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Escalante J, Hamza M, Nishimura B, Melecio M, Davies-Sala C, Tuttobene MR, Subils T, Traglia GM, Pham C, Sieira R, Actis L, Bonomo RA, Tolmasky ME, Ramirez MS. Carbapenem-resistant Acinetobacter baumannii (CRAB): metabolic adaptation and transcriptional response to human urine (HU). RESEARCH SQUARE 2024:rs.3.rs-4415275. [PMID: 38853891 PMCID: PMC11160873 DOI: 10.21203/rs.3.rs-4415275/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major human pathogen and a research priority for developing new antimicrobial agents. CRAB is a causative agent of a variety of infections in different body sites. One of the manifestations is catheter-associated urinary tract infection, which exposes the bacteria to the host's urine, creating a particular environment. Exposure of two CRAB clinical isolates, AB5075 and AMA40, to human urine (HU) resulted in the differential expression levels of 264 and 455 genes, respectively, of which 112 were common to both strains. Genes within this group play roles in metabolic pathways such as phenylacetic acid (PAA) catabolism, the Hut system, the tricarboxylic acid (TCA) cycle, and other processes like quorum sensing and biofilm formation. These results indicate that the presence of HU induces numerous adaptive changes in gene expression of the infecting bacteria. These modifications presumably help bacteria establish and thrive in the hostile conditions in the urinary tract. These analyses advance our understanding of CRAB's metabolic adaptations to human fluids, as well as expanding knowledge on bacterial responses to distinct human fluids containing different concentrations of human serum albumin (HSA).
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Osman AH, Darkwah S, Kotey FCN, Odoom A, Hotor P, Dayie NTKD, Donkor ES. Reservoirs of Nosocomial Pathogens in Intensive Care Units: A Systematic Review. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241243239. [PMID: 38828046 PMCID: PMC11141231 DOI: 10.1177/11786302241243239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/14/2024] [Indexed: 06/05/2024]
Abstract
Background Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been identified as "breeding grounds" for pathogens that cause nosocomial infections. This systematic review aimed to deliver incisive insights on nosocomial pathogens in intensive care units (ICUs) and the role of fomites as potential reservoirs for their transmission. Method An extensive exploration of electronic databases, including PubMed and Scopus, from 1990 to 2023, was carried out between 25th and 29th May 2023, per standard PRISMA guidelines. Information were extracted from articles that reported on fomites in the ICU. Studies that did not quantitatively report the fomite contamination, and those that exclusively took samples from patients in the ICU were excluded from the analysis. Results About 40% of the total samples collected on fomites from all the studies yielded microbial growth, with species of Staphylococcus being the most predominant. Other prevalent microbes were Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Candida spp., Enterococcus sp., and Enterobacter sp. The neonatal intensive care unit (NICU) had the highest proportion of contaminated fomites. Among known fomites, the sphygmomanometer exhibited a 100% detection rate of nosocomial pathogens. This included E. aerogenes, Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), E. coli, and K. pneumoniae. Multidrug-resistant (MDR) bacteria, such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing E. coli, and MDR Pseudomonas aeruginosa were commonly isolated on fomites in the ICUs. Conclusion Many fomites that are readily used in patient care in the ICU harbour nosocomial pathogens. The most common fomite appeared to be mobile phones, sphygmomanometers, and stethoscopes, with Staphylococcus being the most common contaminant. Consequently, the need for rigorous disinfection and sterilization protocols on fomites in the ICU cannot be overemphasized. Additionally, heightened awareness on the subject among health professionals is crucial to mitigating the risk and burden of nosocomial infections caused by drug-resistant bacteria.
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Affiliation(s)
- Abdul-Halim Osman
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Samuel Darkwah
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Fleischer C N Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Alex Odoom
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Prince Hotor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Eric S Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
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Liu J, Zheng W, Wang Z. Test and Development of a Specialized Pipeline for Ventilator Calibration. Crit Rev Biomed Eng 2023; 51:17-28. [PMID: 37824332 DOI: 10.1615/critrevbiomedeng.2023048365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
A specialized Y-type pipeline is developed to replace medical disposable Y-type pipelines for ventilator calibration and to improve accuracy, providing a reference for improvement. According to the calibration specifications of ventilators, tests are performed on specialized pipelines and more to compare their data. Taking the tidal volume 400-mL detection point as an example, the calibration errors made by medical disposable pipelines and specialized pipelines are 6.2% and -0.8%, respectively, and the errors at other detection points are roughly the same. The accuracy of the specialized Y-type pipeline has significantly improved, reducing the impact of the pipeline on tidal volume calibration from more than 6% to less than 1%. The use of specialized pipelines can significantly improve the accuracy and qualification rate of calibration, reducing the consumption of disposable Y-type pipelines and thereby significantly reducing costs and increasing efficiency.
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Affiliation(s)
- Junming Liu
- Tai'an Institute of Quality and Technology Inspection and Testing, Taian, 271000, China
| | - Wenxiu Zheng
- College of Mechanical and Electronic Engineering, Shandong Agricultural University, Taian, 271000, China
| | - Ziyan Wang
- College of Water Conservancy and Civil Engineering, Shandong Agricultural University, Taian, 271000, China
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Mathur P, Malpiedi P, Walia K, Srikantiah P, Gupta S, Lohiya A, Chakrabarti A, Ray P, Biswal M, Taneja N, Rupali P, Balaji V, Rodrigues C, Lakshmi Nag V, Tak V, Venkatesh V, Mukhopadhyay C, Deotale V, Padmaja K, Wattal C, Bhattacharya S, Karuna T, Behera B, Singh S, Nath R, Ray R, Baveja S, Fomda BA, Sulochana Devi K, Das P, Khandelwal N, Verma P, Bhattacharyya P, Gaind R, Kapoor L, Gupta N, Sharma A, VanderEnde D, Siromany V, Laserson K, Guleria R, Malhotra R, Katoch O, Katyal S, Khurana S, Kumar S, Agrawal R, Dev Soni K, Sagar S, Wig N, Garg P, Kapil A, Lodha R, Sahu M, Misra M, Lamba M, Jain S, Paul H, Sarojini Michael J, Kumar Bhatia P, Singh K, Gupta N, Khera D, Himanshu D, Verma S, Gupta P, Kumar M, Pervez Khan M, Gupta S, Kalwaje Eshwara V, Varma M, Attal R, Sudhaharan S, Goel N, Saigal S, Khadanga S, Gupta A, Thirunarayan M, Sethuraman N, Roy U, Jyoti Raj H, D'Souza D, Chandy M, Mukherjee S, Kumar Roy M, Goel G, Tripathy S, Misra S, Dey A, Misra T, Ranjan Das R, Bashir G, Nazir S, Ranjana Devi K, Chaoba Singh L, Bhargava A, Gaikwad U, Vaghela G, Sukharamwala T, Ch. Phukan A, Lyngdoh C, Saksena R, Sharma R, Velayudhan A. Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study. Lancet Glob Health 2022; 10:e1317-e1325. [PMID: 35961355 DOI: 10.1016/s2214-109x(22)00274-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/28/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
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Prevalence of multidrug-resistant strains in device associated nosocomial infection and their in vitro killing by nanocomposites. Ann Med Surg (Lond) 2022; 78:103687. [PMID: 35734711 PMCID: PMC9207053 DOI: 10.1016/j.amsu.2022.103687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
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Nosocomial Infections and Role of Nanotechnology. Bioengineering (Basel) 2022; 9:bioengineering9020051. [PMID: 35200404 PMCID: PMC8869428 DOI: 10.3390/bioengineering9020051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
Nosocomial infections, termed hospital-acquired infections (HAIs), are acquired from a healthcare or hospital setting. HAI is mainly caused by bacteria, such as Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Enterococci spp., Methicillin-resistant Staphylococcus aureus (MRSA), and many more. Due to growing antibacterial resistance, nanotechnology has paved the way for more potent and sensitive methods of detecting and treating bacterial infections. Nanoparticles have been used with molecular beacons for identifying bactericidal activities, targeting drug delivery, and anti-fouling coatings, etc. This review addresses the looming threat of nosocomial infections, with a focus on the Indian scenario, and major initiatives taken by medical bodies and hospitals in spreading awareness and training. Further, this review focuses on the potential role nanotechnology can play in combating the spread of these infections.
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Chandra P, V R, M S, Cs S, Mk U. Multidrug-resistant Acinetobacter baumannii infections: looming threat in the Indian clinical setting. Expert Rev Anti Infect Ther 2021; 20:721-732. [PMID: 34878345 DOI: 10.1080/14787210.2022.2016393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The recent increase in multidrug-resistant strains of A. baumannii has increased the incidences of ventilator-associated pneumoniae, catheter-associated urinary tract infections, and central line-associated blood stream infections, together increasing hospital stay, treatment cost, and mortality. Resistance genes blaOXA and blaNDM are dominant in India. Carbapenem-resistant A. baumannii (CRAB) International clone-2 (IC-2) are rising in India. High dependency on carbapenems and last-resort combination of tigecycline and polymyxins have aggravated outcomes. Despite nursing barriers, ward closure, environmental disinfections etc for detecting and controlling transmission, MDR isolates and CRAB nosocomial outbreaks continue. Treatment cost overruns by AMR adversely affect 80% of Indians without insurance cover. AREA COVERED This narrative review will cover epidemiology, resistance pattern, genetic diversity, device-related infection, cost, and mortality due to multidrug-resistant and CRAB in India. A comprehensive literature search in PubMed and Google Scholar using appropriate keywords at different time points yielded relevant articles. EXPERT OPINION It is challenging to enforce policies to control MDR A. baumannii in India. Government and hospitals should enforce stringent infection control measures, surveillance, and antimicrobial stewardship to prevent further spread and emergence of more virulent and resistant strains. Knowledge on antibiotic resistance mechanisms can help design novel antibiotics that can evade, resistance.
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Affiliation(s)
- Prashant Chandra
- Department of Pharmacy Practice, Centre for Pharmaceutical care, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Rajesh V
- Department of Pharmacy Practice, Centre for Pharmaceutical care, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.,Department of Pharmacy Practice, Nitte Gulabi Shetty Memorial Institute of Pharmaceutical Sciences, Nitte University, Mangaluru, India
| | - Surulivelrajan M
- Department of Pharmacy Practice, Centre for Pharmaceutical care, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Shastry Cs
- Department of Pharmacy Practice, Nitte Gulabi Shetty Memorial Institute of Pharmaceutical Sciences, Nitte University, Mangaluru, India
| | - Unnikrishnan Mk
- Department of Pharmacy Practice, Nitte Gulabi Shetty Memorial Institute of Pharmaceutical Sciences, Nitte University, Mangaluru, India
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Ganesan V, Sundaramurthy R, Thiruvanamalai R, Sivakumar VA, Udayasankar S, Arunagiri R, Charles J, Chavan SK, Balan Y, Sakthivadivel V. Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them? Cureus 2021; 13:e19331. [PMID: 34909294 PMCID: PMC8651063 DOI: 10.7759/cureus.19331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background and objective The prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital. Materials and methods A prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting. Results The surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7). Conclusion DUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.
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Affiliation(s)
- Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Raja Sundaramurthy
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Rajendran Thiruvanamalai
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Vijay Anand Sivakumar
- Department of Anaesthesiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sridhurga Udayasankar
- Department of Paediatrics, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Ramesh Arunagiri
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Jhansi Charles
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sunil Kumar Chavan
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Yuvaraj Balan
- Department of Biochemistry, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
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Khan ID, Gonimadatala G, Narayanan S, Kapoor U, Kaur H, Makkar A, Gupta R. Morbidity, mortality, and emerging drug resistance in Device-associated infections (DAIs) in intensive care patients at a 1000-bedded tertiary care teaching hospital. Med J Armed Forces India 2021; 78:221-231. [PMID: 35463554 PMCID: PMC9023779 DOI: 10.1016/j.mjafi.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Device-associated infections (DAIs) such as ventilator associated pneumonia (VAP), central line-associated blood stream infection (CLABSI), and catheter-related urinary tract infection (CAUTI) are principal contributors to health hazard and a major preventable threat to patient safety. Robust surveillance of DAI delineates infections, pathogens, resistograms, and facilitates antimicrobial therapy, infection-control, antimicrobial stewardship, and improvement in quality of care. Methods This prospective outcome surveillance study was conducted amongst 2067 ICU patients in a 1000-bedded teaching hospital. Clinical, laboratory, and environmental surveillance, as well as screening of health care professionals (HCPs) were conducted using the modified US Centers for Disease Control and Prevention-National Healthcare Safety Network definitions and methods. Morbidity, mortality, and health-care indices were analyzed and two-tier infection prevention and control was promulgated. Results Mean occupancy was 95.34% for 2061 patients of 7381 patients/bed/ICU days. One hundred seventeen episodes of DAI occurred in 1258 patients of 12,882 device-days with mean device utilization ratio of 1.79. Mean rate of DAI was 7.40 per 1000 device days. Multiresistant Pseudomonas aeruginosa was most commonly followed by Acinetobacter. Mean all-cause mortality in ICU was 24.85%, whereas all-cause mortality after DAI was 9.79%. Methicillin-resistant Staphylococcus aureus prevalence was 38.46% amongst health-care professionals. Conclusion Mean rates of VAP, CLABSI, and CAUTI were 20.69, 2.53, and 2.23 per 1000 device days comparable with Indian and global ICUs. Resolute conviction and sustained momentum in infection prevention and control is an essential step toward patient safety.
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Affiliation(s)
- Inam Danish Khan
- Associate Professor (Microbiology), Army College of Medical Sciences & Base Hospital, Delhi Cantt, India
- Corresponding author.
| | | | - S. Narayanan
- Classified Specialist (Respiratory Medicine), Military Hospital Dehradun, India
| | - Umesh Kapoor
- Senior Advisor & Head (Pathology), Military Hospital Jaipur, Rajasthan, India
| | - Harleen Kaur
- Graded Specialist (Microbiology), Command Hospital (Northern Command), Udhampur, India
| | - Anuradha Makkar
- Deputy Dean & Professor (Microbiology), Army College of Medical Sciences & Base Hospital, Delhi Cantt, India
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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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Antibacterial Treatment of Selected High-Touch Objects and Surfaces within Provision of Nursing Care in Terms of Prevention of Healthcare-Associated Infections. Healthcare (Basel) 2021; 9:healthcare9060675. [PMID: 34199992 PMCID: PMC8228692 DOI: 10.3390/healthcare9060675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Prevention of healthcare-associated infections is an important part of providing nursing care. High-touch objects and surfaces that can be contaminated with various bacteria are matters of concern. The possibility of reducing contamination is the use of antibacterial and hydrophobic nanolayers. The aim of this study was to determine, by means of an experimental method, the microbial efficacy of applied antibacterial and hydrophobic nanolayers on high-touch objects and surfaces used in nursing practice in a regional hospital in the Czech Republic. The results show that the antibacterial efficacy of the applied nanolayer was not demonstrated. Furthermore, the results show that selected objects and surfaces can always be contaminated by bacterial agents in about 1/3 of cases. It is mainly contamination with nonpathogenic bacteria; however, the presence of pathogenic bacteria, such as Staphylococcus aureus, has also been detected. The results of this study pinpoint the importance of following the basic rules for the use of decontaminated objects and surfaces used to provide healthcare.
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Bagińska N, Cieślik M, Górski A, Jończyk-Matysiak E. The Role of Antibiotic Resistant A. baumannii in the Pathogenesis of Urinary Tract Infection and the Potential of Its Treatment with the Use of Bacteriophage Therapy. Antibiotics (Basel) 2021; 10:281. [PMID: 33803438 PMCID: PMC8001842 DOI: 10.3390/antibiotics10030281] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 12/20/2022] Open
Abstract
Acinetobacter baumannii are bacteria that belong to the critical priority group due to their carbapenems and third generation cephalosporins resistance, which are last-chance antibiotics. The growing multi-drug resistance and the ability of these bacteria to form biofilms makes it difficult to treat infections caused by this species, which often affects people with immunodeficiency or intensive care unit patients. In addition, most of the infections are associated with catheterization of patients. These bacteria are causative agents, inter alia, of urinary tract infections (UTI) which can cause serious medical and social problems, because of treatment difficulties as well as the possibility of recurrence and thus severely decrease patients' quality of life. Therefore, a promising alternative to standard antibiotic therapy can be bacteriophage therapy, which will generate lower costs and will be safer for the treated patients and has real potential to be much more effective. The aim of the review is to outline the important role of drug-resistant A. baumannii in the pathogenesis of UTI and highlight the potential for fighting these infections with bacteriophage therapy. Further studies on the use of bacteriophages in the treatment of UTIs in animal models may lead to the use of bacteriophage therapy in human urinary tract infections caused by A. baumannii in the future.
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Affiliation(s)
- Natalia Bagińska
- Bacteriophage Laboratory, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (N.B.); (M.C.); (A.G.)
| | - Martyna Cieślik
- Bacteriophage Laboratory, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (N.B.); (M.C.); (A.G.)
| | - Andrzej Górski
- Bacteriophage Laboratory, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (N.B.); (M.C.); (A.G.)
- Phage Therapy Unit, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland
- Infant Jesus Hospital, The Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Ewa Jończyk-Matysiak
- Bacteriophage Laboratory, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (N.B.); (M.C.); (A.G.)
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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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Evaluation of ventilator associated events in critically ill patients with invasive mechanical ventilation: A prospective cohort study at a resource limited setting in Northern India. J Crit Care 2021; 64:29-35. [PMID: 33773301 DOI: 10.1016/j.jcrc.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The primary aim of this study was to identify the modifiable risk factors for acquiring ventilator associated events (VAE). Secondary aims were to investigate the intensive care unit (ICU) course and impact of VAE on patient outcome. METHODS This prospective, observational single center cohort study included 247 patients on mechanical ventilation for 4 calendar days at a 20-bed ICU between January 2018-June 2019. RESULTS VAE occurred in 59 episodes (rate 11.3 per 1000 ventilator-days). The Ventilator Utilization Ratio (VUR) was 0.57. The median time to onset of VAE was 6 days. Sepsis was the most common reason for initiating patients on invasive mechanical ventilation (IMV). Cumulative fluid balance ≥2 l (Odds Ratio 30.92; 95% CI 9.82-97.37) and greater number of days with vasopressor support (Odds Ratio 1.92; 95% CI 1.57-2.36) within 7 days of initiating IMV were significant risk factors for acquiring VAE (p < 0.001). VAE cases were ventilated for significantly more days (20 vs 14 days, p = 0.001, had longer days of ICU stay (29 vs 18 days; p = 0.002) and higher hospital mortality (p = 0.02). Klebsiella pneumoniae was the most common isolate (N = 28) and 32.1% were colistin resistant. CONCLUSIONS Prospective intervention studies are needed to determine if targeting these risk factors can lower VAE rates in our setting.
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Saharman YR, Karuniawati A, Severin JA, Verbrugh HA. Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review. Antimicrob Resist Infect Control 2021; 10:22. [PMID: 33514432 PMCID: PMC7844809 DOI: 10.1186/s13756-020-00871-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background Intensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework.
Main body of the abstract Articles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective. Conclusions Compared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings. Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk)
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Affiliation(s)
- Yulia Rosa Saharman
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Anis Karuniawati
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Henri A Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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16
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Iordanou S, Papathanassoglou E, Middleton N, Palazis L, Timiliotou-Matsentidou C, Raftopoulos V. Device-associated health care-associated infections: The effectiveness of a 3-year prevention and control program in the Republic of Cyprus. Nurs Crit Care 2020; 27:602-611. [PMID: 33314424 DOI: 10.1111/nicc.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Device-associated health care-associated infections (DA-HAIs) are a major threat to patient safety, particularly in the Intensive Care Unit (ICU). This study aimed to evaluate the effectiveness of a bundle of infection control measures to reduce DA-HAIs in the ICU of a General Hospital in the Republic of Cyprus, over a 3-year period. METHODS We studied 599 ICU patients with a length of stay (LOS) for at least 48 hours. Our prospective cohort study was divided into three surveillance phases. Ventilator-associated pneumonia (VAP), central line-associated blood-stream infections (CLABSI), and catheter-associated blood-stream infections (CAUTI) incidence rates, LOS, and mortality were calculated before, during, and after the infection prevention and control programme. RESULTS There was a statistically significant reduction in the number of DA-HAI events during the surveillance periods, associated with DA-HAIs prevention efforts. In 2015 (prior to programme implementation), the baseline DA-HAIs instances were 43: 16 VAP (10.1/1000 Device Days), 21 (15.9/1000DD) CLABSIs, and 6 (2.66/1000DD) CAUTIs, (n = 198). During the second phase (2016), CLABSIs prevention measures were implemented and the number of infections were 24: 14 VAP (12.21/1000DD), 4 (4.2/1000DD) CLABSIs, and 6 (3.22/1000DD) CAUTIs, (n = 184). During the third phase (2017), VAP and CAUTI prevention measures were again implemented and the rates were 6: (3 VAP: 12.21/1000DD), 2 (1.95/1000DD) CLABSIs, and 1 (0.41/1000DD) CAUTIs, (n = 217). There was an overall reduction of 87% in the total number of DA-HAIs instances for the period 1 January 2015 to 31 December 2017. CONCLUSIONS The significant overall reduction in DA-HAI rates indicates that a comprehensive infection control programme can affect DA-HAI rates.
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Affiliation(s)
- Stelios Iordanou
- Intensive Care Unit, Limassol General Hospital, Limassol, Cyprus
| | | | - Nicos Middleton
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Lakis Palazis
- Nicosia General Hospital, Intensive Care Unit, Nicosia, Cyprus
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Singhal T, Shah S, Thakkar P, Naik R. The incidence, aetiology and antimicrobial susceptibility of central line-associated bloodstream infections in intensive care unit patients at a private tertiary care hospital in Mumbai, India. Indian J Med Microbiol 2019; 37:521-526. [PMID: 32436874 DOI: 10.4103/ijmm.ijmm_20_3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background There is a need to generate accurate data on temporal trends in incidence rates, aetiology and antimicrobial susceptibility of central line-associated bloodstream infections (CLABSIs) in the Indian setting. Aim To study the incidence, aetiology and antimicrobial susceptibility of CLABSI in adult, paediatric and neonatal intensive care units (NICUs) in a tertiary care private hospital in Mumbai, India. Materials and Methods This is a prospective observational study conducted at the adult, paediatric and NICUs of tertiary care private hospital from 2011 to 2018. CLABSI was defined as per the Centers for Disease Control criteria. Surveillance of CLABSI in the intensive care units (ICUs) was conducted using a form adapted from the International Nosocomial Infection Control Consortium surveillance system. The incidence rates of CLABSI (per 1000 central line days), crude mortality, aetiology and antimicrobial susceptibility were calculated and reported. Results Six hundred and eighty-six episodes of CLABSI were recorded, and the overall incidence of CLABSI was 5/1000 catheter days, 4.1 in the adult ICU, 5 in the paediatric ICU and 9 in the newborn ICU. Crude mortality in patients with CLABSI in the adult, paediatric and NICUs was 45%, 30% and 7%, respectively. Of the 752 isolates, 80% were Gram negative, 10% Gram positive and 10% yeast. The prevalence of extended-spectrum beta-lactamase producers was 80%, and rates of carbapenem resistance were on an average 50%. Conclusions The CLABSI rates at a well-equipped tertiary care hospital are still significantly higher than the USA benchmarks. Alarming rates of drug resistance in Gram-negative pathogens were seen.
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Affiliation(s)
- Tanu Singhal
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Sweta Shah
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Pooja Thakkar
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Reshma Naik
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
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Di Venanzio G, Flores-Mireles AL, Calix JJ, Haurat MF, Scott NE, Palmer LD, Potter RF, Hibbing ME, Friedman L, Wang B, Dantas G, Skaar EP, Hultgren SJ, Feldman MF. Urinary tract colonization is enhanced by a plasmid that regulates uropathogenic Acinetobacter baumannii chromosomal genes. Nat Commun 2019; 10:2763. [PMID: 31235751 PMCID: PMC6591400 DOI: 10.1038/s41467-019-10706-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/24/2019] [Indexed: 12/18/2022] Open
Abstract
Multidrug resistant (MDR) Acinetobacter baumannii poses a growing threat to global health. Research on Acinetobacter pathogenesis has primarily focused on pneumonia and bloodstream infections, even though one in five A. baumannii strains are isolated from urinary sites. In this study, we highlight the role of A. baumannii as a uropathogen. We develop the first A. baumannii catheter-associated urinary tract infection (CAUTI) murine model using UPAB1, a recent MDR urinary isolate. UPAB1 carries the plasmid pAB5, a member of the family of large conjugative plasmids that represses the type VI secretion system (T6SS) in multiple Acinetobacter strains. pAB5 confers niche specificity, as its carriage improves UPAB1 survival in a CAUTI model and decreases virulence in a pneumonia model. Comparative proteomic and transcriptomic analyses show that pAB5 regulates the expression of multiple chromosomally-encoded virulence factors besides T6SS. Our results demonstrate that plasmids can impact bacterial infections by controlling the expression of chromosomal genes. Acinetobacter baumannii is generally considered an opportunistic pathogen. Here, Di Venanzio et al. develop a mouse model of catheter-associated urinary tract infection and show that a plasmid confers niche specificity to an A. baumannii urinary isolate by regulating the expression of chromosomal genes.
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Affiliation(s)
- Gisela Di Venanzio
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Ana L Flores-Mireles
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, MO, 63110, USA.,Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Juan J Calix
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - M Florencia Haurat
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Nichollas E Scott
- Department of Microbiology and Immunology, Institute for Infection and Immunity, University of Melbourne at the Peter Doherty, Parkville, Victoria, 3010, Australia
| | - Lauren D Palmer
- Department of Pathology, Microbiology, and Immunology and Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Robert F Potter
- The Edison Family Center for Genome Sciences and System Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Michael E Hibbing
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Laura Friedman
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Cátedra de Microbiología, Buenos Aires, C1113AAD, Argentina
| | - Bin Wang
- The Edison Family Center for Genome Sciences and System Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Gautam Dantas
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, 63110, USA.,The Edison Family Center for Genome Sciences and System Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, 63105, USA
| | - Eric P Skaar
- Department of Pathology, Microbiology, and Immunology and Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Scott J Hultgren
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Mario F Feldman
- Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO, 63110, USA.
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Pathogens of Intensive Care Unit-Acquired Infections and Their Antimicrobial Resistance: A 9-Year Analysis of Data from a University Hospital. Jundishapur J Microbiol 2018. [DOI: 10.5812/jjm.67716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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High Prevalence and Endemicity of Multidrug Resistant Acinetobacter spp. in Intensive Care Unit of a Tertiary Care Hospital, Varanasi, India. J Pathog 2018; 2018:9129083. [PMID: 30057820 PMCID: PMC6051072 DOI: 10.1155/2018/9129083] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/31/2018] [Indexed: 01/14/2023] Open
Abstract
The increasing emergence of Acinetobacter spp. with healthcare associated infections (HCAI) in intensive care units (ICU) is alarming. This study was a laboratory-based audit to determine the prevalence of Acinetobacter spp. associated with HCAI in the adult ICU of a tertiary care hospital in Varanasi, north India, with special reference to antimicrobial resistance and resistance determinants over a period of 5 years. A total of 993 cases of HCAI were analyzed. Isolates were characterized as multidrug resistance and extended drug resistance (MDR/XDR) based on antimicrobial susceptibility records. Few (100) randomly selected isolates of Acinetobacter baumannii (A. baumannii) were tested for imipenem, meropenem, and polymyxin B susceptibility by minimum inhibitory concentration (MIC) and for the presence of class A and B carbapenemases by multiplex PCR. Active surveillance of ICU environment was also performed. High prevalence of Acinetobacter related hospital acquired pneumonia (HAP) with significant resistance to imipenem (p<0.05) and 88.02% MDR and 61.97% XDR was detected along with persistence in the ICU environment. The isolates harbored blaIMP (89%), blaVIM (51%), blaNDM-1 (34%), and blaOXA-23-like (93%) genes. Specific interventional measures should be adopted to control these imipenem resistant Acinetobacter spp. which have attained the level of endemicity in our ICU setup.
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Bellissimo-Rodrigues WT, Menegueti MG, Gaspar GG, de Souza HCC, Auxiliadora-Martins M, Basile-Filho A, Martinez R, Bellissimo-Rodrigues F. Is it necessary to have a dentist within an intensive care unit team? Report of a randomised clinical trial. Int Dent J 2018; 68:420-427. [PMID: 29777534 DOI: 10.1111/idj.12397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of dental treatment in improving oral health in critical patients. METHODS This randomised clinical trial was conducted in a general intensive care unit (ICU) at a tertiary care public facility from 1 January 2011 to 8 August 2013. Data from 254 adult patients staying in the ICU for 48 hours or more were analysed. The experimental group (n = 127) had access to dental treatment provided by a dentist four to five times a week, in addition to routine oral hygiene, whereas the control group (n = 127) had access only to routine oral hygiene, including topical application of chlorhexidine, provided by the ICU nursing staff. The baseline oral health status of the enrolled patients was poor and included edentulism, caries, gingivitis, periodontitis and residual roots. Dental treatment consisted of toothbrushing, tongue scraping, removal of calculus, scaling and root planing, caries restoration and tooth extraction. RESULTS The Oral Hygiene Index Simplified (OHI-S) and Gingival Index (GI) scores decreased in the experimental group but did not change significantly in the control group during the ICU stay. Dental treatment prevented most of the episodes of respiratory tract infections, as previously reported. No severe adverse events from the dental treatment were observed. CONCLUSION From an interprofessional perspective, our results support the idea of including dentists in the ICU team to improve oral health in critical patients and effectively prevent respiratory tract infections, in addition to the improvement achievable by applying chlorhexidine alone.
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Affiliation(s)
| | - Mayra Gonçalves Menegueti
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Gilberto Gambero Gaspar
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Maria Auxiliadora-Martins
- Intensive Care Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Anibal Basile-Filho
- Intensive Care Division, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Roberto Martinez
- Infectious Diseases Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando Bellissimo-Rodrigues
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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