Nosocomial infection in an intensive care unit of a tertiary hospital in Nigeria: A 4 year review.

Background: Infection is one of the major factors that determine clinical outcome among patients requiring intensive care unit (ICU) support. The attending mortality is high and depends on source of infection, organisms associated, timeliness and appropriateness of the treatment received. Methods&Materials: Case records of patientswhowere admitted into our 5bedded ICU over a 4 year period were retrospectively reviewed. The average number of admission was 20 per month. A preformed questionnaire was administered and data on clinical and microbiological profile of all the patients with documented infection was obtained. Results: Eighty four episodes of infections were identified in 76 patients. Road traffic accident 29/76(38.2%) and pulmonary embolism12/76(15.8%) were the leading cause of admission. The most common infection was skin and soft tissue infection (SSI) 30/84(35.7%) followed by UTI 23/84(27.4) and primary bacteraemia 18/84(21.4) with the least beingVAP3/84(3.6%). Most of the cases of UTI occurred in patients with RTA and renal failure, while the highest number of primary bacteraemia was seen among patients with burns and renal failure. The most frequent isolates were S. aureus 35/84(41.7%), K. pneumonia 18/84(21.4%) and E. coli 13/84(15.5%). K. pneumonia 2/5(40%) and P. aerugenosa 1/5(20%) were the leading cause of pneumonia, while S. aureus was the commonest cause of SSI 16/30(53.3%), primary bacteremia 10/18(55.6%) and line infection 5/5(100%). There were 3 cases of VAP one each caused by K. pneumonia, P. aerugenosa and S. aureus. High rate of resistance to cloxacillin 19/35(54.3%) and co-trimoxazole 17/26(65.4%) was noted among the S. aureus isolates. All the enterobactrecae isolates that were tested against meropenem were fully susceptible, while resistance rate to ceftriaxone was high; E. coli 5/9(55.6%), K. pneumoniae 10/14 (71.4%) and proteus spp 2/4 (50%). With exception to meropenem and colistin, ciprofloxacin had a better resistance profile against P. aerugenosa and isolated enterobactriacae compared to the other tested B-lactam agents. Conclusion: The study underscores the need to improve infection control practice in our ICU. Resistance to commonly used antibiotic was high and this makes the choice of empiric antibiotic difficult, hence measures to curtail the emergence of resistance pathogens need to be adopted. [ABSTRACT FROM AUTHOR]