The Effect of Using AICs

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The decrease in nosocomial primary BSIs occurred in the two adult ICU units and was associated with the introduction of the AIC and a significant reduction in catheter-related infections. In addition, this decrease in nosocomial BSIs could not be explained by any other factor. The characteristics of the patients in the two units over the two time periods were comparable. The only significant difference in terms of characteristics occurred in the MICU, where there was a higher frequency of male gender in FY 1999.

In a previous prospective randomized study involving catheters impregnated with minocycline-rifampin, male gender was found to be an independent risk factor for catheter colonization, according to a multivariate logistical regression model. Therefore, the increase in the frequency of male gender for FY 1999 should have resulted in increased nosocomial and catheter-related infections rather than the decrease noted in this study. Additionally, the amount of antibiotic usage in the ICU (in grams per 1,000 patient-days) was comparable for FY 1998 and FY 1999, suggesting that systemic antibiotic usage did not contribute to the significant decrease in nosocomial bacteremia or VRE bacteremia that had been noted during the two time periods.

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The only potential confounding factor was that in January 1999 the patients were moved to a new ICU. However, a subset analysis comparing the rate of nosocomial BSIs, Gram-positive BSIs, catheter infections, and nosocomial VRE bacteremia for FY 1998 to the first 4 months of FY 1999, during which time all patients were in the same unit, showed a significant decrease in all of these infections associated with the introduction of AICs. Therefore, the decrease in nosocomial BSIs, as well as in other types of infections, occurred even before the move to the new ICU.

The data from this study suggest that the decrease in nosocomial BSIs associated with the introduction of the AIC could have been associated with a significant decrease in morbidity and could have contributed to earlier discharge from the unit. Pittet et al reported that a single episode of nosocomial BSI would increase the length of hospital buy Canadian viagra stay by an average of 24 days and the length of ICU stay by 8 days. dos Santos et al concluded that the efficacy and impact of new antimicrobial catheters should be assessed in terms of the ability to be associated with earlier discharge from the ICU and decreases in overall morbidity and mortality.

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