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Bassetti M, Monti G, Henriksen AS, Longshaw C. Predicting early appropriate therapy for patients infected by carbapenem-resistant Gram-negative pathogens in intensive care units in Italy. Antimicrob Resist Infect Control 2024; 13:91. [PMID: 39183351 PMCID: PMC11345987 DOI: 10.1186/s13756-024-01452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Antibiotic resistance among Gram-negative bacteria in intensive care units (ICUs) is linked with high morbidity and mortality in patients. In this study, we estimated the therapeutic coverage of various antibiotics, focusing on cefiderocol and comparators, administered empirically against an infection of unknown origin in the ICU. METHODS In the ARTEMIS surveillance study, susceptibilities of 624 Italian Gram-negative isolates to amikacin, aztreonam-avibactam, cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, colistin, imipenem-relebactam, meropenem, and meropenem-vaborbactam were tested by broth microdilution, and results were interpreted by European Committee on Antimicrobial Susceptibility Testing breakpoints. The susceptibility rates from the ARTEMIS study were extrapolated to Gram-negative isolates obtained from 5,774 patients in Italian ICUs in 2021. The sum of the predicted susceptibilities of individual pathogens represented the overall likelihood of in vitro activity of each antibiotic as early targeted therapy for ICU patients. RESULTS A total of 624 Italian Gram-negative isolates included 206 Pseudomonas aeruginosa, 138 Acinetobacter baumannii, 187 Klebsiella pneumoniae, and 93 Escherichia coli. Against A. baumannii, K. pneumoniae, P. aeruginosa, and E. coli, the overall susceptibility rates for cefiderocol were 87.7%, 96.8%, 99%, and 100%, respectively; and for comparator agents, 8.7-96.4%, 25.7-100%, 73.3-100%, and 89.2-100%, respectively. Among the subset of meropenem-resistant isolates, susceptibility rates of A. baumannii, K. pneumoniae, and P. aeruginosa to cefiderocol were 86.4%, 96.2% and 100%, respectively. Corresponding susceptibility rates to comparator agents were 0-96.8%, 0-100%, and 6.4-100%, respectively. There were no meropenem-resistant isolates of E. coli. The extrapolation of data to isolates from Italian ICUs showed that the highest likelihood of therapeutic coverage, both overall and among meropenem-resistant isolates, was reported for colistin (96.8% and 72.2%, respectively) and cefiderocol (95.7% and 71.4%, respectively). All other antibiotics were associated with a likelihood below 73% overall and between 0% and 41.4% for meropenem-resistant isolates. CONCLUSIONS Based on confirmed susceptibility rates and reported ICU prevalence of multiple Gram-negative species, cefiderocol showed a higher predicted therapeutic coverage and utility in ICUs compared with comparator beta-lactam-beta-lactamase inhibitor antibiotics. Cefiderocol may be a promising early treatment option for patients at high risk of carbapenem-resistant Gram-negative bacterial infections in the ICU.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianpaola Monti
- Department of Anesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Quirino A, Cicino C, Scarlata GGM, Marascio N, Di Gennaro G, Matera G, Licata F, Bianco A. Prevalence of Colonization with Multidrug-Resistant Bacteria: Results of a 5-Year Active Surveillance in Patients Attending a Teaching Hospital. Antibiotics (Basel) 2023; 12:1525. [PMID: 37887226 PMCID: PMC10604483 DOI: 10.3390/antibiotics12101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
Combating antimicrobial resistance (AMR) requires comprehensive efforts, such as screening to identify patients colonized by multidrug-resistant microorganisms (MDROs). The primary purpose of this study was to estimate the AMR pattern of methicillin-resistant Staphylococcus aureus (MRSA) isolated from nasal surveillance swabs and MDROs isolated from pharyngeal and rectal surveillance swabs in patients attending a teaching hospital. Data were sought retrospectively, from 1 January 2017 to 31 December 2021, from the records produced by the hospital microbiology laboratory. Duplicate isolates, defined as additional isolates of the same microorganism with identical antibiograms, were excluded. Among Staphylococcus aureus isolates from nasal swabs, 18.2% were oxacillin-resistant. Among Gram-negative bacteria, 39.8% of Klebsiella pneumoniae and 83.5% of Acinetobacter baumannii isolates were carbapenem-resistant. Resistance to three antibiotic categories was high among Acinetobacter baumannii (85.8%) and Klebsiella pneumoniae (42.4%). The present data highlight a high prevalence of MDRO colonization among patients admitted to the hospital and suggest that screening for MDROs could be an important tool for infection control purposes, especially in geographical areas where limiting the spread of MDROs is crucial. The results also underline the importance of active surveillance, especially for carbapenem-resistant, Gram-negative bacteria in reducing their transmission, especially in high-risk units.
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Affiliation(s)
- Angela Quirino
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Claudia Cicino
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Giuseppe Guido Maria Scarlata
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Nadia Marascio
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Gianfranco Di Gennaro
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Giovanni Matera
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Aida Bianco
- Department of Medical and Surgical Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy;
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Temesgen M, Kumalo A, Teklu T, Alemu G, Odoko D. Bacterial Profile and Their Antimicrobial Susceptibility Pattern of Isolates Recovered from Intensive Care Unit Environments at Wachemo University Nigist Ellen Mohammed Memorial Comprehensive Specialized Hospital, Southern Ethiopia. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:1216553. [PMID: 37745268 PMCID: PMC10516698 DOI: 10.1155/2023/1216553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023]
Abstract
Background Bacterial contamination of indoor hospitals, especially in intensive care units is a serious health hazard in the world with a high morbidity and mortality rates. Particularly, multidrug-resistant bacteria can cross-contaminate medical devices, inanimate surfaces, health care providers, and patients in the intensive care unit. This study was aimed to assess the bacterial profile and their antimicrobial susceptibility patterns of bacterial isolates from intensive care unit at WUNEMMCSH (Wachemo University Nigest Ellen Mohammed Memorial Compressive Specialized Hospital), Southern Ethiopia. Methods A hospital-based cross sectional study was conducted on 180 intensive care unit environmental samples at WUNEMMCSH from August 1, 2022, to October 30, 2022. In this study, a total of 180 swab samples were collected from medical devices, inanimate surfaces, patients, and health care providers from the intensive care unit by using sterile cotton-tipped swabs moistened with normal saline. Then, bacterial isolates were identified using the standard culture method, Gram stain, and biochemical tests. Antimicrobial susceptibility tests for bacterial isolates were performed by using the Kirby Bauer disk diffusion method. Data were entered into EpiData Version 4.6 cleanup and exported to SPSS V25 for analysis. Results A total of 180 swab samples were processed from intensive care unit environments, and 143 (79.4%) were found to have been contaminated by at least one potential pathogenic bacterial isolate. A total of two hundred and thirty-eight bacteria were isolated. Of these, the predominant bacteria were coagulase-negative Staphylococci 72 (30.3%), S. aureus 61 (25.6%), E. coli 41 (17.2%), and K. pneumoniae 30 (12.6%). Seventy (49%) out of all swabbed samples were contaminated with mixed isolates. In the antimicrobial susceptibility tests, 19 (86%) Gram-positive bacteria and 25 (76%) Gram-negative bacterial isolates were susceptible to nitrofurantoin, respectively. Vancomycin was sensitive to 83% of Gram-positive isolates. Gram-positive and Gram-negative isolates from irrespective sources showed multidrug resistance in 56.4% and 76.2%, respectively. Conclusion The inanimate hospital environments, medical device, health care providers, and patients in ICU rooms of WUNEMMCSH (Wachemo University Nigest Ellen Mohammed Memorial Comprehensive Specialized Hospital) were colonized with 143 (79.4%) of potential pathogenic bacterial isolate, which can cause nosocomial infections with high rates of morbidity and mortality among patients. The frequencies of multidrug-resistant 159 (66.8%) bacterial pathogens were alarmingly high. Therefore, to reduce the risk of bacterial contamination and MDR, strict adherence to hospital infection prevention and control measures should be enforced. These measures include regularly performing hand hygiene, periodic disinfection, and sterilization of medical equipment.
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Affiliation(s)
- Muluneh Temesgen
- Department of Medical Laboratory Science, Hosanna Health Science College, Hosanna, Ethiopia
| | - Abera Kumalo
- Department of Medical Laboratory Science, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Takele Teklu
- Department of Medical Laboratory Science, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Getachew Alemu
- Department of Medical Laboratory Science, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Desta Odoko
- Department of Medical Laboratory Science, Sodo Christian General Hospital, Sodo, Ethiopia
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Li RJ, Wu YL, Huang K, Hu XQ, Zhang JJ, Yang LQ, Yang XY. A prospective surveillance study of healthcare-associated infections in an intensive care unit from a tertiary care teaching hospital from 2012-2019. Medicine (Baltimore) 2023; 102:e34469. [PMID: 37543835 PMCID: PMC10402966 DOI: 10.1097/md.0000000000034469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Healthcare-associated infections (HAIs) continue to be the most common adverse event affecting critically ill inpatients in intensive care units (ICUs). Limited data exist in the English literature on the epidemiology of HAIs in ICUs from China. The purpose of this prospective study was to understand the prevalence and trends of HAIs in the ICU to guide clinicians to take effective prevention and control measures. In total, 20 ICU beds in the hospital from January 2012 to December 2019 were selected for surveillance. HAI diagnosis and device-associated infection surveillance were based on the criteria set forth by the original Ministry of Health of the People's Republic of China. The full-time staff for HAI management monitored all patients who stayed in the ICU > 48 hours during the study period and calculated the device utilization ratio and device-associated infection rate. The rate of HAIs and the adjusted rate were 18.78 per 1000 patient-days and 5.17 per 1000 patient-days, respectively. The rates of ventilator-associated pneumonias, catheter-associated urinary tract infections, and central line-associated bloodstream infections were 22.68 per 1000 device-days, 2.40 per 1000 device-days, and 2.27 per 1000 device-days, respectively. A total of 731 pathogenic bacteria were detected in the patients with HAIs. Gram-negative and gram-positive bacteria accounted for 67.44% and 16.83%, respectively. Continuous target monitoring, regular analysis of high-risk factors, and timely intervention measures could effectively reduce HAIs in the ICU. Additionally, these findings could be used for developing new strategies to prevent and control HAIs in ICUs.
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Affiliation(s)
- Ruo-Jie Li
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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CALABRÒ GIOVANNAELISA, CASELLI ELISABETTA, ROGNONI CARLA, LAURENTI PATRIZIA, MOSCATO UMBERTO, DI PIETRO MARIALUISA, GUALANO MARIAROSARIA, CASCINI FIDELIA, D’AMBROSIO FLORIANA, PATTAVINA FABIO, VINCENTI SARA, MAIDA ADA, MANCINI ROSSELLA, MARTINELLI SILVIA, AMANTEA CARLOTTA, CORONA VALERIOFLAVIO, DANIELE ALESSANDRA, PALADINI ANDREA, ROSSI MARIAFRANCESCA, LA GATTA EMANUELE, PETRELLA LUIGI, PULEO VALERIA, TARRICONE ROSANNA, RICCIARDI WALTER. [Health Technology Assessment of the Probiotic Cleaning Hygiene System (PCHS)]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E1-E123. [PMID: 36819908 PMCID: PMC9910312 DOI: 10.15167/2421-4248/jpmh2022.63.3s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
- VIHTALI - Value In Health Technology and Academy for Leadership & Innovation Spin-Off dell’Università Cattolica del Sacro Cuore, Roma
- Autore corrispondente: Giovanna Elisa Calabrò, Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia - E-mail:
| | - ELISABETTA CASELLI
- Sezione di Microbiologia, Dipartimento di Scienze chimiche, farmaceutiche e agrarie, CIAS e LTTA, Università degli Studi di Ferrara
| | | | - PATRIZIA LAURENTI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - UMBERTO MOSCATO
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Sezione di Medicina del Lavoro, Dipartimento Universitario Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - MARIA LUISA DI PIETRO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - MARIA ROSARIA GUALANO
- Centro di Ricerca e Studi sulla Leadership in Medicina, Università Cattolica del Sacro Cuore, Roma
| | - FIDELIA CASCINI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - FLORIANA D’AMBROSIO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - FABIO PATTAVINA
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - SARA VINCENTI
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - ADA MAIDA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - ROSSELLA MANCINI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - SILVIA MARTINELLI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - CARLOTTA AMANTEA
- Sezione di Medicina del Lavoro, Dipartimento Universitario Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - VALERIO FLAVIO CORONA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - ALESSANDRA DANIELE
- Sezione di Medicina del Lavoro, Dipartimento Universitario Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - ANDREA PALADINI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - MARIA FRANCESCA ROSSI
- Sezione di Medicina del Lavoro, Dipartimento Universitario Scienze della Vita e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - EMANUELE LA GATTA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - LUIGI PETRELLA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - VALERIA PULEO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
| | - ROSANNA TARRICONE
- CERGAS-SDA Bocconi School of Management, Milano
- Dipartimento di Scienze Sociali e Politiche, Università Bocconi, Milano
| | - WALTER RICCIARDI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
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Abstract
Antimicrobial Resistance (AMR) has become a global threat to public health systems around the world in recent decades. In 2017, Italy was placed among the worst-performing nations in Europe by the European Centre for Disease Prevention and Control, due to worryingly high levels of AMR in Italian hospitals and regions. The aim of this systematic review was to investigate the state of the art of research on AMR in Italy over the last five years. The PubMed database was searched to identify studies presenting original data. Forty-three of the 9721 records identified were included. Overall, AMR rates ranged from 3% (in a group of sheep farmers) to 78% (in a hospital setting). The methods used to identify the microorganisms, to test their susceptibility and the criteria adopted for the breakpoint were deficient in 7, 7 and 11 studies, respectively. The main findings of our review were that most studies (79.1%) considered hospitalised patients only, 4 studies (9.3%) analysed non-hospitalised populations only. In addition, only 7 studies were multicentric and no scientific literature on the subject was produced in 7 Italian regions. In order to have a solid basis on the topic for the interventions of public health professionals and other stakeholders, studies analysing the phenomenon should be conducted in a methodologically standardised manner, should include all areas of the country and should also focus on out-of-hospital and community-based care and work settings.
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Zhao T, Du G, Zhou X. Inappropriate urinary catheterisation: a review of the prevalence, risk factors and measures to reduce incidence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S13. [PMID: 35559693 DOI: 10.12968/bjon.2022.31.9.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Urinary tract infections (UTIs) comprise the second most common type of healthcare-associated infections, with up to 80% of UTIs caused by indwelling urinary catheters. Current research suggests that the best way to prevent catheter-associated UTIs (CAUTIs) is to reduce unnecessary catheterisation. Few reviews have focused on the prevalence, risk factors and preventive measures for inappropriate catheterisation. This article, consequently, sought to evaluate the current evidence on the prevalence, risk factors and measures that can be taken to prevent inappropriate urinary catheterisation.
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Affiliation(s)
- Tao Zhao
- Department of Hospital Infection Management, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
| | - Guiqin Du
- Department of Hospital Infection Management, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
| | - Xuan Zhou
- Department of Science and Education, The First People's Hospital of Guiyang, Guiyang City, Guizhou Province, China
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Juliana Martins F, Savacini Sagrillo F, Josiane Vinturelle Medeiros R, Gonçalves de Souza A, Rodrigues Pinto Costa A, Silva Novais J, Alves Miceli L, R Campos V, Marie Sá Figueiredo A, Claudia Cunha A, Lidmar von Ranke N, Lamim Bello M, de A Abrahim-Vieira B, M T De Souza A, A Ratcliffe N, da Costa Santos Boechat F, Cecília Bastos Vieira de Souza M, Rangel Rodrigues C, Carla Castro H. Evaluation of biological activities of quinone-4-oxoquinoline derivatives against pathogens of clinical importance. Curr Top Med Chem 2022; 22:973-991. [PMID: 35524665 DOI: 10.2174/1568026622666220504124710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Microbial resistance has become a worldwide public health problem, and may lead to morbidity and mortality in affected patients. OBJECTIVE Therefore, this work aimed to evaluate the antibacterial activity of quinone-4-oxoquinoline derivatives. METHOD These derivatives were evaluated against Gram-positive and Gram-negative bacteria by their antibacterial activity, anti-biofilm, and hemolytic activities and by in silico assays. RESULTS The quinone-4-oxoquinoline derivatives presented broad-spectrum antibacterial activities, and in some cases were more active than commercially available reference drugs. These compounds also inhibited bacterial adhesion and the assays revealed seven non-hemolytic derivatives. The derivatives seem to cause damage to the bacterial cell membrane and those containing the carboxyl group at the C-3 position of the 4-quinolonic nucleus were more active than those containing a carboxyethyl group. CONCLUSION The isoquinoline-5,8-dione nucleus also favored antimicrobial activity. The study showed that the target of the derivatives must be a non-conventional hydrophobic allosteric binding pocket on the DNA gyrase enzyme.
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Affiliation(s)
- Francislene Juliana Martins
- Federal Fluminense University, Biology Institute, Postgraduate Program in Science and Biotechnology, Niterói, Rio de Janeiro, Brazil
| | - Fernanda Savacini Sagrillo
- Federal Fluminense University, Chemistry Institute, Department of Organic Chemistry, Niterói, Rio de Janeiro, Brazil
| | | | - Alan Gonçalves de Souza
- Federal Fluminense University, Chemistry Institute, Department of Organic Chemistry, Niterói, Rio de Janeiro, Brazil
| | - Amanda Rodrigues Pinto Costa
- Federal Fluminense University, Chemistry Institute, Department of Organic Chemistry, Niterói, Rio de Janeiro, Brazil
| | - Juliana Silva Novais
- Federal Fluminense University, Medical School, Postgraduate in Pathology, Niterói, Rio de Janeiro, Brazil.,Universidade Estácio de Sá (UNESA), Faculdade de Farmácia, São Gonçalo, Rio de Janeiro, Brazil
| | - Leonardo Alves Miceli
- Federal University of Rio de Janeiro, Faculdade de Farmácia, Departamento de Fármacos e Medicamentos, Rio de Janeiro, Brazil
| | - Vinícius R Campos
- Federal Fluminense University, Chemistry Institute, Department of Organic Chemistry, Niterói, Rio de Janeiro, Brazil
| | - Agnes Marie Sá Figueiredo
- Federal University of Rio de Janeiro, Microbiology Institute Professor Paulo Goes, Department of Medical Microbiology, Rio de Janeiro, Brazil
| | - Anna Claudia Cunha
- Federal Fluminense University, Chemistry Institute, Department of Organic Chemistry, Niterói, Rio de Janeiro, Brazil
| | - Natalia Lidmar von Ranke
- Federal University of Rio de Janeiro, Faculdade de Farmácia, Departamento de Fármacos e Medicamentos, Rio de Janeiro, Brazil
| | - Murilo Lamim Bello
- Federal University of Rio de Janeiro, Faculdade de Farmácia, Departamento de Fármacos e Medicamentos, Rio de Janeiro, Brazil
| | - Bárbara de A Abrahim-Vieira
- Federal University of Rio de Janeiro, Faculdade de Farmácia, Departamento de Fármacos e Medicamentos, Rio de Janeiro, Brazil
| | - Alessandra M T De Souza
- Federal University of Rio de Janeiro, Faculdade de Farmácia, Departamento de Fármacos e Medicamentos, Rio de Janeiro, Brazil
| | - Norman A Ratcliffe
- Department of Biosciences, College of Science Swansea University, SA2 8PP. UK
| | | | | | - Carlos Rangel Rodrigues
- Federal University of Rio de Janeiro, Faculdade de Farmácia, Departamento de Fármacos e Medicamentos, Rio de Janeiro, Brazil
| | - Helena Carla Castro
- Federal Fluminense University, Biology Institute, Postgraduate Program in Science and Biotechnology, Niterói, Rio de Janeiro, Brazil
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Suranadi IW, Sucandra IMAK, Fatmawati NND, Wisnawa ADF. A Retrospective Analysis of the Bacterial Infections, Antibiotic Use, and Mortality Predictors of COVID-19 Patients. Int J Gen Med 2022; 15:3591-3603. [PMID: 35392031 PMCID: PMC8983054 DOI: 10.2147/ijgm.s351180] [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: 01/04/2022] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose This study aimed to investigate the rate and profile of bacterial infections, mortality-associated predictors, and report the most common microorganisms and antibiotic use in coronavirus disease-19 (COVID-19) patients. Patients and Methods This study used a retrospective approach to evaluate the bacterial culture, antibiotic use, comorbidities, imaging, and laboratory discoveries of patients with COVID-19 (hospitalized) confirmed by reverse transcription polymerase chain reaction (RT-PCR) between May and December 2020. We have selected 906 COVID-19 positive patients using a consecutive sampling technique and analyzed data using IBM SPSS-22 statistical software. Statistical analysis included univariate, bivariate, and multivariate analysis. It was carried out using multivariable logistic regression analysis to predict the mortality of COVID-19 patients. Results A total of 410 patients, which involved 247 males with a mean age of 53.9 years were evaluated. Based on the results, the positive bacterial culture was detected in 18.3% of all patients who sent the culture sample test, representing bacterial infections. The Acinetobacter baumannii was the most commonly identified organism, while the proportion of patients treated with antibiotics was 83.4%. Furthermore, azithromycin was prescribed in the highest number of patients with approximately 44.3% of all antibiotics. The total mortality rate was 39.8% and its ratio was higher in COVID-19 patients with bacterial infections (65.3%, X2 = 25.1, P<0.001). Patients mortality who used antibiotics were also higher compared to those who did not (89% vs 11%, P<0.014). Age, length of hospitalization, bacterial infection, shortness of breath, neutrophil-to-lymphocyte ratio (NLR), and diabetes mellitus were also associated predictors to increased hospital mortality (adjusted OR (aOR) 0.382, P<0.013; aOR 4.265, P<0.001; aOR 3.720, P<0.001; aOR 3.889, P<0.001; aOR 6.839, P<0.003; aOR 1.844, P<0.030), respectively. Conclusion This study discovered that there is high use of antibiotics amongst COVID-19 patients; however, the bacterial infection rates did not exceed one-fifth of the total patients. Furthermore, older age, bacterial infections, a longer length of hospitalization, diabetes mellitus, shortness of breath, and higher NLR have a significant impact on the mortality of COVID-19 patients.
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Affiliation(s)
- I Wayan Suranadi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
- Correspondence: I Wayan Suranadi, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, 80113, Indonesia, Tel +62 812 3846 3838, Email
| | - I Made Agus Kresna Sucandra
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Ni Nengah Dwi Fatmawati
- Department of Clinical Microbiology, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
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Badparva B, Ghanbari A, Karkhah S, Osuji J, Kazemnejad Leyli E, Jafaraghaee F. Prevention of central line-associated bloodstream infections: ICU nurses' knowledge and barriers. Nurs Crit Care 2022; 28:419-426. [PMID: 35118750 DOI: 10.1111/nicc.12757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality. AIMS AND OBJECTIVES The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence-based guidelines in practice. DESIGN A cross-sectional study. METHODS Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020. RESULTS A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence-based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. CONCLUSIONS Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU. RELEVANCE TO CLINICAL PRACTICE The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence-based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.
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Affiliation(s)
- Bita Badparva
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Ghanbari
- Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.,Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Joseph Osuji
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
| | - Ehsan Kazemnejad Leyli
- Department of Bio-statistics, Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Jafaraghaee
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Kabrah AM, Kabrah SM, Bahwerth FS, Alredaini NF. Antibiotic Resistance Profile of Common Bacteria Isolated from Blood Stream, Lower Respiratory Tract and Urinary Infections in Intensive Care Unit in Saudi Arabia: A Retrospective Study. Ethiop J Health Sci 2021; 31:1231-1240. [PMID: 35392341 PMCID: PMC8968372 DOI: 10.4314/ejhs.v31i6.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background The rate of infections in the intensive care units (ICUs) is rising, mainly because of the increasing use of invasive procedures and specialized devices. This study aimed to identify the antibiotic resistance profile of common bacteria isolated from lower respiratory tract infections (LRTIs), bloodstream infections (BSIs), and urinary infections (UTIs) in ICUs in Saudi Arabia. Methods In the current retrospective study, the isolates and antibiotic resistance were collected from the Electronic Medical Record (EMR) for respiratory, blood, and urine samples. The study sample compromised 96 patients admitted to the ICU at least for 48 hours and have a central venous catheter (CVC) between November 1, 2020, and January 31, 2021. Results 66 (68.8%) of the study sample were males, and 30 (31.2%) were females. LRTIs were the most common isolates (51 samples), followed by BSIs (28 samples) and UTIs (17 samples). The isolated pathogens in this study were Klebsiella pneumoniae (K. pneumoniae) (59.4%), Coagulase-negative staphylococci (CoNS) (11.5%), Escherichia coli (E. coli) (8.4%), Acinetobacter baumannii (A. baumannii) (7.3%), and Staphylococcus aureus (S. aureus) (6.2%). BSI were frequently caused by CoNS (35.7%) and K. pneumoniae (35.7%), while Methicillin-resistant Staphylococcus aureus (MRSA) represented 10.7% of BSI. Vancomycin, Synercid, and Teicoplanin were the commonly used antibiotics and showed 100% sensitivity among S. aureus, including MRSA, while almost 100% resistance was observed for penicillin and oxacillin against the same organisms. The maximum resistance was observed with aztreonam (96.4%), ampicillin (87.3%), followed by co-amoxiclav (83.9%), cotrimoxazole (79.5%) and cephalosporin group antibiotics. Conclusions Strict adherence to infection prevention practices and wise use of antibiotics are recommended to slow the spread of antimicrobial resistance (AMR).
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Affiliation(s)
- Ahmed M Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Saeed M Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Fayez S Bahwerth
- Molecular Genetics, King Faisal Hospital, Ministry of Health, Makkah - Kingdom of Saudi Arabia
| | - Naof F Alredaini
- Faculty Member, King Abdulaziz University in Rabigh, Rabigh - Kingdom of Saudi Arabia
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Resistance Patterns of Gram-Negative Bacteria Recovered from Clinical Specimens of Intensive Care Patients. Microorganisms 2021; 9:microorganisms9112246. [PMID: 34835378 PMCID: PMC8619277 DOI: 10.3390/microorganisms9112246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Intensive care units are complex environments favoring high resistance in microorganisms. This study evaluated the resistance and the distribution dynamics of resistant Gram-negative bacteria (GNB) in patients admitted to intensive care units. This retrospective, record-based, cross-sectional study analyzed all of the antibiograms of patients admitted to the ICUs. The BD Phoenix system (BD Diagnostics, Sparks, MD, USA) was used for bacterial identification and antimicrobial testing. Clinical and Laboratory Standard Institute recommendations were used for antimicrobial testing. Frequencies and percentages of multidrug and pan-drug resistance were calculated. A total of 570 bacterial growths were observed, out of which 437 (76.7%) were of GNB. K. pneumoniae (21.0%), P. aeruginosa (11.8%), and Staphylococcus aureus (13.2%) were the most frequent disease-causing bacteria in intensive care patients. Resistance rates of 73.2% and 70.1% were observed for third- and fourth-generation cephalosporins, respectively, while 48.2% carbapenem and > 65% fluoroquinolones resistance rates were observed. Amikacin was the most effective antibiotic, with a sensitivity rate of 69.5%. A total of 372 (85.1%) of GNB were multidrug resistant. The majority of infections in intensive care patients are caused by multidrug-resistant (MDR) Gram-negative bacteria. Female gender and advancing age are factors favoring MDR. Enhanced surveillance and strengthening of the antimicrobial stewardship program are warranted.
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Bhalla M, Aggarwal A, Fatima KH. Carbapenem-resistant bacteria on hand-held and hands-free electronic devices of healthcare workers and non-healthcare workers in Delhi, India. Infect Prev Pract 2021; 3:100162. [PMID: 34647012 PMCID: PMC8498705 DOI: 10.1016/j.infpip.2021.100162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Monitoring sensitivity profiles of circulating hospital strains is a key activity of a hospital infection control policy. The hospital environment and equipment may be reservoirs for carbapenem-resistant bacteria. Mobile phones have been shown to be a potential source for the transmission of bacteria in the healthcare environment. Methods Bacteria were cultured from seven common electronic devices. These included touchpads, chargers, hands-free headphones/microphones, laptops, digital wristwatches and computer mice which were used by healthcare workers and non-healthcare workers including family members and patient attendants. The Gram-negative bacteria were further analysed for phenotypic and genotypic (blaKPC, blaNDM-1 genes) carbapenem resistance. Results 110 Gram-negative bacteria were isolated Mobile phones were found to be the most heavily contaminated devices and hands-free devices the least. 53.6% (n=59/110) Gram-negative bacteria were phenotypically carbapenem-resistant of which 36.37% (n=40) were metallo-β-lactamase positive. 40% (n=44/110) were genotypically resistant and 30% (n=33) were blaNDM-1 gene positive. 9% (n=10) bacteria had both blaNDM–1and blaKPC genes. Conclusions Carbapenem-resistant bacteria are widespread in India's hospital environment and present a challenge in healthcare. Electronic devices are a potential vehicle for the transmission of carbapenem-resistant bacteria. The results of the study support that hands-free electronic devices are less likely to be contaminated with carbapenem-resistant bacteria and that promoting the use of hands-free devices may help to reduce the spread of multidrug resistant bacteria in healthcare.
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Affiliation(s)
- Manpreet Bhalla
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Delhi, India
| | - Amit Aggarwal
- Department of Microbiology, Janakpuri Super Speciality Hospital, Delhi, India
- Corresponding author. Tel.: +91-9868815008.
| | - Khan Hena Fatima
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Delhi, India
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Poletajew S, Pawlik K, Bonder-Nowicka A, Pakuszewski A, Nyk Ł, Kryst P. Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland. Antibiotics (Basel) 2021; 10:antibiotics10101232. [PMID: 34680812 PMCID: PMC8532629 DOI: 10.3390/antibiotics10101232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Global and local initiatives were recently undertaken to reduce the burden of antibiotic resistance. The aim of the study was to describe the incidence and the aetiology of bacterial infections among hospitalized patients with special attention paid to the multidrug resistant (MDR) bacteria. This retrospective study was based on prospectively collected data from 150,529 consecutive patients hospitalized in a tertiary multidisciplinary hospital in the years 2017–2019. All consecutive microbiological tests from any biological material performed in the analyzed period were included. Microbiological screening tests (n = 10,677) were excluded. The analysis was focused on aetiological factors of bacterial infections, especially the incidence of MDR bacteria and mechanisms of antibiotic resistance. There were 58,789 microbiological tests performed in the analyzed period. The highest testing rate was noticed for intensive care unit (mean of 3.1 tests per one patient), followed by neonatal intensive care unit (2.7), internal medicine (1.9), pediatrics (1.8), and urology (1.2). Among 58,789 tests, 7690 (13.1%) were positive. MDR bacteria were responsible for 1783 infections (23.2%). The most common antibiotic resistance mechanism reported was ESBL production by Klebsiella spp. or Escherichia coli or Enterobacter spp. isolates (47.3% of all MDR cases). ESBL cases were followed by MRSA (14.7%), VRE (14.2%) and MBL producing Klebsiella spp. (5.6%). Among all infections caused by MDR bacteria, 1175 (65.9%) were diagnosed after 72 h of hospitalization (hospital-acquired infections). Apart from AmpC and ESBL producing Escherichia coli, all MDR bacteria were significantly more common in hospital-acquired infection. MDR bacteria are aetiological factors of a significant portion of infections in hospitalized patients with no remarkable change in the incidence in recent years. Production of ESBL is the most common mechanism of antibiotic resistance and should be regarded as one of the most urgent problems in clinical microbiology.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
- Correspondence: ; Tel.: +48-225690148; Fax: +48-225690150
| | - Katarzyna Pawlik
- Infection Control Team, Bielanski Hospital, 80 Cegłowska St., 00809 Warsaw, Poland;
| | - Anna Bonder-Nowicka
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Artur Pakuszewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
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Gozel MG, Hekimoglu CH, Gozel EY, Batir E, McLaws ML, Mese EA. National Infection Control Program in Turkey: The healthcare associated infection rate experiences over 10 years. Am J Infect Control 2021; 49:885-892. [PMID: 33359550 DOI: 10.1016/j.ajic.2020.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of healthcare associated infection (HAI) is generally higher in countries with limited resources than developed countries. To address the high prevalence of HAI, Turkish Ministry of Health introduced a national infection control program in 2005. METHODS Device associated (DA)-HAIs routinely surveyed included ventilator associated events, urinary catheter associated urinary tract infection and central line associated blood stream infection. Rates in DA-HAI were examined from 2008 to 2017 by type of hospitals, bed capacity, and geographic location of hospitals. RESULTS All DA-HAIs declined significantly from 2008 to 2017 nationally for ventilator associated events from 16.69 to 4.86 per 1,000 device days (IRR = 0.29, P < .0001), catheter associated urinary tract infection from 4.98 to 1.59 per 1,000 catheter days (IRR = 0.31, P < .0001) and central line associated blood stream infection from 5.65 to 2.82 per 1,000 catheter days (IRR = 0.47, P < .0001). The rates for DA-HAIs declined significantly in hospitals with ≥200 beds and <200 bed capacity and in all 4 type of hospitals. By 2017 all DA-HAI had significantly improved across all regions. CONCLUSIONS The introduction of a new national surveillance system supported by a national infection control program has significantly reduced 3 major DA-HAIs that are associated with risk of treatment failure and death. The next critical step in sustaining this crucial improvement will require timely feedback to hospitals using technology and continued buy-in from clinicians for their commitment to safety associated with DA-HAIs using aspirational DA-HAI rates.
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D'Ambrosio A, Garlasco J, Quattrocolo F, Vicentini C, Zotti CM. Data quality assessment and subsampling strategies to correct distributional bias in prevalence studies. BMC Med Res Methodol 2021; 21:90. [PMID: 33931025 PMCID: PMC8088017 DOI: 10.1186/s12874-021-01277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background Healthcare-associated infections (HAIs) represent a major Public Health issue. Hospital-based prevalence studies are a common tool of HAI surveillance, but data quality problems and non-representativeness can undermine their reliability. Methods This study proposes three algorithms that, given a convenience sample and variables relevant for the outcome of the study, select a subsample with specific distributional characteristics, boosting either representativeness (Probability and Distance procedures) or risk factors’ balance (Uniformity procedure). A “Quality Score” (QS) was also developed to grade sampled units according to data completeness and reliability. The methodologies were evaluated through bootstrapping on a convenience sample of 135 hospitals collected during the 2016 Italian Point Prevalence Survey (PPS) on HAIs. Results The QS highlighted wide variations in data quality among hospitals (median QS 52.9 points, range 7.98–628, lower meaning better quality), with most problems ascribable to ward and hospital-related data reporting. Both Distance and Probability procedures produced subsamples with lower distributional bias (Log-likelihood score increased from 7.3 to 29 points). The Uniformity procedure increased the homogeneity of the sample characteristics (e.g., − 58.4% in geographical variability). The procedures selected hospitals with higher data quality, especially the Probability procedure (lower QS in 100% of bootstrap simulations). The Distance procedure produced lower HAI prevalence estimates (6.98% compared to 7.44% in the convenience sample), more in line with the European median. Conclusions The QS and the subsampling procedures proposed in this study could represent effective tools to improve the quality of prevalence studies, decreasing the biases that can arise due to non-probabilistic sample collection. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01277-y.
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Affiliation(s)
- A D'Ambrosio
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy.
| | - J Garlasco
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - F Quattrocolo
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - C Vicentini
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
| | - C M Zotti
- Department of Public Health and Paediatric Sciences, University of Turin, Torino, Italy
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Arif S, Sadeeqa S, Saleem Z, Latif S, Sharif M. The burden of healthcare-associated infections among pediatrics: a repeated point prevalence survey from Pakistan. Hosp Pract (1995) 2021; 49:34-40. [PMID: 32990488 DOI: 10.1080/21548331.2020.1826783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are considered a major threat to public health resulting in significant morbidity, mortality, and additional costs. The present study aimed to assess the current patterns and risk factors of HAIs among hospitalized children. MATERIALS AND METHODS Three repeated point prevalence surveys were conducted in the pediatric inpatients of four hospitals by using the methodology developed by the European Center for Disease Prevention and Control. All patients present in the ward at 8:00 AM on the survey day and not discharged from the hospital on the same day were included. A standardized data collection form containing information on the presence of HAIs and the associated risk factors was completed for the patients. FINDINGS Out of 888 hospitalized patients, 116 (13.1%) had the symptoms of HAIs. Most common infections were bloodstream infections (BSIs) (32.8%), pneumonia (21.0%), ear, eyes, nose and throat infections (11.8%), and skin and soft tissue infections (SSTs) (19.0%). Factors significantly associated with infections were the length of hospital stay (p = 0.000), admission to the medicine ward (p = 0.034), and male gender (p = 0.010). BSIs were most common in children belonging to the age group of less than one month (78.9%), who were admitted to intensive care units (73.7%). SSTs including surgical site infections were more prevalent in surgery wards (78.3%). CONCLUSIONS A high rate of HAIs among pediatrics was found in Pakistan. Infection control and prevention strategies are needed with a major focus on interventions to prevent the spread of most prevalent HAIs.
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Affiliation(s)
- Sara Arif
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University , Lahore, Pakistan
| | - Saleha Sadeeqa
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University , Lahore, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Sumaira Latif
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University , Lahore, Pakistan
| | - Muhammad Sharif
- Department of Paediatric Surgery, King Edward Medical University , Lahore, Pakistan
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Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy. Antibiotics (Basel) 2020; 10:antibiotics10010010. [PMID: 33374232 PMCID: PMC7824585 DOI: 10.3390/antibiotics10010010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Antimicrobial resistance (AMR) is one of the most concerning issues in medicine today. The objectives of this study were to investigate the AMR distribution of the blood-borne pathogens isolated over a two-year period in an Italian region. Methods: A retrospective electronic record review of laboratory-confirmed bloodstream infections (BSIs) was done, and data from three major diagnostic laboratories were used. Twelve invasive clinically important bacteria species were included in the sample. Results: During the study period, 1228 positive BSIs were collected. The most common pathogens were Coagulase-negative Staphylococcus (CoNS) (29.7%), Staphylococcus aureus (19.1%) and Escherichia coli (15.9%). With regard to the AMR pattern, 31.7% of CoNS and 28.1% of Staphylococcus aureus were oxacillin-resistant, and almost half of the Enterococci showed resistance to high-level gentamicin. Among Gram-negative species, 11.7% of Escherichia coli and 39.5% of Klebsiella pneumoniae were carbapenem-resistant. Among the non-fermentative Gram-negative bacteria, the most frequently combined AMR pattern was aminoglycosides and fluoroquinolones (48.4% in A. baumannii and 14.6% in P. aeruginosa). Conclusion: The results display an alarming prevalence of AMR among hospital isolated pathogens, consistently higher than the European average. Information from surveillance systems to better characterize the trend in the incidence of AMR at local and national levels is needed.
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Al Qadire M, Hani AM. Nurses and physicians knowledge of guidelines for preventing catheter-related blood stream infections. Nurs Crit Care 2020; 27:594-601. [PMID: 33325063 DOI: 10.1111/nicc.12577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Catheter-related blood stream infection (CRBSI) is considered a major challenge for health care providers working in intensive care units. AIM This study aimed to evaluate and compare the knowledge of evidence-based guidelines for preventing catheter-related blood Stream infections among physicians and nurses working in critical care units in Jordan. DESIGN A cross-sectional survey design was utilized. METHODS The study was conducted in five intensive care units; 181 nurses and 68 physicians were recruited from four governmental hospitals and one university-affiliated hospital. RESULTS The mean total knowledge score for physicians' knowledge was low at 2.6, SD 1.5 (out of 10). While the mean total score for nurses' knowledge was low at 3.3, SD 1.8 (out of 10). The independent t test shows that nurses had a significantly higher mean total knowledge score than physicians (P < .05). CONCLUSIONS The current study demonstrates that Jordanian nurses and physicians working in intensive care units have a low level of knowledge of the guidelines for preventing CRBSI. This problem should be addressed through routine assessment and evaluation and adoption and policies that make nurses and physicians comply with the evidence-based guidelines. Finally, conducting regular educational programmes on CRBSI prevention, and evaluation of compliance with the guidelines in daily clinical practice, are strongly recommended. RELEVANCE TO CLINICAL PRACTICE The results of the current study suggest the need for regular assessment of physicians' and nurses' knowledge and skills with regard to central venous catheter insertion and maintenance care. Based on this assessment and using the best available evidence, training programmes on the prevention of CRBSI should be developed. Courses might be online, face to face, or using high fidelity simulation. Finally, regular observation and evaluation of compliance with the CRBSI guidelines in daily clinical practice is needed.
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Affiliation(s)
- Mohammad Al Qadire
- Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan.,College of Nursing, Sultan Qaboos University, Muscat, Oman
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Despotovic A, Milosevic B, Milosevic I, Mitrovic N, Cirkovic A, Jovanovic S, Stevanovic G. Hospital-acquired infections in the adult intensive care unit-Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. Am J Infect Control 2020; 48:1211-1215. [PMID: 32093978 DOI: 10.1016/j.ajic.2020.01.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Acquisition of Hospital-acquired infections (HAIs) in intensive care units (ICUs) predispose patients to higher mortality rates and additional adverse events. Serbian adult ICUs are rarely investigated for HAIs. The aim of this study was to look into HAIs in an adult ICU and identify risk factors for acquisition of HAIs and mortality. METHODS This retrospective study included 355 patients hospitalized over a 2-year period. Patient characteristics, antimicrobial resistance patterns, and risk factors of acquisition and predictors of mortality in patients who had a HAI were examined. RESULTS HAIs were diagnosed in 32.7% of patients. Resistance rates > 50% were observed in all antimicrobials except for tigecycline (14%), colistin (9%), and linezolid (0%). Predictors of HAI acquisition were underlying viral CNS infections and invasive devices-urinary and central venous catheters, and nasogastric tubes. Diabetes mellitus and intubation (odds ratio 2.5 and 6.7, P = .042 and <.001) were identified as predictors for increased mortality in patients who had a HAI. CONCLUSIONS Prevalence of HAIs and resistance rates are high compared to ICUs in other European countries. Risk factors for both acquisition of HAI and mortality were identified. Large-scale studies are necessary to look at HAIs in adult ICUs in Serbia.
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Affiliation(s)
| | - Branko Milosevic
- Department of Intensive Care, School of Medicine, University of Belgrade, Belgrade, Serbia; University Teaching Hospital for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Milosevic
- University Teaching Hospital for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia; Department of Hepatitis, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Mitrovic
- Department of Intensive Care, School of Medicine, University of Belgrade, Belgrade, Serbia; University Teaching Hospital for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Andja Cirkovic
- Department of Medical Statistics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Snezana Jovanovic
- Department of Microbiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Goran Stevanovic
- University Teaching Hospital for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia; Department of Clinical Pharmacotherapy, School of Medicine, University of Belgrade, Belgrade, Serbia
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Izadi N, Eshrati B, Etemad K, Mehrabi Y, Hashemi-Nazari SS. Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance. New Microbes New Infect 2020; 38:100768. [PMID: 33093962 PMCID: PMC7568181 DOI: 10.1016/j.nmni.2020.100768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023] Open
Abstract
Hospital-acquired infections (HAIs) lead to increased length of hospital stay, inappropriate use of broad-spectrum antibiotics and multiple antibiotic resistance. This study aimed to investigate the rate of HAIs in Iran. In this multi-centre study, the rate of HAIs was calculated based on the data collected through Iranian nosocomial infections surveillance for patients with HAIs, as well as through hospital statistics and information systems on hospital-related variables. Data were analysed using Stata software; in addition, ArcGIS was used for plotting the geographical distribution of HAIs by different provinces. The mean age of the 107 669 patients affected by HAIs was 52 ± 26.71 years. Just over half (51.55%) of the patients were male. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. The most common HAIs were urinary tract infections (26.83%; 1.99 per 1000 patient-days), ventilator-associated events (20.28%; 1.5 per 1000 patient-days), surgical-site infections (19.73%; 1.45 per 1000 patient-days) and bloodstream infections (13.51%; 1 per 1000 patient-days), respectively. The highest rate of HAIs was observed in intensive care units. Device, catheter and ventilator-associated infections accounted for 38.72%, 18.79% and 16% of all HAIs, respectively. Based on the results, HAIs are common in intensive care units, and urinary tract infections and device-related infections are more prevalent in Iran. To reduce HAIs it is recommended to implement appropriate policies and interventions, train staff about the use of devices, and prepare and update protocols and guidelines for improving the quality of care. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. Hospital-acquired infections are common in ICU wards, while UTIs and device-related infections are more prevalent in Iran. Device, catheter and ventilator-associated infections accounted for 38.72, 18.79%, and 16% of all HAIs, respectively.
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Affiliation(s)
- N Izadi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - B Eshrati
- Department of Social Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - K Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Y Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S-S Hashemi-Nazari
- Prevention of Cardiovascular Disease Research Centre, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pelullo CP, Pepe A, Napolitano F, Coppola N, Di Giuseppe G. Perioperative Antibiotic Prophylaxis: Knowledge and Attitudes among Resident Physicians in Italy. Antibiotics (Basel) 2020; 9:E357. [PMID: 32630396 PMCID: PMC7345233 DOI: 10.3390/antibiotics9060357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to evaluate knowledge and attitudes on the perioperative antibiotic prophylaxis (PAP) among surgery and anesthesiology resident physicians in Italy. A Web-based national survey of Italian surgery and anesthesiology resident physicians was conducted between March 2018 and January 2019. Participants completed a questionnaire and three case vignettes for each specialty. Of the 1282 resident physicians selected, 466 completed the online questionnaire for a response rate of 36.3%. More than half of the sample were female (52.9%), and the mean age was 30 years. A total of 36.3% of the participants had an adequate knowledge score about PAP. Multiple logistic regression analysis showed that resident physicians in general surgery compared to those in anesthesiology, those who agreed that PAP must be performed within 60 min before surgical incision, and those who were aware regarding the availability about the availability of national guidelines on PAP, were significantly more likely to have adequate knowledge about PAP. Moreover, 14% of participants were very concerned that patients may contract surgical site infections during hospitalization. These findings should be useful to promote educational intervention specifically targeted for surgery and anesthesiology resident physicians organizing training course on PAP, to improve the correct antibiotic use and to prevent healthcare-associated infections.
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Affiliation(s)
- Concetta Paola Pelullo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
| | - Angela Pepe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80135 Naples, Italy; (C.P.P.); (A.P.); (F.N.)
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Community-Acquired and Healthcare-Associated Sepsis: Characteristics and in-Hospital Mortality in Italy. Antibiotics (Basel) 2020; 9:antibiotics9050263. [PMID: 32438547 PMCID: PMC7277799 DOI: 10.3390/antibiotics9050263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/29/2022] Open
Abstract
Background: The main aim of the study was to analyse characteristics of sepsis according to the setting of occurrence and to identify predictors of sepsis-related in-hospital mortality. Methods: 544 medical records of adult patients with a diagnosis of sepsis were consulted and divided into two groups according to the setting where sepsis originated: community-acquired (CA) and healthcare-associated (HA) sepsis. Results: Overall, 257 (47.2%) patients had HA sepsis and the in-hospital death rate was 33.6%. Results of the multiple logistic regression revealed that patients with HA sepsis were significantly more likely to have been admitted from another hospital or ward, to have a ≥1 Charlson’s index, to be immunesuppressed, and to have undergone a surgical intervention during hospitalization. In-hospital deaths were significantly associated with older age, admission from another hospital or ward, need of haemodialysis and mechanical ventilation (MV), whereas they were less likely in patients with HA sepsis as compared with CA sepsis. Conclusion: Community-acquired and HA sepsis show distinct clinical, prognostic and risk factors profiles, and should be managed according to their differential characteristics.
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Zucco R, Lavano F, Nobile CGA, Papadopoli R, Bianco A. Adherence to evidence-based recommendations for surgical site infection prevention: Results among Italian surgical ward nurses. PLoS One 2019; 14:e0222825. [PMID: 31557219 PMCID: PMC6762080 DOI: 10.1371/journal.pone.0222825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The aims of the study were to assess the level of knowledge, the attitudes and the adherence to evidence-based recommendations for surgical site infection (SSI) prevention and to describe any influences that may motivate nurses to adopt evidence-based practices for SSI prevention. METHODS The present study was a national cross-sectional survey conducted from June to November 2017. For each hospital that agreed to participate, 30 nurses were randomly selected. The questionnaire was aimed at exploring socio-demographic and practice characteristics, knowledge of, attitudes toward, and reported practices regarding evidence-based procedures for SSI prevention. RESULTS Out of 55 hospitals that were contacted, 36 agreed to participate (a response rate of 65%). Of the original sample of 1313 nurses, a total of 1305 returned the questionnaire, a response rate of 99.4%. Regarding knowledge, only 53.8% knew that preoperative hair removal, if necessary, should take place shortly before surgery, and 28.9% of the sample did not know the right definition of "bundle". Over three quarters of participants stated that they always perform hand antisepsis before and after biological sample collection while 9.7% considered that wearing gloves during this practice is sufficient to prevent SSI. Furthermore, 91% of nurses reported that they always performed hand antisepsis before and after invasive procedures. CONCLUSION The study findings highlight the areas that were most lacking in nurses' training and for which targeted activities are needed. These data could support healthcare managers to implement interventions focused at enabling adherence to effective prevention practices to reduce risk to all patients.
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Affiliation(s)
- Rossella Zucco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Francesco Lavano
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Carmelo G. A. Nobile
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
- * E-mail:
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Prevalence of health care-associated infections and antimicrobial resistance of the responsible pathogens in Ukraine: Results of a multicenter study (2014-2016). Am J Infect Control 2019; 47:e15-e20. [PMID: 31000318 DOI: 10.1016/j.ajic.2019.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to obtain the first national estimates of the current prevalence and incidence and death of health care-associated infections (HAIs) of all types in acute care hospitals in Ukraine. METHODS Prospective surveillance was conducted from January 2014 to December 2016 in 17 hospitals. Surveillance case definitions were derived from the Centers for Disease Control and Prevention's National Healthcare Safety Network HAI case definitions. The identification and antimicrobial susceptibility of cultures were determined using a automated microbiology analyzer. Some antimicrobial susceptibility tests used Kirby-Bauer antibiotic testing. RESULTS Of 97,340 patients, 10,986 (11.3%) HAIs were observed. The most frequently reported HAI types were surgical site infections (60%), respiratory tract infections (pneumonia and lower respiratory tract, 18.4%), bloodstream infections (10.2%), and urinary tract infections (9.5%). Death during hospitalization was reported in 9.7% of HAI cases. The most common organism reported was Escherichia coli, accounting for 21.8% of all organisms, followed by Staphylococcus aureus (18.4%), Enterococcus spp (15.7%), and Pseudomonas aeruginosa (12.4%). Antimicrobial resistance among the isolates associated with HAIs showed that 42.1% and 3.6% of coagulase-negative Staphylococcus spp isolates were β-lactam (oxacillin)- and glycopeptide (teicoplanin)-resistant, respectively. Meticillin resistance was reported in 39.2% of S aureus isolates. CONCLUSIONS HAIs and increasing antimicrobial resistance present a significant burden to the Ukraine hospital system. Infection control priorities in hospitals should include preventing surgical site infections, respiratory tract infections (which also include PNEU and LRTI), bloodstream infections, and urinary tract infections, as well preventing infections due to antimicrobial-resistant pathogens.
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Prevalence of healthcare-associated infections and antimicrobial resistance in acute care hospitals in Kyiv, Ukraine. J Hosp Infect 2019; 102:431-437. [PMID: 30910424 DOI: 10.1016/j.jhin.2019.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/18/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are among the most common adverse events in patient care, and account for substantial morbidity and mortality. AIM To obtain the first estimates of the current prevalence of HAIs and antimicrobial resistance in acute care hospitals in Kyiv, Ukraine. METHODS Prospective surveillance was conducted from January 2014 to December 2016 in five acute care hospitals in Kyiv. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. FINDINGS Among 53,884 patients, 3753 (7%) HAIs were observed. The most frequently reported HAIs were respiratory tract infections (pneumonia 19.4%, lower respiratory tract infections 4.1%), surgical site infections (19.6%), urinary tract infections (17.5%) and bloodstream infections (10.6%). Death during hospitalization was reported in 7.2% cases of HAI. The micro-organisms most frequently isolated from HAIs were Escherichia coli (15.9%), Staphylococcus aureus (14.8%), Enterococcus spp. (10.2%), Pseudomonas aeruginosa (8.9%) and Klebsiella spp. (8.9%). Meticillin resistance was reported in 28.2% of S. aureus, and 14.2% of enterococci were resistant to vancomycin. Overall, 35.1% of all Enterobacteriaceae were resistant to third-generation cephalosporins, with the highest resistance rates seen in K. pneumoniae (53.8%) and E. coli (32.1%). CONCLUSIONS Infection control priorities in hospitals should include prevention of surgical site infections, pneumonia, bloodstream infections and urinary tract infections. These results may help to delineate the requirements for infection prevention and control in acute care hospitals.
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Albert NM, Bena JF, Ciudad C, Keleekai-Brapoh N, Morrison SL, Rice K, Slifcak E, Runner JC. Contamination of reusable electroencephalography electrodes: A multicenter study. Am J Infect Control 2018; 46:1360-1364. [PMID: 29997036 DOI: 10.1016/j.ajic.2018.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reusable electroencephalography cup electrodes and lead wires (rEEGs-CELWs) could be a source of microorganisms capable of causing hospital-acquired infections. The purpose of this study was to investigate for bacterial species of cleaned rEEGs-CELWs. METHODS This microbiologic evaluation involved 4 epilepsy monitoring units where rEEGs-CELWs were swabbed for bacteria using standard techniques. Analyses involved descriptive statistics and logistic regression (across sites). RESULTS Of 124 swabs, 31 (25.0%; range, 13.3%-43.3%) showed positive bacterial cultures, without between-site differences (P = .17). Bacteria were labeled by risk for hospital-acquired infection: no risk, potential risk (primarily in immunocompromised patients), and at risk (associated with infections and antibiotic resistance). At-risk bacteria species were Staphylococcus epidermidis (38.7%), Staphylococcus capitis subsp ureolyticus (3.2%), and Staphylococcus haemolyticus (9.6%). Potential-risk species were Micrococcus spp (22.6%), Acinetobacter lwoffii (6.5%), Staphylococcus hominis subsp hominis (6.5%), and Staphylococcus warneri (6.5%). Bacillus (9.6%) was the only no-risk species. Of 18 antibiotics tested on positive cultures, resistant bacteria were found in a median of 1 (range, 0-11) positive culture, equating to a 6.7% (range, 0%-61.1%) resistant antibiotic rate; no microorganisms were resistant to all antibiotics tested. CONCLUSIONS Bacteria that were potential risk or at risk for infection were found on 22.6% of cleaned rEEGs-CELWs. Use of single-use electrodes and research on scalp infection and infection reduction interventions are warranted.
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