NOSOCOMIAL INFECTIONS IN GERMANY (NIDEP) - MICROBIOLOGICAL DIAGNOSIS,ANTIMICROBIAL PROPHYLAXIS AND THERAPY

Background: The NIDEP-study (Nosocomial Infections in Germany - Preval ence and Prevention) is the first large multicenter survey to examine the prevalence of nosocomial infections (NI) in Germany. This part of the NIDEP-study describes the frequency and quality of the microbiolog ical diagnosis, antimicrobial chemoprophylaxis and therapy in represen tative German hospitals. Patients and Methods: Prevalence of nosocomia l infections in 14 966 patients of 72 randomly selected representative German hospitals was determined. Frequency, nature and results of the microbiological diagnosis, antimicrobial chemoprophylaxis and therapy were recorded simultaneously. Results: The total prevalence rate of n osocomial infections was 3.5%. The most common infections were urinary tract infections (42.1%), lower respiratory tract infections (20.6%), postoperative wound infections (15.8%), and septicemia (8.3%). Microb iological evaluation was done in 56.5% of the patients with infections . Only five of the 49 hospitals with less than 400 beds and only nine of the 23 hospitals with more than 400 beds bad their own microbiologi cal department. Antimicrobial chemotherapy was administered in 17.7% o f the patients. In 35.1% of the patients who were treated with antibio tics, no clinical diagnosis of infection was made, criteria for nosoco mial infections were not fulfilled or microbiological evaluation was n ot established. Antimicrobial chemoprophylaxis was done in one third o f the patients. Prophylaxis was missed in 20.6% of patients with color ectal operations, 60.1% of appendectomies, 48% hysterectomies, and 35. 5% of total hip replacements. On the other hand antimicrobial chemopro phylaxis was frequently administered in clean procedures without incre ased risk of postoperative wound infections. Conclusion: Insufficient microbiological evaluation, inadequate perioperative antimicrobial che moprophylaxis and administration of chemotherapy without documented in fection were detected in representative German hospitals.