ABSTRACT Objective: To examine the incidence of and risk factors for device‐associated infections and associated mortality. Design and setting: Prospective surveillance‐based study in ICUs of 19 hospitals in The Netherlands. Patients: The study included 2,644 patients without infection at admission during 1997‐ 2000, staying at the ICU for at least 48 h. Measurements and results: The occurrence of ventilator‐associated pneumonia (VAP), central venous catheter (CVC)‐related bloodstream infection (CR‐BSI), urinary catheter‐ associated urinary tract infection (CA‐UTI) and risk factors was monitored. Of the ventilated patients 19% developed pneumonia (25/1,000 ventilator days); of the patients with a central line 3% developed CR‐BSI (4/1,000 CVC days) and of the catheterized patients 8% developed CA‐UTI (9/1,000 catheter days). Longer device use increased the risk for all infections, especially for CR‐BSI. Independent risk factors were sex, immunity, acute/elective admission, selective decontamination of the digestive tract, and systemic antibiotics at admission, dependent upon the infection type. Crude mortality significantly differed in patients with and without CR‐BSI (31% vs. 20%) and CA‐UTI (27% vs. 17%) but not for VAP (26% vs. 23%). Acquiring a device‐associated infection was not an independent risk factor for mortality. Being in need of ventilation or a central line, and the duration of this, contributed significantly to mortality, after adjusting for other risk factors. Conclusions: Device use was the major risk factor for acquiring VAP, CR‐BSI and CA‐UTI. Acquiring a device‐associated infection was not an independent risk factor for mortality, but device‐use in itself was. 22 Chapter 2
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