Nederlandse resultaten van het Europese prevalentieonderzoek naar infecties tijdens intensive care (EPIIC). II. Aard van de infecties

Evaluation of the point prevalence of ICU-acquired infections, the type of infection, the bacteriological cultures and the antibiotics used.

Design

Point prevalence study.

Setting

78 Dutch ICUs, as part of ICUs in 17 West-European countries.

Method

Collecting data by detailed questionnaires for each patient admitted to one of the participating ICUs, on one specified day: April 29th, 1992. Follow-up lasted 6 weeks.

Results

The most frequently diagnosed ICU-acquired infections were pneumonia and infections of the lower respiratory tract (together 63), followed by urinary tract infections (16), sepsis (16) and wound infections (11). The most frequently cultured pathogens were Gram-negative bacteria (92), especially Enterobacteriaceae (34) and Pseudomonas aeruginosa (30), followed by Staphylococcus (37), Enterococcus (20) and surprisingly: 10 fungi. The most-prescribed antibiotics were the cephalosporins (30), followed by broad-spectrum penicillins (17), metronidazole (17) and aminoglycosides (13). On the day of this survey there was in the Netherlands no infection with MRSA (Methicillin Resistant Staphylococcus aureus), although gentamicin resistant coagulase-negative Staphylococcus and ciprofloxacin-resistant P. aeruginosa were present. In most of the hospitals in the Netherlands, microbiologists, infectious disease specialists (84) and infection control nurses (51) take part in the ICU team. Half of the hospitals use selective decontamination.

Conclusion

ICU-acquired infections are a real threat to the ICU patient. Despite a cautious antibiotics management in the Netherlands, resistance remains a serious problem.