We report the results of the International Infection Control Consortium (INICC) surveillance
study from January 2003 through December 2008 in 173 intensive care units (ICUs) in
Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for
Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN;
formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions
for device-associated health care-associated infection, we collected prospective data
from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate
of 923,624 days. Although device utilization in the developing countries' ICUs was
remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated
nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the
pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI)
in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per
1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated
pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively,
as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus
3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance
of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively),
Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively),
Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas
aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in
the consortium's ICUs, and the crude unadjusted excess mortalities of device-related
infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP).
2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published
by Mosby, Inc. All rights reserved.