Nosocomial infections in a neurosurgery intensive care unit

In order to identify overall and site-specific nosocomial infection (NI) ra tes in patients receiving neurosurgical intensive care therapy, a prospecti ve study was started in February 1997 in the eight-bed neurosurgical ICU of the University Hospital of Freiburg, Germany. Case records were reviewed t wice a week. all microbiology reports were reviewed and ward staff was cons ulted. NI were defined according to the CDC-criteria and were categorised i nto specific infection sites. Within 20 months. 545 patients with a total o f 5,117 patient days were investigated (mean length of stay: 9.4 days). 113 NI were identified in 90 patients (72 pts. with one, 13 with two and 5 wit h three infections, respectively). A moderate to high overall incidence (20 .7/100 pts.) and a moderate incidence density (22.1/1,000 patient days) of NI in the neurosurgical ICU could be documented; these figures are well wit hin the range of published data. Site specific incidence rates and incidenc e densities were: 1 bloodstream infection per 100 patients (0.9 central lin e-associated BSIs per 1,000 central line-days), 9 pneumonias per 100 patien ts(15.1 ventilator-associated pneumonias per 1,000 ventilator-days). 7.3 ur inary tract infections per 100 patients (8.5 urinary catheter-associated UT Is per 1.000 urinary catheter-days). Additionally, 1.1 cases of meningitis, 0.7 brain abscesses/ventriculitis, and 1.7 other infections (surgical site infection. bronchitis, catheter related local infection, diarrhoea) were d ocumented per 100 patients, respectively. 14.6% of isolated pathogens were E. coli, 10.2% enterococci? 9.6% S. aureus, 6.4% CNS, 6.4% Klebsiella spp., 5% Enterobacter spp. and 5% Pseudomonas spp.. In 11 cases of NI no pathoge n could be isolated.