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Yee, Jun, Hyeonmi, Sang-Oh, Hong, Su, Hee, Young, Sung, Tae, Hyukmin, Hee, Jae-Seok, Byung, Hyun-Sook, Eun, Young, and Kyungwon: Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2013 through June 2014
Original Article

J Nosocomial Infect Control 2013;20(2):49-60.

Published online: 3 May 2013

DOI: https://doi.org/10.14192/kjnic.2015.20.2.49

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2013 through June 2014

Gyung Kwak Yee, Yong Choi Jun, Yoo Hyeonmi, Lee Sang-Oh, Bin Kim Hong, Ha Han Su, Jung Choi Hee, Keun Kim Young, Ran Kim Sung, Hyong Kim Tae, Lee Hyukmin, Kyung Chun Hee, Kim Jae-Seok, Wook Eun Byung, Koo Hyun-Sook, Hee Cho Eun, Uh Young, Lee Kyungwon

1Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea

2Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea

3Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, Korea

4Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Korea

5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

6Department of Infection Prevention and Control, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

7Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

8Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

9Infection Control Office, Korea University Guro Hospital, Seoul, Korea

10Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea

11Department of Laboratory Medicine, Catholic Kwandong University College of Medicine, Incheon, Korea

12Department of Infection Control, Kyunghee University Hospital, Seoul, Korea

13Department of Laboratory Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea

14Department of Pediatrics, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea

15Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Osong, Korea

16Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

17Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Jun Yong Choi, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 02-2228-1974, Fax: 02-393-6884 E-mail: seran@yuhs.ac

Received 20 May 2015       Accepted 5 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

In this report, we present the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2013 through June 2014.

Methods

We performed a prospective surveillance of nosocomial urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) in 166 ICUs of 94 hospitals using the KONIS. Nosocomial infection (NI) rate was defined as the number of infections per 1,000 patient-days or device-days.

Results

A total of 2,843 NIs were found during the study period: 861 UTIs (846 were urinary catheter-associated), 1,173 BSIs (1,021 were central line-associated), and 809 PNEUs (498 were ventilator-associated). The rate of urinary catheter-associated UTIs was 1.21 per 1,000 device-days (95% confidence interval [CI]=1.13-1.29), and the urinary catheter utilization ratio was 0.84 (95% CI=0.839-0.841). The rate of central line-associated BSIs was 2.33 per 1,000 device-days (95% CI=2.20-2.48), and the utilization ratio was 0.53 (95% CI=0.529-0.531). The rate of ventilator-associated PNEUs (VAPs) was 1.46 per 1,000 device-days (95% CI=1.34-1.60), and the utilization ratio was 0.41 (95% CI=0.409-0.411). In hospitals with more than 900 beds, although the ventilator utilization ratio was highest, the rate of VAPs was lower than in hospitals with 300-699 or 700-899 beds.

Conclusion

BSIs were the most commonly reported nosocomial infections. Although device utilization ratios had increased, nosocomial infection rates did not differ significantly from those during the previous period (July 2012 through June 2013).

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 2013 through June 2014
Variables Number (%)
Characteristics of hospitals  
Total no. of hospitals 94
No. of university-affiliated hospitals 65 (69.2)
No. of major teaching hospitals 69 (73.4)
No. of private hospitals 76 (80.9)
Average no. of beds 759
Beds size  
≥900 21 (22.3)
700-899 32 (34.1)
300-699 41 (43.6)
Area  
Seoul 29 (30.8)
Kangwon/Gyeonggi/Incheon 26 (27.7)
Central/South 39 (41.5)
Hospitals with special ward  
Hemato-oncology 47 (50.0)
Bone marrow transplantation 36 (38.3)
Solid organ transplantation 18 (19.2)
Hemodialysis 91 (96.8)
Infectious Diseases Physician per hospital 1.4
Infection Control Professional per hospital 1.9
Beds per Infection Control Professional 397
Composition of intensive care units (ICUs)  
Total no. of ICUs 166
Medical ICU 64 (38.5)
Medical combined ICU 35 (21.1)
Surgical combined ICU 24 (14.5)
Surgical ICU 20 (12.0)
Neurosurgical ICU 23 (13.9)
Duration of Surveillance  
3 months 12 (7.2)
6 months 16 (9.7)
9 months 1 (0.6)
12 months 137 (82.5)
Table 2.
Pooled means of nosocomial infection rates, by number of hospital beds, July 2013 through June 2014
Nosocomial infection rate No. of hospital beds
≥900 700-899 300-699 All
No. of units 42 60 64 166
Patient-days 209,373 342,175 280,880 832,428
Infection rate*        
No. of infections 657 1,277 909 2,843
Pooled mean 3.14 3.73 3.24 3.42
95% CI 2.91-3.39 3.53-3.94 3.03-3.45 3.29-3.54
UTI rate†        
No. of UTI 148 380 333 861
Pooled mean 0.71 1.11 1.19 1.03
95% CI 0.60-0.83 1.00-1.23 1.07-1.32 0.97-1.11
BSI rate‡        
No. of BSI 348 472 353 1,173
Pooled mean 1.66 1.38 1.26 1.41
95% CI 1.50-1.85 1.26-1.51 1.13-1.40 1.33-1.49
PNEU rate§        
No. of PNEU 161 425 223 809
Pooled mean 0.77 1.24 0.79 0.97
95% CI 0.66-0.90 1.13-1.37 0.70-0.91 0.91-1.04

*(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 decive-associated infection rates, by number of hospital beds, July 2013 through June 2014
No. of hospital beds No. of units No. of infection Device-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
Urinary catheter-associated UTI rate*
≥900 42 142 179,813 0.79 0.67-0.93 0 0 0.35 1.00 2.15
700-899 60 376 292,982 1.28 1.16-1.42 0 0.27 0.90 1.81 3.10
300-699 64 328 229,137 1.43 1.29-1.60 0 0.58 1.17 2.05 2.68
All 166 846 701,932 1.21 1.13-1.29 0 0.26 0.87 1.79 2.71
Central line-associated BSI rate†
≥900 42 316 131,204 2.41 2.16-2.69 0.11 0.85 2.29 3.83 5.31
700-899 60 410 179,898 2.28 2.07-2.51 0.44 1.25 1.72 3.06 4.31
300-699 64 295 126,354 2.36 2.08-2.62 0 0 2.00 3.32 5.28
All 166 1,021 437,456 2.33 2.20-2.48 0 0.94 1.94 3.31 5.08
Ventilator-associated PNEU rate‡
≥900 42 89 95,011 0.94 0.76-1.15 0 0.23 0.90 1.63 3.96
700-899 60 270 143,540 1.88 1.67-2.12 0 0.34 0.79 2.51 4.92
300-699 64 139 101,524 1.37 1.16-1.62 0 0 0.68 2.11 3.47
All 166 498 340,075 1.46 1.34-1.60 0 0 0.81 2.06 3.93

*(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 2013 through June 2014
No. of hospital beds No. of units Device-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
Urinary catheter utilization ratio*
≥900 42 179,813 209,373 0.86 0.859-0.861 0.73 0.84 0.87 0.93 0.96
700-899 60 292,982 342,175 0.86 0.859-0.861 0.72 0.82 0.90 0.94 0.97
300-699 64 229,137 280,880 0.82 0.819-0.821 0.52 0.76 0.86 0.91 0.97
All 166 701,932 832,428 0.84 0.839-0.841 0.71 0.80 0.87 0.93 0.97
Central line utilization ratio†
≥900 42 131,204 209,373 0.63 0.628-0.632 0.45 0.52 0.62 0.79 0.85
700-899 60 179,898 342,175 0.53 0.528-0.532 0.34 0.44 0.52 0.68 0.78
300-699 64 126,354 280,880 0.45 0.448-0.452 0.22 0.31 0.45 0.55 0.66
All 166 437,456 832,428 0.53 0.529-0.531 0.29 0.41 0.52 0.65 0.79
Ventilator utilization ratio‡
≥900 42 95,011 209,373 0.45 0.448-0.452 0.24 0.31 0.45 0.59 0.78
700-899 60 143,540 342,175 0.42 0.418-0.422 0.22 0.31 0.40 0.50 0.63
300-699 64 101,524 280,880 0.36 0.358-0.362 0.15 0.24 0.36 0.48 0.57
All 166 340,075 832,428 0.41 0.409-0.411 0.21 0.28 0.39 0.50 0.62

*(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 2013 through June 2014
Type of ICU No. of units No. of infection Device-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
Urinary catheter-associated UTI rate*
MICU 64 302 281,818 1.07 0.96-1.20 0 0.28 0.80 1.38 2.42
MCICU 35 173 154,370 1.12 0.97-1.30 0 0.30 0.81 1.70 2.37
SCICU 24 121 90,767 1.33 1.12-1.59 0 0.46 0.99 2.10 3.37
SICU 20 93 78,232 1.19 0.97-1.46 0 0.04 0.71 1.99 2.94
NSICU 23 157 96,745 1.62 1.39-1.90 0 0 1.13 2.47 4.45
Central line-associated BSI rate†
MICU 64 507 187,293 2.71 2.48-2.95 0 1.18 2.04 4.14 5.44
MCICU 35 178 91,263 1.95 1.68-2.26 0 0.53 2.00 3.10 4.16
SCICU 24 124 54,919 2.26 1.89-2.69 0.47 1.04 1.90 3.44 4.95
SICU 20 102 52,546 1.94 1.60-2.36 0 0.52 1.39 2.59 3.79
NSICU 23 110 51,435 2.14 1.77-2.58 0 0.49 1.57 3.22 6.33
Ventilator-associated PNEU rate‡
MICU 64 155 159,445 0.97 0.83-1.14 0 0 0.53 1.21 2.23
MCICU 35 113 68,687 1.65 1.37-1.98 0 0 0.88 2.33 3.47
SCICU 24 81 43,976 1.84 1.48-2.29 0 0.72 1.27 2.50 3.33
SICU 20 35 37,759 0.93 0.67-1.29 0 0.68 0.78 1.53 4.00
NSICU 23 114 30,208 3.77 3.14-4.53 0 0 2.03 6.03 10.90

*(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 2013 through June 2014
Type of ICU No. of units Device-days Patient-days Pooled mean 95% CI 10‰ 25‰ 50‰ 75‰ 90‰
Urinary catheter utilization ratio*
MICU 64 281,818 342,363 0.82 0.819-0.821 0.71 0.76 0.85 0.89 0.95
MCICU 35 154,370 186,301 0.83 0.828-0.832 0.63 0.77 0.87 0.92 0.96
SCICU 24 90,767 104,078 0.87 0.868-0.872 0.53 0.86 0.92 0.95 0.98
SICU 20 78,232 92,433 0.85 0.848-0.852 0.58 0.81 0.90 0.94 0.98
NSICU 23 96,745 107,253 0.90 0.898-0.902 0.77 0.88 0.92 0.97 0.99
Central line utilization ratio†
MICU 64 187,293 342,363 0.55 0.548-0.552 0.33 0.45 0.54 0.64 0.78
MCICU 35 91,263 186,301 0.49 0.488-0.492 0.26 0.38 0.46 0.66 0.79
SCICU 24 54,919 104,078 0.53 0.527-0.533 0.21 0.39 0.52 0.62 0.80
SICU 20 52,546 92,433 0.57 0.567-0.573 0.25 0.44 0.63 0.79 0.85
NSICU 23 51,435 107,253 0.48 0.477-0.483 0.33 0.40 0.48 0.59 0.70
Ventilator utilization ratio‡
MICU 64 159,445 342,363 0.47 0.486-0.472 0.24 0.38 0.47 0.54 0.73
MCICU 35 68,687 186,301 0.37 0.368-0.372 0.17 0.25 0.36 0.49 0.59
SCICU 24 43,976 104,078 0.42 0.417-0.423 0.20 0.30 0.40 0.50 0.62
SICU 20 37,759 92,433 0.41 0.407-0.413 0.14 0.24 0.36 0.49 0.65
NSICU 23 30,208 107,253 0.28 0.277-0.283 0.11 0.23 0.28 0.31 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
Organisms No. of isolates
SUTI ABUTI UTI BSI PNEU3 PNEU2 PNEU1 PNEU All
Gram-positive cocci (%) 219 7 226 619 1 20 171 192 1,037
  (25.2) (17.5) (24.9) (50.7) (14.2) (19.8) (27.8) (26.5) (36.3)
Staphylococcus aureus 18 2 20 185 0 16 159 175 380
Coagulase-negative staphylococci 21 1 22 178 0 0 3 3 203
Streptococcus pneumoniae 1 0 1 0 0 0 5 5 6
Streptococcus species 8 0 8 10 0 0 2 2 20
Enterococcus faecalis 98 0 98 97 0 2 0 2 197
Enterococcus faecium 70 4 74 144 1 2 2 5 223
Enterococcus species 2 0 2 3 0 0 0 0 5
Others 1 0 1 2 0 0 0 0 3
Gram-positive bacilli (%) 2 (0.2) 0 (0) 2 (0.2) 2 (0.2) 0 (0) 0 (0) 2 (0.3) 2 (0.3) 6 (0.2)
Corynebacterium species 1 0 1 2 0 0 2 2 5
Others 1 0 1 0 0 0 0 0 1
Gram-negative bacilli (%) 349 18 367 390 3 73 434 510 1,267
  (40.1) (45.0) (40.3) (32.0) (42.9) (72.3) (70.4) (70.5) (44.4)
Escherichia coli 101 6 107 19 0 0 13 13 139
Klebsiella pneumoniae 68 6 74 54 0 13 80 93 221
Klebsiella species 2 0 2 6 0 0 3 3 11
Enterobacter cloacae 12 0 12 16 0 3 9 12 40
Enterobacter aerogenes 8 0 8 8 0 2 19 21 37
Enterobacter species 1 0 1 1 0 0 0 0 2
Serratia marcescens 70 7 15 0 0 8 8 30
Proteus mirabilis 19 1 20 3 0 0 0 0 23
Proteus species 3 0 3 0 0 0 0 0 3
Citrobacter freundii 6 1 7 4 0 0 0 0 11
Citrobacter species 1 0 1 0 0 0 1 1 2
Morganella morganii 3 0 3 0 0 0 1 1 4
Pseudomonas aeruginosa 74 3 77 30 1 6 69 76 183
Pseudomonas species 0 0 0 1 0 0 0 0 1
Acinetobacter baumannii 38 1 39 176 2 45 214 261 476
Acinetobacter species 2 0 2 6 0 0 1 1 9
Burkholderia cepacia 10 1 17 0 2 3 5 23
Burkholderia species 0 0 0 1 0 0 0 0 1
Stenotrophomonas maltophilia 00 0 23 0 2 12 14 37
Sphingomonas paucimobilis 1 0 1 3 0 0 0 0 4
Chryseobacterium species 0 0 0 5 0 0 1 1 6
Others 2 0 2 2 0 0 0 0 4
Anaerobes (%) 0 (0) 0 (0) 0 (0) 10 (0.8) 0 (0) 1 (1.0) 0 (0) 1 (0.1) 11 (0.4)
Fungi (%) 300 15 315 199 3 7 9 19 533
  (34.5) (37.5) (34.6) (16.3) (42.9) (6.9) (1.5) (2.6) (18.7)
Candida albicans 118 8 126 78 0 3 6 9 213
Candida tropicalis 69 4 73 29 0 0 0 0 102
Candida glabrata 30 1 31 24 1 0 0 1 56
Candida parapsilosis 80 8 32 0 0 0 0 40
Candida species 53 1 54 25 1 0 1 2 81
Cryptococcus species 1 0 1 7 0 2 0 2 10
Trichosporon asahii 11 1 12 0 0 0 0 0 12
Yeast 10 0 10 30 0 1 1 14
Aspergillus species 0 0 0 1 1 2 1 4 5
Total 870 40 910 1,220 7 101 616 724 2,854
Table 8.
Susceptibilities of major pathogens isolated from patients with nosocomial infections
Organisms No. of resistant/total isolates (%)
Methicillin-resistant Staphylococcus aureus 333/380 (87.6)
Vancomycin-resistant Enterococcus faecalis 9/197 (4.6)
Vancomycin-resistant Enterococcus faecium 110/223 (49.3)
Cefotaxime-resistant Escherichia coli 65/139 (46.8)
Cefotaxime-resistant Klebsiella pneumoniae 129/221 (58.3)
Ciprofloxacin-resistant Escherichia coli 86/139 (61.9)
Ciprofloxacin-resistant Klebsiella pneumoniae 104/221 (47.1)
Imipenem-resistant Pseudomonas aeruginosa 81/183 (44.3)
Imipenem-resistant Acinetobacter baumannii 420/476 (88.2)
Table 9.
Comparison of the device utilization ratios and the rates of device-associated infections from 2009 through 2014
Parameter July 2009-June 2010 July 2010-June 2011 July 2011-June 2012 July 2012-June 2013 July 2013-June 2014
No. of hospitals 63 72 81 91 94
No. of units 116 130 143 161 166
Patient-days 518,620 585,325 698,595 867,683 832,428
Device-days          
Urinary catheter-days 446,612 503,365 590,793 679,076 701,932
Central line-days 289,380 309,500 362,576 426,783 437,456
Ventilator-days 209,858 233,640 282,472 321,601 340,075
No. of infections          
Urinary catheter-associated UTI 2,119 1,949 1,366 854 846
Central line-associated BSI 948 932 1,091 1,096 1,021
Ventilator-associated PNEU 410 410 481 526 498
Device utilization ratio (95% CI) [range*]          
Urinary catheter 0.86 0.86 0.85 0.78 0.84
  (0.859-0.861) (0.859-0.861) (0.849-0.851) (0.779-0.781) (0.839-0.841)
  [0.73-0.96] [0.73-0.97] [0.71-0.97] [0.70-0.98] [0.71-0.97]
Central line 0.56 0.53 0.52 0.49 0.53
  (0.559-0.561) (0.529-0.531) (0.519-0.521) (0.489-0.491) (0.529-0.531)
  [0.35-0.82] [0.31-0.81] [0.30-0.79] [0.29-0.80] [0.29-0.79]
Ventilator 0.41 0.40 0.40 0.37 0.41
  (0.409-0.411) (0.399-0.401) (0.399-0.401) (0.369-0.371) (0.409-0.411)
  [0.19-0.62] [0.19-0.61] [0.20-0.65] [0.17-0.66] [0.21-0.62]
Rate per 1,000 device-days (95% CI) [range*]          
Urinary catheter-associated UTI 4.75 3.87 2.26 1.26 1.21
  (4.55-4.95) (3.70-4.05) (2.14-2.39) (1.18-1.34) (1.13-1.29)
  [1.14-8.40] [0-8.80] [0-5.61] [0-4.08] [0-2.71]
Central line-associated BSI 3.28 3.01 3.01 2.57 2.33
  (3.07-3.49) (2.82-3.21) (2.84-3.19) (2.42-2.72) (2.20-2.48)
  [0.68-5.61] [0-6.92] [0-6.64] [0-7.35] [0-5.08]
Ventilator-associated PNEU 1.95 1.75 1.70 1.64 1.46
  (1.77-2.15) (1.59-1.93) (1.56-1.86) (1.50-1.78) (1.34-1.60)
  [0-6.33] [0-5.88] [0-5.96] [0-6.67] [0-3.93]

*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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