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Mamo D, Aklog E, Gebremedhin Y. Patterns of admission and outcome of patients admitted to the intensive care unit of Addis Ababa Burn Emergency and Trauma Hospital. Sci Rep 2023; 13:6364. [PMID: 37076540 PMCID: PMC10113727 DOI: 10.1038/s41598-023-33437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
Data on patterns of intensive care unit (ICU) admission including age, and severity of illness is essential in developing better strategies for resource allocation to improve outcomes. A 2-year cross-sectional study of 268 patients using a systematic random sampling and structured questionnaire obtained from the database was conducted with the aim of examining patterns of admission among patients admitted to the ICU of Addis Ababa burn emergency and trauma (AaBET) hospital. Data were entered into Epi-Info version 3.5.3 and exported to SPSS version 24 for analysis. Bivariate and multivariate logistic regression were used for association. A P-value of 0.05 at a 95% confidence interval was declared clinically significant. Of the 268 charts reviewed, 193 (73.5%) of them were men with a mean age of 32.6 years. Trauma accounted for 163 (53.4%) of admissions. Burn admission category, Glasgow coma score of 3-8, and not receiving pre-referral treatment were found to be substantially correlated with mortality in both bivariate and multivariate analysis. Trauma constituted a sizeable cause of ICU admission. Road traffic accidents of traumatic brain injuries were the major causes of admission. Developing good pre-referral care equipped with manpower and ambulance services will improve the outcome.
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Affiliation(s)
- Dirijit Mamo
- Department of Emergency and Critical Care Medicine, St. Paul`S Hospital Millennium Medical College, Addis-Ababa Burn, Emergency, and Trauma Hospital, Addis-Ababa, Ethiopia.
| | - Etsegenet Aklog
- Department of Emergency and Critical Care Medicine, St. Paul`S Hospital Millennium Medical College, Addis-Ababa Burn, Emergency, and Trauma Hospital, Addis-Ababa, Ethiopia
| | - Yemane Gebremedhin
- Department of Emergency and Critical Care Medicine, St. Paul`S Hospital Millennium Medical College, Addis-Ababa Burn, Emergency, and Trauma Hospital, Addis-Ababa, Ethiopia
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2
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Devrim I, Erdem H, El-Kholy A, Almohaizeie A, Logar M, Rahimi BA, Amer F, Alkan-Ceviker S, Sonmezer MC, Belitova M, Al-Ramahi JW, Pshenichnaya N, Gad MA, Santos L, Khedr R, Hassan AN, Boncuoglu E, Cortegiani A, Marino A, Liskova A, Hakamifard A, Popescu CP, Khan MA, Marinova R, Petrov N, Nsutebu E, Shehata G, Tehrani HA, Alay H, Mareković I, Zajkowska J, Konkayev A, Ramadan ME, Pagani M, Agin H, Tattevin P, El-Sokkary R, Ripon RK, Fernandez R, Vecchio RFD, Popescu SD, Kanj S. Analyzing central-line associated bloodstream infection prevention bundles in 22 countries: The results of ID-IRI survey. Am J Infect Control 2022; 50:1327-1332. [PMID: 35263612 DOI: 10.1016/j.ajic.2022.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries. METHODS The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income. RESULTS Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n = 6) ICUs had no CLABSI bundle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05). CONCLUSIONS Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries.
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Affiliation(s)
- Ilker Devrim
- Pediatric Infectious Diseases Department, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye.
| | - Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Abdullah Almohaizeie
- Pharmaceutical Care Division, King Faisal Specialist Hospital Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mateja Logar
- Department of Infectious Diseases, UMC Ljubljana, Ljubljana, Slovenia
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sevil Alkan-Ceviker
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University, Medical Faculty Hospital, Canakkale, Türkiye
| | - Meliha Cagla Sonmezer
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, School of Medicine, Ankara, Türkiye
| | - Maya Belitova
- Department of Anesthesiology and Intensive Care, University Hospital "Queen Giovanna"-ISUL, EAD, Sofia, Bulgaria
| | - Jamal Wadi Al-Ramahi
- Department of Infectious Diseases, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Maha Ali Gad
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Egypt
| | - Lurdes Santos
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University/Children Cancer Hospital Egypt, Cairo, Egypt
| | - Abdullahi Nur Hassan
- Department of Infectious Diseases and Clinical Microbiology, Algomed Hospital, Adana, Türkiye
| | - Elif Boncuoglu
- Pediatric Infectious Diseases Department, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo and Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Andrea Marino
- Department of Infectious Diseases, Garibaldi Nesima Hospital, Catania, Italy
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Corneliu Petru Popescu
- Dr. Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | | | | | | | - Emmanuel Nsutebu
- Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Hamed Azhdari Tehrani
- Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Handan Alay
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Faculty of Medicine, Erzurum, Türkiye
| | - Ivana Mareković
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Croatia
| | | | - Aidos Konkayev
- Institution of Trauma and Orthopedics, Astana Medical University, Nur-Sultan, Kazakhstan
| | | | - Michele Pagani
- UOC Anestesia e Rianimazione 1, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hasan Agin
- Pediatric Intensive Care Unit, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Pierre Tattevin
- Department of Infectious and Tropical Diseases, University Hospital of Pontchaillou, Rennes, France
| | - Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Bangladesh
| | | | | | | | - Souha Kanj
- American University of Beirut Medical Center, Beirut, Lebanon
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3
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An Alliance of Carbapenem-Resistant Klebsiella pneumoniae with Precise Capsular Serotypes and Clinical Determinants: A Disquietude in Hospital Setting. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:6086979. [DOI: 10.1155/2022/6086979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022]
Abstract
Carbapenemase-resistant Klebsiella pneumoniae (CRKP) is a genuine burden for physicians and researchers. We aimed at carbapenemase resistance and its relation with capsular serotyping in K. pneumoniae and studied some clinical determinants, which may influence the clinical infections. Initially, 61 K. pneumoniae isolates obtained from various clinical specimens were confirmed at the molecular level and then antimicrobial susceptibility test was performed followed by capsular serotyping performed by multiplex PCR. All isolates were subjected to the detection of carbapenemase genes including blaKPC, blaNDM-1, blaOXA-48, blaVIM, and blaIMP. Clinical and demographic data of all patients were reviewed including age, gender, underlying diseases, and the treatment obtained. Multidrug-resistance was a predominant feature in 77% K. pneumoniae strains. Presence of extended-spectrum beta-lactamase was detected phenotypically in 59% K. pneumoniae strains. Carbapenem resistance was noticed phenotypically in 24.6% isolates. blaOXA-48 and blaNDM-1 were the most frequent carbapenemase genes. blaNDM-1 positive isolates correlated with gentamicin, amikacin, imipenem, and meropenem resistance (
). The nosocomial isolates mostly harbored blaOXA-48 gene (
). Amongst all the K. pneumoniae isolates, 59% isolates could be typed and serotype K54 had the highest prevalence followed by K20 and K5. Correlation between the carbapenemase genes, serotype and type of infection showed that blaOXA-48 positive strains had a significant association with K20 serotype and urinary tract infections (
) while, K20 serotype and blaKPC positive strains were significantly associated with wound infections (K20,
and blaKPC, and
). Mucoid phenotype was not found related to presence of specific carbapenemase genes or serotypes except serotype K20 (
). Patients with monotherapy had treatment failure in comparison to the combination therapy for blaKPC-associated infections. In conclusion, the present investigation exhibited the significant association between K20 serotype with blaOXA-48. The predominance of K54 reveals the possibility of endemicity in our hospital setting. K. pneumoniae isolated from wound specimens significantly harbors K20 serotype and blaKPC gene. Comprehensive clinical information and the distribution of antibiotic resistance genes, and serotypes may play important roles in the treatment process.
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4
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Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey. J Infect Public Health 2022; 15:950-954. [DOI: 10.1016/j.jiph.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
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5
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Kolpen M, Dalby Sørensen C, Faurholt-Jepsen D, Hertz FB, Jensen PØ, Bestle MH. Endotracheal lactate reflects lower respiratory tract infections and inflammation in intubated patients. APMIS 2022; 130:507-514. [PMID: 35349738 DOI: 10.1111/apm.13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess L-lactate and D-lactate in endotracheal aspirate from intubated patients hospitalized at the intensive care unit and explore their use as diagnostic biomarkers for inflammation and lower respiratory tract infections (LRTI). Tracheal aspirates from 91 intubated patients were obtained at time of intubation and sent for microbiological analyses, neutrophil count, and colorimetric lactate measurements. We compared the concentration of lactate from patients with microbiological verified LRTI or clinical/radiological suspicion of LRTI with a control group. In addition, associations between inflammation and the lactate isomers were examined by correlating L-lactate and D-lactate with sputum neutrophils and clinical assessments. The concentration of L-lactate was increased in aspirates with verified or suspected LRTI (p < 0.001) relative to the control group at Day 0. Connections between L-lactate and inflammation were indicated by the correlation between neutrophils and L-lactate (p < 0.001). We found no increase in sputum D-lactate from patients with verified or suspected LRTI relative to the control group and D-lactate was not correlated with neutrophils. L-lactate was found to be a potential indicator for inflammation and LRTI at the time of intubation. An association was found between neutrophil count and L-lactate. Interestingly, the increase of L-lactate in the control group after intubation may suggest that intubation challenges the host response by inflicting tissue damage or by introducing infectious microbes.
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Affiliation(s)
- Mette Kolpen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Dalby Sørensen
- Department of Anesthesiology and Intensive Care, Nordsjaellands Hospital, Copenhagen University Hospital, Hillerød, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Peter Østrup Jensen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.,Costerton Biofilm Center, Department of Immunology and Microbiology, Faculty of Health Sciences University of Copenhagen, Copenhagen, Denmark
| | - Morten Heiberg Bestle
- Department of Anesthesiology and Intensive Care, Nordsjaellands Hospital, Copenhagen University Hospital, Hillerød, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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6
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Murila BL, Nyamu DG, Kinuthia RN, Njogu PM. Rational use of antibiotics and covariates of clinical outcomes in patients admitted to intensive care units of a tertiary hospital in Kenya. Hosp Pract (1995) 2022; 50:151-158. [PMID: 35297278 DOI: 10.1080/21548331.2022.2054632] [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: 10/18/2022]
Abstract
OBJECTIVES : Rational use of antibiotics implies appropriate choice of an antibiotic administered at correct dose, frequency and duration using the most suitable route of administration. Irrational antibiotics use is associated with antimicrobial resistance, drug failure and high mortality in the critical care units (CCUs). This study sought to establish rational use of antibiotics and determinants of clinical outcomes of patients admitted in the CCUs at the Kenyatta National Hospital (KNH). The findings would guide policy formulation of antibiotics use in hospital CCUs in Kenya and the region. METHODS : Retrospective review of 220 admissions to the KNH CCUs over the period February 2018-February 2020 was conducted. Participants' sociodemographics, clinical characteristics, antibiotics therapy, and outcome of admission were extracted from patient files and analyzed using STATA version 23. Determinants of irrational antibiotic use and covariates of clinical outcomes were computed at 95% confidence. RESULTS The prevalence of rational use of antibiotics was only 18.5%. Inappropriate choice of antibiotics (51.0%) and incorrect duration (32.3%) were the most common irrational practices. Flucloxacillin (100%), cefuroxime (93.3%), cefazolin (85.7%) and ceftriaxone (83.0%) were the most irrationally used antibiotics. Irrational use of ceftriaxone was significantly associated with clinical diagnosis (p=0.012) while that of amoxiclav was associated with patient risk category (p=0.039). Mortality in the CCUs was 10%, and the odds of dying were almost six times among intubated patients compared to those who were not (AOR 5.5, 95% CI=1.1-28.1, p=0.042). CONCLUSION Irrational antibiotics prescribing is high in the KNH CCUs, attributable largely to incorrect choice and wrong duration of antibiotic use. Mortality was significantly associated with intubation. Intensification of management in critical care settings should be directed towards intubated patients while ensuring appropriate choice of antibiotics administered for the correct duration. Future studies should explore factors that could promote rational antibiotics use in critical care settings.
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Affiliation(s)
- Babra Ligogo Murila
- Pharmaceutics and Pharmacy Practice Unit, Department of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - David Gitonga Nyamu
- Pharmaceutics and Pharmacy Practice Unit, Department of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Peter Mbugua Njogu
- Pharmaceutics and Pharmacy Practice Unit, Department of Pharmacy, University of Nairobi, Nairobi, Kenya
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7
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Khan MAS, Hasan MJ, Rashid MU, Kha Sagar S, Khan S, Zaman S, Sumon SM, Basher A, Hawlader MDH, Nabi MH, Kakoly NS. Factors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh. PLoS Negl Trop Dis 2022; 16:e0010235. [PMID: 35231035 PMCID: PMC8887756 DOI: 10.1371/journal.pntd.0010235] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/05/2022] [Indexed: 01/22/2023] Open
Abstract
Background
Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh.
Methods
This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26).
Results
A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07–15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05–10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications.
Conclusion
Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.
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Affiliation(s)
- Md. Abdullah Saeed Khan
- Infectious Disease Hospital, Dhaka, Bangladesh
- Pi Research Consultancy Center, Dhaka, Bangladesh
- * E-mail:
| | | | - Md. Utba Rashid
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Soumik Kha Sagar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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8
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Pandya N, Cag Y, Pandak N, Pekok AU, Poojary A, Ayoade F, Fasciana T, Giammanco A, Caskurlu H, Rajani DP, Gupta YK, Balkan II, Khan EA, Erdem H. International Multicentre Study of Candida auris Infections. J Fungi (Basel) 2021; 7:jof7100878. [PMID: 34682299 PMCID: PMC8539607 DOI: 10.3390/jof7100878] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background:Candida auris has emerged globally as a multi-drug resistant yeast and is commonly associated with nosocomial outbreaks in ICUs. Methods: We conducted a retrospective observational multicentre study to determine the epidemiology of C. auris infections, its management strategies, patient outcomes, and infection prevention and control practices across 10 centres from five countries. Results: Significant risk factors for C. auris infection include the age group of 61–70 years (39%), recent history of ICU admission (63%), diabetes (63%), renal failure (52%), presence of CVC (91%) and previous history of antibiotic treatment (96%). C. auris was commonly isolated from blood (76%). Echinocandins were the most sensitive drugs. Most common antifungals used for treatment were caspofungin (40%), anidulafungin (28%) and micafungin (15%). The median duration of treatment was 20 days. Source removal was conductedin 74% patients. All-cause crude mortality rate after 30 days was 37%. Antifungal therapy was associated with a reduction in mortality (OR:0.27) and so was source removal (OR:0.74). Contact isolation precautions were followed in 87% patients. Conclusions:C. auris infection carries a high risk for associated mortality. The organism is mainly resistant to most azoles and even amphotericin-B. Targeted antifungal therapy, mainly an echinocandin, and source control are the prominent therapeutic approaches.
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Affiliation(s)
- Nirav Pandya
- Consultant Microbiologist & Infection Preventionist, Bhailal Amin General Hospital, Vadodara 390003, India;
| | - Yasemin Cag
- Department of Infectious Diseases & Clinical Microbiology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul 34734, Turkey; (Y.C.); (H.C.)
| | | | | | | | - Folusakin Ayoade
- Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL 33136, USA;
| | - Teresa Fasciana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90133 Palermo, Italy; (T.F.); (A.G.)
| | - Anna Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90133 Palermo, Italy; (T.F.); (A.G.)
| | - Hulya Caskurlu
- Department of Infectious Diseases & Clinical Microbiology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul 34734, Turkey; (Y.C.); (H.C.)
| | | | | | - Ilker Inanc Balkan
- Cerrahpaşa Medical School, Istanbul University, Cerrahpaşa 34096, Turkey;
| | - Ejaz Ahmed Khan
- Shifa International Hospital, Shifa Tameer e Millat University, Islamabad 44000, Pakistan;
| | - Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen 24343, Bahrain
- Correspondence:
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9
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El-Sokkary R, Uysal S, Erdem H, Kullar R, Pekok AU, Amer F, Grgić S, Carevic B, El-Kholy A, Liskova A, Özdemir M, Khan EA, Uygun-Kizmaz Y, Pandak N, Pandya N, Arapović J, Karaali R, Oztoprak N, Petrov MM, Alabadla R, Alay H, Kholy JAE, Landelle C, Khedr R, Mamtora D, Dragovac G, Fernandez R, Evren EU, Raka L, Cascio A, Dauby N, Oncul A, Balin SO, Cag Y, Dirani N, Dogan M, Dumitru IM, Gad MA, Darazam IA, Naghili B, Del Vecchio RF, Licker M, Marino A, Akhtar N, Kamal M, Angioni G, Medić D, Esmaoğlu A, Gergely SB, Silva-Pinto A, Santos L, Miftode IL, Tekin R, Wongsurakiat P, Khan MA, Kurekci Y, Pilli HP, Grozdanovski K, Miftode E, Baljic R, Vahabolgu H, Rello J. Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey. Eur J Clin Microbiol Infect Dis 2021; 40:2323-2334. [PMID: 34155547 DOI: 10.1007/s10096-021-04288-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.
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Affiliation(s)
- Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Serhat Uysal
- Department of Infectious Diseases and Clinical Microbiology, Kanuni Research and Training Hospital, Trabzon, Turkey
| | | | | | | | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Svjetlana Grgić
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Mehmet Özdemir
- Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ejaz Ahmed Khan
- Shifa International Hospital, Islamabad, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Yesim Uygun-Kizmaz
- Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | | | | | - Jurica Arapović
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.,School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Rıdvan Karaali
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nefise Oztoprak
- Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Michael M Petrov
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv & "St. George" University Hospital, Plovdiv, Bulgaria
| | | | - Handan Alay
- School of Medicine, Ataturk University, Erzurum, Turkey
| | - Jehan Ali El Kholy
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University / Children Cancer Hospital Egypt, Cairo, 57357, Egypt
| | | | - Gorana Dragovac
- Institute of Public Health of Vojvodina, Novi Sad, Serbia & University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | | | - Emine Unal Evren
- Dr. Suat Gunsel Hospital, University of Kyrenia, Kyrenia, Cyprus
| | - Lul Raka
- National Institute of Public Health of Kosova & University "Hasan Prishtina", Prishtina, Kosova
| | - Antonio Cascio
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone" - Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties - University of Palermo, 90127 , Palermo, Italy
| | - Nicolas Dauby
- Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | - Ahsen Oncul
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | | | - Yasemin Cag
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Mustafa Dogan
- Namık Kemal University School of Medicine, Tekirdag, Turkey
| | - Irina Magdalena Dumitru
- Clinical Infectious Diseases Hospital Constanta, Ovidius University of Constanta, Constanța, Romania
| | - Maha Ali Gad
- Faculty of Medicine (Kasr Al-Ainy), Cairo University, Cairo, Egypt
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrouz Naghili
- Imam Reza Hospital of Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Monica Licker
- Multidisciplinary Research Center on Antimicrobial Resistance, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Marino
- ARNAS Garibaldi, Unit of Infectious diseases, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | | | - Deana Medić
- Institute for Public Health of Vojvodina and University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Aliye Esmaoğlu
- Erciyes University Medical Faculty Hospital, Kayseri, Turkey
| | - Szabo Balint Gergely
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - André Silva-Pinto
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Recep Tekin
- School of Medicine, Dicle University, Diyarbakir, Turkey
| | | | | | | | - Hema Prakash Pilli
- GITAM Institute of Medical Sciences and Research, Department of Microbiology, Rushikonda, Visakhapatnam, India
| | | | - Egidia Miftode
- St. Parascheva" Clinical Hospital of Infectious Diseases, Iasi, Romania
| | | | - Haluk Vahabolgu
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Jordi Rello
- Clinical Research CHRU (Nimes, France) and Vall d'Hebron Institute of Research, Barcelona, Spain
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10
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Erdem H, Hargreaves S, Ankarali H, Caskurlu H, Ceviker SA, Bahar-Kacmaz A, Meric-Koc M, Altindis M, Yildiz-Kirazaldi Y, Kizilates F, Alsalman J, Cag Y, Kamal AHM, Dokmetas I, Dindar-Demiray EK, Shehata GA, Hasman H, Sadykova A, Llopis F, Ramosaco E, Logar M, Alay H, Kesmez-Can F, Ruch Y, Bulut D, Makek MJ, Marino A, Mahboob A, El-Kholy A, Abdallah D, Sefa-Sayar M, Karaali R, Aslan S, Dar RE, Abdalla E, Monzón-Camps H, Baljić R, Mgdalena DI, Naghili B, Abbas Dafalla ME, Alwashmi ASS, Carmen CR, Ramirez-Estrada S, Wojewodzka-Zelezniakowicz M, Akyildiz O, Zajkowska J, El-Sokkary R, Pandya N, Amer F, Alavi-Darazam I, Grgić S, Wegdan AA, El-Kholy J, Bulut-Avsar C, Kulzhanova S, Tasbakan M, Kumari HP, Dirani N, Koganti K, Konkayev AK, Petrov MM, Cascio A, Liskova A, Del Vecchio RF, Lambertenghi L, Mladenov N, Oncu S, Rello J. Managing adult patients with infectious diseases in emergency departments: international ID-IRI study. J Chemother 2021; 33:302-318. [PMID: 33734040 DOI: 10.1080/1120009x.2020.1863696] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.
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Affiliation(s)
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sevil Alkan Ceviker
- Department of Infectious Diseases and Clinical Microbiology, Kutahya Evliya Celebi Research and Education Hospital, Kutahya, Turkey
| | - Asiye Bahar-Kacmaz
- Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Mustafa Altindis
- Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | | | - Filiz Kizilates
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | | | - Yasemin Cag
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | | | | | - Hakan Hasman
- Emergency Department, Ankara Medicalpark Hospital, Ankara, Turkey
| | - Ainur Sadykova
- Department of Infectious and Tropical Diseases, City Clinical Infectious Hospital, Kazakh National Medical University, Almaty, Kazakhstan
| | - Ferran Llopis
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ergys Ramosaco
- Infectious Diseases Clinic, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Mateja Logar
- Department of Infectious Diseases, UMC Ljubljana, Ljubljana, Slovenia
| | - Handan Alay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Fatma Kesmez-Can
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Dilek Bulut
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | | | - Andrea Marino
- Department of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Amjad Mahboob
- Bacha Khan Medical Complex Swabi, Khyber Pakhtunkhwa, Pakistan
| | | | - Dirar Abdallah
- Department of Intensive Care, Prime Hospital, Dubai, United Arab Emirates
| | - Merve Sefa-Sayar
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | - Ridvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, İstanbul Üniversitesi, Istanbul, Turkey
| | - Selda Aslan
- Department of Infectious Diseases and Clinical Microbiology, Cengiz Gokcek Maternity and Children's Hospital, Gaziantep, Turkey
| | - Razi Even Dar
- Department of Internal Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Esam Abdalla
- Department of Anesthesia & ICU, Assiut University Hospital, Assiut, Egypt
| | - Helena Monzón-Camps
- Emergency Department and Infectious Diseases, Hospital Universitary Mútua Terrassa, Terrassa, Spain
| | - Rusmir Baljić
- Clinic for Infectious Diseases, Sarajevo, Bosnia and Herzegovina
| | - Dumitru Irina Mgdalena
- Clinical Infectious Diseases Hospital, Ovidius University of Constanta, Constanta, Romania
| | - Behrouz Naghili
- Department of Infectious Diseases, Imam Reza Hospital, Tabriz, Iran
| | | | - Ameen S S Alwashmi
- Medical Laboratories Department, College of Applied Medical Sciences, Qassim University, Saudi Arabia
| | - Cernat Roxana Carmen
- Clinical Hospital for Infectious Diseases, Ovidius University Constanta, Constanta, Romania
| | | | | | - Ozay Akyildiz
- Department of Infectious Diseases and Clinical Microbiology, Adana Acibadem Hospital, Adana, Turkey
| | | | - Rehab El-Sokkary
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ilad Alavi-Darazam
- Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Svjetlana Grgić
- Clinic for Infectious Disease, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | | | - Cansu Bulut-Avsar
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkey
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkey
| | | | | | | | - Aidos K Konkayev
- Institution of Trauma and Orthopaedics, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Michael M Petrov
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University, Plovdiv, Bulgaria
| | - Antonio Cascio
- Infectious and Tropical Diseases Section, Department PROMISE, University of Palermo, Palermo, Italy
| | | | | | | | | | - Serkan Oncu
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Jordi Rello
- Critical Care Department, Hospital Vall d'Hebron, Barcelona, Spain.,CIBERES, Madrid, Spain.,Universitat Autonma de Barcelona, Barcelona, Spain
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11
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Hasani A, Soltani E, Ahangarzadeh Rezaee M, Pirzadeh T, Ahangar Oskouee M, Hasani A, Gholizadeh P, Noie Oskouie A, Binesh E. Serotyping of Klebsiella pneumoniae and Its Relation with Capsule-Associated Virulence Genes, Antimicrobial Resistance Pattern, and Clinical Infections: A Descriptive Study in Medical Practice. Infect Drug Resist 2020; 13:1971-1980. [PMID: 32606843 PMCID: PMC7321687 DOI: 10.2147/idr.s243984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 06/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Klebsiella pneumoniae, one of the clinical superbugs, causes diverse infections because of its variable capsular antigens. This study focused on K. pneumoniae and aimed to assess any correlation between capsular serotype, capsule-associated virulence genes, and evaluate its resistance to conventional antibiotics in order to gain insight into any regional differences. Materials and Methods A total of 61 K. pneumoniae collected from various clinical specimens were confirmed genotypically. Clinical and demographic data for all patients were reviewed. All isolates were subjected to antimicrobial susceptibility tests. Capsular serotyping and capsule-associated virulence genes were studied using the molecular method. Results All typeable isolates were typed into K5, K20, and K54 serotypes, and among them, K54 was observed to be predominant. The most common capsule-associated virulence genes comprised uge (93.4%), ycfM (91.8%), and wabG (88.5%), while wcaG (29.5%) and rmpA (21.3%) were noted at much lower prevalence rates. The gene wcaG was significantly associated with K54 positive isolates (p = 0.001), while rmpA was associated with K20 positive isolates (p = 0.01). Conclusion Serotype K54 had a high frequency in isolates collected from patients with pulmonary diseases, while serotype K20 was associated with burn patients. Carbapenems and levofloxacin were the best therapeutic options for the treatment of infections with serotypes K20 and K54.
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Affiliation(s)
- Alka Hasani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences, Tabriz, Iran.,Sina Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elghar Soltani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences, Tabriz, Iran
| | - Mohammad Ahangarzadeh Rezaee
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences, Tabriz, Iran
| | - Tahereh Pirzadeh
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences, Tabriz, Iran
| | - Mahin Ahangar Oskouee
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences, Tabriz, Iran
| | - Akbar Hasani
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pourya Gholizadeh
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences, Tabriz, Iran
| | - Arezoo Noie Oskouie
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences, Tabriz, Iran
| | - Ehsan Binesh
- Department of Infectious Disease, School of Medicine, Shahroud University of Medical Science, Shahroud, Iran
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12
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Ranaei MA, Shahraki-Zahedan S, Mohagheghi-Fard AH, Salimizand H, Ordoni R, Amini Y. Prevalence of the blaCTX-M and antibiotic resistance pattern among clinical isolates of Acinetobacter baumannii isolated from Zahedan, Southeast Iran. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model. Eur J Clin Microbiol Infect Dis 2019; 39:689-701. [PMID: 31823148 DOI: 10.1007/s10096-019-03781-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/27/2019] [Indexed: 02/08/2023]
Abstract
We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.
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14
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Treatment of ventilator-associated pneumonia (VAP) caused by Acinetobacter: results of prospective and multicenter ID-IRI study. Eur J Clin Microbiol Infect Dis 2019; 39:45-52. [PMID: 31502120 PMCID: PMC7222138 DOI: 10.1007/s10096-019-03691-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
Abstract
Ventilator-associated pneumonia (VAP) due to Acinetobacter spp. is one of the most common infections in the intensive care unit. Hence, we performed this prospective-observational multicenter study, and described the course and outcome of the disease. This study was performed in 24 centers between January 06, 2014, and December 02, 2016. The patients were evaluated at time of pneumonia diagnosis, when culture results were available, and at 72 h, at the 7th day, and finally at the 28th day of follow-up. Patients with coexistent infections were excluded and only those with a first VAP episode were enrolled. Logistic regression analysis was performed. A total of 177 patients were included; empiric antimicrobial therapy was appropriate (when the patient received at least one antibiotic that the infecting strain was ultimately shown to be susceptible) in only 69 (39%) patients. During the 28-day period, antibiotics were modified for side effects in 27 (15.2%) patients and renal dose adjustment was made in 38 (21.5%). Ultimately, 89 (50.3%) patients died. Predictors of mortality were creatinine level (OR, 1.84 (95% CI 1.279-2.657); p = 0.001), fever (OR, 0.663 (95% CI 0.454-0.967); p = 0.033), malignancy (OR, 7.095 (95% CI 2.142-23.500); p = 0.001), congestive heart failure (OR, 2.341 (95% CI 1.046-5.239); p = 0.038), appropriate empiric antimicrobial treatment (OR, 0.445 (95% CI 0.216-0.914); p = 0.027), and surgery in the last month (OR, 0.137 (95% CI 0.037-0.499); p = 0.003). Appropriate empiric antimicrobial treatment in VAP due to Acinetobacter spp. was associated with survival while renal injury and comorbid conditions increased mortality. Hence, early diagnosis and appropriate antibiotic therapy remain crucial to improve outcomes.
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15
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Seifi A, Dehghan-Nayeri N, Rostamnia L, Varaei S, Akbari Sari A, Haghani H, Ghanbari V. Health care-associated infection surveillance system in Iran: Reporting and accuracy. Am J Infect Control 2019; 47:951-955. [PMID: 30738720 DOI: 10.1016/j.ajic.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Valid data are a crucial aspect of infection prevention and control programs. The aim of this study was to examine the accuracy of routine reporting in the Iranian Nosocomial Infection Surveillance System in intensive care units. METHODS A blinded retrospective review of general intensive care unit medical records was performed with a standard case-finding form. Infection control nurses (ICNs) were also interviewed to explore possible reasons for differences. RESULTS The results of 951 events in 856 medical records were assessed. Sensitivity, specificity, and positive and negative predictive values of routine surveillance were 27.5%, 97.2%, 69%, and 85.3%, respectively. The results indicate 82.2%, 68.4%, 62.7%, and 57.3% under-reporting of surgical site infections, urinary tract infections, bloodstream infections, and pneumonia, respectively. Over-reporting of approximately 8%-15% was detected in 4 types of health care-associated infections (HAIs). Misinterpretation of HAI definition, high ICN workload, and inactivity of infection control link nurses were the main causes of inaccurate reporting. CONCLUSIONS Under and over-reporting of HAIs are main challenges of HAIs reporting in Iran. Developing guidelines, empowering ICNs through specialized training and activating infection control link nurses are necessary to achieve more accurate data in the Iranian Nosocomial Infection Surveillance System.
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16
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Saleem Z, Godman B, Hassali MA, Hashmi FK, Azhar F, Rehman IU. Point prevalence surveys of health-care-associated infections: a systematic review. Pathog Glob Health 2019; 113:191-205. [PMID: 31215326 PMCID: PMC6758614 DOI: 10.1080/20477724.2019.1632070] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Health-care-associated infections (HAIs) are considered a serious public health issues that contribute substantially to the global burden of mortality and morbidity with respect to infectious diseases. The aim is to assess the burden of health-care-associated infections by collation of available data from published point prevalence surveys (PPS) on HAIs to give future guidance. Study protocol and methodology were designed according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Published research papers that conducted a point prevalence survey of HAIs in hospital settings by following the structured survey methodology employed by European Centre of Disease Prevention and Control (ECDC) were included. Of 1212 articles, 67 studies were included in the final analysis conducted across different countries. Overall, 35 studies were conducted in Europe, 21 in Asia, 9 in America, and 2 in Africa. The highest prevalence of HAIs was recorded in a study conducted in adult ICU settings of 75 regions of Europe (51.3%). The majority of the studies included HAI data on urinary tract infections, respiratory tract infections, and bloodstream infections. Klebsiella pneumonia, Pseudomonas aeruginosa and E. coli were the most frequent pathogens responsible for HAIs. PPS is an useful tool to quantify HAIs and provides a robust baseline data for policymakers. However, a standardize surveillance method is required. In order to minimize the burden of HAIs, infection prevention and control programs and antibiotic stewardship may be effective strategies to minimize the risk of HAIs.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
- Rashid Latif College of Pharmacy, Lahore, Pakistan
| | - Brian Godman
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | | | - Faiza Azhar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Inayat Ur Rehman
- School of Pharmacy, Monash University Malaysia, Kuala Selangor, Malaysia
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, Pakistan
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17
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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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18
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Vazin A, Mahi Birjand M, Darake M. Evaluation of vancomycin therapy in the adult ICUs of a teaching hospital in southern Iran. Drug Healthc Patient Saf 2018; 10:21-26. [PMID: 29670404 PMCID: PMC5896641 DOI: 10.2147/dhps.s149451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Vancomycin resistance in intensive care units (ICUs) accounts for significant morbidity and excess costs. The objective of the present study was to determine the appropriateness of vancomycin use in the various ICUs of Nemazee Hospital, Shiraz, Iran. METHODS This prospective study was performed on 95 critically ill patients (48 males and 47 females) who were treated with vancomycin for at least 3 subsequent doses in 6 ICUs during 12 months. Required demographic, clinical, and paraclinical data were collected by a pharmacist. Fifteen indexes were considered for evaluation of vancomycin use. RESULTS Ventilator-associated hospital-acquired pneumonia (22.6%), sepsis (22.1%) and CNS infection (12.6%) were found to be the most important indications for vancomycin prescription. Vancomycin was prescribed empirically in 81% of patients. None of the patients received loading dose, and most of the patients received fixed dose. The rate of prolonged empiric antibiotic therapy was 68.5% in patients who received vancomycin. The mean score of vancomycin use in the ICUs of Nemazee Hospital was 7.1±0.6 out of 15, implying that the rate of vancomycin use was in accordance with the guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital based on Infectious Diseases Society of America by 47.3%. CONCLUSION Based on our results, the weakness in using vancomycin was related to not administering loading dose, the practice of prescribing fixed-dose vancomycin and prolonged duration of empiric therapy. Efforts to improve the pattern of vancomycin prescription and utilization in these ICUs should be undertaken.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Motahare Mahi Birjand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Darake
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Guducuoglu H, Gursoy NC, Yakupogullari Y, Parlak M, Karasin G, Sunnetcioglu M, Otlu B. Hospital Outbreak of a Colistin-Resistant, NDM-1- and OXA-48-Producing Klebsiella pneumoniae: High Mortality from Pandrug Resistance. Microb Drug Resist 2017; 24:966-972. [PMID: 29265963 DOI: 10.1089/mdr.2017.0173] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Colistin resistance causes substantial problems in the treatment of serious infections with carbapenem-resistant (CR) gram-negative bacteria. In this study, we report a fatal hospital outbreak from the spread of a pandrug-resistant Klebsiella pneumoniae clone. An outbreak investigation was conducted after consecutive isolation of nine CR-K. pneumoniae (CR-Kp) strains from eight patients in two intensive care units of a university hospital within 2 weeks. Carbapenem and colistin resistance genes were investigated with PCR, clonal relationships of isolates were studied with pulse-field gel electrophoresis, and multilocus sequence types were determined. The outcomes of the affected patients were analyzed. Genotyping showed a predominant CR-Kp clone consisting of seven strains from six patients. These strains were in ST11 type, an international high-risk clone. They were resistant to all antimicrobials, including colistin, and positive for NDM-1 and OXA-48 carbapenemases, but negative for plasmid-borne colistin resistance genes. One patient had colonization and the remaining five died due to the infection within mean 12 days. No environmental or staff links could be established, and the outbreak was stopped by augmenting infection-control measures. Colistin-resistant K. pneumoniae could clonally expand in the hospital setting, and this spread might be associated with high mortality due to the lack of an appropriate treatment option. Immediate implementation of infection-control measures may be the best way to limit fatal consequences of the spread of such incurable pathogens.
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Affiliation(s)
- Huseyin Guducuoglu
- 1 Department of Medical Microbiology, Faculty of Medicine, Yuzuncu Yıl University , Van, Turkey
| | - Nafia Canan Gursoy
- 2 Department of Medical Microbiology, Faculty of Medicine, Inonu University , Malatya, Turkey
| | - Yusuf Yakupogullari
- 2 Department of Medical Microbiology, Faculty of Medicine, Inonu University , Malatya, Turkey
| | - Mehmet Parlak
- 1 Department of Medical Microbiology, Faculty of Medicine, Yuzuncu Yıl University , Van, Turkey
| | - Gokhan Karasin
- 1 Department of Medical Microbiology, Faculty of Medicine, Yuzuncu Yıl University , Van, Turkey
| | - Mahmut Sunnetcioglu
- 3 Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yuzuncu Yil University , Van, Turkey
| | - Baris Otlu
- 2 Department of Medical Microbiology, Faculty of Medicine, Inonu University , Malatya, Turkey
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Tissera K, Liyanapathirana V, Dissanayake N, Pinto V, Ekanayake A, Tennakoon M, Adasooriya D, Nanayakkara D. Spread of resistant gram negatives in a Sri Lankan intensive care unit. BMC Infect Dis 2017; 17:490. [PMID: 28697755 PMCID: PMC5506608 DOI: 10.1186/s12879-017-2590-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Infections with multi drug resistant (MDR) organisms are a major problem in intensive care units (ICUs). Proper infection control procedures are mandatory to combat the spread of resistant organisms within ICUs. Well stablished surveillance programmes will enhance the adherence of the staff to infection control protocols. The study was conducted to assess the feasibility of using basic molecular typing methods and routine hospital data for laboratory surveillance of resistance organisms in resource limited settings. Methods A retrospective study was conducted using consecutive Gram negative isolates obtained from an ICU over a six month period. Antibiotic sensitivity patterns and random amplified polymorphic DNA (RAPD) based typing was performed on the given isolates. Results Of the seventy isolates included in the study, seven were E.coli. All E.coli were MDRs and Extended Spectrum β lactamse (ESBL) producers carrying blaCTX-M. Fourteen isolates were K.pneumoniae, and all were MDRs and ESBL producers. All K.pneumoniae harboured blaSHV while 13 harboured blaCTX-M. The MDR rate among P.aeruginosa was 13% (n=15) while all acinetobacters (n=30) were MDRs. Predominant clusters were identified within all four types of Gram negatives using RAPD and the ICU stay of patients overlapped temporally. Conclusion We propose that simple surveillance methods like RAPD based typing and basic hospital data can be used to convince hospital staff to adhere to infection control protocols more effectively, in low and middle income countries.
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Affiliation(s)
- Kavinda Tissera
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Veranja Liyanapathirana
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Nilanthi Dissanayake
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Vasanthi Pinto
- Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Asela Ekanayake
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Manjula Tennakoon
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Dinuka Adasooriya
- Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Dulmini Nanayakkara
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka
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21
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Community acquired infections among refugees leading to Intensive Care Unit admissions in Turkey. Int J Infect Dis 2017; 58:111-114. [PMID: 28419820 DOI: 10.1016/j.ijid.2017.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/16/2017] [Accepted: 02/23/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Data on the impact of refugees on Intensive Care Units (ICUs) are lacking in the literature, in particular for community-acquired (CA) infectious diseases, for which they are known to be at higher risk. We did a descriptive, multicenter study to analyze CA infections among refugee patients requiring ICU admission. METHODS Inclusion criteria were adult refugee patients admitted to an ICU due to CA infections. Anonymized data were collected between January 1, 2010 and December 30, 2015 across 10 referral centers. RESULTS 29.885 patients were admitted to the ICUs in the study period. 37 patients were included the study, the majority were from Syria (n=31, 83.8%). Mean (SD) age of the patients was 45.92±20.16years. The 5-year prevalence rate was 123.8 per 100.000 patients in the ICUs. All patients had at least one comorbid condition. Forty-nine CA infections were diagnosed. The most common CA infection was pneumonia (49%) followed by urinary-tract infections (16.3%). 21 patients (56.7%) hospitalized in the ICU had trauma history. Mortality rate was high at 22 patients (59.5%) with 5 (22.7%) deaths directly attributed to CA infections. CONCLUSIONS Refugees presented to ICUs with CA infections similar to the host populations (pneumonia and urinary-tract infections) but had high mortality rates (59.5%). It seems that Turkish ICUs were not congested with the refugee patients' influx for CA infections. More research needs to be done to better understand how to deliver preventative and timely health care services to this group of patients.
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Tosun S, Batirel A, Oluk AI, Aksoy F, Puca E, Bénézit F, Ural S, Nayman-Alpat S, Yamazhan T, Koksaldi-Motor V, Tekin R, Parlak E, Tattevin P, Kart-Yasar K, Guner R, Bastug A, Meric-Koc M, Oncu S, Sagmak-Tartar A, Denk A, Pehlivanoglu F, Sengoz G, Sørensen SM, Celebi G, Baštáková L, Gedik H, Dirgen-Caylak S, Esmaoglu A, Erol S, Cag Y, Karagoz E, Inan A, Erdem H. Tetanus in adults: results of the multicenter ID-IRI study. Eur J Clin Microbiol Infect Dis 2017; 36:1455-1462. [PMID: 28353183 DOI: 10.1007/s10096-017-2954-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital's Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.
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Affiliation(s)
- S Tosun
- Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - A Batirel
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - A I Oluk
- Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - F Aksoy
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - E Puca
- Department of Infectious Diseases, University Hospital Center "Mother Teresa", Tirana, Albania
| | - F Bénézit
- Infectious Diseases and Intensive Care Unit, University Hospital of Pontchaillou, Rennes, France
| | - S Ural
- Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University, Izmir, Turkey
| | - S Nayman-Alpat
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - T Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - V Koksaldi-Motor
- Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University, Hatay, Turkey
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - E Parlak
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, University Hospital of Pontchaillou, Rennes, France
| | - K Kart-Yasar
- Department of Infectious Diseases and Clinical Microbiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - R Guner
- Ataturk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara, Turkey
| | - A Bastug
- Department of Infectious Diseases and Clinical Microbiology, Numune Training and Research Hospital, Ankara, Turkey
| | - M Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Izmit, Turkey
| | - S Oncu
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - A Sagmak-Tartar
- Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey
| | - A Denk
- Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey
| | - F Pehlivanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - G Sengoz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - S M Sørensen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - G Celebi
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bulent Ecevit University, Zonguldak, Turkey
| | - L Baštáková
- Faculty Hospital Brno, Department of Infectious Diseases and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - H Gedik
- Department of Infectious Diseases and Clinical Microbiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - S Dirgen-Caylak
- Department of Infectious Diseases and Clinical Microbiology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - A Esmaoglu
- Faculty of Medicine, Department of Anesthesiology Intensive Care Unit, Erciyes University, Kayseri, Turkey
| | - S Erol
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Y Cag
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - E Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - H Erdem
- Principal Coordinator of ID-IRI, Ankara, Turkey.
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Iwuafor AA, Ogunsola FT, Oladele RO, Oduyebo OO, Desalu I, Egwuatu CC, Nnachi AU, Akujobi CN, Ita IO, Ogban GI. Incidence, Clinical Outcome and Risk Factors of Intensive Care Unit Infections in the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. PLoS One 2016; 11:e0165242. [PMID: 27776162 PMCID: PMC5077115 DOI: 10.1371/journal.pone.0165242] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background Infections are common complications in critically ill patients with associated significant morbidity and mortality. Aim This study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital. Materials and Methods This was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died. Antimicrobial susceptibility testing of isolates was done using CLSI guidelines. Results Seventy-one patients were recruited with a 45% healthcare associated infection rate representing an incidence rate of 79/1000 patient-days in the intensive care unit. Bloodstream infections (BSI) 49.0% (22/71) and urinary tract infections (UTI) 35.6% (16/71) were the most common infections with incidence rates of 162.9/1000 patient-days and 161.6/1000 patient-days respectively. Staphylococcus aureus was the most common cause of BSIs, responsible for 18.2% of cases, while Candida spp. was the commonest cause of urinary tract infections, contributing 25.0% of cases. Eighty percent (8/10) of the Staphylococcus isolates were methicillin-resistant. Gram-negative multidrug bacteria accounted for 57.1% of organisms isolated though they were not ESBL-producing. Use of antibiotics (OR = 2.98; p = 0.03) and surgery (OR = 3.15, p< 0.05) in the month preceding ICU admission as well as urethral catheterization (OR = 5.38; p<0.05) and endotracheal intubation (OR = 5.78; p< 0.05) were risk factors for infection. Conclusion Our findings demonstrate that healthcare associated infections is a significant risk factor for ICU-mortality and morbidity even after adjusting for APACHE II score.
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Affiliation(s)
- Anthony A. Iwuafor
- Department of Medical Microbiology and Parasitology, College of Medical Sciences, University of Calabar, Calabar, Nigeria
- * E-mail:
| | - Folasade T. Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
| | - Rita O. Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
| | - Oyin O. Oduyebo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Nigeria
| | - Ibironke Desalu
- Department of Anaesthesia, College of Medicine, University of Lagos, Nigeria
| | - Chukwudi C. Egwuatu
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
| | - Agwu U. Nnachi
- Department of Immunology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
| | - Comfort N. Akujobi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
| | - Ita O. Ita
- Department of Medical Microbiology and Parasitology, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Godwin I. Ogban
- Department of Medical Microbiology and Parasitology, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Abstract
Septic shock is still a lethal disease in intensive care units (ICU). The mortality can exceed 40% even with therapeutic management. The high mortality is clearly associated with the delay of appropriate antimicrobial therapy. Early diagnosis and identification of infectious source is the mainstay of optimal therapeutic management. On the other hand, source control and optimize antibiotic dosing according to pharmacokinetics (PK)/pharmacodynamics (PD) properties of antibiotics and organ dysfunction of patients are required to get the best clinical outcome.
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Affiliation(s)
- Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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25
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Granzer H, Hagen RM, Warnke P, Bock W, Baumann T, Schwarz NG, Podbielski A, Frickmann H, Koeller T. Molecular Epidemiology of Carbapenem-Resistant Acinetobacter Baumannii Complex Isolates from Patients that were Injured During the Eastern Ukrainian Conflict. Eur J Microbiol Immunol (Bp) 2016; 6:109-17. [PMID: 27429793 PMCID: PMC4936333 DOI: 10.1556/1886.2016.00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 12/30/2022] Open
Abstract
This study addressed carbapenem-resistant Acinetobacter baumannii complex (ABC) isolates from patients that were injured during the military conflict in the Eastern Ukraine and treated at German Armed Forces Hospitals in 2014 and 2015. Clonal diversity of the strains and potential ways of transmission were analyzed. Patients with one or several isolation events of carbapenem-resistant ABC were included. Isolates were characterized by VITEK II-based identification and resistance testing, molecular screening for frequent carbapenemase genes, and DiversiLab rep-PCR-based typing. Available clinical information of the patients was assessed. From 21 young male Ukrainian patients with battle injuries, 32 carbapenem- and fluoroquinolone-resistant ABC strains were isolated. Four major clonal clusters were detected. From four patients (19%), ABC isolates from more than one clonal cluster were isolated. The composition of the clusters suggested transmission events prior to the admission to the German hospitals. The infection and colonization pressure in the conflict regions of the Eastern Ukraine with ABC of low clonal diversity is considerable. Respective infection risks have to be considered in case of battle-related injuries in these regions. The low number of local clones makes any molecular exclusion of transmission events difficult.
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Affiliation(s)
- Heike Granzer
- Laboratory Department I, Central Institute of the German Armed Forces in Koblenz , Germany
| | - Ralf Matthias Hagen
- North Atlantic Treaty Organization Center of Excellence in Military Medicine (NATO MilMedCOE) , Munich, Germany
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock , Germany
| | - Wolfgang Bock
- Laboratory Department I, Central Institute of the German Armed Forces in Munich , Germany
| | - Tobias Baumann
- Laboratory Department I, Central Institute of the German Armed Forces in Kiel (branch office in Berlin) , Germany
| | - Norbert Georg Schwarz
- Infectious Disease Epidemiology Group, Bernhard Nocht Institute of Tropical Medicine Hamburg , Germany
| | - Andreas Podbielski
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock , Germany
| | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Germany
| | - Thomas Koeller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock , Germany
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Hadifar S, Moghoofei M, Nematollahi S, Ramazanzadeh R, Sedighi M, Salehi-Abargouei A, Miri A. Epidemiology of Multidrug Resistant Uropathogenic Escherichia coli in Iran: a Systematic Review and Meta-Analysis. Jpn J Infect Dis 2016; 70:19-25. [PMID: 27000462 DOI: 10.7883/yoken.jjid.2015.652] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Urinary tract infection (UTI) is one of the most common infections in humans. It is primarily caused by uropathogenic Escherichia coli (UPEC), which has a high multidrug resistance (MDR). In consideration of the prevalence of MDR-UPEC strains, the aims of the present study were to systematically review the published data about the prevalence rate of MDR-UPEC from different parts of Iran and to establish the overall relative frequency (RF) of these strains in Iran. We searched several databases including PubMed, ISI Web of Science, Scopus, Google Scholar, IranMedex, and Iranian Scientific Information Database by using the following keywords: "Escherichia coli", "multidrug resistant", "MDR", "urinary tract infections", "UTI", "uropathogenic". and "Iran". Articles or abstracts that reported the prevalence of MDR-UPEC were included in this review. We found 15 articles suitable for inclusion in this study. A pooled estimation of 10,247 UPEC strains showed that 49.4% (95% confidence interval = 48.0-50.7%) of the stranis were MDR positive. The RF of MDR-UPEC in different studies varied from 10.5% to 79.2% in the Kashan and Hamedan provinces, respectively. According to the results of the present study, the RF of MDR-UPEC in Iran is high. Thus, measures should be taken to keep the emergence and transmission of these strains to a minimum.
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Affiliation(s)
- Shima Hadifar
- Department of Microbiology, Pasteur Institute of Tehran
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27
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Erdem H, Ak O, Elaldi N, Demirdal T, Hargreaves S, Nemli SA, Cag Y, Ulug M, Naz H, Gunal O, Sirmatel F, Sipahi OR, Alpat SN, Ertem-Tuncer G, Sozen H, Evlice O, Meric-Koc M, Dogru A, Koksaldi-Motor V, Tekin R, Ozdemir D, Ozturk-Engin D, Savasci U, Karagoz E, Cekli Y, Inan A. Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study. Eur J Clin Microbiol Infect Dis 2016; 35:903-10. [PMID: 26964538 PMCID: PMC7087946 DOI: 10.1007/s10096-016-2614-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
Mass gatherings pooling people from different parts of the world—the largest of which is to Mecca, Saudi Arabia, for Hajj—may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were ≥ 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3–7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
| | - O Ak
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - N Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - T Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, Commonwealth Building, Hammersmith Campus, London, UK
| | - S A Nemli
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Y Cag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - M Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey
| | - H Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - O Gunal
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - F Sirmatel
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Bolu, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - S N Alpat
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - G Ertem-Tuncer
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - H Sozen
- Department of Infectious Diseases and Clinical Microbiology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - O Evlice
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - M Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Izmit, Turkey
| | - A Dogru
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - V Koksaldi-Motor
- Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University, Hatay, Turkey
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - D Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Duzce University School of Medicine, Konuralp, Duzce, Turkey
| | - D Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - U Savasci
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - E Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Military Hospital, Van, Turkey
| | - Y Cekli
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Roberts JA, Choi GYS, Joynt GM, Paul SK, Deans R, Peake S, Cole L, Stephens D, Bellomo R, Turnidge J, Wallis SC, Roberts MS, Roberts DM, Lassig-Smith M, Starr T, Lipman J. SaMpling Antibiotics in Renal Replacement Therapy (SMARRT): an observational pharmacokinetic study in critically ill patients. BMC Infect Dis 2016; 16:103. [PMID: 26932762 PMCID: PMC4773999 DOI: 10.1186/s12879-016-1421-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022] Open
Abstract
Background Optimal antibiotic dosing is key to maximising patient survival, and minimising the emergence of bacterial resistance. Evidence-based antibiotic dosing guidelines for critically ill patients receiving RRT are currently not available, as RRT techniques and settings vary greatly between ICUs and even individual patients. We aim to develop a robust, evidence-based antibiotic dosing guideline for critically ill patients receiving various forms of RRT. We further aim to observe whether therapeutic antibiotic concentrations are associated with reduced 28-day mortality. Methods/Design We designed a multi-national, observational pharmacokinetic study in critically ill patients requiring RRT. The study antibiotics will be vancomycin, linezolid, piperacillin/tazobactam and meropenem. Pharmacokinetic sampling of each patient’s blood, RRT effluent and urine will take place during two separate dosing intervals. In addition, a comprehensive data set, which includes the patients’ demographic and clinical parameters, as well as modality, technique and settings of RRT, will be collected. Pharmacokinetic data will be analysed using a population pharmacokinetic approach to identify covariates associated with changes in pharmacokinetic parameters in critically ill patients with AKI who are undergoing RRT for the five commonly prescribed antibiotics. Discussion Using the comprehensive data set collected, the pharmacokinetic profile of the five antibiotics will be constructed, including identification of RRT and other factors indicative of the need for altered antibiotic dosing requirements. This will enable us to develop a dosing guideline for each individual antibiotic that is likely to be relevant to any critically ill patient with acute kidney injury receiving any of the included forms of RRT. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN12613000241730) registered 28 February 2013
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Affiliation(s)
- Jason A Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia. .,Royal Brisbane & Women's Hospital, Queensland, Australia.
| | - Gordon Y S Choi
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
| | - Gavin M Joynt
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
| | - Sanjoy K Paul
- Clinical Trials & Biostatistics Unit, QIMR Berghofer, Queensland, Australia.
| | - Renae Deans
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.
| | - Sandra Peake
- The Queen Elizabeth Hospital, South Australia, Australia.
| | - Louise Cole
- Nepean Hospital, New South Wales, Australia.
| | | | | | - John Turnidge
- Royal Women's and Children's Hospital, Queensland, Australia.
| | - Steven C Wallis
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.
| | - Michael S Roberts
- Therapeutics Research Unit, The University of Queensland, Queensland, Australia.
| | - Darren M Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia.
| | | | - Therese Starr
- Royal Brisbane & Women's Hospital, Queensland, Australia.
| | - Jeffrey Lipman
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia. .,Royal Brisbane & Women's Hospital, Queensland, Australia.
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Phu VD, Wertheim HFL, Larsson M, Nadjm B, Dinh QD, Nilsson LE, Rydell U, Le TTD, Trinh SH, Pham HM, Tran CT, Doan HTH, Tran NT, Le ND, Huynh NV, Tran TP, Tran BD, Nguyen ST, Pham TTN, Dang TQ, Nguyen CVV, Lam YM, Thwaites G, Van Nguyen K, Hanberger H. Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units. PLoS One 2016; 11:e0147544. [PMID: 26824228 PMCID: PMC4732823 DOI: 10.1371/journal.pone.0147544] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/04/2016] [Indexed: 12/29/2022] Open
Abstract
Background Vietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam. Methods Monthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08:00 a.m. on the survey day were included. Results Among 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively). Conclusion A high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.
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Affiliation(s)
- Vu Dinh Phu
- Intensive Care Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Heiman F L Wertheim
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Mattias Larsson
- Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Behzad Nadjm
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Quynh-Dao Dinh
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Lennart E Nilsson
- Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ulf Rydell
- Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | | | | | | | - Hanh Thi Hong Doan
- Board of Directors, Vietnam-Sweden Uong Bi Hospital, Quang Ninh, Vietnam
| | - Nguyen Thua Tran
- Department of General Internal Medicine & Geriatric, Hue Central General Hospital, Hue, Vietnam
| | - Nhan Duc Le
- Board of Directors, Da Nang Hospital, Da Nang, Vietnam
| | - Nhuan Van Huynh
- Infectious Department, Binh Dinh Hospital, Binh Dinh, Vietnam
| | | | - Bao Duc Tran
- Planning Department, Dak Lak Hospital, Dak Lak, Vietnam
| | | | | | - Tam Quang Dang
- Board of Directors, Can Tho Central General Hosptial, Can Tho, Vietnam
| | | | - Yen Minh Lam
- Board of directors, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.,Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Kinh Van Nguyen
- Board of Directors, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Hakan Hanberger
- Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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30
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Alp E, Erdem H, Rello J. Management of septic shock and severe infections in migrants and returning travelers requiring critical care. Eur J Clin Microbiol Infect Dis 2016; 35:527-33. [PMID: 26825315 PMCID: PMC7088366 DOI: 10.1007/s10096-016-2575-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 01/03/2016] [Indexed: 12/13/2022]
Abstract
During the past decade, global human movement created a virtually "borderless world". Consequently, the developed world is facing "forgotten" and now imported infectious diseases. Many infections are observed upon travel and migration, and the clinical spectrum is diverse, ranging from asymptomatic infection to severe septic shock. The severity of infection depends on the etiology and timeliness of diagnosis. While assessing the etiology of severe infection in travelers and migrants, it is important to acquire a detailed clinical history; geography, dates of travel, places visited, type of transportation, lay-overs and intermediate stops, potential exposure to exotic diseases, and activities that were undertaken during travelling and prophylaxis and vaccines either taken or not before travel are all important parameters. Tuberculosis, malaria, pneumonia, visceral leishmaniasis, enteric fever and hemorrhagic fever are the most common etiologies in severely infected travelers and migrants. The management of severe sepsis and septic shock in migrants and returning travelers requires a systematic approach in the evaluation of these patients based on travel history. Early and broad-spectrum therapy is recommended for the management of septic shock comprising broad spectrum antibiotics, source control, fluid therapy and hemodynamic support, corticosteroids, tight glycemic control, and organ support and monitoring. We here review the diagnostic and therapeutic routing of severely ill travelers and migrants, stratified by the nature of the infectious agents most often encountered among them.
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Affiliation(s)
- E Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - H Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - J Rello
- Critical Care Department, Hospital Vall d'Hebron, CIBERES, Universitat Autonma de Barcelona, Barcelona, Spain.
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31
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Yalçınsoy M, Salturk C, Takır HB, Kutlu SB, Oguz A, Aksoy E, Balcı M, Kargın F, Mocin OY, Adıguzel N, Gungor G, Karakurt Z. Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study. Wien Klin Wochenschr 2015; 128:95-101. [PMID: 26542131 DOI: 10.1007/s00508-015-0884-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 10/12/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) have been associated with financially significant economic burden and increased case fatality rate in adult intensive care units (ICUs). This study was designed to evaluate case fatality rate among patients with NP and VAP in a respiratory ICU. METHODS In 2008-2013, VAP and NP in the ICUs were included in this retrospective single-centre cohort study. Data on demographics, co-morbidities, severity of illness, mechanical ventilation, empirical treatment, length of hospital stay and laboratory findings were recorded in each group, as were case fatality rate during ICU admission and after discharge including short-term (28-day) and long-term (a year) case fatality rate. RESULTS A total of 108 patients with VAP (n = 64, median (IQR) age: 70 (61-75) years, 67.2% were men) or NP (n = 44, median (IQR) age: 68 (62-74) years, 68.2% were men) were found. Appropriate empirical antibiotic therapy was identified only in 45.2 and 42.9% of patients with VAP and NP, respectively. Overall case fatality rate in VAP and NP (81.3 vs 84.1), ICU case fatality rate (42.2 vs 45.5%), short-term case fatality rate (15.6 vs 27.3%) and long-term case fatality rate (23.4 vs 11.4%) were similar between VAP and NP groups along with occurrence 50% of case fatality rate cases in the first 2 months and 90% within the first year of discharge. Multivariate analysis showed that chronic obstructive pulmonary disease (COPD) (HR: 3.15, 95% CI: 1.06-9.38; p = 0.039) and presence of septic shock (HR: 3.83, 95% CI: 1.26-11.60; p = 0.018) were independently associated with lower survival. CONCLUSION In conclusion, our findings in a retrospective cohort of respiratory ICU patients with VAP or NP revealed high ICU, short- and long-term case fatality rates within 1 year of diagnosis, regardless of the diagnosis of NP after 48 h of initial admission or after induction of ventilator support. COPD and presence of septic shock are associated with high fatality rate and our findings speculate that as increasing compliance with infection control programs and close monitoring especially in 2 months of discharge might reduce high-case fatality rate in patients with VAP and NP.
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Affiliation(s)
- Murat Yalçınsoy
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey.
| | - Cuneyt Salturk
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Hurıye Berk Takır
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Semra Batı Kutlu
- Infectious clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayşegul Oguz
- Nurse department, Infectious clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emine Aksoy
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Merih Balcı
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Feyza Kargın
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Ozlem Yazıcıoglu Mocin
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Nalan Adıguzel
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Gokay Gungor
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
| | - Zuhal Karakurt
- Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, bağlarbaşı mah. Atatürk cad. maral sok. yunus emre apt. No: 7/7 Maltepe, Istanbul, Turkey
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Tabatabaei SM, Behmanesh Pour F, Osmani S. Epidemiology of Hospital-Acquired Infections and Related Anti-Microbial Resistance Patterns in a Tertiary-Care Teaching Hospital in Zahedan, Southeast Iran. ACTA ACUST UNITED AC 2015. [DOI: 10.17795/iji-29079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Farsiani H, Mosavat A, Soleimanpour S, Nasab MN, Salimizand H, Jamehdar SA, Ghazvini K, Aryan E, Baghani AA. Limited genetic diversity and extensive antimicrobial resistance in clinical isolates of Acinetobacter baumannii in north-east Iran. J Med Microbiol 2015; 64:767-773. [PMID: 25991693 DOI: 10.1099/jmm.0.000090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study determined the mechanisms and patterns of antimicrobial resistance among the isolates obtained from different wards of a teaching hospital in the city of Mashhad in north-east Iran. Between January 2012 and the end of June 2012, 36 isolates of Acinetobacter baumannii were collected from different wards of Ghaem Hospital. Antimicrobial susceptibility testing and epsilometer testing (E-test) were performed. The genetic resistance determinants of A, B and D classes of β-lactamases, aminoglycoside modifying enzymes (AMEs), efflux pumps and ISAba1 elements were assessed by PCR. Repetitive extragenic palindromic element (REP)-PCR was performed to find the genetic relatedness of the isolates. Colistin was the most effective antibiotic of those tested, where all isolates were susceptible. E-test results revealed high rates of resistance to imipenem, ceftazidime and ciprofloxacin. The majority of isolates (97 %) were multidrug-resistant. OXA-51, OXA-23 and tetB genes were detected in all isolates, but OXA-58, IMP and tetA were not detected. The prevalence of OXA-24, bla(TEM), bla(ADC), bla(VIM) and adeB were 64, 95, 61, 64 and 86 %, respectively. ISAba1 was found to be inserted into the 5' end of OXA-23 in 35 isolates (97 %). Of the AMEs, aadA1 (89 %) was the most prevalent, followed by aphA1 (75 %). The band patterns reproduced by REP-PCR showed that 34 out of 36 isolates belonged to one clone and two singletons were identified. The results confirmed that refractory A. baumannii isolates were widely distributed and warned the hospital infection control team to exert strict measures to control the infection. An urgent surveillance system should be implemented.
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Affiliation(s)
- Hadi Farsiani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arman Mosavat
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Soleimanpour
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahbobeh Naderi Nasab
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Himen Salimizand
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Amel Jamehdar
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ghazvini
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Aryan
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali-Asghar Baghani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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López Hernández Y, Yero D, Pinos-Rodríguez JM, Gibert I. Animals devoid of pulmonary system as infection models in the study of lung bacterial pathogens. Front Microbiol 2015; 6:38. [PMID: 25699030 PMCID: PMC4316775 DOI: 10.3389/fmicb.2015.00038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/12/2015] [Indexed: 01/15/2023] Open
Abstract
Biological disease models can be difficult and costly to develop and use on a routine basis. Particularly, in vivo lung infection models performed to study lung pathologies use to be laborious, demand a great time and commonly are associated with ethical issues. When infections in experimental animals are used, they need to be refined, defined, and validated for their intended purpose. Therefore, alternative and easy to handle models of experimental infections are still needed to test the virulence of bacterial lung pathogens. Because non-mammalian models have less ethical and cost constraints as a subjects for experimentation, in some cases would be appropriated to include these models as valuable tools to explore host-pathogen interactions. Numerous scientific data have been argued to the more extensive use of several kinds of alternative models, such as, the vertebrate zebrafish (Danio rerio), and non-vertebrate insects and nematodes (e.g., Caenorhabditis elegans) in the study of diverse infectious agents that affect humans. Here, we review the use of these vertebrate and non-vertebrate models in the study of bacterial agents, which are considered the principal causes of lung injury. Curiously none of these animals have a respiratory system as in air-breathing vertebrates, where respiration takes place in lungs. Despite this fact, with the present review we sought to provide elements in favor of the use of these alternative animal models of infection to reveal the molecular signatures of host-pathogen interactions.
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Affiliation(s)
- Yamilé López Hernández
- Centro de Biociencias, Universidad Autónoma de San Luis Potosí San Luis de Potosí, Mexico
| | - Daniel Yero
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona Barcelona, Spain ; Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona Barcelona, Spain
| | - Juan M Pinos-Rodríguez
- Centro de Biociencias, Universidad Autónoma de San Luis Potosí San Luis de Potosí, Mexico
| | - Isidre Gibert
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona Barcelona, Spain ; Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona Barcelona, Spain
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Erdem H, Stahl JP, Inan A, Kilic S, Akova M, Rioux C, Pierre I, Canestri A, Haustraete E, Engin DO, Parlak E, Argemi X, Bruley D, Alp E, Greffe S, Hosoglu S, Patrat-Delon S, Heper Y, Tasbakan M, Corbin V, Hopoglu M, Balkan II, Mutlu B, Demonchy E, Yilmaz H, Fourcade C, Toko-Tchuindzie L, Kaya S, Engin A, Yalci A, Bernigaud C, Vahaboglu H, Curlier E, Akduman D, Barrelet A, Oncu S, Korten V, Usluer G, Turgut H, Sener A, Evirgen O, Elaldi N, Gorenek L. The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study. Eur J Clin Microbiol Infect Dis 2014; 33:1591-9. [PMID: 24789652 DOI: 10.1007/s10096-014-2116-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey,
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[Nosocomial infections in intensive care units]. Enferm Infecc Microbiol Clin 2014; 32:320-7. [PMID: 24661994 DOI: 10.1016/j.eimc.2014.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/23/2014] [Indexed: 12/22/2022]
Abstract
Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs.
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