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ISSN:2240-2594

NOSOCOMIAL INFECTIONS IN AN INTENSIVE CARE UNIT: PREDISPOSING ROLE OF ENTERAL FEEDING TUBE IN CRITICALLY ILL PATIENTS

INFEZIONI NOSOCOMIALI IN UNA UNITA’ DI TERAPIA INTENSIVA: RUOLO PREDISPONENTE DEL SONDINO PER NUTRIZIONE ENTERALE NEI PAZIENTI CRITICI

Belvisi V 1, Citton R 1, Di Vincenzo E 2, Del Borgo C 1, Melucci A 2, Cosentino C 2, Mastroianni CM

1

Infectious Disease Unit, “Sapienza” University of Rome, SM Goretti Hospital, Latina (Italy)

2

Intensive Care Unit S.M. Goretti Hospital, Latina (Italy)

1

U.O.C. di Malattie Infettive , “Sapienza” Università di Roma, Ospedale S.M. Goretti, Latina

2

U.O.C. di Terapia Intensiva, Ospedale S.M. Goretti, Latina

Citation: Belvisi V, Citton R, Di Vincenzo E, et al. Nosocomial infections in an intensive care unit: predisposing role of enteral feeding tube in critically ill patients. Prevent Res 2012; 2 (2): 97-105

Key words: healthcare-associated infections (HAIs), ventilator-associated pneumonia (VAP), nasogastric tube

Parole chiave: infezioni correlate all’assistenza sanitaria, polmoniti associate a ventilatore, sondino nasogastrico

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Apr-Jun 2012|P&R Scientific|Volume 2|N°2

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Nosocomial infections in an intensive care unit: predisposing role of enteral feeding tube in critically ill patients

Abstract Background: Healthcare-Associated Infections (HAIs) are a major issue in Intensive Care Units (ICU). In this context it is of particular importance the use of invasive devices and their management. Objectives: Aim of the study was to show correlations between possible risk factors and the occurrence of HAIs in the ICU of S.M. Goretti Hospital, Latina, Italy. Methods: Total number of patients hospitalized in the ICU during the study period (June 2008-June 2009) was 205. Analysis of

medical records was conducted using a form prepared on the detection model for the surveillance of

hospital infections (NNIS) and data were evaluated through a model of multiple logistic regression analysis. Results: Patients with a diagnosis of HAI were 30 (14.8%), 8% of isolates were multi-drug-resistant bugs. Following the CDC/NHSN criteria, it was possible to identify 13 patients (6.5%) with central venous catheter-related sepsis (BSICVC) and 26 patients (12.6%) with pneumonia associated with mechanical ventilation (VAP). Variables statistically significant for the development of nosocomial infections were: living in healthcare facilities (p = 0.008), presence of polytrauma (p = 0.04), surgical procedures (p = 0.003), cerebrospinal fluid derivation (p = 0.0001), presence of central venous catheter (p = 0.05), oro-tracheal intubation (p = 0.001), presence of nasogastric tube (p = 0.001) and parenteral nutrition (p = 0.0005). Conclusions: In our ICU the presence of nasogastric tube has emerged in multivariate analysis as a new independent risk factor for HAIs, especially VAP : p = 0.0008, OR (95% CI) 32.31.

Abstract Introduzione: Le infezioni correlate all’assistenza sanitaria sono un problema emergente nei reparti di Terapia Intensiva. In questo contesto assume una particolare importanza l’utilizzo di devices invasivi e la gestione del rischio ad essi correlato. Obiettivi: Scopo dello studio è stato quello di dimostrare correlazioni fra possibili fattori di rischio e l’insorgenza di infezioni correlate all’assistenza nella Terapia Intensiva dell’Ospedale S. M. Goretti, Latina, Italia. Metodi: 205 pazienti sono stati ricoverati presso la Terapia Intensiva durante il periodo di studio (Giugno 2008-Giugno 2009). L’analisi delle cartelle cliniche è stata condotta utilizzando una scheda sul modello delle schede di rilevazione per le infezioni ospedaliere del NNIS e i dati sono stati valutati usando un modello di analisi statistica di regressione logistica multipla. Risultati: I pazienti con una diagnosi di infezione correlata all’assistenza sono risultati 30 (14.8%), 8% degli isolati erano germi multi-farmaco-resistemti. Seguendo i criteri CDC/NHSN, è stato possibile identificare 13 pazienti (6.5%) con sepsi correlata a catetere venoso centrale (BSI-CVC) e 26 pazienti (12.6%) con polmonite associata a ventilazione meccanica (VAP). Variabili statisticamente significative per lo sviluppo di infezioni nosocomiali sono risultate: provenienza da una struttura sanitaria assistenziale (p = 0.008), presenza di politrauma (p = 0.04), interventi chirurgici (p = 0.003), derivazioni liquorali (p = 0.0001), presenza di catetere venoso centrale (p = 0.05), intubazione oro-tracheale (p = 0.001), presenza di sondino naso-gastrico (p = 0.001) e nutrizione parenterale (p = 0.0005). Conclusioni: Nella nostra Terapia Intensiva la presenza di sondino naso- gastrico è emerso all’analisi multivariata come un nuovo fattore di rischio indipendente per lo sviluppo di infezioni relate all’assistenza sanitaria, in particolare per le VAP: p = 0.0008, OR (95% CI) 32.31.

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Apr-Jun 2012|P&R Scientific|Volume 2|N°2

Nosocomial infections in an intensive care unit: predisposing role of enteral feeding tube in critically ill patients

Introduction Healthcare-Associated Infections (HAIs) are a serious complication of hospitalization, resulting in an enormous burden in terms of excess morbidity and mortality rates and health care costs, especially in Intensive Care Units (ICU) , where their onset is more frequent, due to the nature of treatments applied and the susceptibility of patients (1). In this context, the use of invasive devices and their management is really important (2, 3). The aim of this research was to determine risk factors and produce a clinical and microbiological analysis of nosocomial infections in the ICU of the Hospital S. M. Goretti, Latina. Methods All patients admitted to the intensive care unit of S. M. Goretti Hospital of Latina over a one-year period (June 2008-June 2009) were included in the study. The data collection was conducted through analysis of medical records using a form prepared on the

model for the

surveillance of hospital infections (NNIS). For each patient the following data were recorded: demographic characteristics (age; sex; home, nosocomial or health care residence provenance); cause of admission; risk factors during the 30 days before admission to ICU and during hospitalization: presence of infection, corticotherapy, surgical operations, surgical drains, cerebrospinal fluid shunt, presence of central venous devices, urinary catheter, nasogastric tube, parenteral nutrition, oro-tracheal intubation; clinical conditions using GCS and APACHE II; comorbidity (cancer, diabetes, renal failure, etc.); medical and antibiotic therapy; clinical condition at isolation time; site of infection: distinguishing ventilatorassociated pneumonia (VAP) and sepsis / bloodstream infection (BSI), according to the CDC / NHSN criteria (1); pathogens isolated and patterns of susceptibility to antibiotic; diagnosis of nosocomial infection versus colonization; clinical evolution. The data collected into an electronic database (Office Excel, Microsoft Inc., USA) were used to study the characteristics and identify risk factors for acquiring nosocomial infections in patients hospitalized in the ICU. The variables were analyzed using the “Two-tailed tests” and the “Student's t test”. The confidence interval of 95% (95% CIs) was used to calculate the significance of the “odds ratio” (OR). Statistical significance was placed with a level of p