Risque de décès lié aux infections associées aux dispositifs médicaux

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Publiée Dec 29, 2015
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Vol. 93 No 10 (2015): Revue oct. 2015

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Nabiha Bouafia
Imed Chouchène
Asma Ben Cheikh
Slaheddine Bouchoucha
Mansour Njah

Résumé

RESUME

Prérequis: Les infections nosocomiales acquises en milieu de réanimation constituent un problème majeur de santé publique partout dans le monde.
Objectif : Déterminer l’incidence et les facteurs de risque d’infections associées aux dispositifs médicaux (IAD) ainsi que ceux contribuant à la survenue de décès dans une unité de soins intensifs en Tunisie.
Méthodes : Nous avons mené une étude prospective d’incidence durant six mois dans le service de réanimation médicale adulte du CHU Farhat Hached de Sousse (Tunisie). Ont été inclus les patients dont la durée d’hospitalisation était supérieure à 48h.
Résultats : Durant la période d'étude, 105 patients ont été observés; 16 d'entre eux (15,2%) ont développé 17 épisodes d’infections associées aux dispositifs médicaux (16,9 /1000 jours d'hospitalisation). Les infections associées aux cathéters centraux et périphériques étaient les plus fréquentes (respectivement ; 21,4 / 1000 jours d’exposition et 10,2 / 1000 jours d’exposition). La mortalité globale était de 40%. Les facteurs de risque indépendants de contracter une infection en réanimation sont l’exposition au cathéter veineux central (p = 0,031) et la durée prolongée du séjour (0,002), ceux de la mortalité sont l’immunosuppression (p = 0,013), la survenue d’infections associées aux dispositifs médicaux (p = 0,002) et l'exposition au cathéter veineux central (p = 0,001).
Conclusion : Même si les taux d’infections associées aux dispositifs médicaux en milieu de réanimation tunisien étaient inférieures à celles publiées dans certains rapports d'autres pays d'Afrique du Nord, les caractéristiques de ces infections ainsi que le risque de décès, dominés par l’exposition au cathétérisme vasculaire montrent la nécessité de multiplier les efforts de contrôle de ces infections dans notre hôpital.

Mots-clés :

Infections associées aux dispositifs médicaux - Unité de soins intensifs - Mortalité- Prévention - facteurs de risque

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