, Volume 33, Issue 2, pp 271-278
Date: 05 Dec 2006

Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system

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Abstract

Objective

To examine the incidence of and risk factors for device-associated infections and associated mortality.

Design and setting

Prospective surveillance-based study in ICUs of 19 hospitals in The Netherlands.

Patients

The study included 2,644 patients without infection at admission during 1997–2000, staying in the ICU for at least 48 h.

Measurements and results

The occurrence of ventilator-associated pneumonia (VAP), central venous catheter (CVC) related bloodstream infection (CR-BSI), urinary catheter-associated urinary tract infection (CA-UTI) and risk factors was monitored. Of the ventilated patients 19% developed pneumonia (25/1,000 ventilator days); of those with a central line 3% developed CR-BSI (4/1,000 CVC days,) and of catheterized patients 8% developed CA-UTI (9/1,000 catheter days). Longer device use increased the risk for all infections, especially for CR-BSI. Independent risk factors were sex, immunity, acute/elective admission, selective decontamination of the digestive tract, and systemic antibiotics at admission, dependent upon the infection type. Crude mortality significantly differed in patients with and without CR-BSI (31% vs. 20%) and CA-UTI (27% vs. 17%) but not for VAP (26% vs. 23%). Acquiring a device-associated infection was not an independent risk factor for mortality. Being in need of ventilation or a central line, and the duration of this, contributed significantly to mortality, after adjusting for other risk factors.

Conclusions

Device use was the major risk factor for acquiring VAP, CR-BSI and CA-UTI. Acquiring a device-associated infection was not an independent risk factor for mortality, but device use in itself was.

This work was performed within the project "Prevention of Hospital Infections Through Surveillance (PREZIES) at the National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands.
This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-006-0465-2.