The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright (C) 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
[1]INICC, RA-1195 Buenos Aires, DF, Argentina;
[2]Zhongshan Hosp, Shanghai, Peoples R China;
[3]Univ Wisconsin, Sch Med, Madison, WI USA;
[4]Medanta Medcity, New Delhi, India;
[5]Thammasat Univ Hosp, Pathum Thani, Thailand;
[6]Hosp Sao Paulo, Sao Paulo, Brazil;
[7]Ondokuz Mayis Univ, Sch Med, Samsun, Turkey;
[8]Natl Univ Singapore Hosp, Singapore 117548, Singapore;
[9]Univ Pontificia Javeriana, Hosp Univ San Ignacio, Bogota, Colombia;
[10]Jordan Univ Hosp, Amman, Jordan;
[11]Inst Mexicano Seguro Social, Torreon, Mexico;
[12]INEN, Lima, Peru;
[13]St Lukes Med Ctr, Quezon City, Philippines;
[14]Ibn Sina Med ICU, Rabat, Morocco;
[15]Hosp Docente Clin Quirurg Joaquin Albarran Doming, Havana, Cuba;
[16]Filip II Special Hosp Surg, Skopje, Macedonia;
[17]Ctr Hosp Pereira Rosell Bouar, Montevideo, Uruguay;
[18]Hop Enfants, Tunis, Tunisia;
[19]Hosp Nacl Ninos Benjamin Bloom, San Salvador, El Salvador;
[20]San Jorge Childrens Hosp, Asociac Epidemiologos Puerto Rico, Guaynabo, PR USA;
[21]Hosp Kaunas Univ Med, Kaunas, Lithuania;
[22]Ain Shams Fac Med, Cairo, Egypt;
[23]Liaquat Natl Hosp, Karachi, Pakistan;
[24]Amer Univ Beirut, Med Ctr, Beirut, Lebanon;
[25]Hosp Hotel La Catolica, San Jose, Costa Rica;
[26]Clin Hosp San Fernando, Panama City, Panama;
[27]Prishtina Univ, Natl Inst Publ Hlth Kosova, Prishtina, Kosovo, Serbia;
[28]Prishtina Univ, Sch Med, Prishtina, Kosovo, Serbia;
[29]Sunway Med Ctr Berhad, Petaling Jaya, Malaysia;
[30]Monash Univ, Petaling Jaya, Malaysia;
[31]Cho Ray Hosp, Ho Chi Minh City, Vietnam;
[32]King Fahad Med City, Riyadh, Saudi Arabia;
[33]Univ Hosp Heraklion, Iraklion, Greece;
[34]Hosp Eugenio Espejo, Quito, Ecuador;
[35]Hosp Gen Plaza Salud, Santo Domingo, Dominican Rep;
[36]Univ Hosp Queen Giovanna ISUL, Sofia, Bulgaria;
[37]Bahry Accid & Emergency Hosp, Khartoum, Sudan;
[38]Hosp Militar Dr Carlos Arvelo, Caracas, Venezuela;
[39]Sri Jayewardenepura Gen Hosp, Nugegoda, Sri Lanka
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