Risk factors for broncho-pulmonary nosocomial infection in medical intensive care unit

Broncho-pulmonary nosocomial infection (BPNI) has the highest incidence of nosocomial infection in intensive care unit (ICU) and is associated with substantial morbidity and mortality. The objective of this study is to determine the risk factors for BPNI and improve the prevention of this infection.

Patients and methods

Characteristics of all patients admitted in a 30-beds university medical ICU were prospectively collected from 03/93 to 09/99. The diagnosis criteria for nosocomial pneumonia and bronchitis were those published by the CDC. Patients with first BPNI were compared to the others by univariate and multivariate analysis.

Results

We diagnosed 517 first BPNI representing: 12% of the 3681 patients hospitalised in our unit, 11.6 episodes/1000 days of hospitalization and 16 episodes/1000 days of ventilation. Microbiology studies were positives for 455 (88%) BPNI: Acinetobacter (28.1%), P. aeruginosa (23.1%), Staphylococcus aureus (12.6%). The 517 BPNI included 282 (54.5%) pneumonia and 235 (45.5%) bronchitis.

Conclusion

Prevention of BPNI should consider all measures to decrease ICU stay, length of mechanical ventilation and the use of steroids, sedatives, H2-blockers, omeprazole, sucralfate and ATB therapy; especially in patients with renal failure.

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