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Thapa D, Liu T, Yang C, Acharya SP, Tam HL, Chair SY. Identifying the barriers and facilitators to implementation of ventilator bundle in the nepalese intensive care unit: A descriptive qualitative study. Aust Crit Care 2024; 37:212-221. [PMID: 37455212 DOI: 10.1016/j.aucc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/29/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND A ventilator bundle is an effective preventive strategy against the development of ventilator-associated pneumonia (VAP). However, in clinical practice ventilator bundle implementation is poor. Understanding the barriers to ventilator bundle implementation in low- and middle-income countries can inform the development of effective implementation strategies to reduce the burden of VAP. OBJECTIVES The primary objective of this study was to explore the barriers and facilitators of ventilator bundle implementation perceived by healthcare professionals (HCPs) working in intensive care units (ICU) in Nepal. The secondary objective was to prioritise the barriers when developing implementation strategies. METHODS This study used a pragmatic approach comprising a series of methods to identify the implementation strategies: (i) Barriers and facilitators were explored using a qualitative study design. Twenty-one HCPs selected using the maximum variation sampling technique from a large tertiary hospital, completed semistructured interviews. All the interviews were recorded, transcribed word-by-word, and uploaded into NVivo for analysis using the thematic analysis approach. (ii) After analysis, nine participants were selecteded to determine the priority order of the barriers using a barrier identification and mitigation tool. RESULTS The data analysis revealed five main themes and 19 subthemes that affected ventilator bundle implementation. The main themes were provider-related factors, organisational and practice-related factors, performances of work, environmental conditions, and patient-related factors. The common barriers were job insecurity, poor knowledge, negative attitude, insufficient equipment, and severity of patient disease. Common facilitators were educational training, equipment functioning, adequate staff, strong leadership, and organisational support. Finally, eight main barriers were prioritised to target the change. CONCLUSION The barriers to implementing ventilator bundles in ICUs were identified. Focussing on addressing the prioritised barriers may aid in improving patient care and safety in ICUs. Results may guide HCPs in the development of implementation strategies to reduce the burden of VAP.
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Affiliation(s)
- Dejina Thapa
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China.
| | - Ting Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Chen Yang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Subhash Prasad Acharya
- Department of Critical Care Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Hon Lon Tam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China.
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China.
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Li RJ, Wu YL, Huang K, Hu XQ, Zhang JJ, Yang LQ, Yang XY. A prospective surveillance study of healthcare-associated infections in an intensive care unit from a tertiary care teaching hospital from 2012-2019. Medicine (Baltimore) 2023; 102:e34469. [PMID: 37543835 PMCID: PMC10402966 DOI: 10.1097/md.0000000000034469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Healthcare-associated infections (HAIs) continue to be the most common adverse event affecting critically ill inpatients in intensive care units (ICUs). Limited data exist in the English literature on the epidemiology of HAIs in ICUs from China. The purpose of this prospective study was to understand the prevalence and trends of HAIs in the ICU to guide clinicians to take effective prevention and control measures. In total, 20 ICU beds in the hospital from January 2012 to December 2019 were selected for surveillance. HAI diagnosis and device-associated infection surveillance were based on the criteria set forth by the original Ministry of Health of the People's Republic of China. The full-time staff for HAI management monitored all patients who stayed in the ICU > 48 hours during the study period and calculated the device utilization ratio and device-associated infection rate. The rate of HAIs and the adjusted rate were 18.78 per 1000 patient-days and 5.17 per 1000 patient-days, respectively. The rates of ventilator-associated pneumonias, catheter-associated urinary tract infections, and central line-associated bloodstream infections were 22.68 per 1000 device-days, 2.40 per 1000 device-days, and 2.27 per 1000 device-days, respectively. A total of 731 pathogenic bacteria were detected in the patients with HAIs. Gram-negative and gram-positive bacteria accounted for 67.44% and 16.83%, respectively. Continuous target monitoring, regular analysis of high-risk factors, and timely intervention measures could effectively reduce HAIs in the ICU. Additionally, these findings could be used for developing new strategies to prevent and control HAIs in ICUs.
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Affiliation(s)
- Ruo-Jie Li
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Shrestha SK, Trotter A, Shrestha PK. Epidemiology and Risk Factors of Healthcare-Associated Infections in Critically Ill Patients in a Tertiary Care Teaching Hospital in Nepal: A Prospective Cohort Study. INFECTIOUS DISEASES: RESEARCH AND TREATMENT 2022; 15:11786337211071120. [PMID: 35095279 PMCID: PMC8793418 DOI: 10.1177/11786337211071120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022]
Abstract
Background: Healthcare-associated infection (HAI) is an important public health problem, particularly in intensive care units (ICUs). We aimed to examine the epidemiology and risk factors of HAIs in our ICUs and study their microbiological profile. Methods: We evaluated 100 consecutive patients in 3 medical and surgical ICUs of a tertiary care teaching hospital daily starting in January 2016 using the Centers for Disease Control and Prevention definitions and methods. We determined the incidence and sites of HAIs, identified the causative microorganism, and studied their antibiotic sensitivity profiles. We investigated risk factors for the development of an HAI using a multiple logistic regression model. Results: Of 300 patients, 129 patients (43%) developed HAIs (55.96 HAI events per 1000 ICU-days). Pneumonia was the most common type of HAI (57, 41%). Escherichia coli was the most frequently isolated microorganism (20, 29%) and 74% of the pathogens isolated were multi-drug resistant. The presence of an invasive device (Odds Ratio, 4.29; 95% Confidence Interval, 2.52-7.51) and use of sedation (Odds Ratio, 2.24; 95% Confidence Interval, 1.31-3.87) were the statistically significant risk factors for HAIs. Conclusions: We found a high incidence of HAIs in our ICUs and a high burden of multidrug-resistant microorganisms highlighting the importance of infection control and antibiotic stewardship.
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Affiliation(s)
- Sailesh Kumar Shrestha
- Department of Internal Medicine, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Andrew Trotter
- Department of Internal Medicine, Division of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
| | - Pradeep Krishna Shrestha
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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Koju P, Liu X, Zachariah R, Bhattachan M, Maharjan B, Madhup S, Shewade HD, Abrahamyan A, Shah P, Shrestha S, Li H, Shrestha R. Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal. Public Health Action 2021; 11:32-37. [PMID: 34778013 PMCID: PMC8575378 DOI: 10.5588/pha.21.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal. OBJECTIVES 1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures. DESIGN This was a cohort study using secondary data (December 2017 to April 2018). RESULTS Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common. CONCLUSION We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.
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Affiliation(s)
- P Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - X Liu
- School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Zachariah
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - M Bhattachan
- World Health Organization, Country Office, Kathmandu, Nepal
| | - B Maharjan
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - S Madhup
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South East Asia, New Delhi, India
| | - A Abrahamyan
- Tuberculosis Research and Prevention Centre, Yerevan, Armenia
| | - P Shah
- School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China
| | - S Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - H Li
- School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China
| | - R Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
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Lim C, Ashley EA, Hamers RL, Turner P, Kesteman T, Akech S, Corso A, Mayxay M, Okeke IN, Limmathurotsakul D, van Doorn HR. Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries. Clin Microbiol Infect 2021; 27:1391-1399. [PMID: 34111583 PMCID: PMC7613529 DOI: 10.1016/j.cmi.2021.05.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Routine microbiology results are a valuable source of antimicrobial resistance (AMR) surveillance data in low- and middle-income countries (LMICs) as well as in high-income countries. Different approaches and strategies are used to generate AMR surveillance data. OBJECTIVES We aimed to review strategies for AMR surveillance using routine microbiology results in LMICs and to highlight areas that need support to generate high-quality AMR data. SOURCES We searched PubMed for papers that used routine microbiology to describe the epidemiology of AMR and drug-resistant infections in LMICs. We also included papers that, from our perspective, were critical in highlighting the biases and challenges or employed specific strategies to overcome these in reporting AMR surveillance in LMICs. CONTENT Topics covered included strategies of identifying AMR cases (including case-finding based on isolates from routine diagnostic specimens and case-based surveillance of clinical syndromes), of collecting data (including cohort, point-prevalence survey, and case-control), of sampling AMR cases (including lot quality assurance surveys), and of processing and analysing data for AMR surveillance in LMICs. IMPLICATIONS The various AMR surveillance strategies warrant a thorough understanding of their limitations and potential biases to ensure maximum utilization and interpretation of local routine microbiology data across time and space. For instance, surveillance using case-finding based on results from clinical diagnostic specimens is relatively easy to implement and sustain in LMIC settings, but the estimates of incidence and proportion of AMR is at risk of biases due to underuse of microbiology. Case-based surveillance of clinical syndromes generates informative statistics that can be translated to clinical practices but needs financial and technical support as well as locally tailored trainings to sustain. Innovative AMR surveillance strategies that can easily be implemented and sustained with minimal costs will be useful for improving AMR data availability and quality in LMICs.
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Affiliation(s)
- Cherry Lim
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Elizabeth A Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Vientiane, Laos
| | - Raph L Hamers
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Thomas Kesteman
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | - Samuel Akech
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Alejandra Corso
- National/Regional Reference Laboratory for Antimicrobial Resistance (NRL), Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Vientiane, Laos; Institute of Research and Education Development (IRED), University of Health Sciences, Vientiane, Laos
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Viet Nam.
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Kharel S, Bist A, Mishra SK. Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review. PLoS One 2021; 16:e0247832. [PMID: 33690663 PMCID: PMC7942996 DOI: 10.1371/journal.pone.0247832] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/14/2021] [Indexed: 12/17/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). The South East Asian Region is a part of the world with limited health resources where infectious diseases are still underestimated. We aimed to review the literature in this part of the world to describe incidence, mortality and microbiological evidence of VAP and explore preventive and control strategies. We selected 24 peer-reviewed articles published from January 1, 2000 to September 1, 2020 from electronic databases and manual searching for observational studies among adult patients diagnosed with VAP expressed per thousand days admitted in ICU. The VAP rates ranged from 2.13 to 116 per thousand days, varying among different countries of this region. A significant rate of mortality was observed in 13 studies ranging from 16.2% to 74.1%. Gram negative organisms like Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae and Gram-positive organisms like Staphylococcus aureus and Enterococcus species were frequently found. Our findings suggest an alarming situation of VAP among patients of most of the countries of this region with increasing incidence, mortality and antibiotic resistance. Thus, there is an urgent need for cost effective control and preventive measures like interventional studies and educational programs on staff training, hand hygiene, awareness on antibiotic resistance, implementation of antibiotic stewardship programs and appropriate use of ventilator bundle approach.
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Affiliation(s)
- Sanjeev Kharel
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
- * E-mail:
| | - Anil Bist
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Shyam Kumar Mishra
- Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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Branco A, Lourençone EMS, Monteiro AB, Fonseca JP, Blatt CR, Caregnato RCA. Education to prevent ventilator-associated pneumonia in intensive care unit. Rev Bras Enferm 2020; 73:e20190477. [PMID: 32813804 DOI: 10.1590/0034-7167-2019-0477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate nursing adherence to the Ventilator-Associated Pneumonia Prevention Bundle and the incidence rate, before and after Continuing education. METHODS a quasi-experimental, retrospective study with a total of 302 patients on mechanical ventilator admitted to the Intensive Care Unit. Data obtained from the application of the bundle, from June 2017 to June 2018. In December 2017, a training on the infection was carried out with 48 professionals. RESULTS the mean age of patients was 62.39±17.06 years old. Appropriate measures before and after training, respectively: position of the ventilator filter 94.8% and 96.2%, p=0.074; elevated headboard 88.4% and 94.5%, p<0.001; oral hygiene with chlorhexidine 89.5% and 98.2%, p<0.001; teeth brushing 80.8% and 96.4%, p<0.001; and cuff pressure 92.7% and 95.6%, p=0.002. Incidence density was 7.99 for 4.28 infections/1000 ventilators per day. CONCLUSION the bundle application and education made it possible to increase adherence and decrease infection.
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Affiliation(s)
- Aline Branco
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | - Carine Raquel Blatt
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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El Mekes A, Zahlane K, Ait Said L, Tadlaoui Ouafi A, Barakate M. The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. J Infect Public Health 2019; 13:637-643. [PMID: 31537511 DOI: 10.1016/j.jiph.2019.08.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 08/05/2019] [Accepted: 08/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intensive care units (ICUs) are considered epicenters of antibiotic resistance. The aim of this study is to determine clinical risk factors, epidemiology and the causative agents of multi-drug resistant bacteria in the ICU of the University Hospital in Marrakesh-Morocco. METHODS A one year case control study was carried out in our 10-bed clinical and surgical ICU from March 2015 to March 2016. The epidemiological surveillance was done by collecting data in the medical records with the help of a questionnaire. The antibiotic susceptibility testing was used following the recommendations of the Antibiogram Committee of the French Society of Microbiology and the European Committee for Antimicrobial Susceptibility Testing, 2015. RESULTS Among the 479 admitted patients, 305 bacteria were isolated and identified as Acinetobacter baumannii (31%), Enterobactereacae species (30%), and Staphylococcus (24%), P. aeruginosa (10%) and other bacterial strains (5%). The rate of MDR bacteria acquisition was 41% (124/305) with domination of A. baumannii resistant to imipenem (70%) and followed by Extended Spectrum β-lactamases producing Enterobacteriaceae, P. aeruginosa resistant to Ceftazidime, and Methicillin-resistant S. aureus (18%, 7%, and 5% respectively). The distribution of the common nosocomial infections were dominated by pneumonia, bacteremia, and catheter-related blood stream infections (39%, 29%, and 17%) respectively. Multivariate analysis identified lack of patient isolation precautions (OR: 7.500), use of quadri or triple therapy (OR: 5.596; OR: 5.175), and mechanical ventilation (OR: 4.926), as the most significant clinical and epidemiological factors associated with acquisition of MDR bacteria. The attributable mortality, in this ICU, of patients with MDR bacteria, is about 12%. CONCLUSIONS The incidence of MDR was higher compared with that of developed countries. The implementation of standard infection control protocols, active surveillance of MDR and generation of data on etiological agents and their antimicrobial susceptibility patterns are urgently needed in our hospital.
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Affiliation(s)
- Adel El Mekes
- Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco; Laboratory of Biology and Biotechnology of Microorganisms, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
| | - Kawtar Zahlane
- Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco
| | - Loubna Ait Said
- Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco
| | - Ahmed Tadlaoui Ouafi
- Laboratory of Biotechnology and Molecular Bioengineering, Faculty of Science and Technology Gueliz, Cadi Ayyad University, Marrakesh, Morocco
| | - Mustapha Barakate
- Laboratory of Biology and Biotechnology of Microorganisms, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco.
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Peng D, Li X, Liu P, Luo M, Chen S, Su K, Zhang Z, He Q, Qiu J, Li Y. Epidemiology of pathogens and antimicrobial resistanceof catheter-associated urinary tract infections in intensivecare units: A systematic review and meta-analysis. Am J Infect Control 2018; 46:e81-e90. [PMID: 30174256 DOI: 10.1016/j.ajic.2018.07.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the intensive care unit (ICU), catheter-associated urinary tract infection (CAUTI) is the most common urinary tract infection. Nevertheless, there is no systematic review to investigate the epidemiology of pathogens and antimicrobial resistance of CAUTIs in ICUs. METHODS Eight electronic databases were searched for eligible studies. A meta-analysis was performed to calculate the CAUTI incidence per 1,000 catheter days, the proportion of pathogen distribution, and the resistance rate with R3.3.2 software. RESULTS Seventy-five studies were included. The total weighted CAUTI incidence per 1,000 catheter days was 7.78. Gram-negative bacteria (47.46%), fungi (27.81%), and gram-positive bacteria (19.06%) were isolated. Candida spp (27.4%), Escherichia spp (23.41%), and Enterococcus spp (15.0%) were the most frequent pathogens. Candida albicans, Candida tropicalis, and Candida glabrata were generally resistant to itraconazole, with resistance rates of 42.5%, 53.0%, and 59.7%, respectively. Escherichia spp displayed high rates of resistance to ampicillin (87.3%), ciprofloxacin (71.7%), and norfloxacin (71.2%). Enterococcus spp showed high rates of resistance to erythromycin (83.9%), penicillin (76.7%), and levofloxacin (73.8%). CONCLUSIONS In ICUs, the CAUTI incidence per 1,000 catheter days is high. CAUTIs were mainly caused by gram-negative bacteria that were resistant to common antibiotics. There is a pressing demand for future research into CAUTI, including effective prevention, an understanding of antimicrobial resistance mechanisms, and development of new antibiotics for patient safety.
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Investigation on Risk Factors of Ventilator-Associated Pneumonia in Acute Cerebral Hemorrhage Patients in Intensive Care Unit. Can Respir J 2017; 2017:7272080. [PMID: 29391844 PMCID: PMC5748108 DOI: 10.1155/2017/7272080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/17/2017] [Accepted: 09/25/2017] [Indexed: 12/11/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is a predominant factor of pulmonary infection. We analyzed the risk factors of VAP with acute cerebral hemorrhage in intensive care unit (ICU) by univariate and multivariate logistic regression analyses. After comparison of 197 cases of the VAP and non-VAP patients, we found that age > 65 years (P = 0.003), smoke (P = 0.003), coronary heart disease (P = 0.005), diabetes (P = 0.001), chronic obstructive pulmonary disease (COPD) (P = 0.002), ICU and hospital stay (P = 0.01), and days on mechanical ventilation (P = 0.01) were significantly different, indicating that they are risk factors of VAP. All the age > 65 years (OR = 3.350, 95% CI = 1.936–5.796, P ≤ 0.001), smoke (OR = 3.206, 95% CI = 1.909–5.385, P ≤ 0.001), coronary heart disease (OR = 3.179, 95% CI = 1.015–4.130, P = 0.017), diabetes (OR = 5.042, 95% CI = 3.518–7.342, P ≤ 0.001), COPD (OR = 1.942, 95% CI = 1.258–2.843, P = 0.012), ICU and hospital stay (OR = 2.34, 95% CI = 1.145–3.892, P = 0.038), and days on mechanical ventilation (OR = 1.992, 95% CI = 1.107–3.287, P = 0.007) are independent risk factors of VAP. After observation of patients with 6 months of follow-up, the BI score was significantly lower in VAP than that in non-VAP, and the rebleeding rate and mortality rate were significantly higher in VAP than those in non-VAP. Thus, the prognosis of the patients with acute cerebral hemorrhage and VAP in ICU is poor.
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