Eepidemiological Interregional Multicenter Study of Healthcare-Associated Infections in the Intensive Care Units. First Results

The intensive development of medical technologies is accompanied by equally rapid changes in the epidemic process of healthcare-associated infections (HAIs). According to experts, in order to increase the sensitivity of the surveillance system, official registration should be supplemented by multicenter targeted studies. Aim . To determine the prevalence and incidence of HAIs in the intensive care units (ICUs) of the Russian Federation, the dominant pathogens and their antibiotic resistance. Materials and Methods . A one-day epidemiological interregional multicenter cross-section survey of HAIs in the ICUs of the Russian Federation (EMMI) was carried out. 54 ICUs from 50 medical organizations in 27 subjects of the Russian Federation (25 specialized and 25 general hospitals) of all federal districts voluntarily participated in the study. Results . The prevalence of HAI in the intensive care unit (Ward-Specific Point Prevalence) was 19.88% [13.94–25.5]. The Incidence Density of HAI was 19.72 [15.5–25.1] cases and 28.52 [23.3–34.8] episodes per 1000 patient-days (in adults – 22.52 [17.1–29.6] cases and 32.88 [26.2–41.2] episodes of HAI per 1000 patient-days; in children – 13.54 [8.3–23.1] cases and 19.51 [12.6–29.8] episodes per 1000 patient-days; in children under 1 year – 11.44 [5.9–21.2] cases and 17.16 [10.2–28.4] episodes per 1000 patient-days). The Device-specific Incidence Density of catheter-associated bloodstream infections (CLABSI) was 7.12 [6.39–7.81] per 1000 catheterization days, catheter-associated urinary tract infections (CAUTI) – 10.99 [9.99-11.99] per 1000 catheterization days, lower respiratory tract infections – 14.56 [11.0–19.3] per 1000 patient-days and 27.33 [25.77–28.89] per 1000 days of mechanical ventilation (VAP). Three microorganisms were in the lead: Klebsiella pneumoniae (33/35.48%), Acinetobacter baumannii (16/17.20%) and Pseudomonas aeruginosa (12/12.90%). In the group of ventilator-associated pneumonia, Klebsiella pneumoniae caused 47.82% of all cases. Multidrug resistance was demonstrated by 75% of Klebsiella pneumoniae strains. Conclusion . A multicenter One-day point-prevalence survey allowed to clarify the prevalence and incidence density of HAIs in the ICU, and also revealed the dominance of multidrug-resistant Klebsiella pneumoniae in all regions as a causative agent of various forms of HAIs in the ICU. A high level of VAP was revealed, which requires additional research in order to adjust the preventive measures taken into account the characteristics of Klebsiella pneumoniae.