SVIBOR - Project code: 3-01-243

MINISTRY OF SCIENCE AND TECHNOLOGY

Strossmayerov trg 4, HR - 10000 ZAGREB
tel.: +385 1 459 44 44, fax: +385 1 459 44 69
E-mail: ured@znanost.hr

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Project code: 3-01-243


HOSPITAL INFECTIONS IN INTENSIVE CARE UNITS


Main researcher: BEUS, IVAN (61520)


Assistants
Type of research: basic
Duration from: 01/01/91. to 12/31/94.
Papers on project (total): 21
Papers on project quoted in Current Contents: 3
Institution name: Bolnica "Dr. Fran Mihaljević", Zagreb (143)
Department/Institute: INTENSIVE CARE UNIT
Address: MIROGOJSKA 8, 10000 ZAGREB, CROATIA
City: 10000 - Zagreb, Croatia
Communication
Fax: 385 (0)1 4225907
Phone: 385 (0)1-4557222
Summary: In a prospective five year study we evaluated 514 patientsadmitted into our ICU regarding the frequency and type ofhospital infections in patients who were treated for more than 24hours. Two hundred eighty-nine patients (56.2%) were mechanicallyventilated. Hospital infections (total 395 episodes) wereobserved in 208 patients (40.4%). Incidence of nosocomial sepsiswas 23.9%, pneumonia 17.1% and urinary tract infections (UTI)21.2%. We observed significant decrease of nosocomial sepsis from38.6% in 1990 to 16.8% in 1992, 19.1% in 1993 and 18.4% in 1994 (p=0.003). We didn't observe difference in the rate of nosocomial pneumonia and UTI. We evaluated sensibility of 1375 isolates isolated fromurine, blood, tips of central venous catheters, tracheal aspirateand gastric juice. Gram-negative bacteria still dominated(67.2%). Among gram-negative isolates very high resistance rateto common antibiotics was observed. Of 1273 gram-negative bacteria 62.3% were resistant gentamicin, 28.8% to netilmicin, 43.5% to amikacin, 66% to cefotaxime, 37.6% to ciprofloxacin. The lowest resistance rate was to imipenem, only 5.1%. For the first time weobserved dependence of resistance to the site of isolation.Lowest resistance rate was among gram-negative bacteria isolatedfrom gastric juice, and highest in microorganisms isolated fromblood. Clinicaly significant gram-negative isolates from blood and urine were significantly more resistant than isolates that causes nosocomial pneumonia.

Keywords: nosocomial infections, sepsis, pneumonia, urinary tract infections, antibiotics, resistance, central venous catheters, intensive care unit, Pseudomonas aeruginosa, colonisation of mucous membranes

Research goals: Goals of the study are to evaluate the incidience of nosocomial infections in ICU, particularly in mechanically ventilated patients. Emphasis is on etiology of infections (sepsis, pneumonia and UTI) and sensitivity of isolated microorganisms. We would try to find out if there was difference in sensitivity of bacteria isolated from various patient's materials. If so, approach to the therapy of various nosocomial infections would not be equal, and there would be possibility to choose the most appropriate antibiotic. Our hypothesis is that: a)nosocomial infections (sepsis, pneumonia, UTI) in patients who are treated because of their primary diseases with antibiotics, differ regarding the incidence, time of onset, and particularly antibiotic resistance of isolated pathogens; b) mucous membranes of respiratory, urinary tract and stomach are colonised by bacteria of different antibacterial sensitivity. Further goal is to evaluate the levels of antipseudomonal antibodies in serum of the patients in whom P.aeruginosa is isolated from mucous membranes. That would be indicator of infection.

COOPERATION - INSTITUTIONS


  1. Name of institution: Imunološki zavod Zagreb (dr Boris Gmajnički)
    Type of institution: Other
    Type of cooperation: Joint project
    City: 10000 - Zagreb, Croatia

  2. Name of institution: Darmouth Hitchcock Medical Center
    Type of institution: University/Faculty
    Type of cooperation: Systematic exchange of experts
    City: Lebanon, New Hampshire, USA
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