Device-Associated Infections Rates and Mortality in Intensive Care Units of Peruvian Hospitals. International Nosocomial Infection Control Consortium (INICC) Findings

Objective: We sought to measure Device-associated infection (DAI) rates, microbiological profile, bacterial resistance, and attributable mortality in intensive care units (ICUs) in hospitals members of the International Nosocomial Infection Control Consortium (INICC) in Peru. Methods: Prospective cohort surveillance of DAIs was done in four ICUs in four hospitals applying the definitions of the CDC-NNIS System. Results: From September 2003 to October 2007, 1,920 patients hospitalized in ICUs for an aggregate of 9,997, days acquired 249 DAIs, with a rate of 13.0%, and 24.9 DAIs per 1,000 ICU-days. Ventilator-associated pneumonia (VAP) rate was 31.3 per 1000 ventilator-days, Central venous catheter-related-Bloodstream infections (CVC-BSI) rate was 7.7 cases per 1,000 catheter-days, and Catheter-associated urinary tract infections (CAUTI) was 5.1 cases per 1,000 catheter-days. 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 piperacilin- tazobactam; 65.0% of Pseudomonas aeruginosa isolates were resistant to ciprofloxacin, 62.0% were resistant to ceftazidime, 29.4% were resistant to piperacilin- tazobactam, and 36.1% were resistant to imipenem. Extra mortality for VAP was 24.5%, (RR 2.07, P<0.001); and for CVC-BSI was 15.0% (RR 2.75, P=0.028). Conclusion: In these ICUs of Peru, DAI rates are high. Active infection control programs consisting of surveillance of DAIs and implementation of guidelines for prevention can ensure improvement in patient safety.