We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National
Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated
health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated
nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of
central venous catheter (CVC)-associated
bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of
ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000
ventilator-days, respectively, as was the rate of
catheter-associated
urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000
catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to
methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to
ceftazidime or
ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to
imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to
piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related
infections ranged from 23.6% (CVC-associated
bloodstream infections) to 29.3% (VAP).