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Turkistani R, Aghashami AS, Badhduoh SS, Fadhel RT, Albaity AO, Malli IA, Osman S, Alshehri RA, Aldabbagh MA. The Effect of Ventilator-Associated Pneumonia on the Time-to-Extubation in Adult and Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study. Cureus 2024; 16:e52070. [PMID: 38213942 PMCID: PMC10782147 DOI: 10.7759/cureus.52070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) ranks as a prominent hospital-acquired infection. VAP has been shown to have a detrimental impact on patients and healthcare facilities, leading to extended hospital stays, increased demands on medical resources, and higher financial expenses. This study aims to assess the influence of VAP on time-to-extubation and length of hospital stay (LOS) in patients requiring mechanical ventilation for more than 48 hours in pediatric and adult intensive care units (ICU). METHODS This retrospective cohort study included adult and pediatric ICU patients admitted to King Abdul-Aziz Medical City in Jeddah, Saudi Arabia, from June 2016 to May 2020. The study encompassed ICU patients who required mechanical ventilation for more than 48 hours. Time-to-extubation and LOS were measured in days and compared between those who developed VAP and those who did not. A Kaplan-Meier curve was employed to estimate and compare both groups' survival functions (time-to-event). RESULTS The study involved 367 subjects, with 226 adults and 141 pediatric patients. Among the 367 mechanically ventilated patients, 33 (8.99%) developed VAP during their ICU stay, with 9 of them being children. VAP patients experienced a significantly longer time to extubation than non-VAP patients (13.5 vs. six days, p<0.0001). Likewise, ICU stays for VAP patients were significantly longer than those for non-VAP patients (19.5 vs. 13 days, p<0.002). However, the mortality rate at 28 days from intubation did not exhibit significant differences between the VAP and non-VAP groups (36.36% vs. 27.54%, p=0.283). CONCLUSION This study underscores that VAP patients face a substantial delay in time-to-extubation and an increased length of ICU stay compared to non-VAP patients. Such findings substantially impact the cost of hospital care and the risk of exposure to other infection-related complications while under mechanical ventilation. Enhanced preventive measures are warranted to reduce the occurrence and consequences of VAP.
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Affiliation(s)
- Raneem Turkistani
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Afnan S Aghashami
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Shatha S Badhduoh
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Rowaida T Fadhel
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Amani O Albaity
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Israa A Malli
- Basic Medical Sciences, King Saud Bin Abdulaziz University for Health and Sciences College of Medicine, Jeddah, SAU
| | - Sara Osman
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah, SAU
| | | | - Mona A Aldabbagh
- Department of Pediatrics, Division of Infectious Diseases, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- Institutional Review Board, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Bonell A, Azarrafiy R, Huong VTL, Viet TL, Phu VD, Dat VQ, Wertheim H, van Doorn HR, Lewycka S, Nadjm B. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis 2019; 68:511-518. [PMID: 29982303 PMCID: PMC6336913 DOI: 10.1093/cid/ciy543] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/29/2018] [Indexed: 01/31/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.
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Affiliation(s)
- Ana Bonell
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | - Vu Thi Lan Huong
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Thanh Le Viet
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | | | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - H Rogier van Doorn
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Sonia Lewycka
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Behzad Nadjm
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
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Al-Abdely HM, Khidir Mohammed Y, Rosenthal VD, Orellano PW, ALazhary M, Kaid E, Al-Attas A, Hawsawi G, Kelany A, Hussein B, Esam B, Altowerqi R, Alkamaly MA, Tawfic NA, Cruzpero E, Al Rashidi RM, Thomas R, Molano AM, Al Enazy HA, Al Adwani FM, Casuyon Pahilanga AM, Alatawi S, Nakhla R, Al Adwani FM, Gasmin Aromin R, Balon Ubalde E, Hanafy Diab H, Kader NA, Hassan Assiry IY, Sawan FA, Ammari HE, Mashiakhy AM, Santiago EB, Chua CM, Dalis IM, Arishi HM, Lozada R, Al-Zaydani Asiri IA, Ahmed H, Jarie A, Al-Qathani AS, Al-Alkami HY, AlDalaton M, Alih SJ, Alaliany MJ, Helali NJ, Sindayen G, Malificio AA, Al Dossari HB, Algethami AG, Mohamed D, Yanne L, Tan A, Babu S, Abduljabbar SM, Rushdi H, Fernandez J, Hussain WM, Rajavel RD, Bukhari SZ, Turkistani AA, Mushtaq JJ, Albeladi E, Aboushoushah S, Qushmaq N, Shyrine L, Philipose J, Raees M, AbdulKhalik NS, Madco M, Abdulghany M, Manao A, Acostan C, Safwat R, Halwani M, Abdul Aal NA, Thomas A, Abdulatif SM, Ariola NC, Mutwalli AH, Ariola N, Bohlega E, Simon S, Damlig E, Elsherbini SG, Krishne IT, Abraham S, Ali Karrar MA, Gosn NA, Al Hindi AA, Jaha RN, AlQahtani SM, Abdul Aziz AO, Demaisip NL, Laungayan Cortez E, Cabato AF, Gonzales Celiz JM, Al Raey MA, Al Darani SA, Aziz MR, Manea BA, Samy E, Briones S, Krishnan R, Raees SS, Tabassum K, Ghalilah KM, Alradady M, Al Qatri A, Chaouali M, Elsisi M, Aldossary HA, Al-Suliman S, Al Talib AA, Albaghly N, Haqlre Mia ME, Al-Gethamy MM, Alamri DM, Al-Saadi AS, Ayugat EP, Al Hazazi NA, Al Hussain MI, Caminade Y, Santos AJ, Abdulwahab MH, Al-Garni BT. Impact of the International Nosocomial Infection Control Consortium (INICC)’s multidimensional approach on rates of ventilator-associated pneumonia in intensive care units in 22 hospitals of 14 cities of the Kingdom of Saudi Arabia. J Infect Public Health 2018; 11:677-684. [DOI: 10.1016/j.jiph.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/09/2018] [Accepted: 06/05/2018] [Indexed: 01/30/2023] Open
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Rosenthal VD, Desse J, Maurizi DM, Chaparro GJ, Orellano PW, Chediack V, Cabrera R, Golschmid D, Silva CG, Vimercati JC, Stagnaro JP, Perez I, Spadaro ML, Montanini AM, Pedersen D, Paniccia TL, Ríos Aguilera AM, Cermesoni R, Mele JI, Alda E, Paldoro AE, Ortta AR, Cooke B, García MC, Obed MN, Domínguez CV, Saúl PA, Rodríguez del Valle MC, Bianchi AC, Alvarez G, Pérez R, Oyola C. Impact of the International Nosocomial Infection Control Consortium's multidimensional approach on rates of ventilator-associated pneumonia in 14 intensive care units in 11 hospitals of 5 cities within Argentina. Am J Infect Control 2018; 46:674-679. [PMID: 29329916 DOI: 10.1016/j.ajic.2017.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. METHODS A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. RESULTS We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days-with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days-with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). CONCLUSIONS Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina.
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Hospital-acquired lower respiratory tract infections among high risk hospitalized patients in a tertiary care teaching hospital in China: An economic burden analysis. J Infect Public Health 2017; 11:507-513. [PMID: 29113779 DOI: 10.1016/j.jiph.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 10/07/2017] [Accepted: 10/12/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Data on the economic burden of hospital-acquired lower respiratory tract infection (LRTI) among high risk hospitalized patients are lacking in China. This study aims to fill this knowledge gap. METHODS We used a prospective matched cohort design, comparing patients with LRTIs and 1:1 matched patients without LRTIs. Study period was from January 2013 to December 2015 analyzing inpatients from high risk wards - intensive care unit (ICU), dialysis, hematology, etc. - in a tertiary hospital. Hospital information system and hospital infection surveillance system were applied to extract necessary information. The primary outcome was incidence of hospital-acquired LRTIs, and the secondary was economic burden outcomes, including incremental medical costs and prolonged length of stay (LOS). Wilcoxon's signed rank test was used to explore the differences in the economic burden. RESULTS Among 5990 hospital visitors over the period of time, 895 (14.94%) had hospital-acquired LRTIs. We analyzed 340 patients with LRTIs and 340 respective controls without infections. The median hospital costs for patients with ICU-acquired LRTIs were significantly higher than those without LRTIs in other wards ($12,301.17 vs. $4674.64, P<0.01). The average attributable cost per patient was $2853.93 ($6916.48 vs. $4062.55, P<0.01). Patients from hematology department had the longest LOS, at 15days (25days vs. 10 days, P<0.01). An LRTI led to an attributable increase in LOS by 8days on average (P<0.01). Western medicine, treatment and laboratory test were the dominant contributors to the growth in overall medical costs in hospital-acquired LRTIs. CONCLUSIONS Hospital-acquired LRTI imposed considerable economic burden on patients hospitalized in high risk wards in China. This study provides the first data for economic evaluation of LRTI, highlighting the urgent need to establish targeted preventive strategies to minimize the occurrence of this complication to reduce economic burden.
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Rosenthal VD. International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system. Am J Infect Control 2016; 44:e81-90. [PMID: 26975716 DOI: 10.1016/j.ajic.2016.01.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) is an international, nonprofit, multicentric health care-associated infection (HAI) cohort surveillance network with a methodology based on the U.S. Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN). The INICC was founded in 1998 to promote evidence-based infection control in limited-resource countries through the analysis of surveillance data collected by their affiliated hospitals. The INICC is comprised of >3,000-affiliated infection control professionals from 1,000 hospitals in 67 countries and is the only source of aggregate standardized international data on HAI epidemiology. Having published reports on device-associated (DA) HAI (HAI) and surgical site infections (SSIs) from 43 countries and several reports per individual country, the INICC showed DA HAI and SSI rates in limited-resources countries are 3-5 times higher than in high-income countries. METHODS The INICC developed the INICC Multidimensional Approach (IMA) for HAI prevention with 6 components, bundles with 7-13 elements, and the INICC Surveillance Online System (ISOS) with 15 modules. RESOURCES In this article the IMA, the ISOS for outcome surveillance of HAIs and process surveillance of bundles to prevent HAIs, and the use of surveillance data feedback are described. COMMENTS Remarkable features of the IMA and ISOS are INICC's applying of the latest published CDC-NHSN HAI definitions, including their updates and revisions in 2008, 2013, 2015 and 2016; INICC's informatics system to check accuracy of fulfillment of CDC-NHSN HAI criteria; and INICC's system to check compliance with each bundle element.
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Rosenthal VD, Dueñas L, Sobreyra-Oropeza M, Ammar K, Navoa-Ng JA, Casares ACBD, Machuca LDJ, Ben-Jaballah N, Hamdi A, Villanueva VD, Tolentino MCV. Findings of the International Nosocomial Infection Control Consortium (INICC), Part III Effectiveness of a Multidimensional Infection Control Approach to Reduce Central Line—Associated Bloodstream Infections in the Neonatal Intensive Care Units of 4 Developing Countries. Infect Control Hosp Epidemiol 2015; 34:229-37. [DOI: 10.1086/669511] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce central line-associated bloodstream infection (CLABSI) rates.Setting.Four neonatal intensive care units (NICUs) of INICC member hospitals from El Salvador, Mexico, Philippines, and Tunisia.Patients.A total of 2,241 patients hospitalized in 4 NICUs for 40,045 bed-days.Methods.We conducted a before-after prospective surveillance study. During Phase 1 we performed active surveillance, and during phase 2 the INICC multidimensional infection control approach was implemented, including the following practices: (1) central line care bundle, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CLABSI rates, and (6) performance feedback of infection control practices. We compared CLABSI rates obtained during the 2 phases. We calculated crude stratified rates, and, using random-effects Poisson regression to allow for clustering by ICU, we calculated the incidence rate ratio (IRR) for each follow-up time period compared with the 3-month baseline.Results.During phase 1 we recorded 2,105 CL-days, and during phase 2 we recorded 17,117 CL-days. After implementation of the multidimensional approach, the CLABSI rate decreased by 55%, from 21.4 per 1,000 CL-days during phase 1 to 9.7 per 1,000 CL-days during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33–0.63]). The IRR was 0.53 during the 4–12-month period and 0.07 during the final period of the study (more than 45 months).Conclusions.Implementation of a multidimensional infection control approach was associated with a significant reduction in CLABSI rates in NICUs.
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Rosenthal VD, Dueñas L, Sobreyra-Oropeza M, Ammar K, Navoa-Ng JA, Casares ACBD, Machuca LDJ, Ben-Jaballah N, Hamdi A, Villanueva VD, Tolentino MCV. Findings of the International Nosocomial Infection Control Consortium (INICC), Part III Effectiveness of a Multidimensional Infection Control Approach to Reduce Central Line—Associated Bloodstream Infections in the Neonatal Intensive Care Units of 4 Developing Countries. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/522261] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce central line-associated bloodstream infection (CLABSI) rates.Setting.Four neonatal intensive care units (NICUs) of INICC member hospitals from El Salvador, Mexico, Philippines, and Tunisia.Patients.A total of 2,241 patients hospitalized in 4 NICUs for 40,045 bed-days.Methods.We conducted a before-after prospective surveillance study. During Phase 1 we performed active surveillance, and during phase 2 the INICC multidimensional infection control approach was implemented, including the following practices: (1) central line care bundle, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CLABSI rates, and (6) performance feedback of infection control practices. We compared CLABSI rates obtained during the 2 phases. We calculated crude stratified rates, and, using random-effects Poisson regression to allow for clustering by ICU, we calculated the incidence rate ratio (IRR) for each follow-up time period compared with the 3-month baseline.Results.During phase 1 we recorded 2,105 CL-days, and during phase 2 we recorded 17,117 CL-days. After implementation of the multidimensional approach, the CLABSI rate decreased by 55%, from 21.4 per 1,000 CL-days during phase 1 to 9.7 per 1,000 CL-days during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33–0.63]). The IRR was 0.53 during the 4–12-month period and 0.07 during the final period of the study (more than 45 months).Conclusions.Implementation of a multidimensional infection control approach was associated with a significant reduction in CLABSI rates in NICUs.
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A descriptive study of nosocomial infections in an adult intensive care unit in fiji: 2011-12. J Trop Med 2014; 2014:545160. [PMID: 25309601 PMCID: PMC4182895 DOI: 10.1155/2014/545160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/25/2014] [Indexed: 01/26/2023] Open
Abstract
Nosocomial infections in an intensive care unit (ICU) are common and associated with a high mortality but there are no published data from the Oceania region. A retrospective study in Fiji's largest ICU (2011-12) reported that 114 of a total 663 adult ICU admissions had bacteriological culture-confirmed nosocomial infection. The commonest sites of infection were respiratory and bloodstream. Gram negative bacteria were the commonest pathogens isolated, especially Klebsiella pneumoniae (extended-spectrum β-Lactamase-producing), Acinetobacter, and Pseudomonas species. Mortality for those with a known outcome was 33%. Improved surveillance and implementation of effective preventive interventions are needed.
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Nhu NTK, Lan NPH, Campbell JI, Parry CM, Thompson C, Tuyen HT, Hoang NVM, Tam PTT, Le VM, Nga TVT, Nhu TDH, Van Minh P, Nga NTT, Thuy CT, Dung LT, Yen NTT, Van Hao N, Loan HT, Yen LM, Nghia HDT, Hien TT, Thwaites L, Thwaites G, Chau NVV, Baker S. Emergence of carbapenem-resistant Acinetobacter baumannii as the major cause of ventilator-associated pneumonia in intensive care unit patients at an infectious disease hospital in southern Vietnam. J Med Microbiol 2014; 63:1386-1394. [PMID: 25038137 PMCID: PMC4170484 DOI: 10.1099/jmm.0.076646-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that affects up to 30 % of intubated and mechanically ventilated patients in intensive care units (ICUs) worldwide. The bacterial aetiology and corresponding antimicrobial susceptibility of VAP is highly variable, and can differ between countries, national provinces and even between different wards in the same hospital. We aimed to understand and document changes in the causative agents of VAP and their antimicrobial susceptibility profiles retrospectively over an 11 year period in a major infectious disease hospital in southern Vietnam. Our analysis outlined a significant shift from Pseudomonas aeruginosa to Acinetobacter spp. as the most prevalent bacteria isolated from quantitative tracheal aspirates in patients with VAP in this setting. Antimicrobial resistance was common across all bacterial species and we found a marked proportional annual increase in carbapenem-resistant Acinetobacter spp. over a 3 year period from 2008 (annual trend; odds ratio 1.656, P = 0.010). We further investigated the possible emergence of a carbapenem-resistant Acinetobacter baumannii clone by multiple-locus variable number tandem repeat analysis, finding a blaOXA-23-positive strain that was associated with an upsurge in the isolation of this pathogen. We additionally identified a single blaNDM-1-positive A. baumannii isolate. This work highlights the emergence of a carbapenem-resistant clone of A. baumannii and a worrying trend of antimicrobial resistance in the ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.
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Affiliation(s)
- Nguyen Thi Khanh Nhu
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Phu Huong Lan
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Christopher M Parry
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Corinne Thompson
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Minh Hoang
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Pham Thi Thanh Tam
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vien Minh Le
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, CA, USA.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Vu Thieu Nga
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Do Hoang Nhu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Pham Van Minh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Thu Nga
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Cao Thu Thuy
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Le Thi Dung
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nguyen Van Hao
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Huynh Thi Loan
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ho Dang Trung Nghia
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Louise Thwaites
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Vinh Chau
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Baker
- The London School of Hygiene and Tropical Medicine, London, UK.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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El-Saed A, Balkhy HH, Al-Dorzi HM, Khan R, Rishu AH, Arabi YM. Acinetobacter is the most common pathogen associated with late-onset and recurrent ventilator-associated pneumonia in an adult intensive care unit in Saudi Arabia. Int J Infect Dis 2013; 17:e696-701. [DOI: 10.1016/j.ijid.2013.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 01/30/2013] [Accepted: 02/02/2013] [Indexed: 01/12/2023] Open
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12
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The author replies. Crit Care Med 2013; 41:e97. [DOI: 10.1097/ccm.0b013e318291b89e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leistner R, Kankura L, Bloch A, Sohr D, Gastmeier P, Geffers C. Attributable costs of ventilator-associated lower respiratory tract infection (LRTI) acquired on intensive care units: a retrospectively matched cohort study. Antimicrob Resist Infect Control 2013; 2:13. [PMID: 23556425 PMCID: PMC3620937 DOI: 10.1186/2047-2994-2-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/29/2013] [Indexed: 01/07/2023] Open
Abstract
Background Lower respiratory tract infections (LRTI) are the most common hospital-acquired infections on ICUs. They have not only an impact on each patient’s individual health but also result in a considerable financial burden for the healthcare system. Our aim was to determine the costs and the length of stay of patients with ICU-acquired LRTI. Methods We used a retrospectively matched cohort design, comparing patients with ICU-acquired LRTI and ICU patients without LRTI. LRTI was diagnosed using the definitions of the Centers for Disease Control and Prevention (CDC). Study period was from January to December 2010 analyzing patients from 10 different ICUs (medical, surgical, interdisciplinary). The device utilization ratio was defined as number of ventilator days divided by number of patient days and the device-associated LRTI rate was defined as number of ventilator associated LRTI divided by number of ventilator days. Patients were matched by age, sex, and prospectively obtained Simplified Acute Physiology Score II (SAPS II). The length of ICU stay of control patients needed to be at least as long as that of LRTI-patients before onset of LRTI. We used the Wilcoxon signed-rank test for continuous variables and the McNemar’s test for categorical variables. Results The analyzed ICUs had 40,772 patient days in the study period with a median ventilation utilization ratio of 56 (IQR 42–65). The median device-associated LRTI rate was 3.35 (IQR 0.96-5.36) per 1,000 ventilation days. We analyzed 49 patients with ICU-acquired LRTI and 49 respective controls without LRTI. The median hospital costs for LRTI patients were significantly higher than for patients without LRTI (45,041 € vs. 26,467 €; p < .001). The attributable costs per LRTI patient were 17,015 € (p < .001). Patients with ICU acquired LRTI stayed longer in the hospital than patients without (36 days vs. 24 days; p = 0.011). An LRTI lead to an attributable increase in length of stay by 9 days (p = 0.011). Conclusions ICU-acquired LRTI is associated with increased hospital costs and prolonged hospital stay. Hospital management should therefore implement control measurements to keep the incidence of ICU-acquired LRTI as low as possible.
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Affiliation(s)
- Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of nosocomial Infections, Charité, University Medicine Berlin, Hindenburgdamm 27, Berlin, 12203, Germany.
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Wolkewitz M, Allignol A, Harbarth S, de Angelis G, Schumacher M, Beyersmann J. Time-dependent study entries and exposures in cohort studies can easily be sources of different and avoidable types of bias. J Clin Epidemiol 2012; 65:1171-80. [PMID: 23017635 DOI: 10.1016/j.jclinepi.2012.04.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/21/2012] [Accepted: 04/20/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To display and discuss the reasons and consequences of length and time-dependent bias. They might occur in presence of a time-dependent study entry or a time-dependent exposure which might change from unexposed to exposed. STUDY DESIGN AND SETTING Recalling the popular study of Oscar nominees and using a real-data example from hospital epidemiology, we give innovative and easy-to-understand graphical presentations of how these biases corrupt the analyses via distorted time-at-risk. Cumulative hazard plots and Cox proportional hazards models were used. We are building bridges to medical disciplines such as critical care medicine, hepatology, pharmaco-epidemiology, transplantation medicine, neurology, gynecology and cardiology. RESULTS In presence of time-dependent bias, the hazard ratio (comparing exposed with unexposed) is artificially underestimated. The length bias leads to an artificial underestimation of the overall hazard. When both biases coexist it can lead to different directions of biased hazard ratios. CONCLUSION Since length and time-dependent bias might occur in several medical disciplines, we conclude that understanding and awareness are the best prevention of survival bias.
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Affiliation(s)
- Martin Wolkewitz
- Institute of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany.
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Rasslan O, Seliem ZS, Ghazi IA, El Sabour MA, El Kholy AA, Sadeq FM, Kalil M, Abdel-Aziz D, Sharaf HY, Saeed A, Agha H, El-Abdeen SAEWZ, El Gafarey M, El Tantawy A, Fouad L, Abel-Haleim MM, Muhamed T, Saeed H, Rosenthal VD. Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health 2012; 5:394-402. [DOI: 10.1016/j.jiph.2012.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 07/19/2012] [Accepted: 07/22/2012] [Indexed: 01/30/2023] Open
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International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am J Infect Control 2012; 40:396-407. [PMID: 21908073 DOI: 10.1016/j.ajic.2011.05.020] [Citation(s) in RCA: 297] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 05/19/2011] [Indexed: 02/08/2023]
Abstract
The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia).
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Wolkewitz M, Allignol A, Graves N, Barnett AG. Is 27 really a dangerous age for famous musicians? Retrospective cohort study. BMJ 2011; 343:d7799. [PMID: 22187325 PMCID: PMC3243755 DOI: 10.1136/bmj.d7799] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the "27 club" hypothesis that famous musicians are at an increased risk of death at age 27. Design Cohort study using survival analysis with age as a time dependent exposure. Comparison was primarily made within musicians, and secondarily relative to the general UK population. SETTING The popular music scene from a UK perspective. PARTICIPANTS Musicians (solo artists and band members) who had a number one album in the UK between 1956 and 2007 (n = 1046 musicians, with 71 deaths, 7%). MAIN OUTCOME MEASURES Risk of death by age of musician, accounting for time dependent study entry and the number of musicians at risk. Risk was estimated using a flexible spline which would allow a bump at age 27 to appear. RESULTS We identified three deaths at age 27 amongst 522 musicians at risk, giving a rate of 0.57 deaths per 100 musician years. Similar death rates were observed at ages 25 (rate = 0.56) and 32 (0.54). There was no peak in risk around age 27, but the risk of death for famous musicians throughout their 20s and 30s was two to three times higher than the general UK population. CONCLUSIONS The 27 club is unlikely to be a real phenomenon. Fame may increase the risk of death among musicians, but this risk is not limited to age 27.
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Affiliation(s)
- Martin Wolkewitz
- Freiburg Center of Data Analysis and Modelling, University of Freiburg and Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany
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