Nosocomial infections in medical-surgical intensive care units in Argentina: Attributable mortality and length of stay

Background: Nosocomial infections are an important public health problem in many developing countries, particularly in the intensive care unit (ICU). Limited data exists on the incidence and burden of nosocomial infection in the ICU in Argentina. Methods: We performed baseline prospective nosocomial infection surveillance of all patients for 6 months in 3 medical-surgical ICUs (MS-ICUs) in Argentina (2 months in each ICU). Nosocomial infections were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance definitions. Overall and site-specific nosocomial infection rates, attributable mortality, and excess length of hospital stay were calculated. Results: The overall nosocomial infection rate was 27% and 90 per 1000 patient-days. The most common site of infection was catheter-related bloodstream infection (32 %), followed by ventilator-associated pneumonia (25 %), and catheter-associated urinary tract infection (23%). The rate of central catheter-associated bloodstream infection in the MS-ICU was 44.61 per 1000 device-days, with an attributable mortality of 25%, and 12 attributable extra days of hospital stay. The urinary catheter-associated urinary tract infection rate in the MS-ICU was 22.55 per 1000 urinary catheter-days, with an attributable mortality of 5%, and 5 excess extra days of hospital stay. The ventilator-associated pneumonia rate in the MS-ICU was 50.87 per 1000 ventilator-days with an attributable mortality of 35%, and 10 attributable extra days of hospitalization. Conclusion: Our study finds high rates of nosocomial infections in ICUs in Argentina, associated with a considerable attributable mortality and excess length of stay. Ongoing targeted surveillance and implementation of infection control strategies is necessary to control this growing problem.