Surveillance of Healthcare-Associated Infections in Adult Intensive Care Units. REA-Raisin Network, France, 2012 Results
Surveillance of healthcare-associated infections (HAIs) in intensive care units is a priority because patients are at higher risk of infection due to their critical condition and the invasive devices to which they are exposed. Since 2004, surveillance coordinated by the Network for Alert, Investigation, and Surveillance of HAI (Raisin) in intensive care has focused on infections associated with invasive devices for which a prevention strategy is essential: pneumonia (PNE), colonization, infection, or bacteremia (COL/ILC/BLC) associated with central venous catheters (CVC), urinary tract infections (UTI), and bacteremia (BAC). Each year, participating units collect data over a 6-month period on all patients hospitalized for more than 2 days (d). From January to June 2012, 196 departments included 29,554 patients (mean age: 63 years), hospitalized for an average of 11.6 days, of whom 67.5% were admitted to medical wards, 18.7% to emergency surgery, and 13.8% to elective surgery; 8.4% of patients were trauma patients, 15.0% were immunocompromised, and 58.3% received antibiotic therapy upon admission. The mean IGS II score was 44.4, and the in-department mortality rate was 18.4%. Exposure to invasive devices is common: intubation (66.0%), central venous catheter (CVC) (65.2%), and urinary catheter (87.6%). Among the 29,554 patients, 13.1% developed at least one infection; 11.2% of CVCs cultured yielded a positive result (COL/ILC/BLC). The most frequently isolated microorganisms were P. aeruginosa (16.0%), E. coli (13.0%), S. aureus (10.3%), S. epidermidis (6.5%), and Klebsiella pneumoniae (5.0%); 25.5% of S. aureus strains are methicillin-resistant (48.7% in 2004). Regarding Enterobacteriaceae, 17.5% of strains produce ESBL and 2.4% are resistant to imipenem. Incidence rates are 14.66 PNE per 1,000 intubation-days, 3.85 URI per 1,000 catheterization-days, 3.47 BAC per 1,000 hospital days, 0.79 ILC, and 0.68 BLC per 1,000 CVC-days. These rates vary significantly from one department to another depending on patient characteristics. From 2004 to 2012 across the entire network, while certain risk factors increased (age, ISC II, antibiotics on admission, exposure to invasive devices), there was a decrease in incidence rates for URIs (-53.7%) and PNE (-9.8%) and an increase for BAC (+4.8%). Since 2007, the incidence of bloodstream infections (BSI) has decreased by 31.3% and that of invasive site infections (ISI) by 42.8%, while the proportion of positive central venous catheter (CVC) cultures has remained fairly stable (-6.9%). These data serve as a national benchmark to better understand healthcare-associated infections (HAIs) in intensive care and enable participating units to evaluate and guide their prevention measures. (R.A.)
Author(s): Savey A, Machut A, Réseau d'alerte d'investigation et de surveillance des infections nosocomiales (RAISIN
Publishing year: 2013
Pages: 38 p.
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