Device-Associated Infections and Patterns of Antimicrobial Resistance in a Medical-Surgical Intensive Care Unit in a University Hospital in Thailand
Somchit Thongpiyapoom RN*, Montha Na Narong RN*, Nonglak Suwalak RN, MPA*, Silom Jamulitrat MD**, Prasopsuk Intaraksa RN*, Jaruwan Boonrat RN*, Nongyao Kasatpibal RN, MNS***, Akeu Unahalekhaka RN, MSc***
Affiliation : * Songklanagarind Hospital ** Department of Community Medicine, Faculty of Medicine, Prince of Songkla University *** Faculty of Nursing, Chiang Mai University
Background : Surveillance of nosocomial infection in the intensive care unit (ICU) received a high level of
attention and outcome indicators are now used in benchmarking the quality of patient care. Since 1999 the
surveillance has targeted three site-specific, device-associated infections, including ventilator-associated
pneumonia (VAP), central-line-related bloodstream infection (CR-BSI), and catheter-related urinary tract
infection (CR-UTI). The authors conducted a two-year prospective study on the incidences of these infections
acquired in an ICU and report herein, together with the antibiotic susceptibility patterns of the microorganisms
isolated in an ICU.
Patients and Method : Continuous prospective data collection was conducted on patients admitted to an
adult medical-surgical ICU of a university hospital in Thailand from June 2000 to May 2002.
Results : A total 1422 patients with a total of 9370 patient-days were enrolled in the study. The incidence of
VAP, CR-BSI, and CR-UTI were 10.8/1000 ventilator-days (95%C.I: 8.5-13.6), 2.6/1000 central-line-days
(95%C.I: 1.5-4.4), and 13.8/1000 urinary-catheter-days (95%C.I: 10.7-17.5) respectively. The most common
causative pathogens were Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, and
Klebsiella pneumoniae. The proportion of methicillin-resistant Staphylococcus aureus, imipenem-resistant
P. aeruginosa, ceftazidime-resistant A. baumannii, third-generation-cephalosporin-resistant K. pneumoniae,
and quinolone-resistant E. coli were 68.8%, 30.9%, 68.5%, 44.6%, 38.3% respectively.
Conclusion : The incidences of VAP and CR-BSI were comparable to the National Nosocomial Infection
Surveillance (NNIS) report. But the incidence of CR-UTI was over the 90th percentile. The antibiotic resistance
had become a serious problem.
Keywords : Intensive care unit, Cross infection, Device-associated infection, Antimicrobial resistance
