fue de 24,5 por ciento (RR = 2,07; P < 0,001) y por IC-CVC fue de 15,0 por ciento (RR = 2,75; P = 0,028). De las IAA por Staphylococcus aureus, 73,5 por ciento se debían a cepas resistentes a la meticilina; de los aislamientos de Enterobacteriaceae, 40,5 por ciento eran resistentes a la ceftriaxona, 40,8 por ciento a la ceftazidima y 32,0 por ciento a la piperacilina-tazobactam. De los aislamientos de Pseudomonas aeruginosa, 65,0 por ciento eran resistentes a la ciprofloxacina; 62,0 por ciento a la ceftazidima; 36,1 por ciento al imipenem; y 29,4 por ciento a la piperacilina-tazobactam. CONCLUSIONES: Las elevadas tasas de IAA encontradas en los hospitales peruanos señalan...