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Risk factors, antimicrobial susceptibility pattern and patient outcomes of Pseudomonas aeruginosa infection: A matched case-control study. J Infect Public Health 2021; 14:152-157. [PMID: 33422856 DOI: 10.1016/j.jiph.2020.11.010] [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] [Received: 01/27/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa is a leading nosocomial Gram-negative bacteria associated with prolonged hospitalization, and increased morbidity and mortality. Limited data exist regarding P. aeruginosa infection and outcome in patients managed in intensive care units (ICUs) in the Gulf countries. We aimed to determine the risk factors, antimicrobial susceptibility pattern and patient outcomes of P. aeruginosa infection in ICU. METHODS In this matched case-control study, all P. aeruginosa infections that occurred >48 h after hospital admission between January 31st 2016 and December 31st 2018 at ICUs affiliated with King Abdulaziz Medical City, Riyadh were included. P. aeruginosa was identified using MALDI-TOF (Vitek-MS) by biomérieux, and the antimicrobial susceptibility testing was performed using an automated biomérieux VITEK®️ 2 Antimicrobial Susceptibility card. RESULTS The study included 90 cases and 90 controls. Compared with controls, cases had significantly higher mean ICU stay and higher proportions with previous history of antimicrobial therapy, coronary artery disease, malignancy, hemodialysis, previous surgery, use of central line, urethral catheterization, nasogastric tube, and tracheostomy. In a multivariate conditional logistic regression analysis, factors independently associated with P. aeruginosa infection were ICU duration [Odds Ratio (OR) 9.05, 95%CI 2.53-32.27, p = .001], previous surgery (OR = 7.33, 95%CI 1.66-32.36, p = .009), tracheostomy (OR = 11.13, 95%CI 1.05-118.59, p = .046), urethral catheterization (OR = 7.38, 95%CI 1.21-45.11, p = .030) and use of aminoglycosides (OR = 10.59, 95%CI 1.14-98.13, p = .038). Approximately 41% of P. aeruginosa isolates were resistant to imipenem, while 36.7% were multidrug-resistant. Mortality was similar in both groups: 54(60%) cases and 51(56.7%) controls; p = .650. CONCLUSIONS The study identifies several potentially modifiable factors associated with P. aeruginosa infection in ICUs. Identification of these factors could facilitate case identification and enhance control measures.
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Kabir ARML, Roy S, Habib RB, Anwar KS, Mollah MAH, Amin R, Mridha AA, Majumder JU, Hossain MD, Haque N, Ahmed S, Chisti MJ. Cystic Fibrosis Diagnosed Using Indigenously Wrapped Sweating Technique: First Large-Scale Study Reporting Socio-Demographic, Clinical, and Laboratory Features among the Children in Bangladesh A Lower Middle Income Country. Glob Pediatr Health 2020; 7:2333794X20967585. [PMID: 33195743 PMCID: PMC7607759 DOI: 10.1177/2333794x20967585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
Due to lack of robust data on childhood cystic fibrosis (CF) in Bangladesh we sought to evaluate their clinico-epidemiology. A cross-sectional observation was conducted adopting CF-foundation consensus-panel-diagnostic criteria in 3 tertiary-care-hospitals in Bangladesh from 2000 to 2017. Clinically suspected 95 CF-cases were subjected to sweat-chloride testing using locally-developed a fast, cheap and effective indigenously body-wrapped sweating technique measured by US-Easy Lyte-automated microprocessor-controlled analyzer marking ≥60 mmol/L as positive. Mean-age of CF-cases at disease-onset was 16.9 ± 26.6 months that significantly differed with age-at-diagnosis (P < .02). Pulmonary syndromes included chronic wet cough in 100%, respiratory distress in 90.5%, digital-clubbing in 78%, mucopurulent-sputum in 74%-cases, and crepitation in 82%. Radio-imaging revealed bronchiectasis in 60%, hyperinflation/peribronchial-thickening in 22% and, pan-sinusitis in 89%-cases. While 37% had history-of malabsorption, high-fecal-fat revealed in 53%-cases. Malnutrition prevailed as severe-underweight in 87%-cases and all CF-cases (100%) had high sweat-chloride (mean = 118 ± 53.34 mmol/L). Thus, children with pulmonary features coupled with severe malnutrition and associated radio-imaging bronchiectasis should be screened for CF with a fast, cheap and effective sweat test in resource poor settings.
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Affiliation(s)
| | - Sudipta Roy
- Ad-din Women’s Medical College Hospital, Dhaka, Bangladesh
| | | | | | | | - Ruhul Amin
- Institute of Child Health (BICH), Dhaka, Bangladesh
| | | | | | | | | | - Shakil Ahmed
- Shaheed Shuhrawardy Medical College, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Lepainteur M, Ogna A, Clair B, Dinh A, Tarragon C, Prigent H, Davido B, Barbot F, Vaugier I, Afif M, Roux AL, Rottman M, Orlikowski D, Herrmann JL, Annane D, Lawrence C. Risk factors for respiratory tract bacterial colonization in adults with neuromuscular or neurological disorders and chronic tracheostomy. Respir Med 2019; 152:32-36. [PMID: 31128607 DOI: 10.1016/j.rmed.2019.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe the endotracheal respiratory flora in a population of adults suffering from neuromuscular or neurological disorders requiring a long-term tracheostomy and to identify risk factors for colonization. We conducted a prospective and single-center observational study among patients with chronic tracheostomy admitted for planned respiratory assessment between February 2015 and December 2016. Data were collected from patient interview and medical charts with a standardized questionnaire. A tracheal aspiration was performed for each patient. Humidifiers were analysed for bacteriological contamination. Overall 77 tracheal aspirates (TA) were obtained from patients included. Pathogenic bacteria were found in 90% of cases (69/77) with a majority of Pseudomonas aeruginosa (32/77, 41%), Staphylococcus aureus (34/77, 44%) and Serratia marcesens. (22/79, 38%) Amoxicillin + Clavulanic-acid and Cefotaxime were adapted for respectively in only 28% and 35% of the subjects due to the natural resistance of organisms. No pathogenic bacteria were isolated from humidifier samples. Risk factors significantly associated with P. aeruginosa colonization were residence in a medical-care home (p = 0.01, OR = 3.8 [1.1; 15.1]) and the presence of a cuff (p = 0.003, OR = 4.4 [1.1; 20.6]). Significant quantities of pathogenic bacteria are frequently isolated from TA of tracheostomised patients in the absence of infection. The frequent resistance of these pathogens to Amoxicillin + Clavulanic-acid precludes the use of this antibiotic in the empiric treatment of pneumonia in this population.
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Affiliation(s)
- Margaux Lepainteur
- Laboratoire de microbiologie et unité d'hygiène hospitalière APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Adam Ogna
- Réanimation adultes, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Bernard Clair
- Réanimation adultes, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Aurélien Dinh
- Maladies infectieuses, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Catherine Tarragon
- Réanimation adultes, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Hélène Prigent
- Réanimation adultes, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Benjamin Davido
- Maladies infectieuses, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Frédéric Barbot
- CIC1429 INSERM AP-HP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Isabelle Vaugier
- CIC1429 INSERM AP-HP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Muriel Afif
- Pharmacie hospitalière, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Anne-Laure Roux
- Laboratoire de microbiologie et unité d'hygiène hospitalière APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France; INSERM U1173, UFR Simone Veil, Versailles-Saint-Quentin University, 78180, Saint-Quentin en Yvelines, France
| | - Martin Rottman
- Laboratoire de microbiologie et unité d'hygiène hospitalière APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France; INSERM U1173, UFR Simone Veil, Versailles-Saint-Quentin University, 78180, Saint-Quentin en Yvelines, France
| | - David Orlikowski
- Réanimation adultes, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France; CIC1429 INSERM AP-HP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Jean-Louis Herrmann
- Laboratoire de microbiologie et unité d'hygiène hospitalière APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France; INSERM U1173, UFR Simone Veil, Versailles-Saint-Quentin University, 78180, Saint-Quentin en Yvelines, France
| | - Djillali Annane
- Réanimation adultes, APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France
| | - Christine Lawrence
- Laboratoire de microbiologie et unité d'hygiène hospitalière APHP, Hôpitaux Universitaires Paris Ile de France Ouest, site R. Poincaré, 92380, Garches, France; INSERM U1173, UFR Simone Veil, Versailles-Saint-Quentin University, 78180, Saint-Quentin en Yvelines, France.
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Tan CY, Chiu NC, Lee KS, Chi H, Huang FY, Huang DTN, Chang L, Kung YH, Huang CY. Respiratory tract infections in children with tracheostomy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 53:315-320. [PMID: 30131258 DOI: 10.1016/j.jmii.2018.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Children with tracheostomy are at increased risk for respiratory tract infections, yet the risk involved in tracheostomy related infections is unclear. METHODS We conducted a retrospective review of the medical records of children who underwent tracheostomy between January 2002 and December 2016 at a teaching hospital in Taipei. Demographics, underlying disease, indication for tracheostomy, laboratory data and management, and long-term outcome data were collected. Infection episodes were grouped into definite, possible, non-bacterial pneumonia, and local infection groups. RESULTS Ninety patients were enrolled. Forty-two (46.7%) patients had infections that required hospitalization. Definite bacterial pneumonia accounted for 12 (8.5%) episodes, 113 episodes (80.1%) were possible bacterial pneumonia, 12 (8.5%) were non-bacterial pneumonia, and 4 (2.8%) were local infections. Patients with definite and possible bacterial pneumonia were found to have a longer hospital duration than patients with non-bacterial pneumonia (p=0.024), with mean hospitalization stays of 8.83±5.59 days and 5.67±2.55 days, respectively. The median duration from tracheostomy to bacterial pneumonia was 1.78 years (range, 0.04- 11.38) whereas for the non-bacterial pneumonia group it was 0.57 years (range, 0.04-6.61). Cerebral palsy (CP) (adjusted odds ratio [AOR] 3.65; 95% confidence interval [CI]: 1.11-11.99; p=0.033) and gastroesophageal reflux disease (GERD) (AOR 2.84; 95% CI: 1.09-7.38; p=0.033) were independently associated with respiratory tract infections in these children. CONCLUSION In this study, CP and GERD were associated with infections in children with tracheostomy. Bacterial and non-bacterial pneumonia are difficult to differentiate clinically which may lead to unnecessary antibiotics use.
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Affiliation(s)
- Chiew-Yin Tan
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
| | - Kuo-Sheng Lee
- Department of Otorhinolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Fu-Yuan Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | | | - Lung Chang
- Department of Pediatrics, MacKay Memorial Hospital Tamshui, New Taipei, Taiwan
| | - Yen-Hsin Kung
- Department of Pediatrics, MacKay Memorial Hospital Tamshui, New Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
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β -Lactamase-Producing Multidrug-Resistant Bacterial Pathogens from Tracheal Aspirates of Intensive Care Unit Patients at National Institute of Neurological and Allied Sciences, Nepal. ISRN MICROBIOLOGY 2013; 2013:847569. [PMID: 24078895 PMCID: PMC3775398 DOI: 10.1155/2013/847569] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/22/2013] [Indexed: 11/18/2022]
Abstract
The widespread use of tracheal intubation and mechanical ventilation to support the critically ill patients increases the risk of development of tracheobronchitis and bronchopneumonia. This cross-sectional study was conducted with an aim to isolate and identify bacterial pathogens from tracheal aspirates producing extended-spectrum β -lactamase (ESBL), AmpC β -lactamase, and metallo- β -lactamase (MBL) from August 2011 to April 2012 at National Institute of Neurological and Allied Sciences (NINAS), Kathmandu, Nepal. ESBL was detected by combined disk assay using cefotaxime and cefotaxime with clavulanate, AmpC β -lactamase by inhibitor-based method using cefoxitin and phenylboronic acid, and MBL by Imipenem-EDTA combined disk method. 167 bacterial strains were isolated from 187 samples and majority of them were Acinetobacter spp. followed by Klebsiella pneumoniae with 32.9% and 25.1%, respectively. 68.8% of isolates were multidrug resistant (MDR) and Acinetobacter spp. constituted 85.4%. ESBL, AmpC β -lactamase, and MBL were detected in 35 (25%), 51 (37.2%), and 11 (36.7%) isolates, respectively. Pseudomonas spp. (42.8%) were the predominant ESBL producer while Acinetobacter spp. were the major AmpC β -lactamase producer (43.1%) and MBL producer (54.5%).
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