Evaluation of Nosocomial Infections and Related Hospital Mortality in Coronary Intensive Care Unit

Abstract

Introduction: Mechanical/therapeutic technologies have resulted in an increased risk of infections including ventilator-associated pneumonia, central line-associated bloodstream infections, and potentially increased the risk of care process complications such as anesthesia/intubation/sedation complications; central line infections, stress ulcers, delirium, and the use of inappropriate or false medications in coronary intensive care units. These complications are associated with significantly increased in-hospital mortality, morbidity, length of stay, and/or healthcare costs and are potentially preventable. We aimed to evaluate the nosocomial infections developed in the coronary intensive care unit and the relationship between coronary intensive care unit infections and in-hospital mortality. Patients and Methods: The data of 500 patients followed in the coronary intensive care unit more than 48 hours between 01.01.2019 and 31.12.2020 were retrospectively analyzed. Patient records were obtained from surveillance data obtained by infectious diseases and clinical microbiology specialists and infection control nurses through daily visits. The criteria determined by the Centers for Disease Control and Prevention were used in the diagnosis of nosocomial infections. Various clinical samples (blood, urine, endotracheal aspiration fluid) taken from the patients were processed in the microbiology laboratory using qualitative or quantitative methods. Results: The most common detected infection type was catheter-related bloodstream infection (79.1%), followed by catheter-associated urinary tract infection (18.7%) and ventilator-associated pneumonia (6.25%) respectively. Gram-negative bacillus infections accounted for 70.8% of the causative agents, gram-positive cocci for 20.18%, and fungal infections for 12.5%. The most frequently detected microorganism species were Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) [7 (14.5%), 6 (12.5%)] respectively. Central venous catheter use was more common in non-infected group than infected group [45.0 (93.8%), 50.0 (73.5%) p= 0.005]. Continuous renal replacement therapy was more common in infected group compared to non-infected group [32 (66.7%), 21 (30.9%) p< 0.001]. The numbers of intubated days were higher in the infected group than in the non-infected group and this was statistically significant [mean (SD) 9.9 ± 9.2, 2.3 ± 2.9, P< 0.001]. In-hospital mortality rates were higher in infected group compared to non-infected group [28 (58.3%), 19 (27.9%), p= 0.001]. Conclusion: We found a significant relationship between nosocomial infections and in-hospital mortality in patients who were followed in coronary intensive care unit more than 48 hours [OR= 3.52 (1.30-9.53 CI= 95%) P= 0.01]. The most common sites of nosocomial infections are catheter-related bloodstream infections followed by catheter-associated urinary tract infections and ventilator-associated pneumonia. In multidisciplinary coronary intensive care units, daily visits with infectious diseases and clinical microbiology specialists and infection control nurses, close clinical and laboratory follow-up (detection of fever, elevation in procalcitonin and C-reactive protein (CRP) levels) are indispensable and more importantly nosocomial infections and infection-related mortality are preventable.