Surveillance von nosokomialen Infektionen bei neurochirurgischen Patienten mit Liquordrainagen
by Lennart-Hendrik Neuss née Neuss
Date of Examination:2024-06-18
Date of issue:2024-06-12
Advisor:Andreas Beste
Referee:Prof. Dr. Simone Scheithauer
Referee:PD Dr. Christian von der Brelie
Persistent Address:
http://dx.doi.org/10.53846/goediss-10536
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Abstract
English
BACKGROUND: Health-care-associated infections (HCAIS) are a major problem for patients and the entire healthcare system. Not only do they lead to an enormous economic burden for society, they also pose a serious risk to patients in terms of increased mortality and lasting negative consequences for their quality of life. In order to quantify the situation and make it comparable, there are so-called surveillance systems that allow to collect and evaluate standardized data. The aim here is to maintain an overview of the national incidence of infection and subsequently to be able to draw conclusions about infection prevention. METHODS: This study included a patient collective (n=376) consisting of neurosurgical patients with ventricular drainage, including external ventricular drains and lumbar drains, in all neurosurgical normal and intensive care units (ICU) as well as the intermediate care unit of the Universitätsmedizin Göttingen. HCAIs were recorded according to the definitions of the "Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen" by the "Krankenhaus-Infektions-Surveillance-System" (KISS). The patients were observed from admission to discharge over a three-year period from 2019-2022. In addition to descriptive methods, a risk factor analysis using logistic regression was also used for the evaluation. RESULTS: In 376 patients with a total of 8122 patient days, the results showed 169 HCAIs in 138 patients with at least one HCAI, an infection rate of 36.7% and an incidence density of 20.8 infections/1000 patient days (ICU 32.3/1000 patient days, normal ward 9.2/1000 patient days). The most common infections were hospital-acquired pneumonia (25.0%) with an incidence density of 11.6 infections/1000 patient days (ICU 21.6/1000 patient days, normal ward 1.5/1000 patient days), urinary tract infections (13.8%) with 6, 4 infections/1000 patient days (ICU 9.1/1000 patient days, normal ward 3.7/1000 patient days) and surgical site infection (5.1%) with 2.3 infections/1000 patient days (ICU 0.7/1000 patient days, normal ward 4.0/1000 patient days). Ventilator-associated pneumonia occured with an incidence density of 37.5/1000 device days, all in an ICU, catheter-associated urinary tract infections with an incidence density of 14.7/1000 device days overall, 14.1/1000 device days in ICU and 16.2/1000 device days in normal wards and centralline-associated bloodstream infection with an incidence density of 1.0/1000 device days in total, 1.2/1000 device days regarding only ICU). The infection rate for surgical interventions on the head was 4.6%, of which 0.8% in the intensive care unit and 3.8% in the normal ward. The three most frequently detected pathogens were S. aureus (25.3%), E. coli (19.1%) and Klebsiella pneumoniae (16.7%). The MDRO density was 1.2 cases/1000 patient days, of which MRSA was 0.3 cases/1000 patient days. With regard to the risk factor analysis, the length of stay (p=<0.001; OR=1.051) and an intensive care unit stay (p=<0.001; OR=4.046) in particular were found to be highly significant risk factors for the occurrence of a HCAI. There was no significant difference in the number of infections before and after the start of the COVID-19 pandemic. Age played a subordinate role as a risk factor for HCAI. Compared to summer, HCAIs occurred significantly more frequently in winter (p=<0.001; OR=3.333) and fall (p=0.01; OR=2.161). The duration of device use was shown to be a highly significant risk factor for ventilator-associated pneumonia (p=<0.001; OR=1.183) and catheter-associated urinary tract infections (p=<0.001; OR=1.930). CONCLUSION: The patient population of neurosurgical patients with ventricular drainage is exposed to a high risk of HCAIs with an infection rate that can be classified as high. Special protection against infection is required by means of suitable preventive measures. Based on this, collective-specific research should be carried out.
Keywords: hcai; infection; VAP; cauti; clabsi; surveillance; ventriculardrainge
