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Epidemiology, risk factors and outcome of nosocomial infections in a Respiratory Intensive Care Unit in North India.

Agarwal R, Gupta D, Ray P, Aggarwal AN, Jindal SK

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India. riteshpgi@gmail.com

OBJECTIVE: To determine the epidemiology, risk factors and outcome of infections in a Respiratory Intensive Care Unit (RICU) of a tertiary care institute in northern India. METHODOLOGY: Prospective, observational clinical study. RESULTS: The study included 201 patients (1285 patient days) admitted to RICU over a period of one-and-a-half years. A total of 77 infections were identified in 67 patients (33.5%). The infections included pneumonia (23%), sepsis of unknown origin (10.5%), bacteremia (7.5%), urinary tract infections (1.5%), catheter related blood stream infections (1%) and Clostridium difficile colitis (1%). The most commonly identified organisms were the Acinetobacter species (34.8%), Pseudomonas aeruginosa (23.9%) and Escherichia coli (15.2%). The median length of stay in patients with and without infection was 13 days (interquartile range, IQR, 28) and 4 days (interquartile range, IQR, 3), respectively (p<0.0001). Multivariate analysis showed the following risk factors for ICU-acquired infection: the admitting diagnosis of infection (odds ratio [OR] 3.3; 95% confidence intervals [CI] 1.06-10.1), length of stay in the RICU (OR, 1.2; 95% confidence intervals [CI] 1.1-1.33); renal failure (OR, 4.7; 95% CI, 1.52-14.41) and institution of parenteral nutrition (OR, 16.9; 95% CI, 1.07-269.03). Multivariate analysis showed the following risk factors for death in ICU: APACHE II scores (OR, 1.06; 95% CI, 1.01-1.11), and endotracheal intubation (OR, 5.07; 95% CI, 1.24-20.65). CONCLUSIONS: This study clearly documents a high prevalence rate of infections in the ICU, and the data suggest that occurrence of infections was associated with a prolonged ICU stay but had no significant effect on the final outcome.

Published 17 July 2006 in J Infect, 53(2): 98-105.
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