[Epidemiology of nosocomial bacterial infections in a neonatal and pediatric Tunisian intensive care unit]

A Two-Year Surveillance of Central Line-Associated Bloodstream Infections in the Trauma ICU of a Tertiary Care Hospital in India

Aim The aim of the study is to identify the risk factors and mortality associated with central line-associated bloodstream infection (CLABSI) and to investigate the incidence and associated etiology in trauma patients admitted to the trauma ICU (TICU) of a tertiary care teaching hospital in Northern India. Materials and methods The study was a prospective study conducted in the trauma ICU of a tertiary care teaching hospital in India from November 2020 to October 2022. Adult patients >18 years of age who were on central line for >48 hours were included in the study. The automated blood culture system BacT/ALERT 3D (bioMérieux, Durham, NC) was used for microbial detection from blood samples. We recorded patients' daily progress, and catheter-related data was collected and used as variables. All the data was analyzed using the Statistical Package for Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Armonk, NY) to evaluate the risk factors associated with CLABSI. Result A total of 516 admissions occurred during the surveillance period, out of which 352 patients fulfilled the inclusion criteria and were enrolled in the study. Out of these 352 patients, a total of 74 patients developed central line-associated bloodstream infection (CLABSI). Thus, the incidence of CLABSI was 16.4 per 1000 central line days and 13.2 per 1000 inpatient days with a 0.8 device utilization ratio (DUR). The most common organisms isolated from these CLABSI cases were Acinetobacter species (23%), followed by Escherichia coli (16.5%) and Staphylococcus aureus (15.6%). The independent healthcare-associated risk factors for CLABSI were longer length of ICU stay and prolonged duration of central venous catheterization. The most common comorbidity associated with CLABSI was diabetes mellitus (20.3%), followed by hypertension (14.8%), and the mortality rate was 41.9%. Conclusion The healthcare-associated risk factors such as longer length of ICU stay and prolonged duration of central venous catheterization are the risk factors for developing central line-associated bloodstream infections (BSI).

[Neonatal healthcare associated-infections in the Maghreb. A systematic review and meta-analysis]

BACKGROUND

Healthcare-associated infections are a major source of morbidity and mortality in neonatology. Our aim was to describe the epidemiology of Healthcare-associated infections in neonatology (frequency, associated factors and prognosis).

METHODS

Articles were searched in the PubMed, Scopus and Web of Science databases. We included observational studies describing prevalence, incidence or mortality among new-born babies having developed infections more than 48hours after hospitalization. The pooled prevalence, incidence and mortality estimates were analysed using the random effects model. Publication bias was analysed using the funnel plot and Egger's test statistics. Data analysis was carried out using R Studio software v1.2.

RESULTS

Among the initially identified 137 studies, ten articles fulfilled the inclusion criteria and were included in the metanalysis. They mainly concerned Morocco, Tunisia and Algeria. Pooled incidence was 10% (95% CI [4%-18%]) and overall mortality was 49% (95% CI [33%-66%]). Heterogeneity between studies was significantly high, with rates of 98% and 90% respectively.

CONCLUSION

This review underlined a need to undertake more large-scale multicentric surveys and studies on monitoring systems and the attitudes and practices of relevant caregivers, the objective being to better understand the realities of healthcare-associated infections in Greater Maghreb neonatology units.

Screening for Carbapenemases in Ertapenem-Resistant Enterobacteriaceae Collected at a Tunisian Hospital Between 2014 and 2018

Background

Carbapenem-resistance is frequently detected in Enterobacteriaceae isolated from patients in Tunisia. The study was performed to identify frequent carbapenemases in Tunisian isolates.

Methods

Between May 2014 and January 2018, 197 ertapenem-resistant Enterobacteriaceae were isolated at the microbiological department of the Military Hospital of Tunis. The strains were phenotypically characterized and then subjected to in-house polymerase chain reaction (PCR) targeting the carbapenemase genes bla_IMP, bla_VIM, bla_NDM, bla_SPM, bla_AIM, bla_DIM,bla_GIM, bla_SIM, bla_KPC, bla_BIC, and bla_OXA-48.

Results

The assessed 197 ertapenem-resistant Enterobacteriaceae from Tunis comprised 170 Klebsiella pneumoniae, 19 Enterobacter cloacae, 6 Escherichia coli, 1 Citrobacter sedlakii, and 1 Enterobacter asburiae. Thereby, 55 out of 197 isolates (27.9%) were from blood cultures, suggesting a systemic disease. The carbapenemase gene bla_OXA-48 quantitatively dominated by far with 153 detections, followed by bla_NDM with 14 detections, which were distributed about the whole study interval. In contrast, bla_BIC and bla_VIM were only infrequently identified in 5 and 3 cases, respectively, while the other carbapenamases were not observed.

Conclusions

The carbapenemase gene bla_OXA-48 was identified in the vast majority of ertapenem-resistant Tunisian Enterobacteriaceae while all other assessed carbapenemases were much less abundant. In a quantitatively relevant minority of isolates, the applied PCR-based screening approach did not identify any carbapenemases.

[Nosocomial urinary tract and surgical site infection rates in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo]

Introduction

Les patients hospitalisés en Afrique intertropicale sont exposés à un risque des infections nosocomiales. La rareté des données publiées sur le sujet limite l’analyse descriptive de la situation. L’objectif de ce travail était de déterminer l’incidence, les germes en cause et les facteurs de risque des infections nosocomiales urinaires et des sites opératoires à la maternité de l’HGR Katuba de Lubumbashi en République Démocratique du Congo(DRC).

Méthodes

Nous avons réalisé une étude descriptive longitudinale de la période allant du 1^er octobre 2014 au 1^er Janvier 2015. Notre population d’étude était constituée de 207 femmes ayant séjourné dans cette maternité. La collecte de données était réalisée d’une manière exhaustive.

Résultats

L’incidence de ces infections nosocomiales était de 15,5%. Les parturientes ayant passé plus de trois jours à l'hôpital avaient trois fois plus de risque de développer une infection nosocomiale (p = 0,003) tandis que celles qui ont eu un accouchement avec complication avaient quatre fois plus de risque de contracter une infection nosocomiale (p = 0,000). Escherichia coli était l'agent causal le plus isole (38,1%), suivi de Citrobacter freundii (23,8%), Acinobacter baumannii (18, 2%), Staphylococcus aureus (18,2%), Enterococcus feacalis (14,3%) et Pseudomonas aeruginosa (9,1%). L'ampicilline était l'antibiotique le plus prescrit auquel tous les microbes isoles ont été résistants.

Conclusion

Il faut améliorer des conditions d’hygiène hospitalière; mais aussi une étude ultérieure pour étudier la ressemblance entre les souches des germes de l’environnement et celles trouvés dans les liquides biologiques.

[Clinical and bacteriological profile of neonatal bacterial infection at Laquintinie Hospital, Douala (Cameroon)]

INTRODUCTION

The World Health Organization has estimated that the global incidence of neonatal deaths was 2,8 million in 2015, of which 47,6% were due to infections. These infections can affect newborns babies ages 0-1 month through 3 months.

METHODS

This is a prospective study conducted from 1 March to 30 June 2015 in the Neonatology service of the Laquintinie Hospital at Douala. All symptomatic newborns with or without anamnestic criteria and all asymptomatic newborns, with at least an infectious risk and a positive blood culture or an abnormal blood count or positive C-reactive protein were included in the study.

RESULTS

Of the 310 newborns enrolled in the study, 300 were retained for neonatal infection, corresponding to a total incidence of 96.8%. We performed 104 cultures, of which 25 were positive, corresponding to an incidence of confirmed neonatal infection of 24%. The factors associated with infection were unexplained preterm birth < 35 weeks of amenorrhea (45,1%) and neonatal resuscitation (34,8%). Fever (56%) and neurological disorders (48.8%) were the most frequent clinical symptoms. Gram-negative bacteria were the most frequent germs (56%). Imipenem (95%) and amikacin (66.7%) were the most effective antibiotics. Outcome was favorable in 66,4% of cases and the overall mortality rate was 33,6%.

CONCLUSION

This study revealed a high prevalence of neonatal bacterial infection in this Hospital. Bacterial ecology was dominated by Gram-negative bacteria. It was recorded a significant resistance to the most widely used antibiotics and a fairly high mortality.

[Epidemiology of nosocomial bacterial infection in a neonatal intensive care unit in Morocco]

In neonatal intensive care units, the incidence of nosocomial infection is high. This study aimed to determine the epidemiology of a nosocomial bacterial infection in the neonatal intensive care unit of Mohamed VI university hospital. A total of 702 newborns were included in this study. Of the 702 neonates studied, 91 had developed a nosocomial infection. The incidence rate was 13% and incidence density was 21.2 per 1000 patient-days. The types of infection were: bloodstream infections (89%), pneumonia (6.6%), meningitis (3.3%), and urinary tract infections (1.1%). Nosocomial infection was particularly frequent in cases of low birth weight, prematurity, young age at admission, umbilical venous catheter, and mechanical ventilation. Multiresistant bacteria included enterobacteria producing betalactamase (76.9%), especially enterobacteria that were dominated by Klebsiella pneumoniae (39.7%). The mortality rate was 52.7% in nosocomial infections, 19 (20.87%) of whom had septic shock. The results of this study show that nosocomial infection is an intrahospital health problem that could be remedied by a prevention strategy.

Risk factors for healthcare-associated infection in pediatric intensive care units: a systematic review

A systematic review of observational studies on risk factors for healthcare-associated infection in pediatric Intensive Care Units (ICU) was carried out. Studies indexed in MEDLINE, LILACS, Cochrane, BDENF, CAPES databases published in English, French, Spanish or Portuguese between 1987 and 2006 were included and cross references added. Key words for search were 'cross infection' and 'Pediatric Intensive Care Units' with others sub-terms included. 11 studies were selected from 419 originally found: four studies had healthcare-associated infection as the main outcome without a specific site; three articles identified factors associated with lower respiratory tract infection (pneumonia or tracheitis); three articles were concerned with laboratory-confirmed bloodstream infection; and a single retrospective study analyzed urinary tract infection. The production of evidence on risk factors Paediatric ICU has not kept up the same pace of that on adult - there are few studies with adequate design and statistical analysis. The methodological diversity of the studies did not allow for a summarized measurement of risk factors.

[Iatrogenic meningitis after diagnosis lumbar puncture: 3 cases reports in the paediatric Children's Hospital of Tunis]

We have collected cases of iatrogenic meningitis managed in the Children's Hospital of Tunis, between January 1998 and December 2006. Clinical information about each patient were collected, all bacterial samples were investigated in the microbiology laboratory of the hospital. Bacterial isolates were identified according to conventional criteria. In the interval under study, we recorded three cases of iatrogenic meningitis after lumbar puncture. Two cases occurred in newborn admitted for suspicion of neonatal infection and one in a 2-month-old infant admitted for exploration of hyperpyretic convulsion. In all patients, the initial cerebrospinal fluid was normal. All patients developed symptoms of acute meningitis within 72 hours after lumbar puncture; the second cerebrospinal fluid was, then, typical for purulent meningitis. The causal agents isolated in the three cases were Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens, all resistant to beta-lactams by extended spectrum beta-lactamase production. The use of quinolones was required in all cases. Different complications were recorded: hydrocephalus and brain abscess in one case, respiratory and hemodynamic failure managed in the intensive care unit in the second, and brain hygroma in the third case. This study shows high morbidity of iatrogenic meningitis. Simple aseptic precautions undertaken before the procedure of lumbar puncture can prevent such cases. The urgent need for increasing the awareness among medical personnel in hospitals of developing countries cannot be overemphasized.

Risk factors for healthcare-associated infection in a pediatric intensive care unit

OBJECTIVE

Identify risk factors for first-onset healthcare-associated infection (HAI) in a pediatric intensive care unit (PICU).

DESIGN

Prospective cohort study.

SETTING

Medical-surgical PICU in a hospital for patients in the public healthcare system.

PATIENTS

From January 2005 to June 2006, daily surveillance was carried out on 870 patients ages 0 to 18 yrs during their stay in the PICU through to 48 hrs after discharge (5773 patient-days).

MEASUREMENTS AND MAIN RESULTS

In 256 admissions, there were 363 episodes of HAI, with a cumulative incidence of 41.7% and a density of 62.9 of 1000 patient-days. Intrinsic and extrinsic factors were investigated and measured until occurrence of first-onset HAI (diagnosed according to Nosocomial Infection Surveillance System criteria) or until discharge or death. In the multivariate logistic regression analysis, risk factors for first-onset HAI in the PICU (controlled for length of stay) were as follows: age under 2 years (odds ratio [OR]), 1.80; 95% confidence interval [CI]), 1.30-2.49); days on ventilator duration (OR, 1.16; 95% CI, 1.08-1.25); transfused blood products (OR, 1.49; 95% CI, 1.08-2.06), glucocorticoids (OR, 1.45; 95% CI, 1.04-2.02) and H2 blockers (OR, 1.47; 95% CI, 1.05-2.06).

CONCLUSIONS

Efforts toward a reduction in the exposure to extrinsic risk factors should be made, as each of these factors separately explains 30% of the risk of HAI. Interventions directed at processes related to the use of a ventilator and limitations on its duration of use should be a priority in HAI control strategies, as each day of ventilator use increases the risk of HAI.

Epidemiology of hospital-acquired bloodstream infections in a Tunisian pediatric intensive care unit: a 2-year prospective study

BACKGROUND

There are few data providing rates of nosocomial bloodstream infections (NBI) in pediatric intensive care patients from developing regions of the world.

OBJECTIVES

To describe the epidemiology of NBI in a Tunisian pediatric intensive care unit (PICU).

METHODS

A prospective surveillance study from January 2004 through December 2005 was performed in the PICU of the Children's Hospital of Tunis. All patients who remained in the PICU for more than 48 hours were included. Centers for Disease Control and Prevention criteria were applied for the diagnosis of NBI.

RESULTS

Six hundred forty-seven patients aged 0 to 15 years were included. Forty-one NBIs occurred in 38 patients. The NBI rate was 7/1000 patient days (6.3/100 admissions). Twenty-seven NBIs (66%) occurred in patients with central venous catheter (CVC). CVC-associated infection rate was 14.8 per 1000 catheter days. Gram-negative rods were involved in 53.6% of NBIs. The most common organisms causing NBIs were Staphylococcus aureus (26.8%), Klebsiella pneumoniae (19.5%) and Coagulase-negative staphylococci (17%). Staphylococcus aureus was methicillin-resistant in 9.1% of cases. Eighty-seven percent of Klebsiella pneumoniae isolates had extended-spectrum beta-lactamases. The PICU crude mortality rate of infected patients was 42% (versus 5.9% in noninfected patients; P< .001). Multivariate logistic regression analyses demonstrated device utilization ratio greater than 1 (odds ratio [OR]=8.46; 95% confidence interval [CI] 3.11-23; P< .001) and previous colonization with multidrug resistant gram-negative rods (OR=2; 95% CI 1.39-2.89; P< .001) significantly related to NBI.

CONCLUSIONS

Considering the high incidence of NBI resulted from multiple drug-resistant gram-negative rods in our center, implementation of improved infection control practices is required.