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Gautam G, Satija S, Kaur R, Kumar A, Sharma D, Dhakad MS. Insight into the Burden of Antimicrobial Resistance among Bacterial Pathogens Isolated from Patients Admitted in ICUs of a Tertiary Care Hospital in India. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:7403044. [PMID: 38223353 PMCID: PMC10787651 DOI: 10.1155/2024/7403044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
Intensive care unit (ICU) patients are prone to develop infections by hospital prevalent organisms. The aim of the study was to determine the bacteriological profiles and their drug resistance pattern among different infections in ICU patients of a tertiary care hospital. The record-based retrospective data of culture reports of the patients admitted to all the ICUs of a tertiary care hospital during the period from January 2020 to May 2022 were analyzed. A total of 3,056 samples were obtained from 2308 patients. The infection rate among ICU patients was found to be 53.40%. Isolates belonged equally to males (50.86%) and females (49.14%). The most common culture-positive clinical specimen received was blood (39.08%) followed by respiratory samples (29.45%). Acinetobacter sp. (33.02%) was the most common organism isolated from various clinical specimens, followed by Klebsiella pneumoniae (20.89%), and Escherichia coli (13.8%). More than 80% of Acinetobacter species were found to be resistant to third-generation cephalosporins, aminoglycosides, and carbapenems, whereas minocycline (56.31% S) and colistin (100% S) were the most effective drugs. Klebsiella sp. was found to be more resistant than E.coli, and the least resistance was observed to be tetracycline (43.97%) and doxycycline (55.84%). Among Staphylococcus aureus, 82.78% of strains were methicillin-resistant (MRSA). Vancomycin-resistant Enterococci (VRE) sp. accounted for 16.67% of the isolates. Evidence-based knowledge regarding the local bacterial organisms and their antimicrobial resistance pattern is pivotal in deciding empirical drug therapy, ultimately leading to the management of antimicrobial resistance (AMR).
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Affiliation(s)
| | - Shweta Satija
- Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
| | - Ravinder Kaur
- Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
| | - Anil Kumar
- Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
| | - Divakar Sharma
- Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
| | - Megh Singh Dhakad
- Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002, India
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Nanao T, Nishizawa H, Fujimoto J. Empiric antimicrobial therapy in the intensive care unit based on the risk of multidrug-resistant bacterial infection: a single-centre case‒control study of blood culture results in Japan. Antimicrob Resist Infect Control 2023; 12:99. [PMID: 37697404 PMCID: PMC10496235 DOI: 10.1186/s13756-023-01303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Infections and sepsis are the leading causes of death in intensive care units (ICUs). Antimicrobial agent selection is challenging because the intervention is directly related to the outcome, and the problem of antimicrobial resistance (AMR) must be considered. Therefore, in this study, we aimed to clarify the epidemiological data and examine whether the detection rate of multidrug-resistant (MDR) bacteria differed depending on the presence or absence of the risk of MDR bacterial infections to establish guidance regarding the choice of antimicrobial therapy for ICU patients. METHODS This retrospective case‒control study was performed in a single ICU in Japan. Patients admitted to the ICU who underwent blood culture (BC) analysis were considered for inclusion in this study; patients were at risk of MDR bacterial infections, and controls were not. The primary outcome measure was the detection rate of MDR bacteria in BCs collected from patients and controls. The secondary outcome measure was the selection rate of anti-Pseudomonas and anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs for patients and controls. RESULTS Among the 1,730 patients admitted to the ICU during the study period, BCs were obtained from 186 patients, and 173 samples were finally included in the analysis (n = 129 cases; n = 44 controls). No MDR bacteria or Pseudomonas aeruginosa were detected in the controls (14 (11%) vs. 0 (0%)) (P = 0.014) However, there was no difference in empiric antimicrobials, including anti-MRSA (30 (23%) vs. 12 (27%)) (P = 0.592) and anti-Pseudomonas aeruginosa (61 (47%) vs. 16 (36%)) (P = 0.208) drugs, that were administered to the two groups. CONCLUSIONS Even in critically ill patients in the ICU, MDR bacteria are unlikely to be detected in patients without the risk of MDR bacterial infections. Therefore, for such patients, a strategy of starting empiric narrow-spectrum antimicrobial therapy rather than empiric broad-spectrum therapy should be considered. This strategy, in conjunction with daily updates of clinical and epidemiological data at each facility, will promote the appropriate use of antimicrobials and reduce the emergence of MDR bacteria in the ICU. TRIAL REGISTRATION None.
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Affiliation(s)
- Taikan Nanao
- Department of Intensive Care Medicine, Yokohama Rosai Hospital, 3211, Kozukue, Kouhoku, Yokohama, Kanagawa, 222-0036, Japan.
- Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan.
| | - Hideo Nishizawa
- Department of Intensive Care Medicine, Yokohama Rosai Hospital, 3211, Kozukue, Kouhoku, Yokohama, Kanagawa, 222-0036, Japan
| | - Junichi Fujimoto
- Department of Intensive Care Medicine, Yokohama Rosai Hospital, 3211, Kozukue, Kouhoku, Yokohama, Kanagawa, 222-0036, Japan
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Chenchula S, Sadasivam B, Shukla A, Pathan S, Saurabh saigal. Health care associated infections, antimicrobial resistance and outcomes in patients admitted to intensive care unit, India: A five-Year retrospective cohort study. J Infect Prev 2023; 24:159-165. [PMID: 37333868 PMCID: PMC10273797 DOI: 10.1177/17571774231161821] [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: 11/09/2021] [Accepted: 02/16/2023] [Indexed: 09/20/2023] Open
Abstract
Background The present study was conducted to study the prevalence of HAIs in a newly established MICU, common microorganisms causing HAIs and their antibiotic-sensitivity profile, and antimicrobial utilization and mortality rate. Methods The present retrospective cohort study was carried out at AIIMS, Bhopal (2015-2019). The prevalence of HAIs was determined; sites of HAIs and common causative microorganisms were identified, and their antibiotic-sensitivity profiles were studied. The group of patients with HAIs was matched with a control group drawn from the pool of patients without HAIs; this matching was done with respect to age, gender, and clinical diagnosis. Antimicrobial utilization, Period of ICU stay, comorbidities and patient mortality rates in the two groups were analyzed. The clinical criteria by the CDC- National Nosocomial Infections Surveillance to diagnose HAIs. Results A total of 281 ICU patients' records were analyzed. The mean age was 47.21 ± 19.07 years. Of these 89 were found to have developed ICU-acquired HAIs (Prevalance:32%). Bloodstream infections (33%) and respiratory tract infections (30.68%), catheter-associated urinary tract infections (25.56%), and surgical site infections (6.76%) were the commonest. The most frequently isolated microorganism causing HAIs was K. pneumonia (18%), A. baumannii (14%) and E. coli (12%), 31% isolates of which were multidrug resistant. The average length of ICU stay was high in patients with HAIs (13.85 vs 8.2 days). The most common co-morbidity was type 2 diabetes mellitus (42.86%). Prolonged ICU stays [OR 1.13, (95% CI; 0.04-0.10)] and the presence of HAIs [OR 1.18(95%CI; (0.03-0.15)] were associated with an increased risk of mortality. Conclusions An increased prevalence of HAIs essentially bloodstream infections and respiratory infections with MDR organisms to antimicrobials in the watch group is highly considerable. Acquisition of HAIs with MDR organisms and increased length of hospital stay are considerable risk factors for increased mortality in ICU-admitted patients. Regular antimicrobial stewardship activities and revising existing hospital infection control policies accordingly may reduce HAIs.
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Affiliation(s)
- Santenna Chenchula
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Ajay Shukla
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Saman Pathan
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Saurabh saigal
- Department of Anaesthesiology & Intensive care, All India Institute of Medical Sciences Bhopal, Bhopal, India
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Elmassry MM, Colmer-Hamood JA, Kopel J, San Francisco MJ, Hamood AN. Anti- Pseudomonas aeruginosa Vaccines and Therapies: An Assessment of Clinical Trials. Microorganisms 2023; 11:916. [PMID: 37110338 PMCID: PMC10144840 DOI: 10.3390/microorganisms11040916] [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: 02/14/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that causes high morbidity and mortality in cystic fibrosis (CF) and immunocompromised patients, including patients with ventilator-associated pneumonia (VAP), severely burned patients, and patients with surgical wounds. Due to the intrinsic and extrinsic antibiotic resistance mechanisms, the ability to produce several cell-associated and extracellular virulence factors, and the capacity to adapt to several environmental conditions, eradicating P. aeruginosa within infected patients is difficult. Pseudomonas aeruginosa is one of the six multi-drug-resistant pathogens (ESKAPE) considered by the World Health Organization (WHO) as an entire group for which the development of novel antibiotics is urgently needed. In the United States (US) and within the last several years, P. aeruginosa caused 27% of deaths and approximately USD 767 million annually in health-care costs. Several P. aeruginosa therapies, including new antimicrobial agents, derivatives of existing antibiotics, novel antimicrobial agents such as bacteriophages and their chelators, potential vaccines targeting specific virulence factors, and immunotherapies have been developed. Within the last 2-3 decades, the efficacy of these different treatments was tested in clinical and preclinical trials. Despite these trials, no P. aeruginosa treatment is currently approved or available. In this review, we examined several of these clinicals, specifically those designed to combat P. aeruginosa infections in CF patients, patients with P. aeruginosa VAP, and P. aeruginosa-infected burn patients.
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Affiliation(s)
- Moamen M. Elmassry
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Jane A. Colmer-Hamood
- Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Michael J. San Francisco
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
- Honors College, Texas Tech University, Lubbock, TX 79409, USA
| | - Abdul N. Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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5
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Naz H, Korkmaz P, Arslanal E, Mıstanoğlu-Özatağ D, Gürbüz H. Prospective Evaluation of Infections in Geriatric Patients in Intensive Care Units. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:268-273. [PMID: 38633716 PMCID: PMC10986692 DOI: 10.36519/idcm.2022.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/15/2022] [Indexed: 04/19/2024]
Abstract
Objective Nosocomial infections (NIs) are major health problems with morbidity and mortality. Geriatric patients require intensive care unit (ICU) admission more frequently, and serious challenges occur during treatment. We aimed to evaluate the risk factors of NI and mortality in geriatric patients admitted to the ICU. Materials and Methods The study was conducted between April 2018 and April 2019 in two hospitals. We prospectively recorded the data on the forms prepared according to daily ICU visits. Results During the study period, 600 patients were hospitalized in the ICUs. Geriatric patients constituted 446 (74.3%) of the total number. The NI rate was 59% in adult patients and 80% in geriatric patients. The most frequent NI in geriatric patients was pneumonia (42%). Furthermore, the need for mechanical ventilation support, prolongation of hospital stay, total parenteral nutrition, and tracheostomy were statistically higher in geriatric patients with NI. The mortality rate in geriatric patients was statistically higher than in non-geriatric. We found the rates of prolonged hospitalization, NI development, malignancy, and cerebrovascular disease diagnosis significantly higher in geriatric patients than in non-geriatric patients. Conclusion NI and mortality rate are higher in geriatrics than in adult patients. Pneumonia is the most common type of NI in the ICU. Identification of risk factors regarding NI and mortality in geriatric patients in ICU will contribute to developing strategies for prevention.
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Affiliation(s)
- Hasan Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Pınar Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Esra Arslanal
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Duru Mıstanoğlu-Özatağ
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Hande Gürbüz
- Department of Anesthesiology and Reanimation, University of Health Sciences School of Medicine, Derince Training and Research Hospital, Kocaeli, Turkey
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Cetik Yildiz S. Staphylococcus aureus and Methicillin Resistant Staphylococcus aureus (MRSA) Carriage and Infections. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.107138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Staphylococcus aureus is among the most common opportunistic infections worldwide, as it is found as part of the flora in many parts of the body. S. aureus is the leading cause of nosocomial infections with its ability to rapidly colonize the infected area, high virulence, rapid adaptation to environmental conditions, and the ability to develop very fast and effective resistance even to new generation antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA), first identified in the 1960s, is one of the most successful modern pathogens, becoming an important factor in hospitals in the 1980s. MRSA is an important factor, especially in hospitalized patients and healthcare-associated infections. Patients colonized with S. aureus and MRSA are at risk for community-acquired infections. It is critical that multidrug resistance reduces treatment options in MRSA infections and MRSA strains. These microorganisms have been the subject of research for years as they spread and become resistant in both social and medical settings and cause great morbidity and mortality. With the rapid spread of resistance among bacteria, antibiotic resistance has increased the cost of health care, and this has become the factor limiting the production of new antibiotics.
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7
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Mohammadi A, Khatami F, Azimbeik Z, Khajavi A, Aloosh M, Aghamir SMK. Hospital-acquired infections in a tertiary hospital in Iran before and during the COVID-19 pandemic. Wien Med Wochenschr 2022; 172:220-226. [PMID: 35254565 PMCID: PMC8900468 DOI: 10.1007/s10354-022-00918-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Abstract
Infection prevention protocols are the accepted standard to control nosocomial infections. These protective measures intensified after the coronavirus 2019 (COVID-19) pandemic to reduce the risk of viral transmission. It is the rationale that this practice reduces nosocomial infections. We evaluated the impact of these protective measures on nosocomial infections in our center with more than 20,000 records of annual patient admission. In a retrospective study, we evaluated the incidence of nosocomial infections in Sina hospital for 9 months (April–December 2020) during the COVID-19 period and compared it with the 8 months in the pre-COVID period (April–November 2019). Despite decreasing the number of admissions during the COVID era (hospitalizations showed a reduction of 43.79%), the total hospital nosocomial infections remained unchanged; 4.73% in the pre-COVID period versus 4.78% during the COVID period. During the COVID period the infection percentages increased in the cardiovascular care unit (p-value = 0.002) and intensive care units (p-value = 0.045), and declined in cardiology (p-value = 0.046) and neurology (p-value = 0.019) wards. This study showed that intensifying the infection prevention protocols is important in decreasing the nosocomial infections in some wards (cardiology and neurology). Still, we saw increased nosocomial infection in some wards, e.g., the intensive care unit (ICU) and coronary care unit (CCU). Thus, enhanced infection prevention protocols implemented in hospitals to prevent the spread of a pandemic infection may not always decrease rates of other hospital-acquired infections during a pandemic. Due to limited resources, transfer of staff, and staff shortage due to quarantine measures may prohibit improved prevention procedures from effectively controlling nosocomial infections.
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Affiliation(s)
- Abdolreza Mohammadi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Azimbeik
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Aloosh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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Osme SF, Souza JM, Osme IT, Almeida APS, Arantes A, Mendes-Rodrigues C, Gontijo Filho PP, Ribas RM. Financial impact of healthcare-associated infections on intensive care units estimated for fifty Brazilian university hospitals affiliated to the unified health system. J Hosp Infect 2021; 117:96-102. [PMID: 34461175 DOI: 10.1016/j.jhin.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Studies show that healthcare-associated infections (HAIs) represent a crucial issue in healthcare and can lead to substantial economic impacts in intensive care units (ICUs). AIM To estimate direct costs associated with the most significant HAIs in 50 teaching hospitals in Brazil, affiliated to the unified health system (Sistema Único de Saúde: SUS). METHODS A Monte Carlo simulation model was designed to estimate the direct costs of HAIs; first, epidemiologic and economic parameters were established for each HAI based on a cohort of 949 critical patients (800 without HAI and 149 with); second, simulation based on three Brazilian prevalence scenarios of HAIs in ICU patients (29.1%, 51.2%, and 61.6%) was used; and third, the annual direct costs of HAIs in 50 university hospitals were simulated. FINDINGS Patients with HAIs had 16 additional days in the ICU, along with an extra direct cost of US$13.892, compared to those without HAIs. In one hypothetical scenario without HAI, the direct annual cost of hospital care for 26,649 inpatients in adult ICUs of 50 hospitals was US$112,924,421. There was an increase of approximately US$56 million in a scenario with 29.1%, and an increase of US$147 million in a scenario with 61.6%. The impact on the direct cost became significant starting at a 10% prevalence of HAIs, where US$2,824,817 is added for each 1% increase in prevalence. CONCLUSION This analysis provides robust and updated estimates showing that HAI places a significant financial burden on the Brazilian healthcare system and contributes to a longer stay for inpatients.
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Affiliation(s)
- S F Osme
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - J M Souza
- Institute of Geography, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - I T Osme
- York University, Gledon Campus, Toronto, Canada
| | - A P S Almeida
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - A Arantes
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - C Mendes-Rodrigues
- Institute of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - P P Gontijo Filho
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - R M Ribas
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil.
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Yi J, Kim KH. Identification and infection control of carbapenem-resistant Enterobacterales in intensive care units. Acute Crit Care 2021; 36:175-184. [PMID: 34380190 PMCID: PMC8435449 DOI: 10.4266/acc.2021.00409] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Infections with multidrug-resistant organisms among patients in intensive care units (ICUs) are associated with high mortality. Among multidrug-resistant organisms, carbapenem-resistant Enterobacterales (CRE) harbor important pathogens for healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infections. Risk factors for CRE colonization include underlying comorbid conditions, prior antibiotics exposure, prior use of healthcare facilities, device use, and longer ICU stay. The mortality rate due to invasive CRE infection is 22%–49%, and CRE colonization is associated with an approximately 10-fold increased risk of CRE infection. Infection control measures include hand hygiene, contact precautions, minimizing the use of devices, and environmental control. Additionally, implementing active surveillance of CRE carriage should be considered in ICU settings.
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Affiliation(s)
- Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kye-Hyung Kim
- Medical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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10
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Use of extracorporeal membrane oxygenation in postpartum patients with refractory shock or respiratory failure. Sci Rep 2021; 11:887. [PMID: 33441897 PMCID: PMC7806987 DOI: 10.1038/s41598-020-80423-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
Although extracorporeal membrane oxygenation (ECMO) is increasingly utilized, only a limited level of experience has been reported in postpartum cardiopulmonary failure. Ten critically ill postpartum patients who received ECMO were included between January 2010 and December 2018 in this retrospective observational study. The main indication for ECMO support was peripartum cardiomyopathy (n = 5), followed by postpartum hemorrhage (n = 2). Nine patients initially received veno-arterial ECMO, and one patient received veno-venous ECMO. Major bleeding occurred in six patients. The median number of units of red blood cells (RBC) transfused during ECMO was 14.5 units (interquartile range 6.8–37.8 units), and most RBC transfusions occurred on the first day of ECMO. The survival-to-discharge rate was 80%. Compared to the survival outcomes in female patients of similar age who received ECMO, the survival outcomes were significantly better in the study population (56% versus 80%, P = 0.0004). Despite the high risk of major bleeding, ECMO for patients with postpartum cardiac or respiratory failure showed excellent survival outcomes. ECMO is feasible in these patients and can be carried out with good outcomes in an experienced centre.
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11
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Ng DHL, Choy CY, Chan YH, Young BE, Fong SW, Ng LFP, Renia L, Lye DC, Chia PY. Fever Patterns, Cytokine Profiles, and Outcomes in COVID-19. Open Forum Infect Dis 2020; 7:ofaa375. [PMID: 32999893 PMCID: PMC7499767 DOI: 10.1093/ofid/ofaa375] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
Background Prolonged fever is associated with adverse outcomes in dengue viral infection. Similar fever patterns are observed in COVID-19 with unclear significance. Methods We conducted a hospital-based case–control study of patients admitted for COVID-19 with prolonged fever (fever >7 days) and saddleback fever (recurrence of fever, lasting <24 hours, after defervescence beyond day 7 of illness). Fever was defined as a temperature of ≥38.0°C. Cytokines were determined with multiplex microbead-based immunoassay for a subgroup of patients. Adverse outcomes were hypoxia, intensive care unit (ICU) admission, mechanical ventilation, and mortality. Results A total of 142 patients were included in the study; 12.7% (18/142) of cases had prolonged fever, and 9.9% (14/142) had saddleback fever. Those with prolonged fever had a median duration of fever (interquartile range [IQR]) of 10 (9–11) days for prolonged fever cases, while fever recurred at a median (IQR) of 10 (8–12) days for those with saddleback fever. Both prolonged (27.8% vs 0.9%; P < .01) and saddleback fever (14.3% vs 0.9%; P = .03) were associated with hypoxia compared with controls. Cases with prolonged fever were also more likely to require ICU admission compared with controls (11.1% vs 0.9%; P = .05). Patients with prolonged fever had higher induced protein–10 and lower interleukin-1α levels compared with those with saddleback fever at the early acute phase of disease. Conclusions Prolonged fever beyond 7 days from onset of illness can identify patients who may be at risk of adverse outcomes from COVID-19. Patients with saddleback fever appeared to have good outcomes regardless of the fever.
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Affiliation(s)
- Deborah H L Ng
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Chiaw Yee Choy
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Yi-Hao Chan
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Barnaby E Young
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Siew-Wai Fong
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore
| | - Lisa F P Ng
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore.,National University of Singapore Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Laurent Renia
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,National University of Singapore Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Yong Loo Lin School of Medicine, Singapore
| | - Po Ying Chia
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
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Park YH, Ko RE, Kang D, Park J, Jeon K, Yang JH, Park CM, Cho J, Park YS, Park H, Cho J, Guallar E, Suh GY, Chung CR. Relationship between Use of Rehabilitation Resources and ICU Readmission and ER Visits in ICU Survivors: the Korean ICU National Data Study 2008-2015. J Korean Med Sci 2020; 35:e101. [PMID: 32301293 PMCID: PMC7167400 DOI: 10.3346/jkms.2020.35.e101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/19/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes. METHODS A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit. RESULTS During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30-day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65-0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77-0.88). CONCLUSION In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.
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Affiliation(s)
- Yun Hee Park
- Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ryoung Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jinkyeong Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sook Park
- Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyejung Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Nosocomial Infection Agents of Şişli Hamidiye Etfal Training and Research Hospital: Comparison of 1995 and 2017 Data. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:78-82. [PMID: 32377138 PMCID: PMC7192263 DOI: 10.14744/semb.2019.03271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/07/2019] [Indexed: 11/20/2022]
Abstract
Objectives: Healthcare-associated infections (HCAI), which are important causes of mortality and morbidity, are high cost but preventable infections. This study aimed to determine hospital infections and isolates in Şişli Hamidiye Etfal Training and Hospital and to determine our local data. The changes in the distribution of the isolates in this process were evaluated by comparing the data of 1995 and today. Methods: Materials sent to the microbiology laboratory of our hospital in 1995 and 2017 from the patients hospitalized in the period between June 1-December 31 were evaluated concerning hospital infection. The standard manual methods were used in 1995, while in 2017, MALDI-TOF MS was used for identification and BD Phoenix automated system for antibiotic susceptibility. Results: In 1995, in total, 100 bacteria were isolated from pediatric and adult patients, of which 48 Pseudomonas aeruginosa (48/100), 37 Klebsiella spp (37/100). In 2017, Acinetobacter baumannii causing an important resistance problem was found to be increased in number. The main hospital infection causes were Acinetobacter baumannii (37/179), Klebsiella spp (41/179). In 2017, bacterial diversity was also increased. Conclusion: Isolated strains, as in the past, are gram-negative bacteria, Pseudomonas spp decreased in 2017, and Acinetobacter spp increased. The findings suggest that the automated systems used in microbiology laboratories may have a role in the detection of bacterial diversity.
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Shah A, Ma K, Bhanot N, AlhajHusain A, Cheema T. Acute Respiratory Distress Syndrome From an Infectious Disease Perspective. Crit Care Nurs Q 2019; 42:431-447. [PMID: 31449153 DOI: 10.1097/cnq.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is an inflammatory form of lung injury in response to various clinical entities or inciting events, quite frequently due to an underlying infection. Morbidity and mortality associated with ARDS are significant. Hence, early recognition and targeted treatment are crucial to improve clinical outcomes. This article encompasses the most common infectious etiologies of ARDS and their clinical presentations and management, along with commonly encountered infectious complications in such patients.
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Affiliation(s)
- Arpan Shah
- Divisions of Infectious Disease (Drs Shah and Bhanot) and Pulmonary-Critical Care (Drs Shah, Ma, AlhajHusain, and Cheema), Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
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Anning AS, Dugbatey AA, Kwakye-Nuako G, Asare KK. Antibiotic Susceptibility Pattern of Enterobacteriaceae Isolated from Raw Meat and Ghanaian Coin Currencies at Cape Coast Metropolis, Ghana: The Public Health Implication. Open Microbiol J 2019. [DOI: 10.2174/1874285801913010138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction:
The emergence and upsurge of Multiple Antibiotic Resistant (MDR) Enterobacteriaceae in the environment is a cause of concern as this can result in an outbreak and spread to healthcare settings. MDR Enterobacteriaceae have been associated with high morbidity and mortality due to delay in selecting and delivering active therapy in time.
Aims & Objectives:
The study was conducted to investigate the level of contamination of raw meat and Ghanaian coins in circulation at Cape Coast Metropolis. In all, 10 raw meat were sampled each from chevron and beef from Kotokuraba market, and 400 Ghanaian coin currencies retrieved from food vendors, students, transport operators and banks were used in this study.
Materials & Methods:
The Enterobacteriaceae species isolated were tested for their susceptibility to Ampicillin, Tetracycline (TET), Gentamicin (GEN), Cotrimoxazole (COT), Cefuroxime (CRX), Cefixime (CXM), Cefotaxime (CTX), Penicillin (PEN), Cloxacillin (CXC), Erythromycin (ERY) and Amikacin (AMK) antibiotics using Mueller-Hinton agar antibiotic diffusion technique. Of the isolated Enterobacteriaceae, 30% and 62% from chevron and beef respectively and 14.17%, 13.75% and 10.63% from food vendors, students and transport operators respectively showed resistance to some of the antibiotics tested.
Results & Discussion:
8.6% of the Escherichia coli (E. coli) isolated from chevon were resistant to CRXr-CHLr-AMPr-COTr-GEMr and 15.5% of CRXi-CHLi-AMPr-TETr-COTr from beef. 40.0% of E. coli isolated from coin currencies were resistant to CRXr-CHLr-AMPr-TETr-CTXr, 50.0% of Enterobacter spp to CRXr-CHLr-AMPr-TETr-CTXr, 16.67% of Proteus spp to CRXi-CHLi-AMPr-TETr-AMKi, 40% Pseudomonas spp to CRXr-AMPr-TETr-AMKi and 100% of Enterobacter spp to CRXr-AMPr-TETi-CTXr.
Conclusion:
The multidrug-resistant Enterobacteriaceae isolates from circulating Ghanaian coins and raw meats in the Cape Coast metropolis is an indication of an impending danger which requires immediate attention to prevent a possible outbreak and spread from the society to the hospital setting.
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Steroids in cardiac surgery trial: a substudy of surgical site infections. Can J Anaesth 2018; 66:182-192. [PMID: 30535668 DOI: 10.1007/s12630-018-1253-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/01/2018] [Accepted: 09/14/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Postoperative infection, particularly in cardiac surgery, results in significant morbidity, mortality, and healthcare cost. Identification of novel predictors of postoperative infection can target high-risk populations for prophylactic intervention. METHODS Steroids in cardiac surgery (SIRS) was a multi-centre randomized-controlled trial assessing intraoperative administration of methylprednisone during cardiac surgery, which enrolled 7,507 patients across 80 centres in 18 countries. It demonstrated that administration of steroids had no effect on mortality or major morbidity after cardiac surgery. Our primary objective was to identify risk factors for postoperative surgical site infections using SIRS participants as a cohort. We excluded patients who did not undergo surgery, died intraoperatively, or died within 48 hr of the operation. Patients were assessed for development of "surgical site infection" over the first 30 days postoperatively. Using theoretical and previously identified risk factors, we used forward stepwise entry to create a binary logistic regression model. RESULTS Follow-up at 30 days was complete for all patients; 7,406 were included in the cohort. Surgical site infection occurred in 180 (4.8%) and 184 (5.0%) of patients in the placebo and steroid arms respectively. Significant risk factors (P < 0.05 level) included: diabetes managed with insulin (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI] 1.13 to 2.12), oral hypoglycemics (aOR 1.60; 95% CI 1.18 to 2.16), or diet (aOR 1.81; 95% CI 1.16 to 2.83), female sex (aOR 1.34; 95% CI 1.05 to 1.71), renal failure with (aOR 2.03; 95% CI 1.06 to 3.91), and without (aOR 1.50; 95% CI 1.04 to 2.14) dialysis, > 96 min cardiopulmonary bypass (CPB) time (aOR 1.84; 95% CI 1.44 to 2.35), body mass index (BMI) < 22.3 (aOR 0.44; 95% CI 0.28 to 0.71) or > 30 (aOR 1.49; 95% CI 1.17 to 1.89), peak intensive care unit blood glucose (aOR 1.02 per mmol·L-1; 95% CI 1.00 to 1.04), and coronary artery bypass grafting (CABG) operation type (aOR 2.59; 95% CI 1.87 to 3.59). CONCLUSIONS Patients undergoing CABG, requiring longer CPB, with higher BMI, or with diabetes, are at elevated risk of surgical site infection. Strategies to mitigate this risk warrant further investigation.
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Montrucchio G, Sales G, Corcione S, De Rosa FG, Brazzi L. Choosing wisely: what is the actual role of antimicrobial stewardship in Intensive Care Units? Minerva Anestesiol 2018; 85:71-82. [PMID: 29991221 DOI: 10.23736/s0375-9393.18.12662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
More than two-thirds of critically ill patients receive an antimicrobial therapy with a percentage between 30% and 50% of all prescribed antibiotics reported to be unnecessary, inappropriate or misused. Since inappropriate prescription of antibiotic drugs concurs to dissemination of the multidrug resistant organisms, a reasoned antibiotics use is crucial especially in Intensive Care Unit (ICU), where up to 60% of the admitted patients develops an infection during their ICU stay. Even if the concept of antimicrobial stewardship (AS) has been clearly described as a series of coordinated interventions designed to improve antimicrobial agents use, few studies are reporting about its effectiveness to improve outcomes, reduce adverse events and costs and decrease resistance rate spread. Moreover, although it is recognized that AS programs are particularly indicated in the critical setting due to the huge number of antimicrobial drugs used, the optimal characteristics of these interventions and the best system to evaluate their effectiveness are still unclear. Specific interventions, designed tacking into account the peculiarities of the ICU setting, are hence necessary to set-up an "in-ICU-stewardship," including prompt identification of infected patients, selection of appropriate empiric treatments, optimization of dosing and route of administration, improvement of diagnostic techniques, early de-escalation to achieve shorter duration and avoid unnecessary therapies. The present narrative review summarizes the "state of art" about AS programmes and discusses the effects of the interventions possibly applied in ICU setting to optimize the patient's treatment, reduce the micro-organisms resistance and contain the hospital resources utilization.
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Affiliation(s)
| | - Gabriele Sales
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy.,Department of Anaesthesia, Intensive Care and Emergency, "Città della Salute e della Scienza" Hospital, Turin, Italy
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18
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Hoang D, Khawar N, George M, Gad A, Sy F, Narula P. Video didactic at the point of care impacts hand hygiene compliance in the neonatal intensive care unit (NICU). J Healthc Risk Manag 2018; 37:9-15. [PMID: 29405485 DOI: 10.1002/jhrm.21314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To increase the hand-washing (HW) duration of staff and visitors in the NICU to a minimum of 20 seconds as recommended by the CDC. METHODS Intervention included video didactic triggered by motion sensor to play above wash basin. Video enacted Centers for Disease Control and Prevention (CDC) HW technique in real time and displayed timer of 20 seconds. HW was reviewed from surveillance video. Swabs of hands plated and observed for qualitative growth (QG) of bacterial colonies. RESULTS In visitors, the mean HW duration at baseline was 16.3 seconds and increased to 23.4 seconds at the 2-week interval (p = .003) and 22.9 seconds at the 9-month interval (p < .0005). In staff, the mean HW duration at baseline was 18.4 seconds and increased to 29.0 seconds at 2-week interval (p = .001) and 25.7 seconds at the 9-month interval (p < .0005). In visitors, HW compliance at baseline was 33% and increased to 52% at the 2-week interval (p = .076) and 69% at the 9-month interval (p = .001). In staff, HW compliance at baseline was 42% and increased to 64% at the 2-week interval (p = .025) and 72% at the 9-month interval (p = .001). Increasing HW was significantly associated with linear decrease in bacterial QG. CONCLUSIONS The intervention significantly increased mean HW time, compliance with a 20-econd wash time and decreased bacterial QG of hands and these results were sustained over a 9-month period.
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Affiliation(s)
- Danthanh Hoang
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Nayaab Khawar
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Maria George
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Ashraf Gad
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Farrah Sy
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Pramod Narula
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
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Divatia JV, Abraham B. Multicenter observational study to evaluate epidemiology and resistance patterns of common intensive care unit-infections. Indian J Crit Care Med 2018; 22:20-26. [PMID: 29422728 PMCID: PMC5793017 DOI: 10.4103/ijccm.ijccm_394_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There is limited data regarding the microbiology of Intensive Care Unit (ICU)-acquired infections, such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and catheter-related bloodstream infections (CRBSI) from India. Objectives: To explore the microbiology and resistance patterns of ICU-acquired infections and evaluate their outcomes. Materials and Methods: This was a multicenter observational study, conducted by Indian Society of Critical Care Medicine (MOSER study) between August 2011 and October 2012. Patients in the ICU ≥48 h with any ICU-acquired infection within 14 days of index ICU stay were included. Patient demographics, relevant clinical, and microbiological details were collected. Follow-up until hospital discharge or death was done, and 6-month survival data were collected. Results: Of the 381 patients included in the study, 346 patients had 1 ICU infection and 35 had more than one ICU infection. Among patients with single infections, 223 had VAP with Acinetobacter being the most common isolate. CAUTI was seen in 42 patients with Klebsiella as the most common organism. CRBSI was seen in 81 patients and Klebsiella was the most common causative organism. Multidrug resistance was noted in 87.5% of Acinetobacter, 75.5% of Klebsiella, 61.9% of Escherichia coli, and 58.9% of Pseudomonas isolates, respectively. Staphylococcus constituted only 2.4% of isolates. Mortality rates were 26%, 11.9%, and 34.6% in VAP, CAUTI, and CRBSI, respectively. Conclusion: VAP is the most common infection followed by CRBSI and CAUTI. Multidrug-resistant Gram-negative bacteria are the most common organisms. Staphylococcus aureus is uncommon in the Indian setting.
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20
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Panhotra BR, Saxena AK, Al-Arabi AGAM. The effect of a continuous educational program on handwashing compliance among healthcare workers in an intensive care unit. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14690446040050030401] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Handwashing is simple, cost-effective and the single most important measure in the prevention of transmission of multiple antibiotic-resistant bacteria, which can spread via the contaminated hands of healthcare workers (HCWs) in intensive care units (ICUs). Despite this simplicity and efficacy, compliance with handwashing protocols is unsatisfactory among HCWs in ICUs. No single interventional measure is successful in improving handwashing compliance. A continuous educational program was started in February 1998 by the department of infection control, emphasising the importance of handwashing in the prevention of nosocomial infections in the ICU. It took the form of posters, lectures and regular discussions. The posters were pasted in all the strategic areas of the ICU, displaying the indications and precise technique of handwashing. HCWs were directly observed for handwashing compliance, while working in the ICU. Each indication of handwashing was counted as an opportunity of handwashing. Assessment of handwashing compliance was made once a year during the educational programme. In the final annual assessment in February 2002, out of 1,175 opportunities of handwashing, compliance was observed in 856 (72.8%) among all categories of staff. Highest compliance of 97.5% was recorded among nurses. The compliance among technicians was 47.7%, while the lowest compliance of 37.6% was observed among doctors (RR 2.591, p<0.0001). Opportunities of handwashing utilised with good technique were observed among 98.2% nurses. Handwashing compliance among females was significantly higher (76.2% versus 23.8%) than the male HCWs (RR 3.196, p<0.0001). A comparative study of the yearly assessments made since the start of the educational program also revealed significant increases in handwashing compliance among nurses (p<0.0001) and technicians (p<0.001), while no statistically significant changes in the handwashing behaviour among doctors was observed during the study period (February 1998 to February 2002). Disappointing handwashing compliance among doctors visiting and working in the ICU, despite their better understanding of hospital-acquired infections (HAI) and continuous educational programme remains a cause for concern. Additional efforts are required to discover more effective interventional measures to improve handwashing compliance among doctors.
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Affiliation(s)
- BR Panhotra
- King Fahad Hospital and Tertiary Care Center, Hofuf, Al-Hasa 31982, Saudi Arabia
| | - AK Saxena
- King Fahad Hospital and Tertiary Care Center, Hofuf, Al-Hasa 31982, Saudi Arabia
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21
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Lizan-Garcia M, Peyro R, Cortina M, Crespo MD, Tobias A. Nosocomial Infection Surveillance in a Surgical Intensive Care Unit in Spain, 1996-2000: A Time-Trend Analysis. Infect Control Hosp Epidemiol 2016; 27:54-9. [PMID: 16418988 DOI: 10.1086/499167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Accepted: 07/11/2005] [Indexed: 11/03/2022]
Abstract
Objective.To establish the occurrence, distribution, and secular time trend of nosocomial infections (NIs) in a surgical intensive care unit (ICU).Design and Setting.Follow-up study in a teaching hospital in Spain.Methods.In May 1995 we established an nosocomial infection surveillance system in our surgical ICU. We collected information daily for all patients who were in the ICU for at least 48 hours (546 patients from 1996 through 2000). We used the Centers for Disease Control and Prevention definitions and criteria for infections. Monthly, we determined the site-specific incidence densities of NIs, the rates of medical device use, and the Poisson probability distribution, which determined whether the case count equalled the number of expected cases (the mean number of cases during the previous year, with extreme values excluded). We compared yearly and monthly infection rates by Poisson regression, using site-specific NIs as a dependent variable and year and month as dummy variables. We tested annual trends with an alternative Poisson regression model fitting a single linear trend.Results.The average rate of catheter-associated urinary tract infections was 8.4 per 1000 catheter-days; that of ventilator-associated pneumonia, 21 per 1000 ventilator-days; and that of central line–associated bloodstream infections, 30 per 1000 central line–days. The rate of urinary tract infections did not change over the study period, but there was a trend toward decreases in the rates of central line–associated bloodstream infections and ventilator-associated pneumonia.Conclusion.An NI surveillance and control program contributed to a progressive decrease in NI rates.
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Affiliation(s)
- Maxima Lizan-Garcia
- Servicio Medicina Preventiva/Hospital General, C/ Hermanos Falco 3, Albacete, Spain.
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22
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Sadatsafavi H, Niknejad B, Zadeh R, Sadatsafavi M. Do cost savings from reductions in nosocomial infections justify additional costs of single-bed rooms in intensive care units? A simulation case study. J Crit Care 2016; 31:194-200. [DOI: 10.1016/j.jcrc.2015.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/01/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
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Mechanisms of Stress-Mediated Modulation of Upper and Lower Respiratory Tract Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 874:215-23. [PMID: 26589221 DOI: 10.1007/978-3-319-20215-0_10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Stress is an external factor known to be a potent exacerbator of respiratory infections. Most explanations of how stress affects susceptibility to airway infections focus on the immune system. However, evidence is increasing that respiratory pathogens are equally responsive to the hormonal output of stress. This chapter considers the bacterial and mucosal determinants of respiratory tract infections and their interrelationship during stressful conditions.
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Barr JJ, Dutilh BE, Skennerton CT, Fukushima T, Hastie ML, Gorman JJ, Tyson GW, Bond PL. Metagenomic and metaproteomic analyses of Accumulibacter phosphatis-enriched floccular and granular biofilm. Environ Microbiol 2015; 18:273-87. [PMID: 26279094 DOI: 10.1111/1462-2920.13019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/30/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Abstract
Biofilms are ubiquitous in nature, forming diverse adherent microbial communities that perform a plethora of functions. Here we operated two laboratory-scale sequencing batch reactors enriched with Candidatus Accumulibacter phosphatis (Accumulibacter) performing enhanced biological phosphorus removal. Reactors formed two distinct biofilms, one floccular biofilm, consisting of small, loose, microbial aggregates, and one granular biofilm, forming larger, dense, spherical aggregates. Using metagenomic and metaproteomic methods, we investigated the proteomic differences between these two biofilm communities, identifying a total of 2022 unique proteins. To understand biofilm differences, we compared protein abundances that were statistically enriched in both biofilm states. Floccular biofilms were enriched with pathogenic secretion systems suggesting a highly competitive microbial community. Comparatively, granular biofilms revealed a high-stress environment with evidence of nutrient starvation, phage predation pressure, and increased extracellular polymeric substance and cell lysis. Granular biofilms were enriched in outer membrane transport proteins to scavenge the extracellular milieu for amino acids and other metabolites, likely released through cell lysis, to supplement metabolic pathways. This study provides the first detailed proteomic comparison between Accumulibacter-enriched floccular and granular biofilm communities, proposes a conceptual model for the granule biofilm, and offers novel insights into granule biofilm formation and stability.
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Affiliation(s)
- Jeremy J Barr
- Department of Biology, San Diego State University, San Diego, CA, USA.,Advanced Water Management Centre (AWMC), The University of Queensland, Brisbane, Qld, Australia.,Environmental Biotechnology Cooperative Research Centre (EBCRC), Sydney, NSW, Australia
| | - Bas E Dutilh
- Theoretical Biology and Bioinformatics, Utrecht University, Utrecht, The Netherlands.,Centre for Molecular and Biomedical Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Marine Biology, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Connor T Skennerton
- Advanced Water Management Centre (AWMC), The University of Queensland, Brisbane, Qld, Australia.,Australian Centre for Ecogenomics, School of Chemistry and Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia.,Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Toshikazu Fukushima
- Advanced Water Management Centre (AWMC), The University of Queensland, Brisbane, Qld, Australia.,Division of Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba, Japan
| | - Marcus L Hastie
- Protein Discovery Centre, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Herston, Qld, Australia
| | - Jeffrey J Gorman
- Protein Discovery Centre, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Herston, Qld, Australia
| | - Gene W Tyson
- Advanced Water Management Centre (AWMC), The University of Queensland, Brisbane, Qld, Australia.,Australian Centre for Ecogenomics, School of Chemistry and Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
| | - Philip L Bond
- Advanced Water Management Centre (AWMC), The University of Queensland, Brisbane, Qld, Australia.,Environmental Biotechnology Cooperative Research Centre (EBCRC), Sydney, NSW, Australia
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Sharland M, Saroey P, Berezin EN. The global threat of antimicrobial resistance ‐ The need for standardized surveillance tools to define burden and develop interventions. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sharland M, Saroey P, Berezin EN. The global threat of antimicrobial resistance--The need for standardized surveillance tools to define burden and develop interventions. J Pediatr (Rio J) 2015; 91:410-2. [PMID: 26113428 DOI: 10.1016/j.jped.2015.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Mike Sharland
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom.
| | - Praveen Saroey
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
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Sligl WI, Dragan T, Smith SW. Nosocomial Gram-negative bacteremia in intensive care: epidemiology, antimicrobial susceptibilities, and outcomes. Int J Infect Dis 2015; 37:129-34. [DOI: 10.1016/j.ijid.2015.06.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/03/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022] Open
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Abstract
It is critical for health care personnel to recognize and appreciate the detrimental impact of intensive care unit (ICU)-acquired infections. The economic, clinical, and social expenses to patients and hospitals are overwhelming. To limit the incidence of ICU-acquired infections, aggressive infection control measures must be implemented and enforced. Researchers and national committees have developed and continue to develop evidence-based guidelines to control ICU infections. A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs, is essential. Infection control in the ICU is an evolving area of critical care research.
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Affiliation(s)
- Mohamed F Osman
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA
| | - Reza Askari
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA.
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Obolski U, Alon D, Hadany L, Stein GY. Resistance profiles of coagulase-negative staphylococci contaminating blood cultures predict pathogen resistance and patient mortality. J Antimicrob Chemother 2014; 69:2541-6. [DOI: 10.1093/jac/dku156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Bus L, Diet G, Gadeyne B, Leroux-Roels I, Claeys G, Steurbaut K, Benoit D, De Turck F, Decruyenaere J, Depuydt P. Validity analysis of a unique infection surveillance system in the intensive care unit by analysis of a data warehouse built through a workflow-integrated software application. J Hosp Infect 2014; 87:159-64. [PMID: 24856115 DOI: 10.1016/j.jhin.2014.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 03/30/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND An electronic decision support programme was developed within the intensive care unit (ICU) that provides an overview of all infection-related patient data, and allows ICU physicians to add clinical information during patient rounds, resulting in prospective compilation of a database. AIM To assess the validity of computer-assisted surveillance (CAS) of ICU-acquired infection performed by analysis of this database. METHODS CAS was compared with prospective paper-based surveillance (PBS) for ICU-acquired respiratory tract infection (RTI), bloodstream infection (BSI) and urinary tract infection (UTI) over four months at a 36-bed medical and surgical ICU. An independent panel reviewed the data in the case of discrepancy between CAS and PBS. FINDINGS PBS identified 89 ICU-acquired infections (13 BSI, 18 UTI, 58 RTI) and CAS identified 90 ICU-acquired infections (14 BSI, 17 UTI, 59 RTI) in 876 ICU admissions. There was agreement between CAS and PBS on 13 BSI (100 %), 14 UTI (77.8 %) and 42 RTI (72.4 %). Overall, there was agreement on 69 infections (77.5%), resulting in a kappa score of 0.74. Discrepancy between PBS and CAS was the result of capture error in 11 and 14 infections, respectively. Interobserver disagreement on probability (13 RTI) and focus (two RTI, one UTI) occurred for 16 episodes. The time required to collect information using CAS is less than 30% of the time required when using PBS. CONCLUSION CAS for ICU-acquired infection by analysis of a database built through daily workflow is a feasible surveillance method and has good agreement with PBS. Discrepancy between CAS and PBS is largely due to interobserver variability.
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Affiliation(s)
- L De Bus
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium.
| | - G Diet
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - B Gadeyne
- Department of Information Technology, Ghent University - iMinds, Ghent, Belgium
| | - I Leroux-Roels
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
| | - G Claeys
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
| | - K Steurbaut
- Department of Information Technology, Ghent University - iMinds, Ghent, Belgium
| | - D Benoit
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - F De Turck
- Department of Information Technology, Ghent University - iMinds, Ghent, Belgium
| | - J Decruyenaere
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - P Depuydt
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
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Molecular investigation of bacterial communities on intravascular catheters: no longer just Staphylococcus. Eur J Clin Microbiol Infect Dis 2014; 33:1189-98. [DOI: 10.1007/s10096-014-2058-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/08/2014] [Indexed: 01/18/2023]
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Erden IA, Gülmez D, Pamuk AG, Akincia SB, Hasçelik G, Aypar U. The growth of bacteria in infusion drugs: propofol 2% supports growth when remifentanil and pantoprazole do not. Braz J Anesthesiol 2013; 63:466-72. [PMID: 24565344 DOI: 10.1016/j.bjane.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/31/2012] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Contamination risks of propofol 2%, remifentanil, and pantoprazole; and in vitro effects of these drugs on the growth of common infective agents in intensive care units were evaluated. METHODS For detection of contamination risk, drugs were prepared ready to use under intensive care unit conditions, were tested. Effects of these three drugs on bacterial growth were also investigated. Drugs were prepared at the concentrations used in the intensive care unit and inoculated with common pathogens after which they were incubated at 4°C, 22°C and 36°C. Subcultures were made at 0, 2, 4 and 8h and colony counts were evaluated. Minimum inhibitory concentration values were determined for all drugs at 4°C, 22°C and 36°C. RESULTS No growth was observed in the drugs prepared in the intensive care unit. Propofol tended to support while remifentanil inhibited bacterial growth. Effect of pantoprozole differed according to the bacteria tested. None of the drugs showed antibacterial activity at the maximum concentrations which may be achieved in blood of the patients. CONCLUSION Propofol strongly supports the growth of the microorganisms tested, although remifentanil and pantoprazole do not. Therefore, it is important to follow the strict aseptic techniques for the preparation of propofol.
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Affiliation(s)
- Ismail Aydin Erden
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Dolunay Gülmez
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Almila Gulsun Pamuk
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seda Banu Akincia
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülşen Hasçelik
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ulkü Aypar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Erden IA, Gülmez D, Pamuk AG, Akinci SB, Hasçelik G, Aypar U. Crescimento de bactérias em agentes de infusão: Propofol 2% sustenta o crescimento, enquanto remifentanil e pantoprazol não. Rev Bras Anestesiol 2013. [DOI: 10.1016/j.bjan.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Arora N, Patel K, Engell CA, LaRosa JA. The Effect of Interdisciplinary Team Rounds on Urinary Catheter and Central Venous Catheter Days and Rates of Infection. Am J Med Qual 2013; 29:329-34. [PMID: 24006027 DOI: 10.1177/1062860613500519] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Interdisciplinary team (IDT) rounds were initiated in the intensive care unit (ICU) in June 2010. All catheters were identified by location, duration, and indication. Catheters with no indication were removed. Data were collected retrospectively on catheter days and associated infections in a 20-month period before and after intervention with an aggregate of 19 207 ICU days before and 23 576 ICU days after institution of rounds. Results showed a statistically significant decrease in the number of indwelling urinary catheter (IUC) days (5304 vs 4541 days, P = .05) and catheter-associated urinary tract infection rates (4.71 vs 1.98 infections/1000 ICU days, P < .05). Central line days statistically increased after IDT rounds (3986 vs 4305 days, P < .05) but the catheter-related bloodstream infection rate trended down (3.5 vs 1.6 infections/1000 ICU days, P = .62). This analysis suggests that IDT rounds may have an impact on reducing the number of IUC days and associated infections.
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Uchino M, Ikeuchi H, Matsuoka H, Bando T, Ichiki K, Nakajima K, Takahashi Y, Tomita N, Takesue Y. Catheter-associated bloodstream infection after bowel surgery in patients with inflammatory bowel disease. Surg Today 2013; 44:677-84. [DOI: 10.1007/s00595-013-0683-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 03/04/2013] [Indexed: 12/13/2022]
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Abstract
Critically ill patients in intensive care units are subject to many complications associated with therapy. Many of these complications are health care-associated infections and are related to indwelling devices, including ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection; surgical site infection, venous thromboembolism, deep venous thrombosis, and pulmonary embolus are other common complications. All efforts should be undertaken to prevent these complications in surgical critical care, and national efforts are under way for each of these complications. In this article, epidemiology, risk factors, diagnosis, treatment, and prevention of these complications in critically ill patients are discussed.
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Affiliation(s)
- Kathleen B To
- Division of Acute Care Surgery [Trauma, Burns, Surgical Critical Care, Emergency Surgery], Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109-5033, USA
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Abstract
Disinfection and sterilization in hospitals, is of increasing concern. Nosocomial infections can be defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital. Nosocomial infections are associated with a great deal of morbidity, mortality, and increased financial burden
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Affiliation(s)
- Angela Revelas
- Department of Pathological, General Hospital of St.Nicolaos, Crete-Greece
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Suka M, Yoshida K, Takezawa J. Impact of intensive care unit-acquired infection on hospital mortality in Japan: A multicenter cohort study. Environ Health Prev Med 2012; 9:53-7. [PMID: 21432299 DOI: 10.1007/bf02897932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Accepted: 01/07/2004] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens. METHODS By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox's proportional hazard model. RESULTS After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11,95% CI:0.94-1.31) and drug-resistant pathogens (HR 1.42,95% CI: 1.15-1.77). CONCLUSIONS The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.
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Affiliation(s)
- Machi Suka
- Department of Preventive Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, 216-8511, Kawasaki, Kanagawa, Japan,
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Devarajan J, Vydyanathan A, Xu M, Murthy SM, McCurry KR, Sessler DI, Sabik J, Bashour CA. Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery. J Am Coll Surg 2012; 214:1008-16.e4. [PMID: 22541987 DOI: 10.1016/j.jamcollsurg.2012.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/09/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The best time to perform a tracheostomy in cardiac surgery patients who require prolonged postoperative mechanical ventilation remains unknown. The primary aim of this investigation was to determine if tracheostomy performed before postoperative day 10 improves patient outcomes. STUDY DESIGN We conducted a retrospective review of prospectively collected patient information obtained from the Anesthesiology Institute Patient Registry on adult patients recovering from coronary artery bypass grafting and/or valve surgery. Demographic and comorbidity patient variables were obtained. Patients were divided into 2 groups based on the timing of their tracheostomy: early (less than 10 days) and late (14 to 28 days). The 2 patient groups were matched using propensity scores and compared on morbidity and in-hospital mortality outcomes. The primary outcomes measures were length of stay, morbidity, and in-hospital mortality. RESULTS After propensity matching (n = 114 patients/group), early tracheostomy was associated with decreased in-hospital mortality (21.1% vs 40.4%, p = 0.002) and cardiac morbidity (14.0% vs 33.3%, p < 0.001), along with decreased ICU (median difference 7.2 days, p < 0.001) and hospital (median difference 7.5 days, p = 0.010) durations. The occurrence of sternal wound infection (6.0% vs 19.5%, p = 0.009) was less in the early tracheostomy group, but mediastinitis did not differ significantly (3.5% vs 7.0%, p = 0.24). CONCLUSIONS Tracheostomy within 10 postoperative days in cardiac surgery patients who require prolonged mechanical ventilation was associated with decreased length of stay, morbidity, and mortality.
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Affiliation(s)
- Jagan Devarajan
- Department of General Anesthesia, Cleveland Clinic, Cleveland, OH 44195, USA
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Sachdev G, Napolitano LM. Postoperative pulmonary complications: pneumonia and acute respiratory failure. Surg Clin North Am 2012; 92:321-44, ix. [PMID: 22414416 DOI: 10.1016/j.suc.2012.01.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postoperative pulmonary complications (atelectasis, pneumonia, pulmonary edema, acute respiratory failure) are common, particularly after abdominal and thoracic surgery, pneumonia and atelectasis being the most common. Postoperative pneumonia is associated with increased morbidity, length of hospital stay, and costs. Few institutions have pneumonia prevention programs for surgical patients, and these should be strongly considered. Acute respiratory failure is a life-threatening pulmonary complication that requires institution of mechanical ventilation and admission to the intensive care unit, and is associated with increased risk for ventilator-associated pneumonia. This article discusses epidemiology, risk factors, diagnosis, treatment, and prevention of these pulmonary complications in surgical patients.
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Affiliation(s)
- Gaurav Sachdev
- Division of Acute Care Surgery (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0033, USA
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Hooper CY, Smith WJ. Telavancin for the treatment of nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). Ther Clin Risk Manag 2012; 8:131-7. [PMID: 22547931 PMCID: PMC3333464 DOI: 10.2147/tcrm.s23247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Telavancin is a bactericidal lipoglycopeptide antibiotic that is structurally related to vancomycin. It demonstrates in vitro activity against a variety of Gram-positive pathogens including, but not limited to, methicillin-resistant Staphylococcus aureus (MRSA). Telavancin is currently FDA-approved for the treatment of complicated skin and skin-structure infections. Recently, two randomized clinical trials demonstrated the efficacy and safety of telavancin compared to vancomycin for the treatment of nosocomial pneumonia. Overall, telavancin has a favorable safety profile. However, mild gastrointestinal disturbances and reversible increases in serum creatinine were observed in clinical studies. Additional clinical studies are needed to evaluate telavancin's efficacy and safety in comparison to other antistaphylococcal agents for the treatment of infections such as bacteremia and endocarditis.
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Affiliation(s)
- Candace Y Hooper
- Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, OK, USA
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Abstract
Changing market demand, aging population, severity of illnesses, hospital acquired infection, clinical staff shortage, technological innovations, and environmental concerns-all are shaping the critical care practice in the United States today. However, how these will shape intensive care unit (ICU) design in the coming decade is anybody's guess. In a graduate architecture studio of a research university, students were asked to envision the ICU of the future while responding to the changing needs of the critical care practice through innovative technological means. This article reports the ICU design solutions proposed by these students.
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Abstract
Multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and toxin-producing organisms such as Clostridium difficile have been a concern for over 30 years. An increasing focus is being placed on the role that an unclean environment can play in transmission. This article describes the pathogens of concern and the use of a robust environmental cleaning program to help reduce the chances for hospital-acquired infections.
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The impact of health care restructuring on nosocomially acquired blood stream infections. Can J Infect Dis 2010; 11:34-7. [PMID: 18159263 DOI: 10.1155/2000/869091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/1999] [Accepted: 07/28/1999] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the impact of the health care restructuring, which occurred in Alberta in 1995, on the occurrence of nosocomial blood stream infection and risk factors for these infections at the University of Alberta Hospital. PATIENTS AND METHODS Changes in patient population, hospital bed numbers, admissions and hospital days for 1993 and 1994 (1993/94) were compared with those for 1996 and 1997(1996/97). Central venous catheter (CVC) use in intensive care units (ICU), days of total parenteral nutrition (TPN) and hemodialysis were compared for the two time periods. Prospectively collected data obtained by monitoring blood culture results on nosocomial blood stream infections in 1993/94 were compared with those obtained in 1996/97. RESULTS Hospital bed number fell by 10% between 1993/94 and 1996/97. Annual admissions fell by 19% and patient days by 17%. Some services markedly increased patient days (neurosurgery 49%, nephrology 30%, orthopedic surgery 24%), and others markedly reduced patient days (obstetrics and gynecology 99%, ophthalmology 100%, adult medicine 41%, general paediatrics 38%). ICU use of CVCs increased by 41%, TPN days increased by 25% and hemodialysis runs increased by 9%. Annual nosocomial blood stream infections increased by 31% and the annual rate per 10,000 patient days increased by 60%. TPN-related blood stream infection rates and ICU CVC infection rates did not change from 1993/94 to 1996/97. CONCLUSIONS Hospital restructuring has been associated with a 31% increase in nosocomial blood stream infection number and a 60% increase in rate. The increase has been associated with a change in patient populations and increases in risk factors for blood stream infection.
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Napolitano LM. Perspectives in surgical infections: what does the future hold? Surg Infect (Larchmt) 2010; 11:111-23. [PMID: 20374004 DOI: 10.1089/sur.2010.9932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Lena M Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109-0033, USA.
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Petrosillo N, Capone A, Di Bella S, Taglietti F. Management of antibiotic resistance in the intensive care unit setting. Expert Rev Anti Infect Ther 2010; 8:289-302. [PMID: 20192683 DOI: 10.1586/eri.10.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Over the past few decades, an alarming increase of infections caused by antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus species, carbapenem-resistant Pseudomonas aeruginosa, extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp., and multidrug-resistant Acinetobacter spp., has been observed, particularly in intensive care units. For clinicians, the rising resistance rate observed in nosocomial pathogens, when coupled with the lack of effective antimicrobials, represents the real challenge in the therapeutic management of critically ill patients. The contribution of clinicians in minimizing the increasing trend of resistance is represented by reduction of the patients' exposure to antibiotics, which reduces the resistance-selecting pressure, and by avoiding unnecessary antibiotic treatments. Recent issues on strategies to minimize resistance development and to appropriately manage critically ill patients with infections caused by multidrug-resistant organisms in the intensive care unit setting are discussed in this article.
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Affiliation(s)
- Nicola Petrosillo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Via Portuense, 292-00149 Rome, Italy.
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Lee MC, Saxinger L, Forgie SE, Taylor G. Trends in nosocomial bloodstream infections following health care restructuring in Alberta between 1999 and 2005. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2010; 21:e1-5. [PMID: 21358873 PMCID: PMC2852287 DOI: 10.1155/2010/123764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A previous study at the University of Alberta Hospital/Stollery Children's Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring. DESIGN Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records. SETTING The University of Alberta Hospital/Stollery Children's Hospital (617 adult and 139 pediatric beds, respectively). PATIENTS All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs. RESULTS There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged. CONCLUSIONS These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.
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Affiliation(s)
- Mao-Cheng Lee
- Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital
| | - Lynora Saxinger
- Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital
| | - Sarah E Forgie
- Division of Infectious Diseases, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, Alberta
| | - Geoffrey Taylor
- Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital
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Fuehner T, Lueders D, Niedermeyer J, Ziesing S, Welte T, Hoeper MM. Evaluation of a 24-hour emergency bronchoscopy service in a tertiary care hospital. Ther Adv Respir Dis 2009; 3:65-71. [PMID: 19443517 DOI: 10.1177/1753465809335753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Flexible bronchoscopy has become an important diagnostic and therapeutic tool for the management of patients with various diseases of the chest. Availability of a 24-hour bronchoscopy service equipped with experienced personnel is becoming increasingly important especially for intensive care patients. However, such services have been implemented only in a few medical centres. The aim of this study was to evaluate the usage of a 24-hour emergency service in a large university hospital with a 1 year prospective analysis of emergency bronchoscopy service in a tertiary care centre. METHODS Frequencies, indications and efficiency of therapeutic interventions were evaluated after each bronchoscopy using a specially designed questionnaire. All bronchoscopies were performed as emergency procedures out of operational schedule. A total of 614 emergency bronchoscopies were performed, 88% of them in intensive care units. RESULTS The vast majority (84.5%) of the procedures were necessary for therapeutic interventions; that is, atelectasis, airway secretion, aspiration or bronchopulmonary bleeding. According to prespecified criteria, 37.6% (n = 195) of therapeutic procedures were assessed as 'very helpful' and 3.9% (n = 20) as 'life saving'. Diagnostic bronchoscopies were performed mainly to collect airway material for microbiological evaluations in immunocompromised patients. In these cases, the diagnostic yield was approximately 50%. CONCLUSION The availability of a 24-hour bronchoscopy service has been found to improve patient care and was occasionally considered life saving. Thus, comparable services should be made more widely available.
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Affiliation(s)
- Thomas Fuehner
- Department of Respiratory Medicine, Medizinische Hochschule Hannover, Hannover, Germany.
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Anderson DJ, Richet H, Chen LF, Spelman DW, Hung YJ, Huang AT, Sexton DJ, Raoult D. Seasonal variation in Klebsiella pneumoniae bloodstream infection on 4 continents. J Infect Dis 2008; 197:752-6. [PMID: 18260762 DOI: 10.1086/527486] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Klebsiella pneumoniae causes serious, life-threatening infections in humans in endemic and epidemic settings. The objective of this study was to determine whether the incidence of K. pneumoniae bloodstream infection (BSI) was higher during warm months. METHODS We analyzed surveillance data from 2001-2006 at 4 hospitals located on 4 continents. Incidence rates (IRs) and IR ratios (IRRs) were determined using multivariable Poisson regression. RESULTS In total, 1189 cases of K. pneumonia BSIs occurred during 6,671,337 patient-days. The IR of K. pneumoniae BSI during the 4 warmest months of the year was 2.23/10,000 patient-days, whereas the IR of K. pneumoniae BSI for the other 8 months was 1.55/10,000 patient-days (IRR, 1.46 [95% confidence interval, 1.04-2.06]; P= .03). In contrast, no seasonal variation was identified in rates of BSI due to Enterobacter or Serratia species. Using Poisson regression, we showed that temperature (P< .0001) and dew point (a marker for relative humidity; P< .0001) were both linearly predictive of increasing rates of K. pneumoniae BSI. CONCLUSIONS Environmental pressures may lead to an increase in the IR of K. pneumoniae BSI during the warmest months of the year.
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