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Min, Tae, Sung, Hee, Su, Ji, Eun, Sun, Joong, Young, Kil, Hee, Hyo, Kyung, Joohon, Young, Hong, Heoung-Soo, Jun-Wook, and Jun: Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2012 through June 2013
Original Article

J Nosocomial Infect Control 2013;20(2):37-48.

Published online: 3 May 2013

DOI: https://doi.org/10.14192/kjnic.2015.20.2.37

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Data Summary from July 2012 through June 2013

Hyok Jeon Min, Hyong Kim Tae, Ran Kim Sung, Kyung Chun Hee, Ha Han Su, Hwan Bang Ji, Suk Park Eun, Young Jeong Sun, Sik Eom Joong, Keun Kim Young, Yeon Lee Kil, Jung Choi Hee, Youl Kim Hyo, Mi Kim Kyung, Sung Joohon, Uh Young, Bin Kim Hong, Chung Heoung-Soo, Kwon Jun-Wook, Hee Woo Jun

1Division of Infectious Diseases Soonchunhyang University College of Medicine, Seoul, Korea

2Infection Control Office, Korea University Guro Hospital, Seoul, Korea

3Kyung Hee University School of Medicine, Kyung Hee Hospital, Seoul, Korea

4Division of Infectious Diseases, Seoul Metropolitan Boramae Hospital, Seoul, Korea

5Department of Infection Control, Severance Hospital, Seoul, Korea

6Department of Nursing, Konyang University College of Nursing, Daejeon, Korea

7Division of Infectious Diseases, Hallym University College of Medicine Kangdong Sacred Heart Hospital, Seoul, Korea

8Division of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju Sevrans Christian Hospital, Wonju, Korea

9Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

10The Catholic University of Korea College of Nursing, Seoul, Korea

11Seoul National University School of Public Health and Institution of Health and Environment, Seoul, Korea

12Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju Sevrans Christian Hospital, Wonju, Korea

13Division of Infectious Diseases, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea

14Korea Centers for Disease Control and Prevention, Cheongju, Korea

15Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address reprint requests to Tae Hyong Kim, Division of Infections Diseases, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: 02-709-9194, Fax: 02-709-9083 E-mail: geuncom@schmc.ac.kr

Received 28 April 2015       Accepted 26 November 2015

Copyright © 2013, the Korean Thyroid Association. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The Korean Society for Nosocomial Infection Control (KOSNIC) ran a surveillance system, called as Korean Nosocomial Infections Surveillance (KONIS), since July 2006. Here, we report the annual data of the intensive care unit (ICU) module of the system from July 2012 through June 2013.

Methods

This is a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 161 ICUs in 91 hospitals using the KONIS system. The nosocomial infection (NI) rate was calculated as the number of infections per 1,000 patient days or device days.

Results

A total of 3,042 NIs were reported during the study period: 877 UTIs (854 cases were urinary catheter-associated), 1,272 BSIs (1,096 were central line-associated), and 893 PNEUs (526 cases were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 1.26 cases per 1,000 device days (95% confidence interval; 1.18-1.34) and urinary catheter utilization ratio was 0.78 (0.779-0.781). The rate of central line-associated BSIs was 2.57 (2.42-2.72) and the utilization ratio was 0.49 (0.489-0.491). The rate of ventilator-associated PNEUs was 1.64 (1.50-1.78) and the utilization ratio was 0.37 (0.369-0.371). The urinary catheter utilization ratio was lower in the ICUs of hospitals with 400-699 beds than in those of hospitals with more than 900 beds; nevertheless, CAUTIs were more common in the hospitals with 400-699 beds. The central line-associated BSI (CLABSI) rate was lower in the study period than in the previous period of July 2011-June 2012 [2.57 (2.42-2.72) vs. 3.01 (2.84-3.19)].

Conclusion

The CLABSI rates were lower in the study period than those in the previous years. CAUTIs were more common in the ICUs of hospitals with 400-699 beds than in those of larger hospitals.

Keywords: Intensive care unit, KONIS, Korean Nosocomial Infections Surveillance System, Nosocomial infection

References

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Table 1.
Characteristics of hospitals and intensive care units participated in KONIS from July 2012 through June 2013
Variables Number (%)
Characteristics of hospitals  
Total no. of hospitals 91
No. of university-affiliated hospitals 63 (69.2)
No. of major teaching hospitals 67 (73.6)
No. of private hospitals 74 (81.3)
Beds size  
≥900 21 (23.1)
700-899 29 (31.9)
400-699 41 (45.0)
Area  
Seoul 27 (29.7)
Kangwon/Gyeonggi/Incheon 25 (27.5)
Central/South 39 (42.8)
Hospitals with special ward  
Hemato-oncology 47 (51.6)
Bone marrow transplantation 35 (38.5)
Solid organ transplantation 18 (19.8)
Hemodialysis 89 (97.8)
Composition of intensive care units (ICUs)  
Total no. of ICUs 161
Medical ICU (MICU) 65 (40.3)
Medical combined ICU (MCICU) 32 (19.9)
Surgical combined ICU (SCICU) 20 (12.4)
Surgical ICU (SICU) 22 (13.7)
Neurosurgical ICU (NSICU) 22 (13.7)
Duration of Surveillance  
3 months 5 (3.1)
6 months 23 (14.3)
9 months 2 (1.2)
12 months 131 (81.4)
Table 2.
Pooled means of nosocomial infection rates, by number of hospital beds, July 2012 through June 2013
Nosocomial infection rate No. of hospital beds
≥900 700-899 400-699 All
No. of units 42 55 64 161
Patient-days 211,012 354,779 301,892 867,683
Infection rate*        
No. of infections 759 1,204 1,079 3,042
Pooled mean 3.60 3.39 3.57 3.51
95% CI 3.35-3.86 3.21-3.59 3.37-3.79 3.38-3.63
UTI rate†        
No. of UTI 181 343 353 877
Pooled mean 0.86 0.97 1.17 1.01
95% CI 0.74-0.99 0.87-1.07 1.05-1.30 0.95-1.08
BSI rate‡        
No. of BSI 370 468 434 1,272
Pooled mean 1.75 1.32 1.44 1.47
95% CI 1.58-1.94 1.20-1.44 1.31-1.58 1.39-1.55
PNEU rate§        
No. of PNEU 208 393 292 893
Pooled mean 0.99 1.11 0.97 1.03
95% CI 0.86-1.13 1.00-1.22 0.86-1.08 0.96-1.10

*(No. of UTIs, BSIs, or PNEUs/No. of patient-days)×1,000; †(No. of UTIs/No. of patient-days)×1,000; ‡(No. of BSIs/No. of patient-days)×1,000; §(No. of PNEUs/No. of patient-days)×1,000.

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 3.
Pooled means and percentiles of the distribution of device-associated infection rates, by number of hospital beds, July 2012 through June 2013
Urinary catheter-associated UTI rate*
No. of hospital beds No. of units No. of UTI Urinary catheter-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
≥900 42 177 183,262 0.97 0.83-1.12 0 0 0 1.42 3.51
700-899 55 337 252,102 1.34 1.20-1.49 0 0 0 2.48 3.75
400-699 64 340 243,712 1.40 1.25-1.55 0 0 0 2.14 4.64
All 161 854 679,076 1.26 1.18-1.34 0 0 0 2.11 4.08
Central line-associated BSI rate†
No. of hospital beds No. of units No. of BSI Central line-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
≥900 42 341 135,746 2.51 2.26-2.79 0 0 0 3.97 6.85
700-899 55 409 158,784 2.58 2.34-2.84 0 0 0 4.30 6.94
400-699 64 346 132,253 2.62 2.35-2.91 0 0 0 4.31 8.56
All 161 1,096 426,783 2.57 2.42-2.72 0 0 0 4.18 7.35
Ventilator-associated PNEU rate‡
No. of hospital beds No. of units No. of PNEU Ventilator-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
≥900 42 130 97,922 1.33 1.12-1.58 0 0 0 0 6.05
700-899 55 225 119,682 1.88 1.65-2.14 0 0 0 2.91 7.06
400-699 64 171 103,997 1.64 1.42-1.91 0 0 0 0 6.76
All 161 526 321,601 1.64 1.50-1.78 0 0 0 0 6.67

*(No. of urinary catheter-associated UTIs/No. of urinary catheter-days)×1,000; †(No. of central line-associated BSIs/No. of central line-days)×1,000; ‡(No. of ventilator-associated PNEUs/No. of ventilator-days)×1,000.

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 4.
Pooled means and percentiles of the distribution of device-utilization ratios, by number of hospital beds, July 2012 through June 2013
Urinary catheter utilization ratio*
No. of hospital beds No. of units Urinary catheter-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
≥900 42 183,262 211,012 0.87 0.869-0.871 0.76 0.83 0.90 0.94 0.98
700-899 55 252,102 354,779 0.71 0.709-0.711 0.75 0.83 0.89 0.94 0.98
400-699 64 243,712 301,892 0.81 0.809-0.811 0.59 0.75 0.84 0.93 0.97
All 161 679,076 867,683 0.78 0.779-0.781 0.70 0.80 0.88 0.93 0.98
Central line utilization ratio†
No. of hospital beds No. of units Central line-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
≥900 42 135,746 211,012 0.64 0.638-0.642 0.44 0.52 0.66 0.80 0.88
700-899 55 158,784 354,779 0.45 0.448-0.452 0.35 0.44 0.55 0.69 0.79
400-699 64 132,253 301,892 0.44 0.438-0.442 0.21 0.31 0.43 0.55 0.65
All 161 426,783 867,683 0.49 0.489-0.491 0.29 0.41 0.52 0.67 0.80
Ventilator utilization ratio‡
No. of hospital beds No. of units Ventilator-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
≥900 42 97,922 211,012 0.46 0.458-0.462 0.21 0.31 0.48 0.62 0.73
700-899 55 119,682 354,779 0.34 0.338-0.342 0.21 0.30 0.42 0.52 0.64
400-699 64 103,997 301,892 0.34 0.338-0.342 0.12 0.21 0.32 0.43 0.56
All 161 321,601 867,683 0.37 0.369-0.371 0.17 0.26 0.39 0.52 0.66

*(No. of urinary catheter-days/No. of patient-days); †(No. of central line-days/No. of patient-days); ‡(No. of ventilator-days/No. of patient-days).

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 5.
Pooled means and percentiles of the distribution of device-associated infection rates, by type of ICU, July 2012 through June 2013
Urinary catheter-associated UTI rate*
Type of ICU No. of units No. of UTI Urinary catheter-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
MICU 65 331 282,825 1.17 1.05-1.30 0 0 0 1.93 3.55
MCICU 32 185 144,134 1.28 1.11-1.48 0 0 0 1.90 4.20
SCICU 20 75 75,416 0.99 0.79-1.25 0 0 0 1.75 4.15
SICU 22 108 84,260 1.28 1.06-1.55 0 0 0 2.12 4.14
NSICU 22 155 92,441 1.68 1.43-1.96 0 0 0 2.85 6.09
Central line-associated BSI rate†
Type of ICU No. of units No. of BSI Central line-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
MICU 65 514 184,856 2.78 2.55-3.03 0 0 0 4.42 7.77
MCICU 32 217 88,133 2.46 2.16-2.81 0 0 0 4.11 7.52
SCICU 20 102 46,488 2.19 1.81-2.66 0 0 0 4.14 7.14
SICU 22 169 56,989 2.97 2.55-3.45 0 0 0 4.15 7.65
NSICU 22 94 50,317 1.87 1.53-2.29 0 0 0 3.16 6.71
Ventilator-associated PNEU rate‡
Type of ICU No. of units No. of PNEU Ventilator-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
MICU 65 150 156,644 0.96 0.82-1.12 0 0 0 0 4.18
MCICU 32 95 61,517 1.54 1.26-1.89 0 0 0 0 6.09
SCICU 20 77 33,766 2.28 1.82-2.85 0 0 0 3.32 7.70
SICU 22 71 40,417 1.76 1.39-2.22 0 0 0 0 6.82
NSICU 22 133 29,257 4.55 3.84-5.39 0 0 0 6.83 13.59

*(No. of urinary catheter-associated UTIs/No. of urinary catheter-days)×1,000; †(No. of central line-associated BSIs/No. of central line-days)×1,000; ‡(No. of ventilator-associated PNEUs/No. of ventilator-days)×1,000.

Abbreviations: ICU, intensive care unit; MICU, medical ICU; MCICU, medical combined ICU; SCICU, surgical combined ICU; SICU, surgical ICU; NSICU, neurosurgical ICU; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 6.
Pooled means and percentiles of the distribution of device-utilization ratios, by type of ICU, July 2012 through June 2013
Urinary catheter utilization ratio*
Type of ICU No. of units Urinary catheter-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
MICU 65 282,825 383,453 0.74 0.739-0.741 0.68 0.77 0.84 0.91 0.95
MCICU 32 144,134 174,787 0.82 0.818-0.822 0.70 0.79 0.86 0.92 0.97
SCICU 20 75,416 85,737 0.88 0.878-0.882 0.77 0.86 0.92 0.95 0.98
SICU 22 84,260 98,833 0.85 0.848-0.852 0.62 0.82 0.90 0.96 0.99
NSICU 22 92,441 124,873 0.74 0.738-0.742 0.80 0.87 0.94 0.97 1.00
Central line utilization ratio†
Type of ICU No. of units Central line-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
MICU 65 184,856 383,453 0.48 0.478-0.482 0.32 0.43 0.54 0.67 0.78
MCICU 32 88,133 174,787 0.50 0.498-0.502 0.24 0.37 0.49 0.64 0.77
SCICU 20 46,488 85,737 0.54 0.537-0.543 0.30 0.42 0.55 0.67 0.78
SICU 22 56,989 98,833 0.58 0.577-0.583 0.28 0.42 0.62 0.81 0.87
NSICU 22 50,317 124,873 0.40 0.397-0.403 0.29 0.37 0.48 0.60 0.73
Ventilator utilization ratio‡
Type of ICU No. of units Ventilator-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
MICU 65 156,644 383,453 0.41 0.408-0.412 0.24 0.35 0.46 0.58 0.70
MCICU 32 61,517 174,787 0.35 0.348-0.352 0.13 0.22 0.33 0.48 0.59
SCICU 20 33,766 85,737 0.39 0.387-0.393 0.19 0.26 0.37 0.50 0.66
SICU 22 40,417 98,833 0.41 0.407-0.413 0.15 0.25 0.38 0.58 0.70
NSICU 22 29,257 124,873 0.23 0.228-0.232 0.12 0.18 0.27 0.37 0.48

*(No. of urinary catheter-days/No. of patient-days); †(No. of central line-days/No. of patient-days); ‡(No. of ventilator-days/No. of patient-days).

Abbreviations: ICU, intensive care unit; MICU, medical ICU; MCICU, medical combined ICU; SCICU, surgical combined ICU; SICU, surgical ICU; NSICU, neurosurgical ICU; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 7.
Number (%) of microorganisms isolated from clinical specimens of patients with nosocomial infections
Organism No. of isolates
SUTI ABUTI UTI BSI PNU3 PNU2 PNU1 PNEU All
Gram-positive cocci (%) 238 9 247 691 1 27 216 244 1,182
  (27.2) (23.1) (27.0) (51.4) (12.5) (29.0) (32.4) (31.8) (39.0)
Staphylococcus aureus 19 3 22 232 1 25 200 226 480
Coagulase-negative staphylococci 39 2 41 163   1 3 4 208
Streptococcus pneumoniae       2     5 5 7
Streptococcus species 6   6 9     7 7 22
Enterococcus faecalis 100 1 101 100   1 1 2 203
Enterococcus faecium 71 3 74 178         252
Enterococcus species 3   3 6         9
Others       1         1
Gram-positive bacilli (%) 1   1 10     1 1 12
  (0.1)   (0.1) (0.7)     (0.1) (0.1) (0.4)
Corynebacterium species       5         5
Others 1   1 5     1 1 7
Gram-negative bacilli (%) 316 18 334 424 7 65 441 513 1,271
  (36.1) (46.2) (36.5) (31.6) (87.5) (69.9) (66.1) (66.8) (42.0)
Escherichia coli 100 7 107 25   2 9 11 143
Klebsiella pneumoniae 59 5 64 60   6 77 83 207
Klebsiella oxytoca 3   3 1   1 4 5 9
Enterobacter cloacae 9   9 18     13 13 40
Enterobacter aerogenes 10 3 13 11   5 25 30 54
Enterobacter species 2   24   1 128
Serratia marcescens 5   5 16     8 8 29
Proteus mirabilis 22   22 6     3 3 31
Proteus vulgaris 22           2
Citrobacter freundii       4     2 2 6
Citrobacter species 3   3           3
Morganella morganii 2   2 1     2 2 5
Providencia species 1   1           1
Pseudomonas aeruginosa 60   60 34 2 9 74 85 179
Pseudomonas species 1   1 1     1 1 3
Acinetobacter baumannii 32 3 35 176 5 38 203 246 457
Acinetobacter species       4     2 2 6
Burkholderia cepacia 1   1 10   1 3 4 15
Stenotrophomonas maltophilia       32   1 14 15 47
Others 4   4 21   1   1 26
Anaerobes (%)       5         5
        (0.4)         (0.2)
Fungi (%) 321 12 333 213   1 9 10 556
  (36.6) (30.7) (36.4) (15.9)   (1.1) (1.4) (1.3) (18.4)
Candida albicans 128 4 132 83     6 6 221
Candida tropicalis 60 1 61 43   1   1 105
Candida glabrata 31   31 23     1 1 55
Candida parapsilosis 14 1 15 46         61
Candida species 54 5 59 9         68
Trichosporon species 3   3           3
Trichosporon asahii 91 10 2         12
Yeast 20   20 6         26
Others 2   2 1     2 2 5
Total 876 39 915 1,343 8 93 667 768 3,026
Table 8.
Susceptibilities of major pathogens isolated from patients with nosocomial infections
Organism No. of resistant/total isolates (%)
Methicillin-resistant Staphylococcus aureus 413/477 (86.6)
Vancomycin-resistant Enterococcus faecalis 8/199 (4.0)
Vancomycin-resistant Enterococcus faecium 116/248 (46.8)
Cefotaxime-resistant Escherichia coli 61/137 (44.5)
Cefotaxime-resistant Klebsiella pneumoniae 133/201 (66.2)
Ciprofloxacin-resistant Escherichia coli 78/129 (60.5)
Ciprofloxacin-resistant Klebsiella pneumoniae 112/188 (59.6)
Imipenem-resistant Pseudomonas aeruginosa 71/177 (40.1)
Imipenem-resistant Acinetobacter baumannii 364/438 (83.1)
Table 9.
Comparison of the device utilization ratios and the rates of device-associated infections from 2008 through 2013
July 2008-June 2009 July 2009-June 2010 July 2010-June 2011 July 2011-June 2012 July 2012-June 2013
No. of hospitals 57 63 72 81 91
No. of units 101 116 130 143 161
Patient-days 435,035 518,620 585,325 698,595 867,683
Device-days          
Urinary catheter-days 369,476 446,612 503,365 590,793 679,076
Central line-days 243,882 289,380 309,500 362,576 426,783
Ventilator-days 179,803 209,858 233,640 282,472 321,601
No. of infections          
Urinary catheter-associated UTI 1,772 2,119 1,949 1,366 854
Central line-associated BSI 797 948 932 1,091 1,096
Ventilator-associated PNEU 335 410 410 481 526
Device utilization ratio (95% CI) [range*]          
Urinary catheter 0.85 0.86 0.86 0.85 0.78
  (0.849-0.851) (0.859-0.861) (0.859-0.861) (0.849-0.851) (0.779-0.781)
  [0.71-0.96] [0.73-0.96] [0.73-0.97] [0.71-0.97] [0.70-0.98]
Central line 0.56 0.56 0.53 0.52 0.49
  (0.559-0.561) (0.559-0.561) (0.529-0.531) (0.519-0.521) (0.489-0.491)
  [0.35-0.83] [0.35-0.82] [0.31-0.81] [0.30-0.79] [0.29-0.80]
Ventilator 0.41 0.41 0.40 0.40 0.37
  (0.409-0.411) (0.409-0.411) (0.399-0.401) (0.399-0.401) (0.369-0.371)
  [0.21-0.64] [0.19-0.62] [0.19-0.61] [0.20-0.65] [0.17-0.66]
Rate per 1,000 device-days (95% CI) [range*]          
Urinary catheter-associated UTI 4.80 4.75 3.87 2.26 1.26
  (4.58-5.03) (4.55-4.95) (3.70-4.05) (2.14-2.39) (1.18-1.34)
  [1.08-8.13] [1.14-8.40] [0-8.80] [0-5.61] [0-4.08]
Central line-associated BSI 3.27 3.28 3.01 3.01 2.57
  (3.05-3.51) (3.07-3.49) (2.82-3.21) (2.84-3.19) (2.42-2.72)
  [0.73-5.84] [0.68-5.61] [0-6.92] [0-6.64] [0-7.35]
Ventilator-associated PNEU 1.86 1.95 1.75 1.70 1.64
  (1.67-2.07) 1.77-2.15 1.59-1.93 1.56-1.86 (1.50-1.78)
[0-4.75] [0-6.33] [0-5.88] [0-5.96] [0-6.67]

*10th to 90th percentile range.

Abbreviations: ICU, intensive care unit; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

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