Brief report Characterization of patients exposed to multiple devices but free of hospital-acquired infection at intensive care unit discharge Thomas Bénet MD, MPh a, b , Julie Haesebaert MD, MSc b , Romain Hernu MD c , Vincent Piriou MD, PhD c , Claude Guérin MD, PhD c , Frédéric Aubrun MD, PhD c , Bernard Allaouchiche MD, MPh c , Olivier Bastien MD, PhD c , Jean-Jacques Lehot MD, PhD c , Sabine Chomat-Jaboulay RN a , Solweig Gerbier-Colomban MD, PhD a , Raphaele Girard MD a , Philippe Vanhems MD, PhD a, b, * a Infection Control and Epidemiology Department, Hospices Civils de Lyon, Lyon, France b Epidemiology and Public Health Unit, Université Lyon 1, Lyon, France c Intensive Care Unit, Hospices Civils de Lyon, Lyon, France Key Words: Hospital-acquired infection Intensive care units Invasive device Surveillance Intensive care unit patients exposed to multiple devices but free of hospital-acquired infection (HAI) until discharge were identified through a surveillance network of HAIs in Lyon, France, between 2003 and 2011. Multiexposed patients were defined according to the tenth deciles of length of stay and ex- posures to invasive devices. Overall, 982 (5.0%) multiexposed patients were identified; 154 (15.7%) remained uninfected. Multiexposed infected patients differed from noninfected patients regarding length of exposures and mortality. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Patients hospitalized in intensive care units (ICUs) are at high risk of hospital-acquired infections (HAIs). 1 Major risk factors for HAIs in ICUs are disease severity at admission, prolonged length of stay (LOS), and exposure to invasive devices. 1 The main invasive devices related to HAI risk are endotracheal tubes (ETs), central venous catheters (CVCs), and urinary tract catheters (UTCs). 2-4 However, the determinants of low susceptibility or resistance to HAI have not yet been well investigated. Limited data are available on ICU patients with long LOSs who are exposed to multiple devices for prolonged durations but who did not develop HAIs. This subgroup might present particular characteristics in relation to the risk of HAIs, which could have potential impact on larger populations. Large surveillance systems can identify substantial groups of outliers and report their char- acteristics. The objective of this study was to identify and describe ICU-hospitalized patients exposed to multiple devices but free of HAI until discharge. METHODS Data were collected prospectively as part of a large, previously described, surveillance network of HAIs in ICUs in Southeastern France. 5,6 Briefly, all patients aged 18 years, hospitalized 48 hours between January 1, 2003, and December 31, 2011, in 10 medical, surgical, and neurologic ICUs of Lyon University Hospitals were included. A standardized data sheet was prospectively filled for each patient, based on clinical observations and microbiologic results. The HAIs under surveillance were as follows: hospital- acquired pneumonia, hospital-acquired bloodstream infection, and hospital-acquired urinary tract infection. The standardized definitions followed have been provided elsewhere (surveillance network protocol, REA Sud-Est, http://cclin-sudest.chu-lyon.fr). Only the first HAI at any site was analyzed. The following charac- teristics were collected: (1) ICU stay; (2) characteristics at admis- sion (age, sex, simplified acute physiology score II, immunodeficiency, diagnostic category, and patient origin); (3) * Address correspondence to Philippe Vanhems, MD, PhD, Service d’Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d’Arsonval, 69437 Lyon cedex 03, France. E-mail address: philippe.vanhems@chu-lyon.fr (P. Vanhems). Conflicts of interest: None to report. Funding/support: None. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.10.022 American Journal of Infection Control 43 (2015) 171-3