Evaluation of nosocomial infections and determination of risk factors in intensive care units of Gaziantep University Faculty of Medicine

In this study the aim is to determine the frequency of hospital infections,infectious agents, antibiotic resistance patterns and risk factors for development ofinfection in intensive care units of Gaziantep University Faculty of Medicine.Between 15th November 2004 and 15th May 2006 patients who stayedover 48 hours in internal and surgical intensive care units were followedprospectively. The diagnosis of hospital infection was made according to thecriteria of the `Centers for Disease Control and Prevention? (CDC) and 63 patientswere included in the study in whom infectious agents were isolated. As a controlgroup 56 random patients who did not develope hospital infection were selected.Case and control group were studied as far as avarage age, intensive care unitstay, APACHE II score, mortality rate, central and periferic line, urinary catheter,nasogastric tube, enteral and parenteral feeding days and previous antibioticusage were concerned.For the statistical analysis, SPSS 13.0 package programme was used andgroups were compared with two group t test analysis in a 95% confidence interval.The variables with a p value less than 0.05 were accepted as significant. Inivunivariate analysis variables with a p value less than 0.1 were analised by forwardstepwise logistic regression and independent variables were determined.The rate of nosocomial infection in Gaziantep University Faculty of Medicinein this period was 49.7%. The rate of infection in internal and surgical intensivecare units were 46.2% and 53.3% respectively. Age (p=0.009), hospital stay(p=0.002) and APACHE II score (p=0.001) were determined as significant andindependent risk factors for development of infection. In the internal and surgicalcare units, mortality in patients who developed nosocomial infection was 46%whereas in control group mortality was 19.6% (p=0.003).In the internal and surgical intensive care units other risk factors determinedfor development of infection were the presence of mechanic ventilation,tracheostomy, presence of central catheter and total parenteral nutrition. Therewas no statistically significant difference between patient and control group for theusage of periferic venous, urinary catheter and nasogastric tube. Urinary systeminfection (27.6%), ventilator related pneumonia (23.8%) and blood stream infection(21.9%) were most frequently seen infections in intensive care unit patients. Mostfrequently isolated microorganisms were Pseudomonas aeruginosa (19.7%),Acinetobacter spp. (15.7%), and Staphylococcus aureus (14.3%).Mortality rate of S. aureus infections were higher than infections with othermicroorganisms. Methicilline resistance of S. aureus was 77.2%. In our hospitalcompared to studies made in previous years, resistance rates of Pseudomonasspp. and Acinetobacter spp. increased to all antibiotics except forsulbactam/sefaperazon. Studies about risk facors for the development of infectionsin every single hospital together with studies of infectious agents and resistancepatterns will provide proper hospital specific infection control measures. All theseare possible with establishment of infection control comitte.Key Words: Intensive care unit infection, Risk factors, Antibioticsusceptibility.