Incidence, Clinical Outcome and Risk Factors of Intensive Care Unit Infections in the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria

Abstract

BackgroundInfections are common complications in critically ill patients with associated significant morbidity and mortality.AimThis study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital.Materials and MethodsThis was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died. Antimicrobial susceptibility testing of isolates was done using CLSI guidelines.ResultsSeventy-one patients were recruited with a 45% healthcare associated infection rate representing an incidence rate of 79/1000 patient-days in the intensive care unit. Bloodstream infections (BSI) 49.0% (22/71) and urinary tract infections (UTI) 35.6% (16/71) were the most common infections with incidence rates of 162.9/1000 patient-days and 161.6/1000 patient-days respectively. Staphylococcus aureus was the most common cause of BSIs, responsible for 18.2% of cases, while Candida spp. was the commonest cause of urinary tract infections, contributing 25.0% of cases. Eighty percent (8/10) of the Staphylococcus isolates were methicillin-resistant. Gram-negative multidrug bacteria accounted for 57.1% of organisms isolated though they were not ESBL-producing. Use of antibiotics (OR = 2.98; p = 0.03) and surgery (OR = 3.15, p< 0.05) in the month preceding ICU admission as well as urethral catheterization (OR = 5.38; p<0.05) and endotracheal intubation (OR = 5.78; p< 0.05) were risk factors for infection.ConclusionOur findings demonstrate that healthcare associated infections is a significant risk factor for ICU-mortality and morbidity even after adjusting for APACHE II score.

A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis

“…WHO reports estimate approximately 30% of ICU patients are affected by at healthcare-associated infections while incidence is 3-fold higher in low and middle-income countries [18]. Several reports from these countries suggest the lack of surveillance data thus having a negative influence on the implementation of preventive measures [19][20][21][22][23]. Two EPIC studies in a span of 10 years have demonstrated 20% increase in prevalence of ICU-acquired infections [24,25].…”

Prevalence of nosocomial infections by multidrug resistant organisms in patients admitted to the critical care area of the Regional cancer center, Gujarat, India

“…6 A recently published World Health Organization (WHO) review showed that "in low-and middle-income countries, the frequency of ICU-acquired infection is at least 2-3 times higher than in high-income countries; device-associated infection densities are up to 13 times higher than in the USA". 7 Critically ill patients with severe sepsis in intensive care units (ICUs) require lengthy and expensive management, with an associated high mortality, with rates ranging from 30% to 50%. 7 Graft versus host disease (GVHD) occurs in 20% to 70% of bone marrow transplant(BMT) recipients receiving grafts from different donor sources and are associated with bacteremia.…”

“…7 Critically ill patients with severe sepsis in intensive care units (ICUs) require lengthy and expensive management, with an associated high mortality, with rates ranging from 30% to 50%. 7 Graft versus host disease (GVHD) occurs in 20% to 70% of bone marrow transplant(BMT) recipients receiving grafts from different donor sources and are associated with bacteremia. 8 This study includes discussions on a variety of common clinical-microbiological problems faced in the critical areas and detection of their etiological agents and resistance patterns by conventional and molecular methods.…”

Prevalence, Diagnosis and Local Susceptibility of Staphylococci Infections

“…In a neonatal septicemia study involving 202 infants with risk factors for clinical features of septicemia in the first 3 days of life, 12.5% culture were positive with the predominant organisms being S. aureus (52%) and 30.7% being MRSA [25]. In intensive care unit of a Nigerian hospital, out of 71 patients with healthcare-associated infection, bloodstream and urinary tract infections were the commonest infections, and S. aureus was the commonest cause of bloodstream infection with 80% of the S. aureus being MRSA [26]. In surgical site infections for 103 patients with orthopedic surgery in a hospital in Port Harcourt, Nigeria, the commonest pathogen was S. aureus (34%) including 15 patients with MRSA [27].…”