High Incidence and Fatality of Device Associated Infections in Greek ICUs: Insights from a Two Year Prospective Study

Device-associated infections (DAIs) are a major threat in intensive care units (ICUs), being linked with excess fatality, prolonged hospitalization and costs. We conducted a  two‑year prospective surveillance study (2022-2024) in three adult general ICUs n Athens to estimate the incidence of DAIs and their clinical impact, using CDC/NHSN case definitions. Among 500 eligible patients (>3 ICU days, 10,482 ICU patient-days in total), 268 (51,6%) developed 288 DAI episodes. The overall DAI incidence was 31.2 episodes per 1,000 ICU patient‑days. Incidence by device was 19,2 per 1,000 ventilator-days for ventilator-associated events (VAE), 7,2 per 1,000 central line-days for central line-associated bloodstream infection (CLABSI) and 3,6 per 1,000 urinary catheter-days for catheter-associated urinary tract infection (CAUTI). The most frequent pathogens were Klebsiella pneumoniae (36.2%) and Acinetobacter baumannii (26.5%); among tested Gram-negative isolates, carbapenem resistance was universal. ICU fatality was 41,1% in patients with DAIs versus 23,2% without DAIs. Median ICU lengths of stay was 30 days (IQR 20-44) in patients with DAIs versus 11 days (IQR 8-19) in those without. The high burden of multidrug‑resistant organisms and the excess fatality and length of stay support the urgent implementation of structured antimicrobial-resistance surveillance, antimicrobial-stewardship and device-specific prevention bundles in Greek ICUs.