Hospital Acquired Infections in the Intensive Care Unit at Kigali University Teaching Hospital, a Retrospective Study

Abstract

Background and objectives: According to WHO (World Health Organization), Hospital Acquired Infection (HAI) is an infection that is not typically present at the time of admission, and acquired after hospitalization then manifests after more than 48 hours. Patients in ICU (Intensive Care Unit) are at high risk of getting hospital acquired infections at a rate of 3-5 times compared to general ward. The antimicrobial resistance is high in both low- and middleincome countries. The mortality rate of HAI in ICU exceeds 40% word wide. Data is still low in Rwanda especially ICUs and This is the reason of our study. Our aim is to evaluate the incidence of ICU hospital acquired infection, the common types, the common isolated organisms and related antibiogram. Methods: We conducted a retrospective observational descriptive study of patients admitted to the adult ICU-HDU (High dependency Unit) at CHUK (Kigali University Teaching Hospital) for a duration of 12 months. Data were collected on patients’ characteristics and demographic profile, primary diagnosis of admission, isolated microorganism, the sample source and antimicrobial resistance pattern. All were recorded from ICU logistic book, patients‘s medical files and open clinic to data collection sheet. Data were analyzed using Microsoft excel. Pediatric patients and those with active HAI at the time of ICU-HDU admission were excluded. Results: Total patients found were 309, female 51.9% and male 48.1%, 15% were above 65 years. Most primary admitting diagnosis was trauma at 24%. 98% of patients had urinary catheter, 75% were intubated, 66% were surgical patients, and 36% had a central line placed. The incidence of adult ICU HAI was 21.68% with VAP (Ventilation Associated Pneumonia) as the most common type (63.85%) followed by CAUTI (Catheter Associated Urinary Tract Infection) (15.66%), PBSI (Primary Blood Stream Infection) (13.85%). The incidence density of VAP was 19.0 per 1000 patient-days and that of CAUTI was 2.7 per 1000 patient-days. In general, the most causative organism of HAI was Klebsiella pneumonia followed by Pseudomonas aeruginosa and Acinetobacter. Other identified organisms were Escherichia coli, Proteus mirabilis, and Staphylococcus aureus, Providencia, Citrobacter and Enterococcus. The most common cause of VAP was K. pneumonia followed by P. aeruginosa then Acinetobacter. The most common cause of CAUTI was K. pneumonia followed by Acinetobacter. The most common cause of PBSI was K. pneumonia followed by S. aureus

Then E. coli and Acinetobacter. Generally, the antimicrobial resistance rate was more than 50% in all tested antibiotics except carbapenem, nitrofurantoin, amikacin, and chloramphenicol. Conclusion: The incidence of HAI and antimicrobial resistance in ICU of CHUK is high compared to the population in general wards as well as ICU patients of developed countries. The most common type is VAP. K. pneumonia is the most isolated microorganism. We recommend to strengthen the implementation of the existing infection prevention and control (IPC) guidelines in order to reduce the rate of HAI in ICU of CHUK. This implementation can be achieved by regular training of the staff about IPC, increasing the critical care specialized staff and decreasing their workload. Lastly, we suggest further studies with larger sample size and prospective method to be conducted in the future.