Surveillance of nosocomial infections at a Saudi Arabian military hospital for a one-year periodÜbersicht über nosokomiale Infektionen in einem saudi-arabischen Militärkrankenhaus im Laufe eines Jahres

GMS German Medical Science — an Interdisciplinary Journal

Moataz M. Abdel-Fattah¹ 

[1] Epidemiololgy and Research Unit, Preventive Medicine Department, AlHada Armed Forces Hospital, Taif, Saudi Arabia

关键词: Saudi Arabia;    microorganisms;    sensitivity;    antibiotic;    surveillance;    nosocomial infections;   

Others  :  869018

实施日期：2005-02-02，发布日期：2005-09-01

【 摘 要 】

The objectives of the current study are to define how many and what kind of nosocomial infections are occurring, what are the causative microbes and what kind of drugs can be used in treatment of infection at Al-Hada Armed Forces Hospital, Taif, Saudi Arabia during the year 2004. A prospective study was implemented for all cases admitted at Al-Hada Armed Forces Hospital during the period 1^st January, 2004 till 31^st December, 2004 and which developed infection. Determination of nosocomial infections was performed using standardized CDC criteria. A total of 1382 patients had developed infection during hospital admission and were included in the study. Of them, 668 (48.3%) had nosocomial infection and 714 (51.7%) had community-acquired infection. Among those who developed nosocomial infections, 216 (32.3%), 172 (25.7%) and 124 (18.6%) had respiratory tract (RTI), urinary tract (UTI) and blood stream infections (BSI) respectively. Surgical site infection (SSI) was reported in 86 cases (12.9%). The overall nosocomial infection rate along the study period was 4.98 per 100 discharged patients. Gram-positive organisms were reported in 31.8%. MRSA (Methicillin-resistant S. aureus) was the commonest (10.2%), followed by coagulase negative staphylococci (8.5%) and MSSA (Methicillin-susceptible S. aureus, 7.4%). While Gram-negative organisms were reported in 66.2%, E. coli was the commonest (22.3%), followed by Pseudomonas aeruginosa (17.6%) and Klebsiella pneumoniae (9.9%). Acinetobacter spp. and MRSA were highly sensitive to Imipenem (88.6%) and Vancomycin (98.5%) respectively. E. coli were highly sensitive to most of the antimicrobial agents except ampicillin (26.6%).

Conclusions: Pneumonia, urinary tract infections, and blood stream infections made up the great majority of nosocomial infections. There is a need for further risk assessment associated with main types of infection.

【 授权许可】

   
© 2005 Abdel-Fattah.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

【 参考文献 】

• [1]Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. In: Olmsted RN, ed. APIC infection Control and Applied Epidemiology: Principles and Practice. St. Louis: Mosby; 1996 p. A1-A20.
• [2]Gaynes RP, Horan TC. Surveillance of nosocomial infections. In: Mayhall CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 1999. p. 1285-318.
• [3]Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ET. The Second National Prevalence Survey of infection in hospitals--overview of the results. J Hosp Infect. 1996;32(3):175-90.
• [4]Ayliffe GAJ, Fraise AP, Geddes AM, Mitchell K. The importance of hospital infection. In: Ayliffe GAJ et al, ed. Control of hospital infection: a practical handbook. 4th ed. London: Arnold; 2000. p. 2-3.
• [5]Young LS. Sepsis syndrome. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. New York: Churchill Livingstone; 1995. p. 690-705.
• [6]Eapen CE, Thomas K, Cherian AM, Jeyaseelan L, Mathai D, John G. Predictors of mortality in a medical intensive care unit. Natl Med J India. 1997;10(6):270-2.
• [7]Daschner F. Cost-effectiveness in hospital infection control--lessons for the 1990s. J Hosp Infect. 1989;13(4):325-36.
• [8]Weinstein RA. Nosocomial infection update. Emerg Infect Dis. 1998;4(3):416-20.
• [9]Daschner F, Schumpelick V. MRSA als Herausforderung an die klinische Organisation [MRSA as a challenge to clinical organization]. Chirurg. 2002;73(9):924-9.
• [10]Arya SC, Agarwal N, Agarwal S, George S, Singh K. Nosocomial infection: hospital infection surveillance and control. J Hosp Infect. 2004;58(3):242-3.
• [11]Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40. Erratum in: Am J Infect Control 1988;16(4):177.
• [12]Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.
• [13]Barrow GI, Feltham RKA. Cowan and Steel's Manual for the identification of medical bacteria. 3rd ed. Cambridge: Cambridge University Press; 1993.
• [14]National Community for Clinical Laboratory Standards. Performance Standards for antimicrobial disc susceptibility tests. Wayne, Pennsylvania: National Community for Clinical Laboratory Standards; 2000. NCCLS document; M2- A7.
• [15]Ducel G. Les nouveaux risques infectieux. Futuribles. 1995;203:5-32.
• [16]American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med. 1996;153(5):1711-25.
• [17]Al-Helali NS, Al-Asmary SM, Abdel-Fattah MM, Al-Jabban TM, Al-Bamri AL. Epidemiologic study of nosocomial urinary tract infections in Saudi military hospitals. Infect Control Hosp Epidemiol. 2004;25(11):1004-7.
• [18]Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1999;103(4):e39.
• [19]Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care. 2002;17(1):50-7.
• [20]Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA. 1996;275(11):866-9.
• [21]Fridkin SK, Welbel SF, Weinstein RA. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am. 1997;11(2):479-96.
• [22]Bilal NE, Gedebou M, Al-Ghamdi S. Endemic nosocomial infections and misuse of antibiotics in a maternity hospital in Saudi Arabia. APMIS. 2002;110(2):140-7.
• [23]Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, Hooton TM. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121(2):182-205.
• [24]Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991;91(3B):72S-75S.
• [25]Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, Gibert C. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis. 1989;139(4):877-84.
• [26]Fagon JY, Chastre J, Wolff M, Gervais C, Parer-Aubas S, Stephan F, Similowski T, Mercat A, Diehl JL, Sollet JP, Tenaillon A. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med. 2000;132(8):621-30.
• [27]Johnson JR. Virulence factors in Escherichia coli urinary tract infection. Clin Microbiol Rev. 1991;4(1):80-128.
• [28]Pais P, Khurane R, George J. Urinary tract infections: A retrospective survey of causative organisms and antibiotics prescribed in a tertiary care setting. Indian J Pharmacol. 2002;34:278-80.
• [29]Pittet D, Wenzel RP. Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med. 1995;155(11):1177-84.
• [30]Cockerill FR 3rd, Hughes JG, Vetter EA, Mueller RA, Weaver AL, Ilstrup DM, Rosenblatt JE, Wilson WR. Analysis of 281,797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis. 1997;24(3):403-18.
• [31]Johnson AP. Antibiotic resistance among clinically important gram-positive bacteria in the UK. J Hosp Infect. 1998;40(1):17-26.
• [32]Giacometti A, Cirioni O, Schimizzi AM, Del Prete MS, Barchiesi F, D'Errico MM, Petrelli E, Scalise G. Epidemiology and microbiology of surgical wound infections. J Clin Microbiol. 2000;38(2):918-22.
• [33]The Joanna Briggs Institute. The impact of pre-operative hair removal on surgical site infection. Best Practice. 2003;7(2):1-6.
• [34]Sands K, Vineyard G, Platt R. Surgical site infections occurring after hospital discharge. J Infect Dis. 1996;173(4):963-70.
• [35]Levy SB. Multidrug resistance--a sign of the times. N Engl J Med. 1998;338(19):1376-8.
• [36]Swartz MN. Use of antimicrobial agents and drug resistance. N Engl J Med. 1997;337(7):491-2.
• [37]Chan-Tack KM. Changing antibiotic sensitivity patterns at a university hospital, 1992 through 1999. South Med J. 2001;94(6):619-20.
• [38]Livermore DM, Macgowan AP, Wale MC. Surveillance of antimicrobial resistance. Centralised surveys to validate routine data offer a practical approach. BMJ. 1998;317(7159):614-5.
• [39]Stamm WE, Weinstein RA, Dixon RE. Comparison of endemic and epidemic nosocomial infections. Am J Med. 1981;70(2):393-7.