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Hernández FLC, Virguez JV, Vesga JFG, Castellanos ML, Beltrán GR, Toquica LDL, Gomez CNS, Ríos MVS, Bolívar YRC, Sanchez JIA. Effect of COVID-19 on infections associated with medical devices in critical care. BMC Infect Dis 2024; 24:110. [PMID: 38254034 PMCID: PMC10801999 DOI: 10.1186/s12879-023-08934-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES This study explores the hypothesis that COVID-19 patients are at a heightened risk of healthcare-associated infections (HAIs) associated with medical device usage compared to non-COVID-19 patients. Our primary objective was to investigate the correlation between COVID-19 infection in ICU patients and subsequent HAIs following invasive medical device insertion. Additionally, we aim to assess the impact of SARS-CoV-2 infection on onset times concerning specific microorganisms and the type of medical device, providing valuable insights into this intricate relationship in intensive care settings. METHODOLOGY A retrospective cohort study was conducted using ICU patient records at our hospital from 2020 to 2022. This investigation entailed evaluating the timing of HAIs while distinguishing between patients with and without SARS-CoV-2 infection. We identified and analyzed the type of isolation and infection attributed to the medical device while controlling for ICU duration and ventilator days using Cox regression. RESULTS Our study included 127 patients without SARS-CoV-2 infection and 140 patients with SARS-CoV-2 infection. The findings indicated a higher incidence of HAI caused by various microorganisms associated with any medical device in patients with SARS-CoV-2 (HR = 6.86; 95% CI-95%: 3.26-14.43; p < 0.01). After adjusting for ICU duration and ventilator days, a heightened frequency of HAIs persisted in SARS-CoV-2-infected individuals. However, a detailed examination of HAIs revealed that only ventilation-associated pneumonia (VAP) displayed a significant association (HR = 6.69; 95% CI: 2.59-17.31; p < 0.01). A statistically significant correlation between SARS-CoV-2 infection and the isolation of S. aureus was also observed (p = 0.034). The prevalence of S. aureus infection was notably higher in patients with SARS-CoV-2 (RR = 8.080; 95% CI: 1.052-62.068; p < 0.01). CONCLUSIONS The frequency of pathogen isolates in invasive medical devices exhibited an association with SARS-CoV-2 infection. Critically ill patients with SARS-CoV-2 are more prone to developing early-onset VAP than those without SARS-CoV-2 infection.
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Gu GY, Chen M, Pan JC, Xiong XL. Risk of multi-drug-resistant organism acquisition from prior bed occupants in the intensive care unit: a meta-analysis. J Hosp Infect 2023; 139:44-55. [PMID: 37406860 DOI: 10.1016/j.jhin.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
Multi-drug-resistant organisms (MDROs) have become a global threat to human health. Prior bed occupancy with MDRO infection/colonization is an exposure factor that is closely associated with the MDRO acquisition rates in subsequent bed patients in intensive care units (ICUs). A meta-analysis was conducted to investigate the risk of MDRO acquisition from prior bed occupants in the ICU. PubMed, Cochrane Library, Web of Science, and Embase databases and reference lists were searched for articles published up to December 2021. The Newcastle-Ottawa scale was used for quality assessment. The risk measure was calculated as the odds ratio (OR) and corresponding 95% confidence interval (CI), and the heterogeneity was tested using I2 method and Q test. Eight articles were analysed using a random-effects model. Of the 8147 patients exposed to prior bed occupants infected or colonized with MDROs, 421 had acquired MDROs. The control group consisted of 55,933 patients without exposure factors, of which 1768 had been infected/colonized with MDROs. The pooled acquisition OR for MDROs was 1.80 (95% CI: 1.42, 2.29), P<0.00001. Subgroup analysis based on multi-drug-resistant Gram-positive and Gram-negative organisms was conducted using a fixed-effects model. The results significantly varied between the groups. Heterogeneity was partially explained by the MDRO type. In conclusion, exposure of bed occupants to infected/colonized MDROs significantly increased the risk of MDRO acquisition in subsequent bed occupants.
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Affiliation(s)
- G Y Gu
- Neurosurgical Intensive Care Unit, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - M Chen
- Rehabilitation Medicine Department, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - J C Pan
- Neurosurgical Intensive Care Unit, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - X L Xiong
- The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Almeida Junior ERD, Braga IA, Filho PPG, Ribas RM. Multicentre surveillance of epidemiologically important pathogens causing nosocomial bloodstream infections and pneumonia trials in Brazilian adult intensive care units. J Med Microbiol 2023; 72. [PMID: 36753436 DOI: 10.1099/jmm.0.001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Introduction. Healthcare-associated infections (HAIs) are the most recurrent adverse event in hospitals worldwide and represent an important public health problem.Gap statement. There are a paucity of multicentric data describing severe HAIs such as bloodstream infection (BSI) and pneumonia in Brazil.Aim. To provide an up-to-date picture of the extent and patterns of HAIs in adult intensive care units (ICUs), as well as to identify variables associated with the risk of development of severe infections.Methodology. Point prevalence surveys were conducted using standardized protocols in 35 ICUs from Minas Gerais state, Brazil. Medical records of eligible inpatients at or before 8 am on the survey day were reviewed to identify HAIs present at the time of the survey. A matched-pairs case-control study was performed on a total of 66 pairs for BSI and 115 pairs for pneumonia according to the selection criteria developed.Results. Overall, 171 patients (45.7%) had at least one HAI, with most (78.4%) acquired in the ICU. These patients presented a total of 240 infections; including 123 pneumonia (51.3%) and 66 BSI (27.5%), and 78.9 and 80.3 %, respectively, were acquired in the ICU. Their aetiology showed a predominance of Gram-negative bacteria versus Gram-positive bacteria (48.9 versus 43.3 %), with Acinetobacter baumannii (13.7%) and Pseudomonas aeruginosa (12.8%) being prominent. One striking observation from our data was the higher prevalence of Staphylococcus aureus (14.5%) and coagulase-negative staphylococci (10.2%) observed in the overall HAIs.Conclusion. A high severe ICU-acquired HAI burden was found when compared with findings from other low- and middle-income countries. These data can be utilized for better planning of nosocomial infection surveillance programmes in our hospitals.
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Affiliation(s)
- Elias Rodrigues de Almeida Junior
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Iolanda Alves Braga
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Paulo Pinto Gontijo Filho
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Rosineide Marques Ribas
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Tuncer G, Aktas Z, Basaran S, Cagatay A, Eraksoy H. Biofilm formation of panresistant Klebsiella pneumoniae. Future Microbiol 2022; 17:723-735. [PMID: 35443798 DOI: 10.2217/fmb-2021-0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: The authors aimed to investigate the biofilm-forming features of panresistant Klebsiella pneumoniae (PRKp). Material & methods: The biofilm formations were shown under light microscope and laser scanning confocal microscopy. The optical densities of the wells were measured and classified according to biofilm-forming capacities. Results: The ratio of biofilm-forming K. pneumoniae was established to be 100%. All isolates were found to form high-level biofilms in classification compared with positive and negative controls. No significant difference was detected in the biofilm-forming capacities of K. pneumoniae strains isolated from different sample types. Conclusion: No previous study associated with PRKp isolates was identified in the literature search. There is a need for different approaches characterizing the biofilm-forming features of PRKp.
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Affiliation(s)
- Gulsah Tuncer
- Department of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34104, Turkey
| | - Zerrin Aktas
- Department of Microbiology & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34104, Turkey
| | - Seniha Basaran
- Department of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34104, Turkey
| | - Atahan Cagatay
- Department of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34104, Turkey
| | - Haluk Eraksoy
- Department of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34104, Turkey
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Cook A, Hsia Y, Russell N, Sharland M, Cheung K, Grimwood K, Cross J, Cotrim da Cunha D, Magalhães GR, Renk H, Hindocha A, McMaster P, Okomo U, Darboe S, Alvarez-Uria G, Jinka DR, Murki S, Kandraju H, Dharmapalan D, Esposito S, Bianchini S, Fukuoka K, Aizawa Y, Jimenez-Juarez RN, Ojeda-Diezbarroso K, Pirš M, Rožič M, Anugulruengkitt S, Jantarabenjakul W, Cheng CL, Jian BX, Spyridakis E, Zaoutis T, Bielicki J. Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection-A Global Retrospective Cohort Study. Pediatr Infect Dis J 2021; 40:137-143. [PMID: 33395208 DOI: 10.1097/inf.0000000000002910] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens. METHODS Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children <18 years with blood-culture-confirmed bacterial bloodstream infections (BSI) were collected anonymously using REDCap™ through the Global Antibiotic Prescribing and Resistance in Neonates and Children network from February 2016 to February 2017. Concordance of early empiric antibiotic treatment was determined using European Committee on Antimicrobial Susceptibility Testing interpretive guidelines. The relationship between concordance of empiric regimen and 30-day mortality was investigated using multivariable regression. RESULTS Four hundred fifty-two children with blood-culture-positive BSI receiving early empiric antibiotics were reported by 25 hospitals in 19 countries. Sixty percent (273/452) were under the age of 2 years. S. aureus, E. coli, and Klebsiella spp. were the most common isolates, and there were 158 unique empiric regimens prescribed. Fifteen percent (69/452) of patients received a discordant regimen, and 7.7% (35/452) died. Six percent (23/383) of patients with concordant regimen died compared with 17.4% (12/69) of patients with discordant regimen. Adjusting for age, sex, presence of comorbidity, unit type, hospital-acquired infections, and Gram stain, the odds of 30-day mortality were 2.9 (95% confidence interval: 1.2-7.0; P = 0.015) for patients receiving discordant early empiric antibiotics. CONCLUSIONS Odds of mortality in confirmed pediatric BSI are nearly 3-fold higher for patients receiving a discordant early empiric antibiotic regimen. The impact of improved concordance of early empiric treatment on mortality, particularly in critically ill patients, needs further evaluation.
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Affiliation(s)
- Aislinn Cook
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Yingfen Hsia
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Neal Russell
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Mike Sharland
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | | | - Keith Grimwood
- Gold Coast Health, Gold Coast, QLD, Australia
- Griffith University, QLD, Australia
| | - Jack Cross
- Gold Coast Health, Gold Coast, QLD, Australia
| | - Denise Cotrim da Cunha
- Hospital Infection Control Service of Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Gloria Regina Magalhães
- Hospital Infection Control Service of Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Avni Hindocha
- North Manchester General Hospital, Manchester, United Kingdom
| | - Paddy McMaster
- North Manchester General Hospital, Manchester, United Kingdom
| | - Uduak Okomo
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saffiatou Darboe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, RDT Hospital, Anantapur, Andhra Pradesh, India
| | - Dasaratha R Jinka
- Department of Infectious Diseases, RDT Hospital, Anantapur, Andhra Pradesh, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | - Dhanya Dharmapalan
- Dr. Yewale's Multispecialty Hospital for Children, Vashi, Navi Mumbai, India
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Kahoru Fukuoka
- Division of Infectious Diseases, Department of Paediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuta Aizawa
- Division of Infectious Diseases, Department of Paediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Rodolfo Norberto Jimenez-Juarez
- Infectious Diseases Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico
- Department of Pediatrics, Infectious Diseases Hospital, national Medical Center "La Raza", Mexican Institute of Social Security, Mexico City, Mexico
| | - Karla Ojeda-Diezbarroso
- Infectious Diseases Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico
| | - Mateja Pirš
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Rožič
- Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Watsamon Jantarabenjakul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ching-Lan Cheng
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Bai-Xiu Jian
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Evangelos Spyridakis
- University of Florida College of Medicine, Gainesville, FL
- The Studer Family Children's Hospital at Ascension Sacred Heart, Pensacola, FL
| | - Theoklis Zaoutis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia Bielicki
- From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
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Zhang J, Li X, Xie J, Zheng W. Evaluation of a clinical pharmacist consultation service for patients with infectious diseases in China: a systematic review and meta-analysis. Eur J Hosp Pharm 2019; 27:131-136. [PMID: 32419932 PMCID: PMC7223343 DOI: 10.1136/ejhpharm-2018-001815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 11/03/2022] Open
Abstract
Background Since antibiotic resistance has become a global public health issue, a clinical pharmacist consultation service has been established in China. Objectives To clarify the role of the clinical pharmacist consultation service in the management of infectious diseases (ID). Methods Medline, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Vip Database and Wanfang Database were searched for studies meeting predefined inclusion criteria. The pooled acceptance rate of consultation (ARC) and effective rate of patients treated with the acceptance of pharmacists' suggestions (ERA) were then calculated. Results Fifty studies (involving 8616 patients and 8828 consultations) from 17 different provinces in China were included. The pooled ARC and ERA were 93.13% (95% CI 90.62% to 95.00%) and 93.60% (95% CI 91.99% to 95.24%), respectively. Adopting pharmacists' suggestions can significantly improve the prognosis of patients with ID with a risk ratio of 2.08 (95% CI 1.41 to 3.06). Factors such as study time, characteristics of the research institution and patients have important influences on ARC. Conclusion Prospective cohort studies with better methodology are needed, although a series of uncontrolled studies has shown that the service has excellent acceptance and improves the effectiveness of treatment for ID.
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Affiliation(s)
- Jiaxing Zhang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xiaosi Li
- Department of Pharmacy, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China
| | - Juan Xie
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Wenyi Zheng
- Experimental Cancer Medicine, Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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Peters L, Olson L, Khu DTK, Linnros S, Le NK, Hanberger H, Hoang NTB, Tran DM, Larsson M. Multiple antibiotic resistance as a risk factor for mortality and prolonged hospital stay: A cohort study among neonatal intensive care patients with hospital-acquired infections caused by gram-negative bacteria in Vietnam. PLoS One 2019; 14:e0215666. [PMID: 31067232 PMCID: PMC6505890 DOI: 10.1371/journal.pone.0215666] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antibiotic resistance (ABR) is an increasing burden for global health. The prevalence of ABR in Southeast Asia is among the highest worldwide, especially in relation to hospital-acquired infections (HAI) in intensive care units (ICU). However, little is known about morbidity and mortality attributable to ABR in neonates. AIM This study aimed to assess mortality and the length of hospitalization attributable to ABR in gram-negative bacteria (GNB) causing HAI in a Vietnamese neonatal ICU (NICU). METHODS We conducted a prospective cohort study (n = 296) in a NICU in Hanoi, Vietnam, from March 2016 to October 2017. Patients isolated with HAI caused by GNB were included. The exposure was resistance to multiple antibiotic classes, the two outcomes were mortality and length of hospital stay (LOS). Data were analysed using two regression models, controlling for confounders and effect modifiers such as co-morbidities, time at risk, severity of illness, sex, age, and birthweight. RESULTS The overall case fatality rate was 44.3% and the 30 days mortality rate after infection was 31.8%. For every additional resistance to an antibiotic class, the odds of a fatal outcome increased by 27% and LOS increased by 2.1 days. These results were statistically significant (p < 0.05). CONCLUSION ABR was identified as a significant risk factor for adverse outcomes in neonates with HAI. These findings are generally in line with previous research in children and adults. However, heterogeneous study designs, the neglect of important confounders and varying definitions of ABR impair the validity, reliability, and comparability of results.
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Affiliation(s)
- Lynn Peters
- Global Health program, Karolinska Institutet, Stockholm, Sweden
| | - Linus Olson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
| | - Dung T. K. Khu
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Sofia Linnros
- Global Health program, Karolinska Institutet, Stockholm, Sweden
| | - Ngai K. Le
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
- Department of Microbiology, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Håkan Hanberger
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ngoc T. B. Hoang
- Department of Microbiology, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Dien M. Tran
- Research Institute for Child Health, Hanoi, Vietnam
- Department of Surgery, Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - Mattias Larsson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Training and Research Academic Collaboration Sweden-Vietnam, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Olsen MH, Anhøj J, Knudsen JD, Frimodt-Møller N, Møller K. Comparison of methods for measuring antibiotic consumption in an intensive care unit. APMIS 2019; 127:33-40. [PMID: 30549136 DOI: 10.1111/apm.12909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
Hospitals worldwide are working on minimizing unnecessary use of antimicrobials. To assess actual changes of antimicrobial usage, correct and precise measurements are necessary. This study aimed to compare data on the purchase of antibiotics from the pharmacy and the administration of antibiotics to patients, respectively, in an intensive care unit (ICU). Data were obtained from the Neurointensive Care Unit (NICU) at Rigshospitalet, Denmark. During a 23-month period, comprising 10 770 bed-days (BD), the ward purchased 16 908 defined daily doses (DDD) of antibiotics from the pharmacy, and 15 130 DDD and 41 304 individual doses were administered. Intraclass correlation coefficients (ICCs) were calculated; control and runcharts and a Bland-Altman plot were constructed. Pharmacy sales and drug administration data showed no systematic variation over time with a monthly overestimation of pharmacy sales data of 10% (95% confidence interval (CI), 6.20-14.3%) for all antibiotics, and 7% (95% CI: 1.81-11.1%) for broad-spectrum antibiotics. The antibiotic consumption, without bed-days, has a clinically acceptable ICC of >0.70 and no systematic difference is suggested by the Bland-Altman plot. In this study of a large NICU, whose antibiotic consumption varied at random, pharmacy sales data were an acceptable approximation of the actual summarized drug consumption.
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Affiliation(s)
- Markus Harboe Olsen
- Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Anhøj
- Centre of Diagnostic Investigation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Cornejo-Juárez P, Vilar-Compte D, García-Horton A, López-Velázquez M, Ñamendys-Silva S, Volkow-Fernández P. Hospital-acquired infections at an oncological intensive care cancer unit: differences between solid and hematological cancer patients. BMC Infect Dis 2016; 16:274. [PMID: 27286681 PMCID: PMC4903007 DOI: 10.1186/s12879-016-1592-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 05/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer patients have a higher risk of severe sepsis in comparison with non-cancer patients, with an increased risk for hospital-acquired infections (HAI), particularly with multidrug resistant bacteria (MDRB). The aim of the study is to describe the frequency and characteristics of HAI and MDRB in critically ill cancer patients. METHODS We conducted an 18-month prospective study in patients admitted ≥48 h to an ICU at a cancer referral center in Mexico. Patients with hematological malignancies (HM) were compared with solid tumors. Demographic and clinical data were recorded. Mortality was evaluated at 30-days. RESULTS There were 351 admissions during the study period, among whom 157 (66 %) met the inclusion criteria of the study as follows: 104 patients with solid tumors and 53 with HM. Sixty-four patients (40.7 %) developed 95 episodes of HAI. HAI rate was 4.6/100 patients-days. MDRB were isolated in 38 patients (24 %), with no differences between both groups. Escherichia coli was the main bacteria isolated (n = 24), 78 % were extended spectrum beta-lactamases producers. The only risk factor associated with HAI was the presence of mechanical ventilation for more than 5 days (OR 3.12, 95 % CI 1.6 - 6.2, p = 0.001). At 30-day follow-up, 61 patients (39 %) have died (38 % with solid tumors and 60 % with HM, p < 0.001). No differences were found in mortality at 30-day between patients with HAI (n = 25, 39 %) vs. non-HAI (n = 36, 38.7 %, p = 0.964); neither in those who developed a HAI with MDRB (n = 12, 35.3 %) vs. HAI with non-MDRB (n = 13, 43.3 %, p = 0.51). CONCLUSIONS Patients with cancer who are admitted to an ICU, have a high risk of HAI, but there were no differences patients with solid or hematologic malignancies.
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Affiliation(s)
- Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico.
| | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Alejandro García-Horton
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Marco López-Velázquez
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Silvio Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, México, D.F., Mexico
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Quantitative matrix-assisted laser desorption ionization-time of flight mass spectrometry for rapid resistance detection. J Clin Microbiol 2014; 52:4155-62. [PMID: 25232164 DOI: 10.1128/jcm.01872-14] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antibiotic resistance in Gram-negative microorganisms is an increasing health care problem. The rapid detection of such resistance is crucial for starting an early specific therapy and to enable initiation of the required hygiene measures. With continued emphasis on reducing the cost of laboratory testing, only economical/low-cost approaches have a chance of being implemented. During recent years, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been developed to be a standard method in microbiology laboratories for the rapid and cost-efficient identification of microorganisms. Extending the usage of MALDI-TOF MS in the clinical microbiology laboratory to the area of resistance testing is an attractive option. Quantitative MALDI-TOF MS using an internal standard facilitates the measurement of the quantity of peptides and small proteins within a spectrum. These quantities correlate to the number of microorganisms and therefore to the growth of a microorganism. The comparison of growth in the presence or absence of an antibiotic allows for analysis of the susceptibility behavior of a strain. Here, we describe a novel method and its application in the analysis of 108 Klebsiella sp. isolates. After 1 h of incubation at a meropenem concentration of 8 μg/ml, a sensitivity of 97.3% and a specificity of 93.5% were achieved (compared to Etest results).
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11
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Erdem H, Inan A, Altındis S, Carevic B, Askarian M, Cottle L, Beovic B, Csomos A, Metodiev K, Ahmetagic S, Harxhi A, Raka L, Grozdanovski K, Nechifor M, Alp E, Bozkurt F, Hosoglu S, Balik I, Yilmaz G, Jereb M, Moradi F, Petrov N, Kaya S, Koksal I, Aslan T, Elaldi N, Akkoyunlu Y, Moravveji SA, Csato G, Szedlak B, Akata F, Oncu S, Grgic S, Cosic G, Stefanov C, Farrokhnia M, Müller M, Luca C, Koluder N, Korten V, Platikanov V, Ivanova P, Soltanipour S, Vakili M, Farahangiz S, Afkhamzadeh A, Beeching N, Ahmed SS, Cami A, Shiraly R, Jazbec A, Mirkovic T, Leblebicioglu H, Naber K. Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran--a prospective multicenter point prevalence study. J Infect 2013; 68:131-40. [PMID: 24269951 DOI: 10.1016/j.jinf.2013.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/01/2013] [Accepted: 11/01/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia. METHODS A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists. RESULTS Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%). CONCLUSION ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area.
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Affiliation(s)
- Hakan Erdem
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
| | - Asuman Inan
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Selma Altındis
- Sakarya University, Faculty of Management, Department of Health Administration, Sakarya, Turkey
| | - Biljana Carevic
- Clinical Center of Serbia (CCS), Department for Hospital Epidemiology, Belgrade, Serbia
| | - Mehrdad Askarian
- Department of Community Medicine, School of Medicine, Medicinal & Natural Products Chemistry Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Lucy Cottle
- Royal Liverpool University Hospital, United Kingdom
| | - Bojana Beovic
- University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia
| | - Akos Csomos
- Semmelweis University, Department of Anaesthesia and Intensive Care, Budapest, Hungary
| | - Krassimir Metodiev
- Medical University, Department of Preclinical and Clinical Sciences, Varna, Bulgaria
| | - Sead Ahmetagic
- University Clinical Center Tuzla, Department for Infectious Diseases, Tuzla, Bosnia and Herzegovina
| | - Arjan Harxhi
- University Hospital Center of Tirana, Service of Infectious Disease, Tirana, Albania
| | - Lul Raka
- University of Prishtina, School of Medicine & National Institute of Public Health of Kosova, Prishtina, Kosova, Serbia
| | - Krsto Grozdanovski
- University Clinic for Infectious Diseases, Department of Intensive Care, Skopje, Macedonia
| | - Mihai Nechifor
- Gr. T. Popa University of Medicine and Pharmacy, Department of Pharmacology, Iasi, Romania
| | - Emine Alp
- Erciyes University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkey
| | - Fatma Bozkurt
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - Salih Hosoglu
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - Ismail Balik
- Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Gulden Yilmaz
- Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Matjaz Jereb
- University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia
| | - Fatemeh Moradi
- Clinical Research Center on Infectious Diseases and Tropical Medicine, Bandar Abbas, Iran
| | - Nikolay Petrov
- Military Medical Academy, Department Anaesthesiology and Intensive Care, Sofia, Bulgaria
| | - Selcuk Kaya
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - Iftihar Koksal
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - Turan Aslan
- Bezmi Alem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Nazif Elaldi
- Cumhuriyet University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sivas, Turkey
| | - Yasemin Akkoyunlu
- Bezmi Alem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Seyyed Alireza Moravveji
- Kashan University of Medical Sciences, Trauma Research Center, Department of Community Medicine, Kashan, Iran
| | - Gabor Csato
- Kenézy Hospital, Department of Anesthesiology and Intensive Care, Debrecen, Hungary
| | - Balazs Szedlak
- Borsod County Hospital and Teaching Hospital, Department of Anaesthesiology and Intensive Therapy, Miskolc, Hungary
| | - Filiz Akata
- Trakya University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Edirne, Turkey
| | - Serkan Oncu
- Adnan Menderes University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Aydin, Turkey
| | - Svjetlana Grgic
- University Hospital Clinic for Infectious Diseases, Mostar, Bosnia and Herzegovina
| | - Gorana Cosic
- IPH of Vojvodina, Department of Prevention and Control of Diseases, Medical Faculty, University of Novi Sad, Serbia
| | - Chavdar Stefanov
- University Multiprofile Hospital for Active Treatment, Department of Anesthesiology and Intensive Treatment, St. Georgi, Plovdiv, Bulgaria
| | - Mehrdad Farrokhnia
- Kerman University of Medical Sciences, Department of Internal Medicine, Kerman, Iran
| | - Mária Müller
- Markhot Hospital, Department of Anaesthesiology and Intensive Care, Eger, Hungary
| | - Catalina Luca
- Gr. T. Popa University of Medicine and Pharmacy, Department of Pharmacology, Iasi, Romania
| | - Nada Koluder
- Clinic for Infectious Diseases, Sarajevo, Bosnia and Herzegovina
| | - Volkan Korten
- Marmara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Viliyan Platikanov
- University Hospital "St. Marina", Department of Anesthesiology and ICM, Varna, Bulgaria
| | - Petja Ivanova
- University Hospital "St. Marina", Department of Anesthesiology and ICM, Varna, Bulgaria
| | - Soheil Soltanipour
- Guilan University of Medical Sciences, School of Medicine, Department of Community Medicine, Rasht, Iran
| | - Mahmood Vakili
- Shahid Sadoughi University School of Medicine, Department of Community Medicine, Yazd, Iran
| | - Saman Farahangiz
- Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdorrahim Afkhamzadeh
- Department of Community Medicine, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Salman Shaheer Ahmed
- Erciyes University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkey
| | - Alma Cami
- University Hospital of Pulmonary Disease, Intensive Care Clinic, Tirana, Albania
| | - Ramin Shiraly
- Ilam University of Medical Sciences, Department of Community Medicine, Yazd, Iran
| | - Anja Jazbec
- University Clinical Center Ljubljana, Center for Intensive Internal Medicine, Ljubljana, Slovenia
| | - Tomislav Mirkovic
- University Medical Centre Ljubljana, Department of Anestesiology and Surgical Intensive Care, Ljubljana, Slovenia
| | - Hakan Leblebicioglu
- Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - Kurt Naber
- Technical University of Munich, Munich, Germany
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12
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Affiliation(s)
- Jung Hyun Choi
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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13
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Woerther PL, Angebault C, Jacquier H, Hugede HC, Janssens AC, Sayadi S, El Mniai A, Armand-Lefevre L, Ruppe E, Barbier F, Raskine L, Page AL, de Rekeneire N, Andremont A. Massive Increase, Spread, and Exchange of Extended Spectrum -Lactamase-Encoding Genes Among Intestinal Enterobacteriaceae in Hospitalized Children With Severe Acute Malnutrition in Niger. Clin Infect Dis 2011; 53:677-85. [DOI: 10.1093/cid/cir522] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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14
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Marwick C, Broomhall J, McCowan C, Phillips G, Gonzalez-McQuire S, Akhras K, Merchant S, Nathwani D, Davey P. Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients. J Antimicrob Chemother 2010; 66:387-97. [PMID: 20926396 DOI: 10.1093/jac/dkq362] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) are caused by bacterial invasion of the skin and underlying soft tissues and can present with a wide spectrum of signs, symptoms and illness severity. They are a common indication for antimicrobial therapy. However, there are few data on treatment outcomes or the validity of clinical severity scores. METHODS Two hundred and five adult patients admitted to Ninewells Hospital, Scotland in 2005, and treated with antibiotics for SSTI, were identified. They were stratified into four classes of severity (class IV = most severe) based on sepsis, co-morbidity and their standardized early warning score (SEWS). Empirical antimicrobial therapy by severity class was compared with the recommendations of a UK guideline. RESULTS Thirty-five different empirical antimicrobial regimens were prescribed. Overall, 43% of patients were over-treated, this being particularly common in the lowest severity class I (65% patients). Thirty-day mortality was 9% (18/205) and 17 patients (8%) died during their index admission. Mortality (30 day) and inadequate therapy increased with severity class: I, no sepsis or co-morbidity (45% patients, 1% mortality, 14% therapy inadequate); II, significant co-morbidity but no sepsis (32% patients, 11% mortality, 39% therapy inadequate); III, sepsis but SEWS <4 (17% of patients, 17% mortality, 39% therapy inadequate); and IV, sepsis plus SEWS ≥ 4 (6% of patients, 33% mortality, 92% therapy inadequate). CONCLUSIONS SSTI in hospital is associated with significant mortality. Choice of empirical therapy is not evidence based, with significant under-treatment of severely ill patients.
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Affiliation(s)
- Charis Marwick
- Quality, Safety and Informatics Research Group, Division of Clinical and Population Sciences and Education, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, Scotland, UK.
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