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Abstract
Several tropical or geographically confined infectious diseases may lead to organ failure requiring management in an intensive care unit (ICU), both in endemic low- and middle-income countries where ICU facilities are increasingly being developed and in (nonendemic) high-income countries through an increase in international travel and migration. The ICU physician must know which of these diseases may be encountered and how to recognize, differentiate, and treat them. The four historically most prevalent "tropical" diseases (malaria, enteric fever, dengue, and rickettsiosis) can present with single or multiple organ failure in a very similar manner, which makes differentiation based solely on clinical signs very difficult. Specific but frequently subtle symptoms should be considered and related to the travel history of the patient, the geographic distribution of these diseases, and the incubation period. In the future, ICU physicians may also be more frequently confronted with rare but frequently lethal diseases, such as Ebola and other viral hemorrhagic fevers, leptospirosis, and yellow fever. No one could have foreseen the worldwide 2019-up to now coronavirus disease 2019 (COVID-19) crisis caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was initially spread by travel too. In addition, the actual pandemic due to SARS-CoV-2 reminds us of the actual and potential threat of (re)-emerging pathogens. If left untreated or when treated with a delay, many travel-related diseases remain an important cause of morbidity and even mortality, even when high-quality critical care is provided. Awareness and a high index of suspicion of these diseases is a key skill for the ICU physicians of today and tomorrow to develop.
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Paquet D, Jung L, Trawinski H, Wendt S, Lübbert C. Fever in the Returning Traveler. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:400-407. [PMID: 35469592 PMCID: PMC9492913 DOI: 10.3238/arztebl.m2022.0182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/10/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND It is predicted that approximately two billion tourist trips to foreign countries will be taken worldwide each year by 2030. Germany has long been among the most active countries in tourism. The frequency of illness among persons returning from developing and newly industrialized countries is 43-79%. The appropriate diagnosis of fever in returning travelers is a clinically important matter, as it can be a sign of a life-threatening illness. METHODS This review is based on publications (2001-2022) retrieved by a selective search in PubMed for studies on the epidemiology, diagnosis, and treatment of febrile illnesses in returning travelers, or on specific tropical diseases. RESULTS Diarrhea, fever, and skin changes are the most common manifestations of disease after travel to tropical and sub - tropical areas. The diagnostic evaluation should be performed in a series of steps, beginning with a precise travel history and the identification of specific risk factors. Among travelers returning from sub-Saharan Africa, Plasmodium falciparum malaria is the most common cause of fever on presentation to centers for infectious diseases and tropical medicine, affecting approximately 50 per 1000 travelers. Among persons returning from travel to Southeast Asia, dengue fever is the most common infectious disease, affecting 50-160 per 1000 travelers. Further potentially dangerous diseases include chikungunya and zika fever, typhoid and paratyphoid fever, amoebic liver abscess, visceral leishmaniasis (kala-azar), leptospirosis, and, very rarely, imported cases of viral hemorrhagic fever. COVID-19 and influenza are important differential diagnoses. CONCLUSION The differential diagnosis can be narrowed by thorough history-taking with particular attention to the patient's travel route, combined with a good knowledge of the geographic spread and incubation times of the main tropical diseases. Algorithms help clinicians to focus the diagnostic work-up and select the appropriate further laboratory tests and diagnostic procedures.
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Affiliation(s)
- Dennis Paquet
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Laura Jung
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Henning Trawinski
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Sebastian Wendt
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Division of Microbiology, Institute of Medical Microbiology and Virology, Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Klinikum St. Georg gGmbH, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
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Villamil-Gómez W. Protocolo diagnóstico del síndrome febril con focalidad respiratoria en áreas geográficas de riesgo endémico de infecciones tropicales. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2022; 13:3432-3437. [PMID: 35702162 PMCID: PMC9183391 DOI: 10.1016/j.med.2022.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
La vigilancia sindromática de un grupo de enfermedades que tienen similitud de signos y síntomas, fisiopatología común y etiología diversa está orientada a detectar rápidamente la presencia de brotes con potencial daño a la salud pública, considerando no solo los brotes de origen infeccioso conocidos sino también los de origen desconocido. Se recomienda en pacientes con sospecha de SARS-CoV-2/COVID-19 considerar otras etiologías del síndrome febril tropical en el diagnóstico diferencial cuando residan o provengan de zonas endémicas como es el caso del dengue, la malaria, la leptospirosis, la enfermedad de Chagas aguda y la rickettsiosis, entre otras patologías endémicas, así como la posibilidad de una coinfección SARS-CoV-2, AH1 AH5N1 MERS-CoV con estos patógenos.
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Howells P, Laird S, Johnston AM, Billyard T. Critical illness in the returning traveller. J Intensive Care Soc 2022; 23:87-92. [PMID: 37593535 PMCID: PMC10427841 DOI: 10.1177/1751143721991955] [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: 08/19/2023] Open
Abstract
A 70 year old man, who had recently travelled in rural Iraq, presented with fevers, rigors, and developed multiorgan failure. An extensive range of diagnostic tests was undertaken in an attempt to identify the cause. He was treated with multi-organ support and a number of antibiotics. Critical illness in the returning traveller presents a number of challenges on the ICU: obtaining adequate history, the potentially broad differential diagnosis, the requirement for numerous and sometimes specialised investigations and risks of infection transmission to staff and other patients. Travellers are more often elderly, more likely to have comorbidities and immunosuppression whilst global disease patterns are changing. Particular consideration should be given to unusual infections and venous thromboembolic disease from prolonged immobility whilst in transit, alongside more commonly encountered diseases. Antimicrobial resistance may be encountered and appropriate infection control is essential for the protection of patients, staff and others. Specialist support is available in the UK via the Imported Fever Service, especially for High Consequence Infectious Diseases. Consideration of non-infectious causes of fever and critical illness in returning travellers is also warranted. Crucially, a multidisciplinary team approach with thorough information gathering, repeated clinical review and judicious use of investigations are essential for optimal patient care.
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Affiliation(s)
- Phillip Howells
- Department of Anaesthesia and Critical Care Medicine, Harefield Hospital, London, UK
| | - Steven Laird
- Department of Microbiology, University Hospital Coventry, Coventry, UK
| | - Andrew McD Johnston
- Royal Centre for Defence Medicine, Birmingham, UK
- Department of Critical Care Medicine, University Hospital Birmingham, UK
| | - Thomas Billyard
- Department of Anaesthesia and Critical Care Medicine, University Hospitals Coventry and Warwickshire, UK
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Moser AI, Campos-Madueno EI, Sendi P, Perreten V, Keller PM, Ramette A, Endimiani A. Repatriation of a patient with COVID-19 contributed to the importation of an emerging carbapenemase producer. J Glob Antimicrob Resist 2021; 27:267-272. [PMID: 34718203 PMCID: PMC8552635 DOI: 10.1016/j.jgar.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Patients hospitalised abroad can become colonised with multidrug-resistant bacteria and import them to their home countries. In this study, we characterised an OXA-484 carbapenemase-producing Escherichia coli strain from a Swiss patient infected by SARS-CoV-2 and repatriated from India. METHODS At admission to Switzerland (April 2021), the patient undertook a nasopharyngeal swab to search for SARS-CoV-2 and a rectal swab to detect multidrug-resistant bacteria. Both SARS-CoV-2 and E. coli isolates were whole-genome sequenced and analysed for phylogenetic relatedness. RESULTS The patient was infected with the SARS-CoV-2 B.1.617.2 lineage (VOC Delta), a lineage that began to be reported across Switzerland at that time. He was also colonised with a sequence type 410 (ST410) E. coli strain (L3452210II) producing OXA-484, a single amino acid variant of OXA-181. The blaOXA-484 gene was carried by a 51.5 kb IncX3 plasmid identical to those described in blaOXA-181-harbouring ST410 E. coli strains. Core genome analysis showed that L3452210II was identical (ΔSNV ≤23) to two ST410 OXA-484 producers recently reported in Qatar and Germany, but differed from other ST410 OXA-181 producers reported worldwide. CONCLUSION The patient was infected by an emerging SARS-CoV-2 variant and also imported an E. coli producing OXA-484, an OXA-48-like carbapenemase not yet reported in Switzerland. The genetic background of L3452210II indicated that blaOXA-484 shared the same plasmid as blaOXA-181, but its bacterial host differed from most of the pandemic OXA-181-producing ST410 strains reported previously. This case description underlines that the COVID-19 crisis can contribute to the worldwide spread of emerging carbapenemase producers.
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Affiliation(s)
- Aline I Moser
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland
| | - Edgar I Campos-Madueno
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland; Graduate School of Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland
| | - Vincent Perreten
- Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland
| | - Peter M Keller
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland
| | - Alban Ramette
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland
| | - Andrea Endimiani
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3001, Bern, Switzerland.
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Musalam AMA, Abunamous RES, El-Ashgar NM, Alhana AS. Emergency management to avoid the spread of the COVID-19 pandemic in Gaza Strip. Int J Health Plann Manage 2021; 36:1742-1757. [PMID: 34089200 PMCID: PMC8239705 DOI: 10.1002/hpm.3260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Gaza Strip is exposed to the danger of the novel coronavirus pandemic ‘nCOVID‐19’ spread, which exacerbates the crises severity on this besieged area since 2007. This study aims to identify the preventive actions during the action effectiveness implemented by the Central Emergency Committee and the Ministry of Health to reduce the coronavirus spread in Gaza Strip. The researchers have followed the descriptive and the analytical methodology of the purposive sample responses data from the preventive medicine workers, the security team, and the members of the Central Emergency Committee.The most important results of the study showed that targeted peoples have been reexamined several times to ensure that they are recovered from the disease with an average of 81.0%. The reliability and accuracy of the detection tests of the coronavirus disease were of an average of 79.33%. In addition, the results demonstrate the existence of a strong correlation between the preventive action taken by the Central Emergency Committee and the effectiveness of the procedures to prevent the coronavirus pandemic. Also, the study shows a statistical significance effect at the level of significance (α ≤ 0.05) regarding the prevention procedures from the coronavirus pandemic and the effectiveness of the procedures.
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Affiliation(s)
- Alaa M A Musalam
- Department of Engineering Sciences, University College of Science and Technology, Khan Younis, Palestine
| | - Raed E S Abunamous
- Palestinian Crisis Management Group - College of Science, Islamic University of Gaza, Gaza, Palestine
| | - Nizam M El-Ashgar
- Crisis and Disaster Management Program, Faculty of Science, Islamic University of Gaza, Gaza, Palestine
| | - Ahmed S Alhana
- Radiology Department, Indonesian Hospital in North Gaza, Gaza, Palestine
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Characterization of Ebola Virus Risk to Bedside Providers in an Intensive Care Environment. Microorganisms 2021; 9:microorganisms9030498. [PMID: 33652895 PMCID: PMC7996731 DOI: 10.3390/microorganisms9030498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The 2014–2016 Ebola outbreak in West Africa recapitulated that nosocomial spread of Ebola virus could occur and that health care workers were at particular risk including notable cases in Europe and North America. These instances highlighted the need for centers to better prepare for potential Ebola virus cases; including understanding how the virus spreads and which interventions pose the greatest risk. Methods: We created a fully equipped intensive care unit (ICU), within a Biosafety Level 4 (BSL4) laboratory, and infected multiple sedated non-human primates (NHPs) with Ebola virus. While providing bedside care, we sampled blood, urine, and gastric residuals; as well as buccal, ocular, nasal, rectal, and skin swabs, to assess the risks associated with routine care. We also assessed the physical environment at end-point. Results: Although viral RNA was detectable in blood as early as three days post-infection, it was not detectable in the urine, gastric fluid, or swabs until late-stage disease. While droplet spread and fomite contamination were present on a few of the surfaces that were routinely touched while providing care in the ICU for the infected animal, these may have been abrogated through good routine hygiene practices. Conclusions: Overall this study has helped further our understanding of which procedures may pose the highest risk to healthcare providers and provides temporal evidence of this over the clinical course of disease.
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Princess I, Vadala R. Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art. Indian J Crit Care Med 2021; 25:566-574. [PMID: 34177177 PMCID: PMC8196372 DOI: 10.5005/jp-journals-10071-23810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We live in an era of evolving microbial infections and equally evolving drug resistance among microorganisms. In any healthcare facility, intensivists play the most pivotal role with critically ill patients under their direct care. Majority of the critically ill patients already harbor a microorganism at admission or acquire one in the form of healthcare-associated infections during their course of intensive care unit stay. It is therefore rather imperative for intensivists to possess sound knowledge in clinical microbiology. On a negative note, most clinicians have very meager and remote knowledge acquired during their undergraduate years. This knowledge is rather theoretical than applied and wanes over the years becoming nonbeneficial in intensive patient care. We, therefore, intend to explore important concepts in applied microbiology and infection control that intensivists should know and implement in their clinical practice on a day-to-day basis. How to cite this article: Princess I, Vadala R. Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art. Indian J Crit Care Med 2021;25(5):566–574.
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Affiliation(s)
- Isabella Princess
- Department of Microbiology, Apollo Speciality Hospitals, Vanagaram Branch, Chennai, Tamil Nadu, India
| | - Rohit Vadala
- Metro Centre for Respiratory Diseases, Metro Multispeciality Hospital, Noida, Uttar Pradesh, India
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Abstract
Las enfermedades importadas potencialmente de mayor gravedad son el paludismo, las arbovirosis hemorrágicas, la fiebre tifoidea y la amebosis. Sigue siendo útil considerar que toda fiebre importada de África subsahariana es paludismo hasta poder demostrar lo contrario. Aunque las causas más frecuentes de fiebre procedente de otros destinos son otras, la fiebre siempre obliga a descartar el paludismo. Un paciente febril que presenta sangrado espontáneo debe ser aislado y no realizar ninguna extracción o manipulación de fluidos hasta haber contactado con las autoridades epidemiológicas territoriales. Los pródromos clínicos suelen ser inespecíficos. No obstante, la identificación de factores de riesgo (viajes mochileros o inmigrantes en visita a familiares), sus circunstancias (pacientes que no han realizado quimioprofilaxis antipalúdica) y el periodo de aparición de la fiebre (en general menor de 2 semanas) deben alertar. En los pacientes graves no hay que demorar el inicio de un tratamiento empírico combinado antipalúdico-antibiótico a la espera de resultados microbiológicos.
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Spencer H, Ustianowski A, Farooq H. Assessment of fever in the returning traveller. Br J Hosp Med (Lond) 2019; 79:560-566. [PMID: 30290751 DOI: 10.12968/hmed.2018.79.10.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Evaluation of people returning from trips abroad with fever is an important skill for all general physicians given the increasing trend in foreign travel. This evaluation should comprise a detailed travel history, thorough clinical examination, appropriate initial tests and a knowledge of when to ask for further advice. An understanding of the incubation periods of common imported infections and a syndromic approach to patients' symptoms is helpful in order to narrow down the likely diagnosis. The need to implement relevant infection control precautions has been highlighted by the recent Middle East respiratory syndrome coronavirus and Ebola virus disease outbreaks.
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Affiliation(s)
- Hannah Spencer
- ST3 Registrar, Department of Infectious Diseases, Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester M8 5RB
| | - Andrew Ustianowski
- Consultant in Infectious Diseases and Tropical Medicine, Department of Infectious Diseases, Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester
| | - Hamzah Farooq
- ST5 Infectious Diseases and Virology, Department of Infectious Diseases, Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester
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Draeger CL, Akutsu RDCCDA, de Oliveira KES, da Silva ICR, Botelho RBA, Zandonadi RP. Unhygienic Practices of Health Professionals in Brazilian Public Hospital Restaurants: An Alert to Promote New Policies and Hygiene Practices in the Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071224. [PMID: 30959787 PMCID: PMC6479858 DOI: 10.3390/ijerph16071224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate health professionals’ unhygienic practices and the stages of behaviour change in Brazilian public hospital restaurants. We evaluated all medium/large-sized public hospital restaurants (HRs) from the Brazilian Federal District (n = 9); a representative sample of 128 users). We evaluated the HRs’ physical structures, their consumers’ socio-demographic characteristics, their unhygienic practices, as well as the stages of behavioural change concerning unhygienic practices. All the HRs presented their menus for self-service distribution, so customers entered in lines to serve themselves. All the HRs had hand-wash sinks for customers; 77.8% offered antiseptic liquid soap; 33.3% offered alcohol gel; and 77.8% offered storage for professional accessories before serving food. Almost half (46.8%) of the customers did not sanitise their hands (with water and antiseptic soap and/or use of alcohol gel) immediately before serving, and 24.2% wore professional uniforms at HRs. Almost half (43.5%) of the customers spoke with each other in line while serving their plates and arranged the food on their plates with the serving utensils from the distribution counter. The declaration of behavioural change was inversely associated with the hygiene practices. Almost half of the individuals did not sanitize their hands; however, 90.4% declared “changed behaviour” when this contaminant practice was presented to them. We verified a high percentage of hygiene practices inconsistent with most of the customers´ answers about their stage of behaviour change. Based on the observations of this study, it is necessary for an awareness program to be developed that is focused on customers of HRs in order to reduce unhygienic practices. Also, it is important to promote new policies for proper hygiene practices in hospital restaurants.
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Affiliation(s)
- Cainara Lins Draeger
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil.
| | | | | | | | | | - Renata Puppin Zandonadi
- Department of Nutrition, Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil.
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Nellums LB, Thompson H, Holmes A, Castro-Sánchez E, Otter JA, Norredam M, Friedland JS, Hargreaves S. Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2018; 18:796-811. [PMID: 29779917 PMCID: PMC6032478 DOI: 10.1016/s1473-3099(18)30219-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London.
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Affiliation(s)
| | | | - Alison Holmes
- Department of Medicine, Imperial College London, London, UK
| | | | | | - Marie Norredam
- Danish Research Centre for Migration Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Disease, Copenhagen University Hospital, Hvidovre, Denmark
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Abstract
PURPOSE OF REVIEW Infectious disease outbreaks in the critical care setting are common and serious consequence. This article reviews and summarizes recent outbreaks in the adult ICUs. RECENT FINDINGS Outbreaks of multidrug-resistant bacteria, fungi, and emerging viruses in ICUs from different countries are common. Outbreak investigation relies on epidemiologic methods, microbiologic studies, and molecular typing methods. Overuse of antibiotics, gaps in implementing infection prevention measures, and contaminated environment are common causes of ICU outbreaks. ICU staff awareness of and preparedness for such outbreaks are crucial for outbreak prevention and control. Specific infection control measures vary according to outbreak transmission mode and cause. SUMMARY Outbreaks remain a significant threat to healthcare systems. Proper implementation of infection prevention practices and judicious use of antibiotics are needed for outbreak prevention in adult ICUs. Surveillance, proper outbreak investigation, adherence to infection prevention and control measures, and thorough disinfection of contaminated areas are required to successfully manage outbreaks.
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Nor MBM, Richards GA, McGloughlin S, Amin PR. Pneumonia in the tropics: Report from the Task Force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2017; 42:360-365. [PMID: 29129538 PMCID: PMC7138420 DOI: 10.1016/j.jcrc.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
The aetiology of community acquired pneumonia varies according to the region in which it is acquired. This review discusses those causes of CAP that occur in the tropics and might not be readily recognizable when transplanted to other sites. Various forms of pneumonia including the viral causes such as influenza (seasonal and avian varieties), the coronaviruses and the Hantavirus as well as bacterial causes, specifically the pneumonic form of Yersinia pestis and melioidosis are discussed.
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Affiliation(s)
- Mohd Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Guy A Richards
- Division of Critical Care, Charlotte Maxeke Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Steve McGloughlin
- Intensive Care Unit and Infectious Diseases Physician, The Alfred Hospital, Melbourne, Australia.
| | - Pravin R Amin
- Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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Rello J, Rouby JJ, Sole-Lleonart C, Chastre J, Blot S, Luyt CE, Riera J, Vos MC, Monsel A, Dhanani J, Roberts JA. Key considerations on nebulization of antimicrobial agents to mechanically ventilated patients. Clin Microbiol Infect 2017; 23:640-646. [PMID: 28347790 DOI: 10.1016/j.cmi.2017.03.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 11/30/2022]
Abstract
Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers. To decrease turbulence and limit circuit and tracheobronchial deposition, we recommend: (a) the use of specifically designed respiratory circuits avoiding sharp angles and characterized by smooth inner surfaces, (b) the use of specific ventilator settings during nebulization including use of a volume controlled mode using constant inspiratory flow, tidal volume 8 mL/kg, respiratory frequency 12 to 15 bpm, inspiratory:expiratory ratio 50%, inspiratory pause 20% and positive end-expiratory pressure 5 to 10 cm H2O and (c) the administration of a short-acting sedative agent if coordination between the patient and the ventilator is not obtained, to avoid patient's flow triggering and episodes of peak decelerating inspiratory flow. A filter should be inserted on the expiratory limb to protect the ventilator flow device and changed between each nebulization to avoid expiratory flow obstruction. A heat and moisture exchanger and/or conventional heated humidifier should be stopped during the nebulization period to avoid a massive loss of aerosolized particles through trapping and condensation. If these technical requirements are not followed, there is a high risk of treatment failure and adverse events in mechanically ventilated patients receiving nebulized antibiotics for pneumonia.
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Affiliation(s)
- J Rello
- European Study Group for Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain.
| | - J J Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | | | - J Chastre
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | - S Blot
- Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, European Study Group for Infections in Critically Ill Patients (ESGCIP), Ghent, Belgium
| | - C E Luyt
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | - J Riera
- Critical Care Department, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institut of Research, Barcelona, Spain
| | - M C Vos
- Department of Medical Microbiology and Infectious Diseases, European Study Group of Nosocomial Infections (ESGNI), Rotterdam, The Netherlands
| | - A Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière hospital, Assistance Publique Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France
| | - J Dhanani
- Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane, Australia
| | - J A Roberts
- Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Brisbane, Australia
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First report of NDM-1-producing Klebsiella pneumoniae imported from Africa to Italy: Evidence of the need for continuous surveillance. J Glob Antimicrob Resist 2017; 8:23-27. [DOI: 10.1016/j.jgar.2016.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/17/2016] [Indexed: 01/22/2023] Open
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Aleanizy FS, Mohmed N, Alqahtani FY, El Hadi Mohamed RA. Outbreak of Middle East respiratory syndrome coronavirus in Saudi Arabia: a retrospective study. BMC Infect Dis 2017; 17:23. [PMID: 28056850 PMCID: PMC5217314 DOI: 10.1186/s12879-016-2137-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/17/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The Middle East respiratory syndrome (MERS) is proposed to be a zoonotic disease. Dromedary camels have been implicated due to reports that some confirmed cases were exposed to camels. Risk factors for MERS coronavirus (MERS-CoV) infections in humans are incompletely understood. This study aimed to describe the demographic characteristics, mortality rate, clinical manifestations and comorbidities with confirmed cases of MERS-CoV. METHODS Retrospective chart review were performed to identify all laboratory-confirmed cases of MERS-CoV in Saudi Arabia who reported to the Ministry of Health (MOH) of Saudi Arabia and WHO between April 23, 2014 and August 31, 2015. Patients' charts were also reviewed for demographic information, mortality, comorbidities, clinical presentations, health care facility and presented with descriptive and comparative statistics using non parametric binomial test and Chi-square test. RESULTS Confirmed cases of male patients (61.1%) exceeded those of female patients (38.9%). Infections among Saudi patients (62.6%) exceeded those among non-Saudi patients (37.4%; P = 0.001). The majority of the patients were aged 21-40 years (37.4%) or 41-60 years (35.8%); 43 (22.6%) were aged >61 years, and (8) 4.2% were aged 0-20 years. There was a difference in mortality between confirmed MERS-CoV cases (63.7% alive versus 36.3% dead cases, respectively). Furthermore, fever with cough and shortness of breath (SOB) (n = 39; 20.5%), fever with cough (n = 29; 15.3%), fever (n = 18; 9.5%), and fever with SOB (n = 13; 6.8%), were the most common clinical manifestations associated with confirmed MERS-CoV cases. CONCLUSION MERS-CoV is considered an epidemic in Saudi Arabia. The results of the present study showed that the frequency of cases is higher among men than women, in Saudi patients than non-Saudi, and those between 21 to 60 years are most affected. Further studies are required to improve the surveillance associated with MERS-CoV to get definite and clear answers and better understanding of the MERS-CoV outbreak as well the source, and route of infection transmission in Saudi Arabia.
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Affiliation(s)
- Fadilah Sfouq Aleanizy
- College of Pharmacy, Department of Pharmaceutics, King Saud University, 22452, Riyadh, 11495 Saudi Arabia
| | - Nahla Mohmed
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 12484 Saudi Arabia
| | - Fulwah Y. Alqahtani
- College of Pharmacy, Department of Pharmaceutics, King Saud University, 22452, Riyadh, 11495 Saudi Arabia
| | - Rania Ali El Hadi Mohamed
- College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, 12484 Saudi Arabia
- Scientific research, Federal Ministry of Health, Khartoum, 303 Sudan
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Schlagenhauf P, Gautret P, Rodriguez-Morales AJ, Jones ME, Toovey S, Petersen E, Chen LH. Drug resistant pathogens and travel: No road map but a new initiative from Travel Medicine and Infectious Disease. Travel Med Infect Dis 2016; 14:543-545. [PMID: 27915000 DOI: 10.1016/j.tmaid.2016.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zürich, Switzerland.
| | - Philippe Gautret
- University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France
| | | | - Michael E Jones
- Spire Shawfair Park Hospital, 10 Easter Shawfair, Edinburgh, Scotland, UK
| | | | - Eskild Petersen
- Department of Infectious Diseases, The Royal Hospital, Muscat, Oman and the Institute of Clinical Medicine, University of Aarhus, Denmark
| | - Lin H Chen
- Travel Medicine Center, Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA, USA
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Duong TN, Waldman SE. Importance of a Travel History in Evaluation of Respiratory Infections. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:141-152. [PMID: 32226655 PMCID: PMC7100244 DOI: 10.1007/s40138-016-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW International travel has increased at a fast pace and will continue to rapidly rise. Concomitantly, with this increase in travel is the increase in post travel-related diseases, such as respiratory illnesses. Identifying the cause of the posttravel respiratory illness is a complex challenge for many healthcare professionals because similar presentations occur for both infectious and noninfectious causes. Not only is diagnosis important but also transmission prevention. In the last two decades, there have been several severe infectious respiratory syndromes that have spread through international travel causing epidemics in many countries. RECENT FINDINGS A detailed travel history with the chronology of symptoms paired with the patient's medical risk factors and exposures along with some basic knowledge of infectious respiratory illnesses will help facilitate clinical decision making. This framework will help create a broad, but appropriate differential diagnosis to guide clinical workup, prevent delays in diagnosis, and implement the appropriate precautions to prevent transmission if appropriate. SUMMARY The foundation to diagnosing a travel-related respiratory illness lies within integrating the patient's travel history, comorbid conditions, clinical presentation, exposures, and mode of transmission. A timely and accurate diagnosis benefits not only the patient but also the surrounding community to prevent further individual transmission, epidemics, and pandemics.
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Affiliation(s)
- Theresa N. Duong
- Division of Hospital Medicine, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
| | - Sarah E. Waldman
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
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