Host-Pathogen Interface: Progress in Understanding the Pathogenesis of Infection Due to Multidrug-Resistant Bacteria in the Intensive Care Unit

Impact of a dental care intervention on the hospital mortality of critically ill patients admitted to intensive care units: A quasi-experimental study

BACKGROUND

We aimed to evaluate the impact of providing dental care to critically ill patients on their risk of death and ventilator-associated pneumonia (VAP).

METHODS

A quasi-experimental study was conducted in 2 intensive care units (ICU) from 2016 to 2019. The intervention consisted of implementing routine dental care, focusing on oral hygiene and periodontal treatment, at least 3 times a week, for patients admitted to the study units. In the pre-intervention period, routine oral hygiene was provided by the ICU nursing staff. The primary and secondary study outcomes were mortality, evaluated at the end of the ICU stay, and VAP incidence density, respectively. Data were analyzed using the ARIMA (autoregressive integrated moving average) time series model in R software.

RESULTS

During the intervention period, 5,147 dental procedures were performed among 355 patients. The time series showed that ICU mortality was 36.11%, 32.71%, and 32.30% within the 3 years before the intervention, and 28.71% during the intervention period (P = .015). VAP incidence density did not significantly change during the study period (P = .716).

CONCLUSION

A dental care intervention focused on oral hygiene and periodontal treatment regularly provided by dentists to critically ill patients may decrease their risk of dying in the ICU. Randomized clinical trials should be performed to confirm these findings.

TRIAL REGISTRATION

WHO-affiliated Brazilian Clinical Trials Registry. RBR-4jmz36. Registered 7 October 2018, before first patient enrollment.

Clostridium perfringens Associated with Foodborne Infections of Animal Origins: Insights into Prevalence, Antimicrobial Resistance, Toxin Genes Profiles, and Toxinotypes

Several food-poisoning outbreaks have been attributed to Clostridium perfringens (C. perfringens) worldwide. Despite that, this crisis was discussed in a few studies, and additional studies are urgently needed in this field. Therefore, we sought to highlight the prevalence, antimicrobial resistance, toxin profiles, and toxinotypes of C. perfringens isolates. In this study, 50 C. perfringens isolates obtained from 450 different animal origin samples (beef, chicken meat, and raw milk) were identified by phenotypic and genotypic methods. The antimicrobial susceptibility results were surprising, as most of the isolates (74%) showed multidrug-resistant (MDR) patterns. The phenotypic resistance to tetracycline, lincomycin, enrofloxacin, cefoxitin/ampicillin, and erythromycin was confirmed by the PCR detections of tet, lnu, qnr, bla, and erm(B) genes, respectively. In contrast to the toxinotypes C and E, toxinotype A prevailed (54%) among our isolates. Additionally, we found that the genes for C. perfringens enterotoxin (cpe) and C. perfringens beta2 toxin (cpb2) were distributed among the tested isolates with high prevalence rates (70 and 64%, respectively). Our findings confirmed that the C. perfringens foodborne crisis has been worsened by the evolution of MDR strains, which became the prominent phenotypes. Furthermore, we were not able to obtain a fixed association between the toxinotypes and antimicrobial resistance patterns.

Antimicrobial Susceptibility and Association with Toxin Determinants in Clostridium perfringens Isolates from Chickens

The aim of the present study was to investigate variation in antimicrobial resistance in Clostridium perfringens (C. perfringens) isolated from chickens after withdrawal of antimicrobial growth promoters (AGPs); and to investigate the correlation between the presence of toxin genes (cpb2, netB, and tpeL) and antimicrobial resistance. Altogether, 162 isolates of C. perfringens were obtained from chickens displaying clinical signs of necrotic enteritis (n = 65) and from healthy chickens (n = 97) in Korea during 2010–2016. Compared to before AGP withdrawal, increased antimicrobial resistance or MIC₅₀/MIC₉₀ value was observed for nine antimicrobials including penicillin, tetracycline, tylosin, erythromycin, florfenicol, enrofloxacin, monensin, salinomycin, and maduramycin. Significantly (p < 0.05) higher resistance to gentamicin, clindamycin, and virginiamycin was found in isolates from chickens with necrotic enteritis compared to those from healthy chickens. tpeL gene was not detected in C. perfringens isolates from healthy chickens. A correlation between toxin gene prevalence and antibiotic resistance was found in the C. perfringens isolates. Because the usage of antimicrobials may contribute to the selection of both resistance and toxin genes, these can potentially make it challenging to control antimicrobial resistance in pathogenic colonies. Therefore, a more complete understanding of the interplay between resistance and virulence genes is required.

Multidrug-Resistant Hospital Bacteria: Epidemiological Factors and Susceptibility Profile

Increase in antimicrobial resistance to antibiotics is the product of the evolution and natural adaptation of microorganisms through mutations and genetic recombination caused by the indiscriminate use of antibiotics and the ineffective control and prevention of infection. The current study analyzes the profile of multiresistant hospital bacteria in two hospitals in Pelotas, state of Rio Grande do Sul, Brazil. Over the course of 4 months, patient's gender and age, hospital accommodation type, and sample site were evaluated. Two hundred and eighty-six microbiological culture antibiogram reports of hospitalized patients and outpatients of both sexes, between zero and 96 years of age, were analyzed. Bacterium Klebsiella pneumoniae was the most prevalent. The most resistant Gram-negative bacilli (GNB) were K. pneumoniae (27.5%); Acinetobacter baumannii (24.1%); Escherichia coli (14.7%); and Pseudomonas aeruginosa (14.5%). The most resistant Gram-positive cocci (GPC) were Enterococcus faecium (27.5%) and Staphylococcus aureus (25.5%). The classes of antibiotics with the greatest number of resistant GNB included penicillins (84.8%), quinolones (77.5%), and cephalosporins (75.7%). In the case of GPC, the most resistant were macrolides (95.4%); lincosamides (90.3%), and penicillins (77%). Among GNBs, polypeptides had the highest sensitivity rate (81.3%), whereas, among GPC, fusidanes, glycylcyclines, and lipopeptides had 100% sensitivity.

The Rising Problem of Multidrug-Resistant Organisms in Intensive Care Units

Because of antimicrobial overuse and misuse, the issue of multidrug-resistant organisms has been increasingly significant. Multidrug-resistant organism infection is of extreme concern in critical care patients. Infections with these organisms are difficult to treat because of the elevated rate of antimicrobial therapy failure. Such infections are linked to high mortality, poor prognosis, prolonged hospital stays, and increased medical expenses. Nineteen percent of patients with intensive care unit stays of greater than 24 hours acquire infections. Critically ill patients have risk factors that make them susceptible to infections. Critical care nurses must implement infection prevention interventions. Infection control strategies can be categorized as vertical or horizontal. Vertical approaches target a single pathogen; horizontal approaches are nonspecific. Infection control practice compliance is vital to prevent transmission of multidrug-resistant organisms through cross-contamination. This article discusses the severity of multidrug-resistant organism infection, risk factors, and infection prevention strategies in critical care settings.