An Overall View on Nosocomial Infections in an Intensive Care Unit

Objective: The purpose of this study was to determine the pathogenic agents in nosocomial infections and measure their antimicrobial sensitivity in the intensive care unit. Material and Methods: Between January and October 2007, 250 patients were examined in the intensive care unit of the 1st Internal Medicine Department of Ataturk Training and Research Hospital, which was opened in January 2007. Active and prospective surveillance method based on laboratory data and patients' diagnosis was used for 95 of these patients with hospital-acquired infections. Results: During the study period, 137 infection episodes were determined in 95 patients with a diagnosis of nosocomial infections according to the criteria of Centers for Disease Control (CDC). The infection rate was 38%. Urinary tract infection was the most common infection followed by pneumonia and bacteremia. All patients with urinary tract infection had urinary catheterization, 42.5% of the patients with pneumonia had mechanical ventilation and 68.4% with primary bacteremia had central intravenous catheterization. In these infections, 59.1% of the isolated pathogens were gram-negative bacilli, 38.6% were gram-positive bacteria and the remaining 2.1% were Candida spp. Escherichia coli, S. aureus, P. aeruginosa and coagulase-negative staphylococci were the most common pathogens identified. In urinary tract infections E. coli and in pneumonia and bacteremia S. aureus was the most common responsible pathogen. Among the gram-positive bacteria and gram-negative bacilli, high antimicrobial resistance was observed. Resistance to teicoplanin was 14.6% and linezolid was 11.1%, in S. aureus, whereas resistance to ciprofloxacin was 88.8% and vancomycin was 11.1% in Enterococcus spp. Imipenem was determined as the most effective agent against the isolated gram-negative bacteria, followed by cefepime, however, 16.6% of the Acinetobacter spp. and 17.6% of the P. acruginosa were resistant to imipenem. Conclusion: In order to prevent or reduce the nosocomial infections, surveillance methods must be carried out in intensive care units and in the entire hospital.