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

van der Kooi TI, de Boer AS, Manniën J, Wille JC, Beaumont MT, Mooi BW, van den Hof S

RIVM, Center for Infectious Disease Epidemiology, Postbak 75, Postbox 1, 3720[Symbol: see text]BA, Bilthoven, The Netherlands.

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[Symbol: see text]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.

Published 6 February 2007 in Intensive Care Med, 33(2): 271-8.
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