In a prospective study at a 20-bed intensive care unit, the incidence of nosocomial sepsis was evaluated with causative pathogens and associated risk factors. A total of 182 patients (mean age 56 +/- 17 years), referred from an outpatient setting and admitted for > 48 hr, were enrolled. Over the first 10-month period the incidence of sepsis was high (21.3 per 100 admissions) and most of episodes were central venous catheter (CVC)-associated (47%) and polymicrobial (63%). Increased risk of sepsis was significantly associated with duration of indwelling CVCs and peripheral arterial catheters, mechanical ventilation, and hospital stay. On this ground, mandatory arterial and CVC change every 10 days has been assigned. Over the second 10-month period the incidence of CVC-related (5%) and polymicrobial episodes (9%) was significantly lower than that observed during the first period. However, the routine replacement of vascular catheters failed to show any decrease in the overall incidence of sepsis (22.5 per 100 admissions). As a consequence, other approaches to global infection control need to be developed for this patient population.
