International Impact of COVID-19 on the Diagnosis of Heart Disease

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.OBJECTIVES The study sought to assess COVID-19`s impact on global cardiovascular diagnostic procedural volumes and safety practices.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained.RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoradc echocardiography decreased by 59%, transesophageat echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). hi multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and teteheatth.CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World

OBJECTIVES This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic.BACKGROUND The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality.METHODS Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States.RESULTS Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p 1/4 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p &lt; 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis.CONCLUSIONS We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

Made available in DSpace on 2019-09-12T16:53:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2014We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.[Rosenthal, Victor Daniel] Int Nosocomial Infect Control Consortium, Corrientes Ave 4580,Fl 12,Apt D, RA-1195 Buenos Aires, DF, Argentina[Maki, Dennis George] Univ Wisconsin, Madison, WI USA[Mehta, Yatin] Medanta Medicity, New Delhi, India[Leblebicioglu, Hakan] Ondokuz Mayis Univ, Samsun, Turkey[Memish, Ziad Ahmed] Minist Hlth, Riyadh, Saudi Arabia[Al-Mousa, Haifaa Hassan] Minist Hlth, Kuwait, Kuwait[Balkhy, Hanan] King Saud Bin Abdulaziz Univ Hlth Sci, Riyadh, Saudi Arabia[Hu, Bijie] Fudan Univ, Zhongshan Hosp, Shanghai 200433, Peoples R China[Alvarez-Moreno, Carlos] Univ Nacl Colombia, Clin Univ Colombia, Bogota, Colombia[Medeiros, Eduardo Alexandrino] Hosp Sao Paulo, Sao Paulo, Brazil[Apisarnthanarak, Anucha] Thammasat Univ Hosp, Pathum Thani, Thailand[Raka, Lul] Prishtina Univ, Kosova & Med Sch, Natl Inst Publ Hlth, Prishtina, Kosovo, Serbia[Cuellar, Luis E.] Inst Nacl Enfermedades Neoplas, Lima, Peru[Ahmed, Altaf] Indus Hosp, Karachi, Pakistan[Navoa-Ng, Josephine Anne] St Lukes Med Ctr, Manila, Philippines[El-Kholy, Amani Ali] Cairo Univ Abu El Reesh, Children Hosp, Cairo, Egypt[Kanj, Souha Sami] Amer Univ, Beirut Med Ctr, Beirut, Lebanon[Bat-Erdene, Ider] Cent State Hosp 1, Ulaanbaatar, Mongol Peo Rep[Duszynska, Wieslawa] Wroclaw Univ Hosp, Wroclaw, Poland[Nguyen Van Truong] Hung Vuong Hosp, Ho Chi Minh City, Vietnam[Pazmino, Leonardo N.] Hosp Valles, Hosp Eugenio Espejo, Quito, Ecuador[See-Lum, Lucy Chai] Univ Malaya, Med Ctr, Kuala Lumpur, Malaysia[Fernandez-Hidalgo, Rosalia] Hosp Clin Bibl, San Jose, Costa Rica[Di-Silvestre, Gabriela] Hosp Clin Caracas, Caracas, Venezuela[Zand, Farid] Shiraz Univ Med Sci, Nemazee Hosp, Shiraz, Iran[Hlinkova, Sona] Catholic Univ Ruzomberok, Cent Mil Hosp Ruzomberok, Fac Hlth, Ruzomberok, Slovakia[Belskiy, Vladislav] Privolzhskiy Dist Med Ctr, Nizhnii Novgorod, Russia[Al-Rahma, Hussain] Dubai Hosp, Dubai, U Arab Emirates[Tulio Luque-Torres, Marco] Hosp Especialidades Ctr Med La Raza, Inst Hondureho Seguridad Social, Tegucigalpa, Honduras[Bayraktar, Nesil] Burhan Nalbantoglu Devlet Hastanesi, Nicosia, Cyprus[Mitrev, Zan] Special Hosp Surg Dis Filip Vtori, Skopje, Macedonia[Gurskis, Vaidotas] Hosp Lithuanian Univ, Hlth Sci Kauno Klin, Kaunas, Lithuania[Fisher, Dale] Natl Univ Singapore Hosp, Singapore, Singapore[Abu-Khader, Ilham Bulos] Jordan Univ Hosp, Amman, Jordan[Berechid, Kamal] Ibn Sina, Rabat, Morocco[Rodriguez-Sanchez, Arnaldo] Hosp Episcopal San Lucas Guayama, Guayama, Puerto Rico[Horhat, Florin George] Univ Med & Farm Timisoara, Clin Cty Hosp, Timisoara, Romania[Requejo-Pino, Osiel] Hosp Univ Gral Calixto Garc, Havana, Cuba[Hadjieva, Nassya] Univ Hosp Queen Giovanna ISUL, Sofia, Bulgaria[Ben-Jaballah, Nejla] Hop Enfants, Tunis, Tunisia[Garcia-Mayorca, Elias] Hosp Santo Tomas, Panama City, Panama[Kushner-Davalos, Luis] Caja Salud Banca Privada Reg Paz, La Paz, Bolivia[Pasic, Srdjan] Inst Mother Child Hlth Care Vukan Cupic, Belgrade, Serbia[Pedrozo-Ortiz, Luis E.] Hosp Reg Salto, Salto, Uruguay[Apostolopoulou, Eleni] Sotiria, Athens, Greece[Mejia, Nepomuceno] Hosp Gen Plaza Salud, Santo Domingo, Dominican Rep[Gamar-Elanbya, May Osman] Royal Care Int Hosp, Khartoum, Sudan[Jayatilleke, Kushlani] Sri Jayewardenepura Gen Hosp, Khartoum, Sudan[de Lourdes-Duenas, Miriam] Hosp Nacl Ninos Benjamin Bloom, San Salvador, El Salvador[Aguirre-Avalos, Guadalupe] Hosp Civil Guadalajara Fray Antonio Alcalde, Unidad Terapia Intens Adultos, Guadalajara, Mexico[Marcelo Maurizi, Diego; Montanini, Adriana; Laura Spadaro, Maria] Hosp Municipal Agudos Dr Leonidas Lucero, Bahia Blanca, Buenos Aires, Argentina[Santiago Marcos, Lorenzo; Botta, Priscila; Maria Jerez, Florencia; Constanza Chavez, Maria; Ramasco, Lucia; Isabel Colqui, Maria; Silvia Olivieri, Maria; Silvia Rearte, Ana; Edith Correa, Gladys; Deolinda Juarez, Paola; Fabiana Gallardo, Paola; Patricia Brito, Miriam; Horacio Mendez, Gabriel; Rosa Valdez, Julia; Paola Cardena, Lorena] Hosp Nino Jesus de Tucuman, San Miguel De Tucuman, Argentina[Maria Harystoy, Jose; Jorge Chaparro, Gustavo] Inst Med Platense, La Plata, Buenos Aires, Argentina[Gabriela Rodriguez, Claudia; Toomey, Rodolfo] Inst Med Adrogue, Almirante Brown, Argentina[Caridi, Maria] Centro Gallego Buenos Aires, Buenos Aires, Argentina[Viegas, Monica] Hosp Interzonal Gen Agudos Presidente Peron, Avellaneda, Argentina[Liliana Bernan, Marisa] Hgza San Roque Gonnet, La Plata, Argentina[Romani, Adriana] Clin Modelo Imagmed Soc Anonima, Lanus, Argentina[Beatriz Dominguez, Claudia] Obra Social Empleados Publ Sanatorio Fleming, Mendoza, Argentina[Kushner Davalos, Luis] Caja Salud Banca Privada Reg, La Paz, Bolivia[Richtmann, Rosana; Silva, Camila Almeida; Rodrigues, Tatiane T.] Hosp Maternidade Santa Joana, Sao Paulo, Brazil[Mielle Filho, Amaury; Seerig Palme, Ernandi Dagoberto; Besen, Aline; Lazzarini, Caroline; Cardoso, Caroline Batista] Hosp Santa Catarina, Blumenau, Brazil[Azevedo, Francisco Kennedy; Fontes Pinheiro, Ana Paula; Camacho, Aparecida] Hosp Jardim Cuiaba, Cuiaba, Brazil[De Carvalho, Braulio Matias; Monteiro De Assis, Maria Jose; Vasconcelos Carneiro, Ana Paula; Maciel Canuto, Maria Lilian; Pinto Coelho, Keyla Harten; Moreira, Tamiris; Oliveira, Agamenon Alves; Sousa Colares, Marcela Maria; De Paula Bessa, Marcia Maria; Pinheiro Gomes Bandeira, Tereza De Jesus; De Moraes, Renata Amaral; Campos, Danilo Amancio; Lima De Barros Araujo, Tania Mara] Hosp Messejana, Fortaleza, Brazil[Freitas Tenorio, Maria Tereza; Amorim, Simone; Amaral, Manuela; Lima, Julianne Da Luz; Da Silva Neta, Lindalva Pino; Batista, Caphiane; De Lima Silva, Fabio Jorge; Ferreira De Souza, Maria C.; Guimaraes, Katia Arruda] Santa Casa Misericordia Maceio, Maceio, Brazil[Maluf Lopes, Julia Marcia] Hosp Infantil Joao Paulo 2 Fhemig, Belo Horizonte, Brazil[Nogueira Napoles, Karina M.; Silva Neto Avelar, Lorena Luiza; Vieira, Lilian Aguiar] Santo Ivo, Belo Horizonte, Brazil[De Oliveira Cardo, Luis Gustavo] Hosp Clin Unicamp, Campinas, Brazil[Takeda, Christianne F. V.; Ponte, Glaydson A.; Aguiar Leitao, Fco Eduardo] Hosp Antonio Prudente, Fortaleza, Brazil[Kuchenbecker, Ricardo De Souza; Dos Santos, Rodrigo Pires] Hosp Clin Porto Alegre, Porto Alegre, Brazil[Onzi Siliprandi, Erci Maria] Inst Cardiologia Rio Grande Sul, Porto Alegre, Brazil[Baqueiro Freitas, Luiz Fernando] Hosp Santa Lydia, Ribeirao Preto, Brazil[Martins, Ianick Souto] Hosp Canc Inst Nacl Canc, Rio De Janeiro, Brazil[Casi, Daiane] Hosp Samaritano, Sao Paulo, Brazil[Maretti Da Silva, Maria Angela; Blecher, Sergio; Villins, Margarete; Salomao, Reinaldo] Hosp Santa Marcelina, Sao Paulo, Brazil[Oliveira Castro, Solange Regina; Da Silva Escudero, Daniela V.; Oliveira Reis, Mariana Andrade] Hosp Sao Paulo Escola Paulista Medicina Unifesp, Sao Paulo, Brazil[Mendonca, Marcelo; Furlan, Valter; do Amaral Baruzzi, Antonio Claudio] Totalcor, Sao Paulo, Brazil[Sanchez, Tarquino Eristidesg] Hosp Anchieta Ltda, Taguatinga, Brazil[Moreira, Marina] Hosp Universidade de Taubaté (Unitau)[de Freitas, Wania Vasconcelos; de Souza, Leonardo Passos] Hosp Casa Portugal, Rio de Janeiro, Brazil[Velinova, Velmira Angelova; Hadjieva, Nassya; Petrov, Michael M.; Karadimov, Dimitar Georgiev; Kostadinov, Emil D.; Dicheva, Violeta Jivkova] Queen Giovanna Isul, Sofia, Bulgaria[Wang, Chaohua; Guo, Xiuqin; Geng, Xihua; Wang, Shufang; Zhang, Jinzhi; Zhu, Ling; Zhuo, Shufang; Guo, Chunli] Dong E Peoples Hosp, Liaocheng Shi, Shandong, Peoples R China[Tao, Lili] First Hosp Shanxi Med Univ, Taiyuan, Peoples R China[Li, Ruisheng] Beijing Chao Yang Hosp, Beijing, Peoples R Chin

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN