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Catheter-Associated Urinary Tract Infection in Intensive Care Unit Patients at a Tertiary Care Hospital, Hail, Kingdom of Saudi Arabia. Diagnostics (Basel) 2022; 12:diagnostics12071695. [PMID: 35885599 PMCID: PMC9322978 DOI: 10.3390/diagnostics12071695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are some of the most common hospital-acquired infections (HAIs). Prolonged hospitalization, invasive devices such as catheters, and irrational use of antimicrobial agents are believed to be the major causes of high rates of HAIs. Infections such as pyelonephritis, urethritis, cystitis, and prostatitis are the main concerns in catheterized ICU patients. In these cases, Gram-negative bacteria are the most common bacteria. The present study was undertaken to determine the frequency, antibiograms, disease pattern, and risk factors involved in providing an advocacy recommendation to prevent CAUTI. A total of 1078 patients were admitted to the hospital ICU, out of which healthcare-associated infection was reported in 316 patients. CAUTI was reported only in 70 patients. Klebsiella pneumoniae (20%) was the predominant isolate, with Serratia (3%) and Providencia (3%) species being the least common isolates in this study. The present study provides CAUTI incidence rates in a tertiary care hospital in Hail, Saudi Arabia. Furthermore, information on the risk factors of common associated CAUTI causative organisms and their antibiogram patterns are also presented. This study provides vital information that can be used to formulate an effective antibiotic stewardship program that can be implemented throughout the kingdom.
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Kumar A, Chaudhry D, Goel N, Tanwar S. Epidemiology of Intensive Care Unit-acquired Infections in a Tertiary Care Hospital of North India. Indian J Crit Care Med 2022; 25:1427-1433. [PMID: 35027805 PMCID: PMC8693113 DOI: 10.5005/jp-journals-10071-24058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The majority of nosocomial infections in the hospital setting are found in intensive care units (ICUs). The present study was undertaken to determine the incidence, risk factors, causative microorganisms, and outcome of various ICU-acquired infections. Materials and methods The patients admitted to the ICU of a teaching hospital in North India were prospectively studied. Detailed history, clinical examination, acute physiology and chronic health evaluation score II, simplified acute physiology score II, sequential organ failure assessment score, and baseline investigations were recorded. Patients were assessed daily till 14th day for nosocomial infection as per Centers for Disease Control and Prevention (CDC) guidelines and were followed till death or discharge. Incidence, risk factors, and outcome parameters were calculated using Student t-test, Chi-square test, and stepwise multivariate logistic regression model. Results The overall incidence rate of ICU infections was 27.9%. The most common ICU-acquired infection was ventilator-associated pneumonia followed by catheter-related bloodstream infection and catheter-associated urinary tract infection. Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were implicated in most of the infections. ICU length of stay (LOS) >7 days, neurological dysfunction, endotracheal intubation, ischemic heart disease, and use of antacids/H2 blockers were significantly associated with ICU-acquired infections. The mortality rate was 32.8 and 28.8% in patients with and without ICU infections, respectively (p = 0.531). The ICU LOS (19.23 ± 12.79 days) was significantly higher in the ICU infections group (p <0.001). Conclusion Ventilator-associated pneumonia was the most common nosocomial infection in our study. Gram-negative microorganisms were the predominant causative agents for various ICU-acquired infections. Mortality was not found to be affected but ICU LOS was significantly prolonged as a consequence of the development of ICU-acquired infection. How to cite this article Kumar A, Chaudhry D, Goel N, Tanwar S. Epidemiology of Intensive Care Unit-acquired Infections in a Tertiary Care Hospital of North India. Indian J Crit Care Med 2021;25(12):1427-1433.
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Affiliation(s)
- Amit Kumar
- Department of Medicine, ESIC Postgraduate Institute of Medical Sciences and Research, New Delhi, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pt BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nidhi Goel
- Department of Microbiology, Pt BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shweta Tanwar
- Indian Council of Medical Research, New Delhi, India
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Russo Fiorino G, Maniglia M, Marchese V, Aprea L, Torregrossa MV, Campisi F, Favaro D, Calamusa G, Amodio E. Healthcare-associated infections over an eight year period in a large university hospital in Sicily (Italy, 2011-2018). J Infect Prev 2021; 22:220-230. [PMID: 34659460 DOI: 10.1177/17571774211012448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/01/2021] [Indexed: 01/21/2023] Open
Abstract
Background Up to 7% of hospitalised patients acquire at least one healthcare-associated infection (HAI). The aim of the present study was to quantify the burden of HAIs in an Italian hospital, identifying involved risk factors. Methods Prevalence point study carried out from 2011 to 2018. For each recruited patient, a data entry form was compiled including information on demographics, hospital admission, risk factors, antimicrobial treatment, and infection if present. Results A total of 2844 patients were included and 218 (7.03%) reported an infection. HAI prevalence rates showed a significant increase (average annual per cent change (AAPC) +33.9%; p=0.018) from 2011 to 2014 whereas from 2014 to 2018 a gradual decline was observed (AAPC -6.15%; p=0.35). Urinary tract infection was the most common HAI (25.2%) and a total of 166 (76.1%) pathogens were isolated from 218 infections. Enterococcus and Klebsiella species were the most prevalent pathogens, causing 15.1% and 14.5% of HAIs, respectively. A significant higher risk of HAIs was found in patients exposed to central catheter (adjusted odds ratio (adj-OR)=5.40), peripheral catheter (adj-OR=1.89), urinary catheter (adj-OR=1.46), National Healthcare Safety Network surgical intervention (adj-OR=1.48), ultimately fatal disease (adj-OR=2.19) or rapidly fatal disease (adj-OR=2.09) and in patients with longer hospital stay (adj-OR=1.01). Conclusion Intervention programmes based on guidelines dissemination and personnel training can contribute to reduce the impact of HAI. Moreover, McCabe score can be a very powerful and efficient predictor of risk for HAI. Finally, an unexpected very high burden of disease due to Enterobacteriaceae and Gram positive cocci that could be related to the frequent use of carbapenems and third generation cephalosporins in this hospital was found.
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Affiliation(s)
- Giusy Russo Fiorino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
| | - Marialuisa Maniglia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
| | - Valentina Marchese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
| | - Luigi Aprea
- Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" Palermo, Italy
| | - Maria V Torregrossa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
- Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" Palermo, Italy
| | - Fabio Campisi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
| | - Dario Favaro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
| | - Giuseppe Calamusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
- Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" Palermo, Italy
| | - Emanuele Amodio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" - University of Palermo, Italy
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Otero ML, Menezes RC, Ferreira IBB, Issa FL, Agareno G, Carmo TA, Arriaga MB, Fukutani KF, Pamplona Neto L, Agareno S, Filgueiras Filho NM, Akrami KM, Andrade BB. Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections. Infect Drug Resist 2020; 13:2811-2817. [PMID: 32848430 PMCID: PMC7430765 DOI: 10.2147/idr.s264276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil. Methods Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI. Results A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23–39.27, OR: 2.48, 95% CI 1.17–5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality. Conclusion Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.
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Affiliation(s)
- Matheus L Otero
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Rodrigo C Menezes
- Curso de Medicina, União Metropolitana Para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil
| | | | - Francine L Issa
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Gabriel Agareno
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Thomas Azevedo Carmo
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - María B Arriaga
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | - Kiyoshi F Fukutani
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | | | - Sydney Agareno
- Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Nivaldo M Filgueiras Filho
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Universidade Do Estado Da Bahia (UNEB), Salvador, Bahia, Brazil.,Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Kevan M Akrami
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA
| | - Bruno B Andrade
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil.,Escola Bahiana De Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
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Öztürk R, Murt A. Epidemiology of urological infections: a global burden. World J Urol 2020; 38:2669-2679. [PMID: 31925549 DOI: 10.1007/s00345-019-03071-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/28/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Urinary tract infections (UTIs) are among the most frequent infections in clinical practice worldwide. Their frequency and burden must be higher than available data suggest because they are not among mandatory diseases to be notified. CLASSIFICATION OF URINARY INFECTIONS Although there are many different proposals for classifying UTIs, classifications based on acquisition settings and complication status are more widely used. These include community- acquired UTIs (CAUTIs) or healthcare-associated UTIs (HAUTIs) and uncomplicated or complicated UTIs. EPIDEMIOLOGY OF UROLOGICAL INFECTIONS AND GLOBAL BURDEN As the most frequently seen infectious disease, CAUTIs affect more than 150 million people annually. Complicated UTIs in particular constitute a huge burden on healthcare systems as a frequent reason for hospitalization. The prevalence of HAUTIs ranges between 1.4% and 5.1%, and the majority of them are catheter-related UTIs. Community-onset HAUTIs have gained importance in recent years. CONCLUSION As frequent infectious diseases, UTIs create clinical and economic burdens on healthcare systems, and they also affect quality of life determinants.
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Affiliation(s)
- Recep Öztürk
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey.
| | - Ahmet Murt
- Department of Internal Medicine, Nephrology Unit, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Karlović K, Nikolić J, Arapović J. Ceftriaxone treatment of complicated urinary tract infections as a risk factor for enterococcal re-infection and prolonged hospitalization: A 6-year retrospective study. Bosn J Basic Med Sci 2018; 18:361-366. [PMID: 29750894 DOI: 10.17305/bjbms.2018.3544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 11/16/2022] Open
Abstract
A frequent complication during hospital stay of patients with urinary tract infections (UTIs) is a re-infection of the urinary tract after the initial improvement. In this study, we investigated the impact of two empirical antibiotic therapies on the outcomes of complicated bacterial UTIs. We retrospectively evaluated 325 adult patients hospitalized during 6 years period with a diagnosis of complicated bacterial UTIs. The patients were classified into two groups according to the antibiotic therapy: ceftriaxone- and co-amoxiclav+gentamicin-treated group. Clinical data were collected from the patient records into a designed form. Output data included information on the treatment outcome, length of stay (LOS), development of complications, and cause of re-infections. The patients treated with ceftriaxone had significantly longer LOS (p = 0.012), as well as higher occurrence of complications (p = 0.023) and urinary tract re-infections (p < 0.001), compared to co-amoxiclav+gentamicin-treated group. No significant difference was observed in the treatment outcome between the two groups (p = 0.137). The most common complication in both investigated groups were re-infections of the urinary tract, and Enterococcus spp. was detected as the cause of re-infections only in patients from ceftriaxone-treated group (40/69 patients). Out of the 40 ceftriaxone-treated patients with enterococcal urinary tract re-infections, 35 patients had one or more chronic diseases and 29 patients had urinary catheter inserted. Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay.
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Affiliation(s)
- Kristian Karlović
- Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina.
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The Emerging Resistance in Nosocomial Urinary Tract Infections: From the Pediatrics Perspective. Mediterr J Hematol Infect Dis 2018; 10:e2018055. [PMID: 30210748 PMCID: PMC6131100 DOI: 10.4084/mjhid.2018.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/03/2018] [Indexed: 11/12/2022] Open
Abstract
Background Healthcare-associated infections results in increased health care costs and mortality. There are limited studies concerning the distribution of the etiologic agents and the resistance patterns of the microorganisms causing healthcare-associated urinary tract infections (HA-UTI) in pediatric settings. Objectives The aim of this study was to evaluate the distribution and antibiotic susceptibility patterns of pathogens causing HA-UTI in children. Material and Methods Isolates from 138 children with UTI who were hospitalized in pediatric, neonatal and pediatric surgery intensive care units were reviewed. Results Most common isolated organism was Klebsiella pneumoniae (34.1%) and Escherichia coli (26.8%). Among the Pseudomonas aeruginosa, Meropenem and imipenem resistance rates were 46.2% and 38.5%. Extended-spectrum beta-lactamase (ESBL) production was present in 48 Klebsiella species (82.8%). Among ESBL positive Klebsiella species, the rate of meropenem and imipenem resistance was 18.8%, and ertapenem resistance was 45.9%. Extended spectrum beta-lactamase production was present in 27 (72.9%) Escherichia coli species. Among ESBL positive E. coli, the rate of meropenem and imipenem resistance was 7.4%, and ertapenem resistance was 14.8% Conclusions Emerging meropenem resistance in P. aeruginosa, higher rates of ertapenem resistance in ESBL positive ones in E. coli and Klebsiella species in pediatric nosocomial UTI are important notifying signs for superbug infections.
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Rozenfeld KL, Nitzan O, Peretz A. Presence of anaerobic bacteria in the urinary tract of catheterized ICU patients. Eur J Clin Microbiol Infect Dis 2018; 37:2131-2136. [PMID: 30121803 DOI: 10.1007/s10096-018-3349-9] [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: 07/17/2018] [Accepted: 08/05/2018] [Indexed: 12/20/2022]
Abstract
The purpose of our study was to examine the extent of anaerobic bacteriuria in catheterized patients in the intensive care unit (ICU) and to search for risk factors for anaerobic bacteriuria. A urine culture was collected from each patient every 2 days during their ICU stay and incubated under aerobic and anaerobic conditions. Aerobic and anaerobic blood cultures were collected as well. Demographic, clinical, and laboratory data were collected from patient files. Ninety patients were included in this study, 32 women (35.6%) and 58 men (64.4%). A total of 663 cultures were obtained. Twenty-three patients (25.6%) had growth of anaerobic bacteria in a urinary culture at some point during ICU stay, with Bifidobacterium being the most common pathogen. Aerobic urinary cultures were positive in 38 patients (42.2%). A significant statistical correlation was found between the presence of aerobic and anaerobic bacteria in urine culture (p = 0.0004). Treatment with glycopeptides was found to be inversely associated with anaerobic bacteriuria (p = 0.0292), and treatment with imidazoles was associated with an increased risk of anaerobic bacteriuria (p = 0.0186). None of the patients developed bacteremia with the same anaerobic pathogen that was isolated from their urine. Anaerobic bacteriuria is a common phenomenon in catheterized patients in the ICU. Further studies are needed in order to define the clinical significance of these findings in such patients and in other patient groups as well as in healthy people.
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Affiliation(s)
| | - Orna Nitzan
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Infectious Disease Unit, The Baruch Padeh Medical Center Poriya, Tiberias, Israel
| | - Avi Peretz
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel. .,Clinical Microbiology Laboratory, The Baruch Padeh Medical Center Poriya, Hanna Senesh 818/2, Tiberias, Israel.
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Is a project needed to prevent urinary tract infection in patients admitted to spanish ICUs? Med Intensiva 2018; 43:63-72. [PMID: 29426705 DOI: 10.1016/j.medin.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze epidemiological data of catheter-associated urinary tract infection (CAUTI) in critically ill patients admitted to Spanish ICUs in order to assess the need of implementing a nationwide intervention program to reduce these infections. DESIGN Non-intervention retrospective annual period prevalence analysis. SETTING Participating ICUs in the ENVIN-UCI multicenter registry between the years 2007-2016. PATIENTS Critically ill patients admitted to the ICU with catheter-associated urinary tract infection (CAUTI). MAIN VARIABLES Incidence rates per 1,000 catheter-days; urinary catheter utilization ratio; proportion of CAUTIs in relation to total health care-associated infections (HAIs). RESULTS A total of 187,100 patients, 137,654 (73.6%) of whom had a urinary catheter in place during 1,215,673 days (84% of days of ICU stay) were included. In 4,539 (3.3%) patients with urinary catheter, 4,977 CAUTIs were diagnosed (3.6 episodes per 100 patients with urinary catheter). The CAUTI incidence rate showed a 19% decrease between 2007 and 2016 (4.69 to 3.8 episodes per 1,000 catheter-days), although a sustained urinary catheter utilization ratio was observed (0.84 [0.82-0.86]). The proportion of CAUTI increased from 23.3% to 31.9% of all HAIs controlled in the ICU. CONCLUSIONS Although CAUTI rates have declined in recent years, these infections have become proportionally the first HAIs in the ICU. The urinary catheter utilization ratio remains high in Spanish ICUs. There is room for improvement, so that a CAUTI-ZERO project in our country could be useful.
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Dettenkofer M, Frank U, Just HM, Lemmen S, Scherrer M. Epidemiologische Grundlagen nosokomialer Infektionen. PRAKTISCHE KRANKENHAUSHYGIENE UND UMWELTSCHUTZ 2018. [PMCID: PMC7123496 DOI: 10.1007/978-3-642-40600-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Viele Faktoren tragen zu erhöhten nosokomialen Infektionsraten bei. Der Anteil alter Patienten mit chronischen Krankheiten und Immunsupprimierter steigt. Fortschritte in Diagnostik und Therapie resultieren immer häufiger in invasiven Eingriffen. Antibiotikaresistenzen und Folgen nosokomialer Infektionen erfordern daher eine verlässliche Epidemiologie. Konsequenzen nosokomialer Infektionen betreffen einerseits Patienten (Morbidität und Letalität), aber auch das Gesundheitswesen, dem zusätzliche, teilweise vermeidbare finanzielle Belastungen entstehen.
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Affiliation(s)
- Markus Dettenkofer
- Gesundheitsverbund Landkreis Konstanz, Institut für Krankenhaushygiene & Infektionsprävention, Radolfzell, Germany
| | - Uwe Frank
- Sektion Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Sebastian Lemmen
- Zentralbereich für Krankenhaushygiene, Universitätsklinikum Aachen, Aachen, Germany
| | - Martin Scherrer
- Stabsstelle Techn. Krankenhaushygiene, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Galiczewski JM, Shurpin KM. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure. Intensive Crit Care Nurs 2017; 40:26-34. [PMID: 28237090 DOI: 10.1016/j.iccn.2016.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. AIM The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. METHODS This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. RESULTS The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. CONCLUSION The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes.
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Affiliation(s)
- Janet M Galiczewski
- Stony Brook University School of Nursing, United States; Long Island Jewish Medical Center, United States.
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Abstract
Strains of Klebsiella pneumoniae are frequently opportunistic pathogens implicated in urinary tract and catheter-associated urinary-tract infections of hospitalized patients and compromised individuals. Infections are particularly difficult to treat since most clinical isolates exhibit resistance to several antibiotics leading to treatment failure and the possibility of systemic dissemination. Infections of medical devices such as urinary catheters is a major site of K. pneumoniae infections and has been suggested to involve the formation of biofilms on these surfaces. Over the last decade there has been an increase in research activity designed to investigate the pathogenesis of K. pneumoniae in the urinary tract. These investigations have begun to define the bacterial factors that contribute to growth and biofilm formation. Several virulence factors have been demonstrated to mediate K. pneumoniae infectivity and include, but are most likely not limited to, adherence factors, capsule production, lipopolysaccharide presence, and siderophore activity. The development of both in vitro and in vivo models of infection will lead to further elucidation of the molecular pathogenesis of K. pneumoniae. As for most opportunistic infections, the role of host factors as well as bacterial traits are crucial in determining the outcome of infections. In addition, multidrug-resistant strains of these bacteria have become a serious problem in the treatment of Klebsiella infections and novel strategies to prevent and inhibit bacterial growth need to be developed. Overall, the frequency, significance, and morbidity associated with K. pneumoniae urinary tract infections have increased over many years. The emergence of these bacteria as sources of antibiotic resistance and pathogens of the urinary tract present a challenging problem for the clinician in terms of management and treatment of individuals.
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Cassini A, Plachouras D, Eckmanns T, Abu Sin M, Blank HP, Ducomble T, Haller S, Harder T, Klingeberg A, Sixtensson M, Velasco E, Weiß B, Kramarz P, Monnet DL, Kretzschmar ME, Suetens C. Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study. PLoS Med 2016; 13:e1002150. [PMID: 27755545 PMCID: PMC5068791 DOI: 10.1371/journal.pmed.1002150] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 09/09/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Estimating the burden of healthcare-associated infections (HAIs) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE) project and 2011-2012 data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs. METHODS AND FINDINGS The included HAIs were healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). The burden of these HAIs was measured in disability-adjusted life years (DALYs). Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease. HAP and HA primary BSI were associated with the highest burden because of their high severity. The cumulative burden of the six HAIs was higher than the total burden of all other 32 communicable diseases included in the BCoDE 2009-2013 study. The main limitations of the study are the variability in the parameter estimates, in particular the disease models' case fatalities, and the use of the Rhame and Sudderth formula for estimating incident number of cases from prevalence data. CONCLUSIONS We estimated the EU/EEA burden of HAIs in DALYs in 2011-2012 using a transparent and evidence-based approach that allows for combining estimates of morbidity and of mortality in order to compare with other diseases and to inform a comprehensive ranking suitable for prioritization. Our results highlight the high burden of HAIs and the need for increased efforts for their prevention and control. Furthermore, our model should allow for estimations of the potential benefit of preventive measures on the burden of HAIs in the EU/EEA.
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Affiliation(s)
- Alessandro Cassini
- European Centre for Disease Prevention and Control, Stockholm, Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail: (AC); (DP)
| | - Diamantis Plachouras
- European Centre for Disease Prevention and Control, Stockholm, Sweden
- * E-mail: (AC); (DP)
| | | | | | | | | | | | | | | | | | | | | | - Piotr Kramarz
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Mirjam E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Abstract
PURPOSE OF REVIEW Both in the community and hospital setting, urinary tract infections (UTIs) are common. Initial appropriate empirical treatment requires a good knowledge of epidemiological data. In this review, the most recent global epidemiological data of UTIs have been summarized. RECENT FINDINGS Community-associated UTI (CAUTI) prevalence is 0.7% and the main risk factors are age, history of UTI, sexual activity and diabetes. The most common pathogen is Escherichia coli and resistance rates to common antibiotics depend very much on the geographical location. The lowest observed resistance was for fosfomycin (range: 0-2.9%), nitrofurantoin (range: 0-4.4%) and mecillinam (range: 0-4%). Healthcare-associated UTI (HAUTI) frequency among HCAIs is 12.9 (confidence interval: 10.2-16%), 19.6 and 24% in the United States, Europe and developing countries, respectively. In urology departments, the prevalence is 5.1%. Resistance to almost all antibiotics in HAUTIs is above 20% and there is a significant geographical variation. Community onset HAUTIs bacterial spectrum is similar to hospital onset HAUTIs and different from CAUTIs. SUMMARY It is challenging to provide with an exact frequency of UTIs. Both CAUTI and HAUTI frequency, pathogen spectrum and resistance rates vary according to geographical setting.
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Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study. J Infect Public Health 2016; 9:600-10. [PMID: 26829892 DOI: 10.1016/j.jiph.2015.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/10/2015] [Accepted: 12/19/2015] [Indexed: 11/22/2022] Open
Abstract
Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (p<0.001), presence of congenital abnormalities of kidney and urinary tract (CAKUT) (p<0.0041) and the presence of certain syndromes (Down, William, and Noonan) (p<0.02). Gram-negative bacteria accounted for 63% of the CAUTI. The main causes of CAUTI were Klebsiella (27%), Candida (24%) and Escherichia coli (21%). Resistant organisms caused 34% of CAUTI. Two patients (7%) died in the UTI group compared with the one patient (0.3%) who died in the control group (p<0.05). Based on these findings, we concluded that an increased duration of the urinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study.
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Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial. THE LANCET. INFECTIOUS DISEASES 2016; 16:70-79. [DOI: 10.1016/s1473-3099(15)00238-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 01/19/2023]
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Lall R, Hamilton P, Young D, Hulme C, Hall P, Shah S, MacKenzie I, Tunnicliffe W, Rowan K, Cuthbertson B, McCabe C, Lamb S. A randomised controlled trial and cost-effectiveness analysis of high-frequency oscillatory ventilation against conventional artificial ventilation for adults with acute respiratory distress syndrome. The OSCAR (OSCillation in ARDS) study. Health Technol Assess 2015; 19:1-177, vii. [PMID: 25800686 DOI: 10.3310/hta19230] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with the acute respiratory distress syndrome (ARDS) require artificial ventilation but this treatment may produce secondary lung damage. High-frequency oscillatory ventilation (HFOV) may reduce this damage. OBJECTIVES To determine the clinical benefit and cost-effectiveness of HFOV in patients with ARDS compared with standard mechanical ventilation. DESIGN A parallel, randomised, unblinded clinical trial. SETTING UK intensive care units. PARTICIPANTS Mechanically ventilated patients with a partial pressure of oxygen in arterial blood/fractional concentration of inspired oxygen (P : F) ratio of 26.7 kPa (200 mmHg) or less and an expected duration of ventilation of at least 2 days at recruitment. INTERVENTIONS Treatment arm HFOV using a Novalung R100(®) ventilator (Metran Co. Ltd, Saitama, Japan) ventilator until the start of weaning. Control arm Conventional mechanical ventilation using the devices available in the participating centres. MAIN OUTCOME MEASURES The primary clinical outcome was all-cause mortality at 30 days after randomisation. The primary health economic outcome was the cost per quality-adjusted life-year (QALY) gained. RESULTS One hundred and sixty-six of 398 patients (41.7%) randomised to the HFOV group and 163 of 397 patients (41.1%) randomised to the conventional mechanical ventilation group died within 30 days of randomisation (p = 0.85), for an absolute difference of 0.6% [95% confidence interval (CI) -6.1% to 7.5%]. After adjustment for study centre, sex, Acute Physiology and Chronic Health Evaluation II score, and the initial P : F ratio, the odds ratio for survival in the conventional ventilation group was 1.03 (95% CI 0.75 to 1.40; p = 0.87 logistic regression). Survival analysis showed no difference in the probability of survival up to 12 months after randomisation. The average QALY at 1 year in the HFOV group was 0.302 compared to 0.246. This gives an incremental cost-effectiveness ratio (ICER) for the cost to society per QALY of £88,790 and an ICER for the cost to the NHS per QALY of £ 78,260. CONCLUSIONS The use of HFOV had no effect on 30-day mortality in adult patients undergoing mechanical ventilation for ARDS and no economic advantage. We suggest that further research into avoiding ventilator-induced lung injury should concentrate on ventilatory strategies other than HFOV. TRIAL REGISTRATION Current Controlled Trials ISRCTN10416500.
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Affiliation(s)
- Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | | | | | | | | | | | | | | | - Kathy Rowan
- Intensive Care National Audit & Research Centre, London, UK
| | | | | | - Sallie Lamb
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
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Samraj RS, Stalets E, Butcher J, Deck T, Frebis J, Helpling A, Wheeler DS. The Impact of Catheter-Associated Urinary Tract Infection (CA-UTI) in Critically Ill Children in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2015; 5:7-11. [PMID: 31110876 DOI: 10.1055/s-0035-1568148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 07/12/2015] [Indexed: 10/22/2022] Open
Abstract
Objective Catheter-associated urinary tract infections (CA-UTIs) comprise a significant proportion of hospital-acquired infections. However, the impact of CA-UTIs on important outcome measures, such as length of stay (LOS) and hospital charges, has not been examined in the pediatric intensive care unit (PICU) setting. Design Single-center, retrospective, case-matched, cohort study and financial analysis. Setting PICU in a tertiary-care children's medical center. Patients A total of 41 critically ill children with CA-UTIs and 73 critically ill children without CA-UTI, matched for age, gender, severity of illness, and primary admission diagnosis. Interventions None. Measurements and Main Results We compared the length of hospital stay (LOS in PICU and in hospital), mortality, and hospital costs in critically ill children with CA-UTIs and their matched controls. Critically ill children experiencing CA-UTI had significantly longer PICU LOS, hospital LOS, duration of mechanical ventilation, and mortality compared with matched controls without CA-UTI. The longer LOS resulted in higher PICU and hospital charges in this group. Conclusion Critically ill children with CA-UTI experience worse outcomes in the PICU compared with those without CA-UTI. Further studies on the impact of CA-UTI in the PICU are warranted.
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Affiliation(s)
- Ravi S Samraj
- Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Erika Stalets
- Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - John Butcher
- Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Theresa Deck
- Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - James Frebis
- Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Alma Helpling
- Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Derek S Wheeler
- Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
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19
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Urinary tract infection in elderly trauma patients: review of the Trauma Quality Improvement Program identifies the population at risk. J Trauma Acute Care Surg 2015; 77:952-9. [PMID: 25248065 DOI: 10.1097/ta.0000000000000351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elderly trauma patients are at high risk for urinary tract infection (UTI). Despite this, UTI has been deemed a potentially preventable problem and therefore not reimbursable by the Centers for Medicare and Medicaid Services. Early identification of UTI in these patients should lead to prompt treatment, improved outcomes, and cost savings. Risk factors for UTI development in this population must be elucidated to realize these goals. METHODS The Trauma Quality Improvement Program (TQIP) database was used to analyze elderly patients (≥65 years) admitted as a result of injury during 2011. Patients with genitourinary injuries or undergoing dialysis before admission were excluded. Multivariable logistic regression analysis was conducted to identify UTI risk factors. Mean cost of UTI was calculated based on the assumption of $862 to $1,007 per UTI. RESULTS In total, 33,257 patients were identified; 1,492 developed UTI (4.5%). Multiple significant risk factors were identified, including age greater than 75 years, female sex, ascites, moderate head injury, impaired sensorium, congestive heart failure, and duration of hospital stay (all p < 0.05). Assuming that UTIs diagnosed on hospital Day 1 were preexisting, the cost of UTI to TQIP hospitals ranged from $1,280,959 to $1,496,434 per year. CONCLUSION Duration of stay has a profound impact on the development of UTIs in elderly trauma patients, but overall severity of injury does not. In addition, multiple nonmodifiable risk factors were identified, prompting the possibility for increased screening of occult UTIs. Reimbursement for care of UTI in this complicated patient population should be revisited. The TQIP database must improve urinary catheter data. LEVEL OF EVIDENCE Epidemiologic study, level III.
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20
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Huang WC, Wann SR, Lin SL, Kunin CM, Kung MH, Lin CH, Hsu CW, Liu CP, Lee SSJ, Liu YC, Lai KH, Lin TW. Catheter-Associated Urinary Tract Infections in Intensive Care Units Can Be Reduced by Prompting Physicians to Remove Unnecessary Catheters. Infect Control Hosp Epidemiol 2015; 25:974-8. [PMID: 15566033 DOI: 10.1086/502329] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:Indwelling urinary catheters are the most common source of infections in intensive care units (ICUs). The aim of this study was to evaluate the efficacy of nurse-generated daily reminders to physicians to remove unnecessary urinary catheters 5 days after insertion.Design:A time-sequence nonrandomized intervention study.Setting:Adult ICUs (medical, surgical, cardiovascular surgical, neurosurgical, and coronary care) of a tertiary-care university medical center.Patients:All patients admitted to the adult ICUs during a 2-year period. The study consisted of a 12-month observational phase (15,960 patient-days) followed by a 12-month intervention phase (15,525 patient-days).Intervention:Daily reminders to physicians from the nursing staff to remove unnecessary urinary catheters 5 days after insertion.Results:The duration of urinary catheterization was significantly reduced during the intervention phase (from 7.0 ± 1.1 days to 4.6 ± 0.7 days; P < .001). The rate of catheter-associated urinary tract infection (CAUTI) was also significantly reduced (from 11.5 ± 3.1 to 8.3 ± 2.5 patients with CAUTI per 1,000 catheter-days; P = .009). There was a linear relationship between the monthly average duration of catheterization and the rate of CAUTI (r = 0.50; P = .01). The excess monthly cost of antibiotics for CAUTI was reduced by 69% (from $4,021 ± $1,800 to $1,220 ± $941; P = .004).Conclusion:This study demonstrated that a simple measure instituted as part of a continuous quality improvement program significantly reduced the duration of urinary catheterization, rate of CAUTI, and additional costs of antibiotics to manage CAUTI.
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Affiliation(s)
- Wei-Chun Huang
- Intensive Care Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
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21
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Clec'h C, Schwebel C, Français A, Toledano D, Fosse JP, Garrouste-Orgeas M, Azoulay E, Adrie C, Jamali S, Descorps-Declere A, Nakache D, Timsit JF, Cohen Y. Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients? Infect Control Hosp Epidemiol 2015; 28:1367-73. [DOI: 10.1086/523279] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 08/03/2007] [Indexed: 11/03/2022]
Abstract
Objective.To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.Design.Nested case-control study in a multicenter cohort (the OutcomeRea database).Setting.Twelve French medical or surgical ICUs.Methods.All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age ( ± 10 years), SAPS (Simplified Acute Physiology Score) II score ( ± 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.Results.Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P = .02); the same was true for crude hospital mortality rates (43% vs 30%, P>.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P = .19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P = .64).Conclusion.After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.
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22
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Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, Kitkangvan D, Yuekyen C, Warachan B, Warren DK, Fraser VJ. Effectiveness of Multifaceted Hospitalwide Quality Improvement Programs Featuring an Intervention to Remove Unnecessary Urinary Catheters at a Tertiary Care Center in Thailand. Infect Control Hosp Epidemiol 2015; 28:791-8. [PMID: 17564980 DOI: 10.1086/518453] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/01/2006] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate the efficacy of a multifaceted hospitalwide quality improvement program that featured an intervention to remind physicians to remove unnecessary urinary catheters.Methods.A hospitalwide preintervention-postintervention study was conducted over 2 years (July 1, 2004, through June 30, 2006). The intervention consisted of nurse-generated daily reminders that were used by an intervention team to remind physicians to remove unnecessary urinary catheters, beginning 3 days after insertion. Clinical, microbiological, pharmaceutical, and cost data were collected.Results.A total of 2,412 patients were enrolled in the study. No differences were found in the demographic and/or clinical characteristics of patients between the preintervention and postintervention periods. After the intervention, reductions were found in the rate of inappropriate urinary catheterization (mean rate, preintervention vs postintervention, 20.4% vs 11% [P = .04]), the rate of catheter-associated urinary tract infection (CA-UTI) (mean rate, 21.5 vs 5.2 infections per 1,000 catheter-days [P <.001]), the duration of urinary catheterization (mean, 11 vs 3 days [P < .001]), and the total length of hospitalization (mean, 16 vs 5 days [P < .001]). A linear relationship was seen between the monthly average duration of catheterization and the rate of CA-UTI (r = 0.89; P < .001). The intervention had the greatest impact on the rate of CA-UTI in the intensive care units (mean rate, preintervention vs postintervention, 23.4 vs 3.5 infections per 1,000 catheter-days [P = .01]). The monthly hospital costs for antibiotics to treat CA-UTI were reduced by 63% (mean, $3,739 vs $1,378 [P < .001]), and the hospitalization cost for each patient during the intervention was reduced by 58% (mean, $366 vs $154 [P < .001]).Conclusions.This study suggests that a multifaceted intervention to remind physicians to remove unnecessary urinary catheters can significantly reduced the duration of urinary catheterization and the CA-UTI rate in a hospital in a developing country.
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Affiliation(s)
- Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand.
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Al-Helali NS, Al-Asmary SM, Abdel-Fattah MM, Al-Jabban TM, Al-Bamri ALM. Epidemiologic Study of Nosocomial Urinary Tract Infections in Saudi Military Hospitals. Infect Control Hosp Epidemiol 2015; 25:1004-7. [PMID: 15566040 DOI: 10.1086/502336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractA case-control study of patients with and without confirmed UTI was performed to identify risk factors for nosocomial UTI. Duration of hospitalization, unit of admission, history of diabetes mellitus or debilitating diseases, and duration and number of urinary catheters were independently associated with increased risk of nosocomial UTIs.
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Affiliation(s)
- Nabil S Al-Helali
- Department of Preventative Medicine, Al-Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
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24
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Abstract
An observational study was conducted to describe the epidemiology of bacteriuria and candiduria in the intensive care unit (ICU), and the occurrence of blood stream infection (BSI) associated with ICU-acquired positive urine culture. Between 2006 and 2011, 444 episodes of either bacteriuria or candiduria defined by positive urine culture (microorganisms ⩾105 c.f.u./ml) occurred in 406 patients. Three hundred and seventy-seven (85%) were hospital-acquired including 221 which were ICU-acquired (6·4 ± 0·8 episodes/1000 ICU days). Escherichia coli was the most common bacteria of both community- and ICU-acquired bacteriuria/candiduria (49·2% and 29%, respectively). Candida spp. represented 55% (129/236) of pathogens responsible for ICU-acquired positive urine cultures. Patients with ICU-acquired candiduria had greater illness severity at ICU admission than those with ICU-acquired bacteriuria (APACHE III score 79 ± 25 vs. 66 ± 31, P = 0·0015). BSI associated with ICU-acquired positive urine culture occurred in 0·15/1000 ICU days and was more often due to Candida. In this study, Candida was the most common pathogen responsible for ICU-acquired positive urine cultures and illness severity was a risk factor for candiduria in the study population.
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25
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Coman T, Troché G, Semoun O, Pangon B, Mignon F, Jacq G, Merceron S, Abbosh N, Laurent V, Guezennec P, Henry-Lagarrigue M, Revault-d'Allonnes L, Ben-Mokhtar H, Audibert J, Bruneel F, Resche-Rigon M, Bedos JP, Legriel S. Diagnostic accuracy of urinary dipstick to exclude catheter-associated urinary tract infection in ICU patients: a reappraisal. Infection 2014; 42:661-8. [PMID: 24647770 DOI: 10.1007/s15010-014-0612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/03/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We wanted to assess the diagnostic accuracy of urinary dipstick testing in excluding catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients with fever or hypothermia. METHODS This was a prospective observational cohort study in a medical-surgical ICU. Patients with new-onset fever >38.3 °C or hypothermia <36 °C at least 48 h after urinary catheter insertion were included over a 2-year period. At each episode, a urinary dipstick test and a urine culture were performed as the criterion standard. Extensive microbiological investigations for extra-urinary infections were performed also. The performances of various urinary dipstick result combinations in ruling out CAUTI were compared based on the likelihood ratios (LR+ and LR-). RESULTS Symptomatic CAUTI was diagnosed in 31 (24.4 %) of the 127 included patients (195 episodes of fever or hypothermia). LR+ was best for combined leukocyte esterase-positive and nitrite-positive dipstick results (overall population: 14.91; 95 % confidence interval [95 % CI], 5.53-40.19; patients without urinary symptoms: 15.63; 95 % CI, 5.76-42.39). LR- was best for either leukocyte esterase-positive or nitrite-positive dipstick results (overall population: 0.41; 95 % CI, 0.57-0.65; patients without urinary symptoms, 0.36; 95 % CI, 0.21-0.60). CONCLUSIONS Urinary dipstick testing at the bedside does not help to rule out symptomatic CAUTI in medical or surgical ICU patients with fever or hypothermia.
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Affiliation(s)
- T Coman
- Intensive Care Unit, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay cedex (78), France
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26
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Vincent JL, Chierego M, Struelens M, Byl B. Infection control in the intensive care unit. Expert Rev Anti Infect Ther 2014; 2:795-805. [PMID: 15482241 DOI: 10.1586/14789072.2.5.795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nosocomial infections are common in many hospital departments, but particularly so on the intensive care unit, where they affect some 20 to 30% of patients. While early diagnosis and appropriate treatment are, of course, important, perhaps the greatest challenge is in the application of techniques to limit the development of such infections. This review will briefly discuss some of the background pathophysiology and epidemiology of nosocomial infection, and then focus on general and infection-specific preventative strategies individually and as part of broader infection-control programs with infection surveillance.
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Affiliation(s)
- Jean-Louis Vincent
- Free University of Brussels, Department of Intensive Care, Erasme Hospital, Brussels, Belgium.
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Cangelosi MJ, Rodday AM, Saunders T, Cohen JT. Evaluation of the Economic Burden of Diseases Associated With Poor Nutrition Status. JPEN J Parenter Enteral Nutr 2013; 38:35S-41S. [DOI: 10.1177/0148607113514612] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael J. Cangelosi
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Tully Saunders
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
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Usability application of multiplex polymerase chain reaction in the diagnosis of microorganisms isolated from urine of patients treated in cancer hospital. Radiol Oncol 2013; 47:296-303. [PMID: 24133395 PMCID: PMC3794886 DOI: 10.2478/raon-2013-0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/11/2013] [Indexed: 11/21/2022] Open
Abstract
Background The objective of this study was: i) to compare the results of urine culture with polymerase chain reaction (PCR) -based detection of microorganisms using two commercially available kits, ii) to assess antimicrobial susceptibility of urine isolates from cancer patients to chosen antimicrobial drugs and, if necessary, to update the recommendation of empirical therapy. Materials and methods. A one-year hospital-based prospective study has been conducted in Greater Poland Cancer Centre and Genetic Medicine Laboratory CBDNA Research Centre in 2011. Urine cultures and urine PCR assay from 72 patients were examined Results Urine cultures and urine PCR assay from 72 patients were examined. Urine samples were positive for 128 strains from which 95 (74%) were identical in both tests. The most frequently isolated bacteria in both culture and PCR assay were coliform organisms and Enterococcus spp. The Gram negative bacilli were most resistant to cotrimoxazol. 77.2% of these bacilli and 100% of E. faecalis and S. agalactiae were sensitive to amoxicillin-clavulanic acid. 4.7% of Gram positive cocci were resistant to nitrofurantoin. Conclusions The PCR method quickly finds the causative agent of urinary tract infection (UTI) and, therefore, it can help with making the choice of the proper antimicrobial therapy at an early stage. It appears to be a viable alternative to the recommendations made in general treatment guidelines, in cases where diversified sensitivity patterns of microorganisms have been found.
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Bateman SL, Stapleton AE, Stamm WE, Hooton TM, Seed PC. The type 1 pili regulator gene fimX and pathogenicity island PAI-X as molecular markers of uropathogenic Escherichia coli. MICROBIOLOGY-SGM 2013; 159:1606-1617. [PMID: 23744903 DOI: 10.1099/mic.0.066472-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Uropathogenic Escherichia coli (UPEC) fall within a larger group of isolates producing extraintestinal disease. UPEC express type 1 pili as a critical virulence determinant mediating adherence to and invasion into urinary tract tissues. Type 1 pili expression is under regulation by a family of site-specific recombinases, including FimX, which is encoded from a genomic island called PAI-X for pathogenicity island of FimX. Using a new multiplex PCR, fimX and the additional PAI-X genes were found to be highly associated with UPEC (144/173 = 83.2 %), and more prevalent in UPEC of lower urinary tract origin (105/120 = 87.5 %) than upper urinary tract origin (39/53 = 74 %; P<0.05) or commensal isolates (28/78 = 36 %; P≤0.0001). The Fim-like recombinase gene fimX is the only family member that has a significant association with UPEC compared to commensal isolates. Our results indicate PAI-X genes, including the type 1 pili regulator gene fimX, are highly prevalent among UPEC isolates and have a strong positive correlation with genomic virulence factors, suggesting a potential role for PAI-X in the extraintestinal pathogenic E. coli lifestyle.
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Affiliation(s)
- Stacey L Bateman
- Center for Microbial Pathogenesis, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Ann E Stapleton
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Walter E Stamm
- Deceased.,Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Thomas M Hooton
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33146, USA
| | - Patrick C Seed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA.,Center for Microbial Pathogenesis, Duke University School of Medicine, Durham, NC 27710, USA.,Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710, USA
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Stovall RT, Haenal JB, Jenkins TC, Jurkovich GJ, Pieracci FM, Biffl WL, Barnett CC, Johnson JL, Bensard DD, Moore EE, Cothren Burlew C. A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit. J Am Coll Surg 2013; 217:162-6. [PMID: 23639202 DOI: 10.1016/j.jamcollsurg.2013.02.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) in trauma patients is associated with increased mortality. Whether the urinalysis (UA) is an adequate test for a urinary source of fever in the ICU trauma patient has not been demonstrated. We hypothesized that the UA is a valuable screen for UTI in the febrile, critically ill trauma patient. STUDY DESIGN All trauma ICU patients in our surgical ICU who had a fever (temperature >38.0°C), urinary catheter, UA, and a urine culture between January 1, 2011 and December 13, 2011 were reviewed. A positive UA was defined as positive leukocyte esterase, positive nitrite, WBC > 10/high power field, or presence of bacteria. A positive urine culture was defined as growth of ≥10(5) colony forming units (cfu) of an organism irrespective of the UA result or ≥10(3) cfu in the setting of a positive UA. A UTI was defined as positive urine culture without an alternative cause of the fever. RESULTS There were 232 UAs from 112 patients that met criteria. The majority (75%) of patients were men; the mean age was 40 (±16) years. Of the 232 UAs, 90 (38.7%) were positive. There were 14 UTIs. The sensitivity, specificity, positive predictive value, and negative predictive value of the UA for UTI were 100%, 65.1%, 15.5%, and 100%, respectively. CONCLUSIONS A negative UA reliably excludes a catheter-associated UTI in the febrile, trauma ICU patient with a 100% negative predictive value, and it can rapidly direct the clinician toward more likely sources of fever and reduce unnecessary urine cultures.
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Affiliation(s)
- Robert T Stovall
- Department of Surgery, Denver Health Medical Center and the University of Colorado School of Medicine, Denver, CO 80206, USA.
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Nosova K, Nuño M, Mukherjee D, Lad S, Boakye M, Black K, Patil C. Urinary tract infections in meningioma patients: analysis of risk factors and outcomes. J Hosp Infect 2013; 83:132-9. [DOI: 10.1016/j.jhin.2012.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
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Lee JH, Kim SW, Yoon BI, Ha US, Sohn DW, Cho YH. Factors that affect nosocomial catheter-associated urinary tract infection in intensive care units: 2-year experience at a single center. Korean J Urol 2013; 54:59-65. [PMID: 23362450 PMCID: PMC3556556 DOI: 10.4111/kju.2013.54.1.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/20/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms. MATERIALS AND METHODS A retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included. RESULTS There were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%). CONCLUSIONS The factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.
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Affiliation(s)
- Joon Ho Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
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King C, Garcia Alvarez L, Holmes A, Moore L, Galletly T, Aylin P. Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review. J Hosp Infect 2012; 82:219-26. [DOI: 10.1016/j.jhin.2012.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
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Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital. Med J Armed Forces India 2012; 69:124-9. [PMID: 24600084 DOI: 10.1016/j.mjafi.2012.08.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 08/10/2012] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Healthcare associated infections (HAI) have taken on a new dimension with outbreaks of increasingly resistant organisms becoming common. Protocol-based infection control practices in the intensive care unit (ICU) are extremely important. Moreover, baseline information of the incidence of HAI helps in planning-specific interventions at infection control. METHODS This hospital-based observational study was carried out from Dec 2009 to May 2010 in the 10-bedded surgical intensive care unit of a tertiary care hospital. CDC HAI definitions were used to diagnose HAI. RESULTS A total of 293 patients were admitted in the ICU. 204 of these were included in the study. 36 of these patients developed HAI with a frequency of 17.6%. The incidence rate (IR) of catheter-related blood stream infections (CRBSI) was 16/1000 Central Venous Catheter (CVC) days [95% C.I. 9-26]. Catheter-associated urinary tract infections (CAUTI) 9/1000 urinary catheter days [95% C.I. 4-18] and ventilator-associated pneumonias (VAP) 32/1000 ventilator days [95% confidence interval 22-45]. CONCLUSION The HAI rates in our ICU are less than other hospitals in developing countries. The incidence of VAP is comparable to other studies. Institution of an independent formal infection control monitoring and surveillance team to monitor & undertake infection control practices is an inescapable need in service hospitals.
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Suka M, Yoshida K, Takezawa J. Association between APACHE II score and nosocomial infections in intensive care unit patients: A multicenter cohort study. Environ Health Prev Med 2012; 9:262-5. [PMID: 21432312 DOI: 10.1007/bf02898140] [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: 06/23/2004] [Accepted: 08/31/2004] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients. METHODS Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator; central venous catheter, and APACHE II score (0-5, 6-10, 11-15, 16-20, 21-25, 26-30, and 31+). RESULTS There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection. CONCLUSIONS Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.
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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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Taylor AH, Mitchell AE, Mitchell IM. A 15-year study of the changing demographics and infection risk in a new UK cardiac surgery unit. Interact Cardiovasc Thorac Surg 2012; 15:390-4. [PMID: 22718465 PMCID: PMC3422967 DOI: 10.1093/icvts/ivs278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/21/2012] [Accepted: 05/26/2012] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES National trends in cardiac surgery show a shift towards a higher preoperative risk profile and factors that might also be expected to increase the risk of postoperative infective complications. We document the changing patient demographics in the first 15 years of a new cardiac surgery unit and examine the impact of these and other changes in estate, staffing and clinical protocols, on the risks of common postoperative infections. METHODS Data recorded included patient age, sex and body mass index, type and number of operations, logistic EuroSCORE, mortality rate, urgency of operation, reoperation rate, requirement for intra-aortic balloon pump, incidence of diabetes and the incidence of common postoperative infections. RESULTS A total of 8449 cardiac operations were undertaken. The mean patient age increased from 62.71 to 65.82 years; procedural complexity increased with the proportion of isolated coronary artery bypass procedures falling from 72.8 to 54%; there were increases in the urgency of operation (11.3-26.9%), average patient body mass index (27.01-28.67), the incidence of diabetes (12.3-21.2%), logistic EuroSCORE (5.36-7.74) and intra-aortic balloon pump usage (6.4-15.6%). The incidence of superficial sternal infection reduced (3.9-1.4%); other wound infection rates were low and showed no overall trend with time. Urinary tract infection varied between 0 and 1.7%, but did show a significant increase over the last 3 years (P < 0.01). CONCLUSIONS This study demonstrates a change in the patient profile, yet despite an increase in infection risk factors, no increase in actual infection rates. The importance of non-patient factors in influencing the outcomes after cardiac surgery is discussed.
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Affiliation(s)
- Alice H. Taylor
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham City Hospital, Nottingham, UK
| | - Annelies E. Mitchell
- Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Ian M. Mitchell
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham City Hospital, Nottingham, UK
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Mohammadzadeh M, Behnaz F. Incidence and risk factors of catheter-associated urinary tract infection in Yazd - Iran. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2011.01133.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duane TM, Young A, Weber W, Wolfe LG, Malhotra AK, Aboutanos MB, Whelan JF, Mayglothling J, Ivatury RR. Bladder pressure measurements and urinary tract infection in trauma patients. Surg Infect (Larchmt) 2012; 13:85-7. [PMID: 22364605 DOI: 10.1089/sur.2011.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this trial was to determine if using a closed technique for bladder pressure measurements (BPMs) would eliminate them as a risk factor for urinary tract infection (UTI) in trauma patients, as was shown previously using an open technique. METHODS Data were collected prospectively from January 2006 until December 2009 by a dedicated epidemiology nurse and combined with trauma registry data at our Level 1 trauma center. All trauma patients admitted to the surgical trauma intensive care unit (STICU) with and without UTIs were compared for demographic and epidemiologic data. A closed system was used in which the urinary drainage catheter (UDC) remained connected to the bag and 45 mL of saline was injected through a two-way valved sideport, with subsequent measurements through the sideport. RESULTS There were 1,641 patients in the trial. The UTI group was sicker (Injury Severity Score [ISS] 18.7±11.9 no UTI vs. 28±10.7 UTI; p<0.0001), with longer stays (11.4±12.4 days no UTI vs. 37.9±20.3 days UTI; p<0.0001) and more UDC days (4.3±6.6 no UTI vs. 23.9±16.6 UTI; p<0.0001). The BPM group had more UDC days (15.6 days±16.0 BPM vs. 5.4 days±7.3 no BPM; p<0.0001), yet no difference in UTI rate/1,000 UDC days (5.7 no BPM vs. 8.0 BPM; p=0.5291). Logistic regression demonstrated only UDC days to be a predictor of UTI (1.125; 95% confidence interval [CI] 1.097-1.154; p<0.0001), whereas ISS (1.083, 95% CI 1.063-1.104; p<0.0001) and age (1.051, 95% CI 1.037-1.065; p<0.0001) were the only predictors of death. CONCLUSION Although patients undergoing BPM have more UTIs than patients without BPM, the measurements are not an independent predictor of UTI when done by the closed technique. These findings emphasize the judicious use of BPM with a closed system and, more importantly, the need for early removal of catheters.
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Affiliation(s)
- Therèse M Duane
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
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Temiz E, Piskin N, Aydemir H, Oztoprak N, Akduman D, Celebi G, Kokturk F. Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units. ACTA ACUST UNITED AC 2011; 44:344-9. [PMID: 22200187 DOI: 10.3109/00365548.2011.639031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in intensive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors. METHODS Between April and October 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient. RESULTS Two hundred and four patients were included and 85 developed a nosocomial infection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 developed nosocomial infections at other sites. The CAUTI rate was 19.02 per 1000 catheter-days. A Cox proportional hazard model showed that in the presence of other site nosocomial infections, immune suppression (hazard ratio (HR) 3.73, 95% CI 1.47-9.46; p = 0.006), previous antibiotic usage (HR 2.06, 95% CI 1.11-3.83; p = 0.023), and the presence of a nosocomial infection at another site (HR 1.82, 95% CI 1.04-3.20; p = 0.037) were the factors associated with the acquisition of CAUTIs with or without a nosocomial infection at another site. When we excluded the other site nosocomial infections to determine if the risk factors differed depending on the presence of other nosocomial infections, female gender (HR 2.67, 95% CI 1.03-6.91; p = 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01-1.13; p = 0.019) were found to be the risk factors for the acquisition of CAUTIs alone. CONCLUSIONS Our results showed that the presence of nosocomial infections at another site was an independent risk factor for the acquisition of a CAUTI and that their presence alters risk factors.
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Affiliation(s)
- Ekrem Temiz
- Department of Infectious Diseases, Bitlis Government Hospital, Bitlis, Turkey
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Guggenbichler JP, Assadian O, Boeswald M, Kramer A. Incidence and clinical implication of nosocomial infections associated with implantable biomaterials - catheters, ventilator-associated pneumonia, urinary tract infections. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2011; 6:Doc18. [PMID: 22242099 PMCID: PMC3252661 DOI: 10.3205/dgkh000175] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Health care associated infections, the fourth leading cause of disease in industrialised countries, are a major health issue. One part of this condition is based on the increasing insertion and implantation of prosthetic medical devices, since presence of a foreign body significantly reduces the number of bacteria required to produce infection. The most significant hospital-acquired infections, based on frequency and potential severity, are those related to procedures e.g. surgical site infections and medical devices, including urinary tract infection in catheterized patients, pneumonia in patients intubated on a ventilator and bacteraemia related to intravascular catheter use. At least half of all cases of nosocomial infections are associated with medical devices.Modern medical and surgical practices have increasingly utilized implantable medical devices of various kinds. Such devices may be utilized only short-time or intermittently, for months, years or permanently. They improve the therapeutic outcome, save human lives and greatly enhance the quality of life of these patients. However, plastic devices are easily colonized with bacteria and fungi, able to be colonized by microorganisms at a rate of 0.5 cm per hour. A thick biofilm is formed within 24 hours on the entire surface of these plastic devices once inoculated even with a small initial number of bacteria.The aim of the present work is to review the current literature on causes, frequency and preventive measures against infections associated with intravascular devices, catheter-related urinary tract infection, ventilator-associated infection, and infections of other implantable medical devices. Raising awareness for infection associated with implanted medical devices, teaching and training skills of staff, and establishment of surveillance systems monitoring device-related infection seem to be the principal strategies used to achieve reduction and prevention of such infections. The intelligent use of suitable antiseptics in combination with medical devices may further support reduction and prevention of such infections. In addition to reducing the adverse clinical outcomes related with these infections, such reduction may substantially decrease the economic burden caused by device-related infection for health care systems.
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Brindha SM, Jayashree M, Singhi S, Taneja N. Study of nosocomial urinary tract infections in a pediatric intensive care unit. J Trop Pediatr 2011; 57:357-62. [PMID: 21088066 DOI: 10.1093/tropej/fmq104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Nosocomial urinary tract infections (NUTI) are one of the commonest infections in a Pediatric Intensive Care Unit (PICU). This prospective study was conducted in PICU between January and December 2008 to study the incidence, organisms and risk factors for NUTI. A total of 287 consecutive patients with >48 h PICU stay and sterile admission urine culture, were enrolled and monitored for NUTI (defined as per CDC criteria 1988) till discharge or death. Patients with and without NUTI were compared with respect to demographics, PRISM scores, primary diagnosis, nutritional status and device utilization to identify risk factors. Outcome was defined as length of PICU stay and survival or death. There were 69 episodes of UTI in 60 (20.9%) patients; incidence being 18 episodes/1000 patient days. Candida (52.1%) and Enterococcus (13%) were commonest followed by Escherichia coli (11.6%) and Klebsiella pneumoniae (10.1%). Catheterization and duration of catheterization were the risk factors for NUTI (p < 0.001). The median length of PICU stay was significantly longer in NUTI group compared to non-NUTI group (19 vs. 8 days, p = 0.001). Mortality rates in both the groups were similar.
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Affiliation(s)
- S M Brindha
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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[Urinary tract colonization and infection in critically ill patients]. Med Intensiva 2011; 36:143-51. [PMID: 21839547 DOI: 10.1016/j.medin.2011.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 06/23/2011] [Accepted: 06/30/2011] [Indexed: 11/23/2022]
Abstract
Urinary tract infections (UTIs) account for 20-50% of all hospital-acquired infections occurring in the intensive care unit (ICU). In some reports UTI was found to be more frequent than hospital-acquired pneumonia and intravascular device bacteremia, with a greater incidence in developing countries. The risk factors associated with the appearance of UTI include the severity of illness at the time of admission to the ICU, female status, prolonged urinary catheterization or a longer ICU stay and poor urinary catheter management - mainly disconnection of the closed system. about the present study offers data on the epidemiology of UTI in the ICU, the identified risk factors, etiology, diagnosis, impact upon morbidity and mortality, and the measures to prevent its appearance.
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Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: A systematic review and meta-analysis of observational studies. Crit Care Med 2011; 39:1167-73. [PMID: 21242789 DOI: 10.1097/ccm.0b013e31820a8581] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flores-González JC, Hernández-González A, Rodríguez-López C, Roldán-Cano V, Rubio-Quiñones F, Quintero-Otero S, García-Palacios MV, Pantoja-Rosso S. [Nosocomial urinary tract infection in critical pediatric patients]. Med Intensiva 2011; 35:344-8. [PMID: 21429626 DOI: 10.1016/j.medin.2011.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 01/23/2011] [Accepted: 02/01/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the incidence, etiology and risk factors of nosocomial urinary tract infections (nUTI) in a second level Pediatric Intensive Care Unit (PICU). PATIENTS AND METHODS A prospective study of 104 patients admitted to the PICU with a length of stay of more than 48 hours was carried out over a one year period (January to December 2009) to study the incidence and risk factors of nUTI. Urine samples were collected and cultured in all patients admitted for more than 48 hours to our PICU. Those needing indwelling urinary catheters had urine samples collected upon admission and every 24 hours until catheter retrieval, while those who did not need catheters had samples collected upon admission and every 48 hours until discharge from the PICU. RESULTS Six patients (5.8% of those admitted) were diagnosed of nUTI, with an incidence density of 5/1000 patients/day and 12.2/1000 catheterization days. Four of these were caused by E. coli (including a multiresistant strain), and two by C. albicans. Patients suffering nUTIs had significantly more relevant medical antecedents and a longer period of admittance than patients without nUTI. A statistically nonsignificant tendency towards increased infection risk was also found in younger patients and in those who needed an indwelling catheter for longer periods. CONCLUSIONS We found a higher incidence density of catheter associated nUTI than in other reports. This at least partially could be due to the characteristics of our patients, and to the exhaustive methodology used for detection.
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Affiliation(s)
- J C Flores-González
- Unidad de Cuidados Intensivos Pediátricos, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España.
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Park S, Kim DG, Suh GY, Park WJ, Jang SH, Hwang YI, Han SJ, Jeong HH, Lee CH, Jung KS. Significance of new-onset prolonged sinus tachycardia in a medical intensive care unit: a prospective observational study. J Crit Care 2011; 26:534.e1-534.e8. [PMID: 21376521 DOI: 10.1016/j.jcrc.2011.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/23/2010] [Accepted: 01/01/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Few data are available on sinus tachycardia among medical intensive care unit (ICU) patients. We investigated new critical illnesses related to new-onset prolonged sinus tachycardia (NOPST) and the relationship of NOPST with ICU mortality. METHODS The heart rate (HR) of all enrolled patients was monitored hourly over a 12-month period, and NOPST was defined as sinus tachycardia (>100 beats/min) with an increase in HR of more than 20% from the baseline value lasting longer than 6 hours. RESULTS Among the 522 patients enrolled, the average mean HR was 96.1 ± 18.4 beats/min. Fifty-two (10.0%) patients met the criteria for NOPST; pneumonia, delirium, septic shock, acute respiratory distress syndrome, catheter-related infections, and mechanical ventilator-related problems were related to the occurrence of NOPST. The ICU mortality rate in patients with a NOPST duration of more than 72 hours was higher compared with other patients with NOPST (60.0% vs 18.5%; P = .002). A high daily mean HR rather than NOPST was a significant predictor of ICU mortality (odds ratio, 1.415; 95% confidence interval, 1.177-1.700). CONCLUSIONS Although NOPST was not associated with ICU mortality, it indicates the presence of new critical events in the medical ICU setting.
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Affiliation(s)
- Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Dong-Gyu Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Seoul, Republic of Korea
| | - Woo Jung Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Sang-Jin Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Hyun Hee Jeong
- Department of Nursing, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 39 Boramae-gil, Seoul, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Gyeonggi-do, Republic of Korea.
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Niven D, Fick G, Kirkpatrick A, Grant V, Laupland K. Cost and outcomes of nosocomial bloodstream infections complicating major traumatic injury. J Hosp Infect 2010; 76:296-9. [DOI: 10.1016/j.jhin.2010.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 06/10/2010] [Indexed: 11/29/2022]
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Markovic-Denic L, Mijovic B, Jankovic S. Risk factors for hospital-acquired urinary tract infection: a case–control study. Int Urol Nephrol 2010; 43:303-8. [DOI: 10.1007/s11255-010-9828-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 08/17/2010] [Indexed: 11/28/2022]
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Tay MKX, Lee JYC, Wee IYJ, Oh HML. Evaluation of Intensive Care Unit-acquired Urinary Tract Infections in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n6p460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Urinary tract infections remain one of the most frequently encountered acquired complications in an intensive care unit (ICU). The objective of this study was to determine the incidence, risk factors, microbial sensitivity patterns, and clinical outcomes of patients with UTIs acquired during their admission to an ICU in an acute care hospital in Singapore. Materials and Methods: This was a 14-week prospective study. All ICU patients ≥18 years who remained in the ICU for ≥48 hours were eligible for this study. Patients were reviewed daily and the presence of an ICU-acquired UTI was identified via urinary microscopic examination or culture results. Other data collected included patient demographics, ICU admission criteria, concomitant illnesses, presence of invasive lines, microbial sensitivity and treatment outcomes. Results: Thirty-five (13.7%) cases of ICU-acquired UTI occurred in 256 separate ICU admissions. The most common micro-organisms isolated were Candida spp. (34%). Female gender and prior exposure to antibiotics were independent risk factors for developing an ICU-acquired UTI (P <0.01). Both mean length of ICU stay and duration of catheterisation were significantly longer for patients with ICU-acquired UTI (P <0.001). The mortality rate of patients with ICU-acquired UTIs (12.1%) was slightly higher than those without (9.9%). Conclusions: The incidence of ICU-acquired UTIs was similar to figures reported for nosocomial UTIs from the previous studies. Significant risk factors for developing an ICU-acquired UTI were female gender and history of antibiotic exposure prior to ICU admission. The insignificant link between ICU-acquired UTI and mortality requires further investigation in larger cohorts.
Key words: Medical and surgical ICUs, Nosocomial UTI, Outcomes, Risk factors
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Talaat M, Hafez S, Saied T, Elfeky R, El-Shoubary W, Pimentel G. Surveillance of catheter-associated urinary tract infection in 4 intensive care units at Alexandria university hospitals in Egypt. Am J Infect Control 2010; 38:222-8. [PMID: 19837480 DOI: 10.1016/j.ajic.2009.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 06/24/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We sought to measure the incidence rate of catheter-associated urinary tract infections (CAUTIs), identify risk factors associated with acquiring the infections; and identify the etiologic and antibiotic resistant patterns associated with CAUTIs in the intensive care units (ICUs) of a large University Hospital in Alexandria, Egypt. METHODS Prospective active surveillance of CAUTIs was conducted in 4 ICUs during a 13-month period from January 1, 2007 through January 31, 2008 in Alexandria University Hospital using the standard Centers for Disease Control National Nosocomial Infection Surveillance (NNIS) case definitions. Rates were expressed as the number of infections per 1000 catheter days. RESULTS During the study period, 757 patients were monitored after ICU admission, with either existing indwelling urinary catheters (239), or got catheters inserted after ICU admission (518), for a total duration of 16301 patient days, and 10260 patient catheter days. A total of 161 episodes of infection were diagnosed, for an overall rate of 15.7 CAUTIs per 1000 catheter days. Important risk factors associated with acquiring CAUTI were female gender (Relative risk (RR), 1.7; 95% confidence interval (CI); 1.7-4.3), and previous catheterization within the same hospital admission (RR, 1.6; 95% CI; 1.3-1.96). Patients admitted to the chest unit, patients =40 years, patients with prolonged duration of catheterization, prolonged hospital and ICU stay had a significantly higher risk of acquiring CAUTIs. Out of 195 patients who had their urine cultured, 188 pathogens were identified for 161 infected patients; 96 (51%) were Candida, 63 (33.5%) gram negatives, 29 (15.4%) gram positives. The prevalence of ESBL producers among K. pneumoniae and E. coli isolates was 56% (14/25) and 78.6% (11/14), respectively. CONCLUSION Despite infection control policies and procedures, CAUTI rates remain a significant problem in Alexandria University hospital. Using the identified risk factors, tailored intervention strategies are now being implemented to reduce the rates of CAUTIs in these 4 ICUs.
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Coleman JJ, Okoli I, Tegos GP, Holson EB, Wagner FF, Hamblin MR, Mylonakis E. Characterization of plant-derived saponin natural products against Candida albicans. ACS Chem Biol 2010; 5:321-32. [PMID: 20099897 DOI: 10.1021/cb900243b] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Candida albicans is an opportunistic fungal pathogen capable of life-threatening disseminated infections particularly in immunocompromised patients. Resistance to many clinically used antifungal agents has created a need to identify and develop a new generation of compounds for therapeutic use. A compound screen to identify potential antifungal natural products was undertaken, identifying 12 saponins, some of which have not been previously described. In the Caenorhabditis elegans model, some saponins conferred nematode survival comparable to that of amphotericin B. Of the 12 antifungal saponins identified, two were selected for further analysis. C. albicans isolates were inhibited by these compounds at relatively low concentrations (16 and 32 microg mL(-1)) including isolates resistant to clinically used antifungal agents. C. albicans hyphae and biofilm formation were also disrupted in the presence of these natural products, and studies demonstrate that fungal cells in the presence of saponins are more susceptible to salt-induced osmotic stress. Although saponins are known for their hemolytic activity, no hemolysis of erythrocytes was observed at three times the minimal inhibitory concentration for C. albicans, suggesting the saponins may have a preference for binding to fungal ergosterol when compared to cholesterol. Importantly, when used in combination with photosensitizer compounds, the fungus displayed increased susceptibility to photodynamic inactivation due to the ability of the saponins to increase cell permeability, thereby facilitating penetration of the photosensitizers. The large proportion of compounds identified as antifungal agents containing saponin structural features suggests it may be a suitable chemical scaffold for a new generation of antifungal compounds.
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Affiliation(s)
- Jeffrey J. Coleman
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Ikechukwu Okoli
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - George P. Tegos
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Edward B. Holson
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Florence F. Wagner
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
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