Nosocomial infections in the Intensive Care Unit at Landspitalinn.

OBJECTIVE: To determine the nosocomial infection rate, pathogens, colonisation and hospital mortality in the Intensive Care Unit (ICU) at Landspitalinn, which is a ten bed, general medical-surgical ICU. METHODS: Patients admitted for more than 48 hours were included. Surveillance- cultures were performed on admission and thereafter three times a week (tracheal aspirate, oropharyngeal swab, gastric aspirate, urine and other specimens as indicated). ICU infections were defined by the criteria of CDC, USA. In the first 12 months 140 patients met the inclusion criteria at 150 admissions. The study is ongoing. RESULTS: Eighty-seven ICU-acquired infections were diagnosed in 48 of the 150 admissions (32%), the mean age was 58 years (0-87) and 60% were males. The most common infections were: UTI 27 (31%), pneumonia 18 (21%), septicemia 15 (17%), wound infections eight (9%) and tracheitis seven (8%). Etiologic agents of the 87 infections were E. coli (15), Klebsiella sp. (7) and other Enterobacteriacae (9), Enterococcus sp. (12), Candida sp. (12), S. epidermidis (7), P. aeruginosa (7) and other/unknown pathogens (18). Infected patients stayed for a mean of 15.0 days and uninfected patients 4.2 days (p<0.05). Every patient staying for more than three weeks had at least one infection. The mean age of infected patients was 63 years and of uninfected patients 56 years (p<0.05). Neither APACHE-II nor TISS score on admission differed significantly between the infected and uninfected groups. Mortality in the ICU was 10.4% (5/48) in the infected group and 19.6% (20/102) in the uninfected group (p=0.24). CONCLUSION: Nosocomial infections in patients admitted to the ICU were common and associated with extended stay. Most of the infections were caused by Gram-negative bacilli.