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Critical Care

Open Access

Serial changes in ICU-acquired pneumonia pathogen after the remodeling of the environment in a MICU

  • S Hong1,
  • J Jung1,
  • C Lim1,
  • S Na1,
  • J Ahn2,
  • S Lee1,
  • W Kim1,
  • D Kim1 and
  • Y Koh1
Critical Care20059(Suppl 1):P13

https://doi.org/10.1186/cc3076

Published: 7 March 2005

Introduction

The aim of the study was to observe effects of the improvement of the patient's care facility in a medical ICU (MICU) on ICU-acquired pneumonia (IAP), especially caused by drug-resistant bacteria including methicillin-resistant Staphylococcus aureus, third-generation cephalosporin-resistant Acinetobacter baumanii (ISAB), imipenem-intermediate sensitive A. baumanii (IIAB), imipenem-resistant A. baumanii (IRAB), expanded-spectrum beta-lactamase (ESBL), and imipenem-resistant Pseudomonas aeruginosa (IRPA).

Methods

All critically ill patients with clinically diagnosed IAP between January 2001 and June 2002 (period 1 – before remodeling), October 2002 and March 2003 (period 2 – after remodeling) and October 2003 and March 2004 (period 3 – 1-year follow-up after remodeling) were observed prospectively in the 28-bed MICU of a 2100-bed tertiary-care singer center. Clinical suspicion of IAP was defined by a new and persistent infiltrate on chest radiography associated with at least two of the following: purulent secretions, temperature ≥ 38.5°C or < 36.5°C, and a leukocyte count higher than 10,000/μl or lower than 4000/μl.

Results

A total 1038 patients (355, 353 and 330) were admitted to the MICU during the study periods. At each period, 48 (44 cases, 11%), 38 (34 cases, 8%), and 80 (60 cases, 18%) episodes of clinically diagnosed IAP occurred (P = 0.160). The mean age (62 vs 66 vs 63, P = 0.272), percentage of males (82 vs 82 vs 78, P = 0.800), and mean APACHE III score (67.3 ± 18.7 vs 70.1 ± 26.5 vs 77.7 ± 28.0, P = 0.148) were not different during the study periods. Episodes of MRSA [13(30%) vs 12 (34%) vs 29 (37%)], ISAB [6 (13%) vs 1 (3%) vs 9 (11%), P = 0.243], IRPA [2 (4%) vs 1 (3%) vs 9 (11%), P = 0.150], and ESBL [2 (4%) vs 5 (13%) vs 4 (5%), P = 0.180] were not different during the study periods. Episodes of IIAB [4 (8%) vs 0 (0%) vs 0 (0%), P = 0.006] and IRAB [5 (10%) vs 0 (0%) vs 1 (1%), P = 0.011] were lower in periods 2 and 3 than in period 1. Duration of mechanical ventilation (22.2 ± 13.1 days vs 24.1 ± 13.0 days vs 20.0 ± 13.1 days, P = 0.340), and mortality in the ICU (54.5% vs 44.1% vs 38.3%, P = 0.258) were not different during the study periods. Use of carbapenem [9 (19%) vs 5 (13%) vs 29 (36%), P = 0.011] and glycopeptide [13 (27%) vs 10 (26%) vs 45 (56%), P = 0.001] were higher in period 3 than in periods 1 and 2, and third-generation cephalosporin [21 (44%) vs 20 (53%) vs 19 (24%), P = 0.004] was lower in period 3 than periods 1 and 2.

Conclusion

The incidence of IAP caused by drug resistant bacteria was not affected by the improvement of the patient's care environment in the studied ICU. However, the incidence of IAP by IRAB and IIAB has been decreased after the remodeling.

Authors’ Affiliations

(1)
Asian Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
(2)
Ulsan University Hospital, Ulsan, South Korea

Copyright

© BioMed Central Ltd 2005

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