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Asmare Z, Erkihun M, Abebe W, Ashagre A, Misganaw T, Feleke SF. Catheter-associated urinary tract infections in Africa: Systematic review and meta-analysis. Infect Dis Health 2024; 29:172-179. [PMID: 38485529 DOI: 10.1016/j.idh.2024.02.005] [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: 11/07/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) account for the majority of device-associated healthcare-acquired infections with significant morbidity and mortality worldwide. In developing countries with limited resources, the burden of CAUTI have substantial burden owing to the lack of well-organized infection prevention and control. Although there are studies in African countries, the magnitude of CAUTI is inconsistent. Therefore this systematic review and meta-analysis aimed to determine the pooled prevalence of CAUTI in Africa and identify the pathogens involved. METHODS Systematic review of articles from different databases and search engines such as Medline/PubMed, Google Scholar, Science Direct, and African Journal online were systematically searched to identify potential studies. Data were extracted on Microsoft Excel spreadsheet and analyzed using STATA 17.0. The pooled prevalence of CAUTI was estimated using a random effects model, inverse of variance was used to assess statistical heterogeneity across studies. Egger's tests was performed to identify possible publication bias. RESULTS This systematic review and meta-analysis incorporated twenty studies, revealing a pooled prevalence of CAUTI at 43.28%. Gram-negative bacteria were the leading cause of CAUTI accounts for 82.9%. Escherichia coli (45.06%) was the most frequent gram-negative bacterial isolate involved in CAUTI followed by Klebsiella spp (24.17%). Staphylococcus aureus was the predominant gram-positive bacterial isolate, accounting for 53.24% of gram-positive associated cases in CAUTI. CONCLUSION AND RECOMMENDATIONS In conclusion, the high prevalence of CAUTI in Africa underlines a pressing healthcare challenge. Addressing this issue requires a concerted effort, encompassing health education, infection prevention measures, resource allocation, and collaborative initiatives to enhance patient safety and mitigate the impact of CAUTI on healthcare systems in the region. As prolonged catheterization increases the risk of infection, catheters should only be used for proper indications and removed promptly when no longer needed.
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Affiliation(s)
- Zelalem Asmare
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Mulat Erkihun
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wagaw Abebe
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Agenagnew Ashagre
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Misganaw
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
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Huo X, Liu P. An agent-based model on antimicrobial de-escalation in intensive care units: Implications on clinical trial design. PLoS One 2024; 19:e0301944. [PMID: 38626111 PMCID: PMC11020418 DOI: 10.1371/journal.pone.0301944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/21/2024] [Indexed: 04/18/2024] Open
Abstract
Antimicrobial de-escalation refers to reducing the spectrum of antibiotics used in treating bacterial infections. This strategy is widely recommended in many antimicrobial stewardship programs and is believed to reduce patients' exposure to broad-spectrum antibiotics and prevent resistance. However, the ecological benefits of de-escalation have not been universally observed in clinical studies. This paper conducts computer simulations to assess the ecological effects of de-escalation on the resistance prevalence of Pseudomonas aeruginosa-a frequent pathogen causing nosocomial infections. Synthetic data produced by the models are then used to estimate the sample size and study period needed to observe the predicted effects in clinical trials. Our results show that de-escalation can reduce colonization and infections caused by bacterial strains resistant to the empiric antibiotic, limit the use of broad-spectrum antibiotics, and avoid inappropriate empiric therapies. Further, we show that de-escalation could reduce the overall super-infection incidence, and this benefit becomes more evident under good compliance with hand hygiene protocols among health care workers. Finally, we find that any clinical study aiming to observe the essential effects of de-escalation should involve at least ten arms and last for four years-a size never attained in prior studies. This study explains the controversial findings of de-escalation in previous clinical studies and illustrates how mathematical models can inform outcome expectations and guide the design of clinical studies.
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Affiliation(s)
- Xi Huo
- Department of Mathematics, University of Miami, Coral Gables, FL, United States of Ameica
| | - Ping Liu
- LinkedIn Corporation, Mountain View, CA, United States of Ameica
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Hurley J. Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay. Antibiotics (Basel) 2024; 13:316. [PMID: 38666992 PMCID: PMC11047347 DOI: 10.3390/antibiotics13040316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
Could rebound explain the paradoxical lack of prevention effect against Staphylococcus aureus blood stream infections (BSIs) with antibiotic-based decontamination intervention (BDI) methods among studies of ICU patients within the literature? Two meta-regression models were applied, each versus the group mean length of stay (LOS). Firstly, the prevention effects against S. aureus BSI [and S. aureus VAP] among 136 studies of antibiotic-BDI versus other interventions were analyzed. Secondly, the S. aureus BSI [and S. aureus VAP] incidence in 268 control and intervention cohorts from studies of antibiotic-BDI versus that among 165 observational cohorts as a benchmark was modelled. In model one, the meta-regression line versus group mean LOS crossed the null, with the antibiotic-BDI prevention effect against S. aureus BSI at mean LOS day 7 (OR 0.45; 0.30 to 0.68) inverted at mean LOS day 20 (OR 1.7; 1.1 to 2.6). In model two, the meta-regression line versus group mean LOS crossed the benchmark line, and the predicted S. aureus BSI incidence for antibiotic-BDI groups was 0.47; 0.09-0.84 percentage points below versus 3.0; 0.12-5.9 above the benchmark in studies with 7 versus 20 days mean LOS, respectively. Rebound within the intervention groups attenuated and inverted the prevention effect of antibiotic-BDI against S. aureus VAP and BSI, respectively. This explains the paradoxical findings.
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Affiliation(s)
- James Hurley
- Melbourne Medical School, University of Melbourne, Melbourne, VIC 3052, Australia;
- Ballarat Health Services, Grampians Health, Ballarat, VIC 3350, Australia
- Ballarat Clinical School, Deakin University, Ballarat, VIC 3350, Australia
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Asmare Z, Awoke T, Genet C, Admas A, Melese A, Mulu W. Incidence of catheter-associated urinary tract infections by Gram-negative bacilli and their ESBL and carbapenemase production in specialized hospitals of Bahir Dar, northwest Ethiopia. Antimicrob Resist Infect Control 2024; 13:10. [PMID: 38273339 PMCID: PMC10809431 DOI: 10.1186/s13756-024-01368-7] [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: 08/01/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) due to multidrug-resistant Gram-negative bacilli (GNB) is a common concern globally. Investigating the incidence of CAUTI and associated antibiotic resistance has paramount importance from the health care associated infections perspective. This study therefore assessed the incidence of CAUTIs due to GNB and the production of extended-spectrum beta-lactamase (ESBL) and carbapenemase among inpatients in specialized hospitals of Northwest, Ethiopia. METHODS A total of 363 patients with indwelling urinary catheters who were admitted in the hospital for > 48 h were consecutively enrolled and followed from 3 to 18 days. Data were collected through interviewing and review of medical records. Patients who developed at least one of the following: fever (> 38 OC), suprapubic tenderness, or costovertebral angle pain, coupled with a GNB positive urine culture of ≥ 103 CFU/mL with no more than two bacterial species were defined as CAUTI. The ESBL and carbapenemase production were detected and identified by chromogenic medium. Logistic regression analysis was done to identify associated factors. RESULTS From 363 patients followed, the incidence rate of CAUTI was 27.8 per 1000 catheter days. Catheterization for ≥ 8 days (AOR = 10.6, 95%CI:1.8-62.1) and hospitalization for > 10 days (AOR = 8.1, 95%CI: 2.4-27.2) were the factors significantly associated with CAUTIs. E. coli (n = 18, 34.6%), Proteus species (n = 7, 13.5%), and P. aeruginosa (n = 6, 11.5%) were the most frequent GNB. Isolates revealed high rates of resistance to amoxicillin-clavulanic acid (100%), cefazolin (n = 51, 98%), ceftazidime (n = 47, 90%) and cefotaxime (n = 46, 88%). Most of the GNB isolates (86.5%) were multidrug-resistant. Overall, 19.2% and 5.8% of GNB isolates were ESBL and carbapenemase producers, respectively. CONCLUSIONS Incidence of CAUTI with Gram-negative bacilli is high. As most of the GNB isolates are MDR and showed a super high rate of resistance to amoxicillin-clavulanic and third-generation cephalosporins, empirical treatment with these substances is virtually ineffective in patients with suspected GNB infection in Ethiopia. The expression of ESBL and carbapenemase among GNB isolates is also a concern. Therefore, improved infection prevention and control measures, careful use of catheters and third generation of cephalosporins are needed to improve patient outcomes and reduce the burden of CAUTIs and the spreading of antimicrobial resistance.
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Affiliation(s)
- Zelalem Asmare
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tewachew Awoke
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Genet
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemale Admas
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Addisu Melese
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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AlSaleh E, Naik B, AlSaleh AM. Device-Associated Nosocomial Infections in Intensive Care Units at Al-Ahsa Hospitals, Saudi Arabia. Cureus 2023; 15:e50187. [PMID: 38186514 PMCID: PMC10771822 DOI: 10.7759/cureus.50187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Patients admitted to intensive care units (ICU), especially those with devices used to support their condition, are at a higher risk of getting healthcare-associated infections (HAIs). The aim of the present study was to analyze the surveillance data and assess the device-associated infection (DAI) rates such as central line-associated blood-stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP) and ventilator-associated event (VAE) in ICUs of the Ministry of Health (MoH) hospitals in Al-Ahsa region. Methodology The study was conducted retrospectively using the surveillance data of governmental hospitals' intensive care units in the Al-Ahsa region. The surveillance data was collected from 10 ICUs at six MoH hospitals in the Al-Ahsa region during the year 2022. The data from the participating hospitals was entered into the Health Electronic Surveillance Network (HESN) plus program by trained infection prevention control practitioners of the respective hospitals. Results An overall CLABSI rate of 4.29 per 1000 central line days was reported during the study period. The CAUTI rate was 0.55 with a range from 0 to 1.29 cases per 1000 urinary catheter days. VAP rate ranged from 0.33 to 2.21 cases per 1000 ventilator days (average of 1.17). The study reported VAE only for the adult medical-surgical ICU (3.36 per 1000 ventilator days). Conclusion The present study revealed that the most common DAIs in the Al-Ahsa region are CLABSI and CAUTI. DAI rates generated from this study may be used as benchmarks for regional hospitals. An educational program regarding the prevention and control of DAIs targeting all healthcare workers, especially ICU staff, has to be done in the Al-Ahsa region.
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Affiliation(s)
- Essa AlSaleh
- Infection Control Department, Directorate of Health Affairs, Al-Ahsa, SAU
| | - Balajis Naik
- Infection Control, Al-Ahsa Health Cluster, Ministry of Health Holdings, Al-Ahsa, SAU
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Lohiya R, Deotale V. Surveillance of health-care associated infections in an intensive care unit at a tertiary care hospital in Central India. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc28. [PMID: 38111598 PMCID: PMC10726722 DOI: 10.3205/dgkh000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Introduction Because the risk of health-care associated infections (HAIs) is high in intensive care units, and HAIs are one of the causes of morbidity and mortality and affects the overall quality of health care, the continuous monitoring of HAIs in intensive care patients is essential. Aim and objectives This descriptive cross-sectional study was carried out over a period of five years in a tertiary-care teaching hospital. The aim of the study was to investigate the main and specific types of health-care associated Infections and determine the microbiological profile and antimicrobial susceptibility rates of isolates in patients with HAI. Methods : The active surveillance method was used to detect HAIs in patients who spent over 48 hr in a targeted ICU. Patients with blood stream infections (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and ventilator-associated events (VAE) were included in the study. HAI were diagnosed based on the Centre for Disease Control (CDC)'s National Healthcare Safety Network (NHSN) updated definitions of HAIs. Results A total of 121,051 patient days, including 7,989 central line days, 64,557 urinary catheter days, and 18,443 ventilator days, were recorded in the study population and 832 HAIs were diagnosed (incidence rate 6.9%). The overall rates of BSI, CLABSI, CAUTI and possible ventilator-associated pneumonia (p-VAP) were 3.7, 10.6, 2.1 and 13.4/1,000 device days, respectively. The most common organism isolated from BSI was Acinetobacter baumanii (n=322, 29%), followed by Klebsiella pneumoniae 225 (n=225, 20.3%). 79.8% of Acinetobacter baumanii strains were resistant to imipenem, 77.1% to ciprofloxacin and 76.4% to ampicillin. The most common organisms isolated from CAUTI were non-albicans Candida species (n=38, 18%), followed by E. coli and Citrobacter spp. (each n=33, each 15.7%). Conclusions A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed. Risk factor analysis showed invasive procedures during sepsis and organophosphorous poisoning as significant factors.
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Affiliation(s)
- Ruchita Lohiya
- Dept of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
| | - Vijayshri Deotale
- Dept of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
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Wałaszek M, Serwacki P, Cholewa Z, Kosiarska A, Świątek-Kwapniewska W, Kołpa M, Rafa E, Słowik R, Nowak K, Różańska A, Wójkowska-Mach J. Ventilator-associated pneumonia in Polish intensive care unit dedicated to COVID-19 patients. BMC Pulm Med 2023; 23:443. [PMID: 37974141 PMCID: PMC10652561 DOI: 10.1186/s12890-023-02743-7] [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: 07/12/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Healthcare-Associated Infections (HAI) are most frequently associated with patients in the Intensive Care Unit (ICU). Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), led to ICU hospitalization for some patients. METHODS The study was conducted in 2020 and 2021 at a hospital in southern Poland. The Healthcare-Associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC) was used for HAI diagnosis. The aim of this case-control study was to retrospectively assess the epidemiology of HAIs in ICU patients, distinguishing between COVID-19 and non-COVID-19 cases. RESULTS The study included 416 ICU patients: 125 (30%) with COVID-19 and 291 (70%) without COVID-19, p < 0.05. The mortality rate was 80 (64%) for COVID-19 patients and 45 (16%) for non-COVID-19 patients, p < 0.001. Ventilator-Associated Pneumonia (VAP) occurred in 40 cases, with an incidence rate density of 6.3/1000 patient-days (pds): 14.1/1000 pds for COVID-19 patients vs. 3.6/1000 pds for non-COVID-19 patients. Odds Ratio (OR) was 2.297, p < 0.01. Acinetobacter baumannii was the most often isolated microorganism in VAP, with 25 cases (incidence rate 8.5%): 16 (18.2%) in COVID-19 patients vs. 9 (4.4%) in non-COVID-19 patients. OR was 4.814 (1.084-4.806), p < 0.001. CONCLUSIONS Patients treated in the ICU for COVID-19 faced twice the risk of VAP compared to non-COVID-19 patients. The predominant microorganism in VAP cases was Acinetobacter baumannii.
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Affiliation(s)
- Marta Wałaszek
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | - Piotr Serwacki
- St Luke Regional Hospital in Tarnów, ul. Lwowska 178A, Tarnów, 33-100, Poland
| | - Zbigniew Cholewa
- St Luke Regional Hospital in Tarnów, ul. Lwowska 178A, Tarnów, 33-100, Poland
| | - Alicja Kosiarska
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | | | - Małgorza Kołpa
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | - Elżbieta Rafa
- University of Applied Sciences in Nowy Sącz, ul. Staszica 1, Nowy Sącz, 33-300, Poland
| | - Róża Słowik
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | - Karolina Nowak
- Department of Microbiology, Jagiellonian University Medical College, Czysta str. 18, Krakow, 31-121, Poland
| | - Anna Różańska
- Department of Microbiology, Jagiellonian University Medical College, Czysta str. 18, Krakow, 31-121, Poland.
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Jagiellonian University Medical College, Czysta str. 18, Krakow, 31-121, Poland
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Gautam D, Dolma KG, Khandelwal B, Goyal RK, Mitsuwan W, Pereira MDLG, Klangbud WK, Gupta M, Wilairatana P, Siyadatpanah A, Wiart C, Nissapatorn V. Acinetobacter baumannii in suspected bacterial infections: Association between multidrug resistance, virulence genes, & biofilm production. Indian J Med Res 2023; 158:439-446. [PMID: 38006347 DOI: 10.4103/ijmr.ijmr_3470_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND OBJECTIVES Acinetobacter baumannii has emerged as a nosocomial pathogen with a tendency of high antibiotic resistance and biofilm production. This study aimed to determine the occurrence of A. baumannii from different clinical specimens of suspected bacterial infections and furthermore to see the association of biofilm production with multidrug resistance and expression of virulence factor genes in A. baumannii. METHODS A. baumannii was confirmed in clinical specimens by the detection of the blaOXA-51-like gene. Biofilm production was tested by microtitre plate assay and virulence genes were detected by real-time PCR. RESULTS A. baumannii was isolated from a total of 307 clinical specimens. The isolate which showed the highest number of A. baumannii was an endotracheal tube specimen (44.95%), then sputum (19.54%), followed by pus (17.26%), urine (7.49%) and blood (5.86%), and <2 per cent from body fluids, catheter-tips and urogenital specimens. A resistance rate of 70-81.43 per cent against all antibiotics tested, except colistin and tigecycline, was noted, and 242 (78.82%) isolates were multidrug-resistant (MDR). Biofilm was detected in 205 (66.78%) with a distribution of 54.1 per cent weak, 10.42 per cent medium and 2.28 per cent strong biofilms. 71.07 per cent of MDR isolates produce biofilm (P<0.05). Amongst virulence factor genes, 281 (91.53%) outer membrane protein A (OmpA) and 98 (31.92%) biofilm-associated protein (Bap) were detected. Amongst 100 carbapenem-resistant A. baumannii, the blaOXA-23-like gene was predominant (96%), the blaOXA-58-like gene (6%) and none harboured the blaOXA-24-like gene. The metallo-β-lactamase genes blaIMP-1 (4%) and blaVIM-1(8%) were detected, and 76 per cent showed the insertion sequence ISAba1. INTERPRETATION CONCLUSIONS The majority of isolates studied were from lower respiratory tract specimens. The high MDR rate and its positive association with biofilm formation indicate the nosocomial distribution of A. baumannii. The biofilm formation and the presence of Bap were not interrelated, indicating that biofilm formation was not regulated by a single factor. The MDR rate and the presence of OmpA and Bap showed a positive association (P<0.05). The isolates co-harbouring different carbapenem resistance genes were the predominant biofilm producers, which will seriously limit the therapeutic options suggesting the need for strict antimicrobial stewardship and molecular surveillance in hospitals.
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Affiliation(s)
- Deepan Gautam
- Department of Microbiology, Sikkim Manipal University, Gangtok, Sikkim, India
| | - Karma Gurmey Dolma
- Department of Microbiology, Sikkim Manipal University, Gangtok, Sikkim, India
| | - Bidita Khandelwal
- Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India
| | - Ramesh Kumar Goyal
- Department of Pharmacology, Delhi Pharmaceutical Sciences & Research University, New Delhi, India
| | - Watcharapong Mitsuwan
- Research Centre of Excellence in Innovation of Essential Oil, Walailak University, Thailand
| | | | - Wiyada Kwanhian Klangbud
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Madhu Gupta
- Department of Pharmacology, Delhi Pharmaceutical Sciences & Research University, New Delhi, India
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Abolghasem Siyadatpanah
- Department of Paramedical, Ferdows School of Paramedical & Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Christophe Wiart
- Department of Pharmacology, School of Pharmacy, University of Nottingham, Malaysia Campus, Selangor, Malaysia
| | - Veeranoot Nissapatorn
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
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Aillón-García P, Parga-Landa B, Guillén-Grima F. Effectiveness of copper as a preventive tool in health care facilities. A systematic review. Am J Infect Control 2023; 51:1038-1048. [PMID: 36842712 DOI: 10.1016/j.ajic.2023.02.010] [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: 10/06/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Hospital-acquired infections (HAIs) are a significant clinical and economic burden on health systems worldwide. Copper alloys have been certified by the US EPA as solid antimicrobial materials, but their effectiveness in reducing HAIs is not well established OBJECTIVES: This systematic review aimed to assess copper surfaces in situ efficacy in reducing health care's microbial burden compared to control surfaces. MATERIALS AND METHODS A literature search was conducted using three electronic databases: Web of Science, PubMed, and Scopus, with the keywords "copper" and "surfaces" and "antimicrobial" and "antibacterial" and "infections." Studies from 2010 to 2022 were included. The quality of the studies was independently screened and assessed using the Newcastle Ottawa Scale. RESULTS A total of 56 articles were screened, with 8 included in the review and 7, added from references. Two third of the studies report a significant reduction in the microbial burden on copper objects compared to control objects. The 2 studies with the highest scores on NOS evaluation indicated that using copper or copper alloys in healthcare settings can effectively decrease the number of bacterial contaminations on touch surfaces. CONCLUSIONS The results suggest the potential effectiveness of copper as a preventive tool in healthcare facilities, but further studies and longer trials are needed to establish a relationship between copper and reduced nosocomial infections.
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Affiliation(s)
- Paula Aillón-García
- Rectorado Universidad Politécnica de Madrid, Universidad Politécnica de Madrid, Madrid, Spain.
| | - Blanca Parga-Landa
- Departamento de Arquitectura, Construcción y Sistemas Oceánicos Navales. Escuela Técnica Superior de Ingenieros Navales. Universidad Politécnica de Madrid, Madrid, Spain
| | - Francisco Guillén-Grima
- Department of Preventive Medicine, Clínica Universidad de Navarra, Pamplona, Spain; Area of Epidemiology and Public Health, Clinical Epidemiology Group, Navarra Institute of Health Research (IdiSNA), Pamplona, Spain; Department of Health Sciences, Public University of Navarra, Pamplona, Spain; Instituto de Salud Carlos III, CIBER-OBN, Madrid, Pamplona, Spain
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Damico V, Murano L, Margosio V, Teli M, Ripamonti C, Demoro G, D'Alessandro A, Russello G. Co-infections in critically ill adults with severe acute respiratory syndrome coronavirus 2 infection: an Italian multi-center prospective study. Minerva Med 2023; 114:444-453. [PMID: 35156788 DOI: 10.23736/s0026-4806.22.08026-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND To date, few studies have described Hospital-acquired infections (HAIs) during COVID-19 outbreak. To examine the incidence of HAIs in critically ill adult patients with SARS-CoV-2 infection and to observe risk factors, and the impact on outcome of HAI. METHODS A prospective multicenter study was conducted that included adult patients with SARS-CoV-2 infection admitted to 18 Italian Intensive Care Units from September 2020 to November 2021. RESULTS A total of 589 patients were included. A total of 233 patients were diagnosed with at least one HAI (39.6%). The co-infection/co-colonization rate >48 hours after admission was 31.0 per 1000 person-days (95% CI 18.8-34.8). Age, length of ICU stay >7 days, obesity, type 2 diabetes mellitus, cardiovascular disease, inserted central venous catheter, intubation, APACHE II score >25, mechanical ventilation (MV) >48 hours, obesity and inserted urinary catheter are associated outcomes for infection acquisition. The overall mortality rate of patients was found to be significantly higher in patients who had acquired a HAI (RR=4.37; 95% CI 3.30-5.78; P<0.001). CONCLUSIONS Associated factors for HAI acquisition and mortality in ICU patients were identified and cause for revision of existing infection control policies.
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Affiliation(s)
- Vincenzo Damico
- Department of Anesthesia and Critical Care, ASST Lecco, Lecco, Italy -
| | - Liana Murano
- Sanitary Assistance Residency, Madonna della Neve Nonprofit Organization, Premana, Lecco, Italy
| | - Viola Margosio
- Department of Anesthesia and Critical Care, ASST Lecco, Lecco, Italy
| | - Mauro Teli
- Department of Anesthesia and Critical Care, ASST Lecco, Lecco, Italy
| | - Clara Ripamonti
- Department of Anesthesia and Critical Care, ASST Lecco, Lecco, Italy
| | - Giuseppe Demoro
- Department of Anesthesia and Critical Care, Azienda Sanitaria Sette Laghi, Varese, Italy
| | - Antonella D'Alessandro
- Department of Anesthesia and Critical Care, Ospedale Santissima Annunziata, Taranto, Italy
| | - Giuseppe Russello
- Department of Anesthesia and Critical Care, Caltanissetta Hospital, Caltanissetta, Italy
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11
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E Silva LGA, de Maio Carrilho CMD, Talizin TB, Cardoso LTQ, Lavado EL, Grion CMC. Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study. Acute Crit Care 2023; 38:68-75. [PMID: 36935536 PMCID: PMC10030242 DOI: 10.4266/acc.2022.01375] [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: 11/01/2022] [Accepted: 01/12/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital. METHODS Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model. RESULTS A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality. CONCLUSIONS Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III increased risk of death in ICU survivors.
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Affiliation(s)
| | | | | | | | - Edson Lopes Lavado
- Departamento de Fisioterapia, Universidade Estadual de Londrina, São Paulo, Brazil
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12
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Mengistu DA, Alemu A, Abdukadir AA, Mohammed Husen A, Ahmed F, Mohammed B. Incidence of Urinary Tract Infection Among Patients: Systematic Review and Meta-Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231168746. [PMID: 37096884 PMCID: PMC10134187 DOI: 10.1177/00469580231168746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Healthcare-associated infection is one of the most common and severe threats to patients' health and remains a significant challenge for healthcare providers. Among healthcare-associated infections, urinary tract infection (UTI) is one of the most common infections. This study aimed to determine the global incidence of UTI among patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used to perform this systematic review and meta-analysis. The articles were searched from April 4 to August 5, 2022, from electronic databases (Scopus, PubMed, Web of Science, Google Scholar, DOAJ, and MedNar) using Boolean logic operators, MeSH terms, and keywords. The quality of the study was assessed using the JBI Critical Assessment tool. One thousand nine ninety three articles were retrieved from the electronic databases, of which 38 articles conducted on 981 221 patients were included in the current study. The study found the global pooled incidence of UTI accounted for 1.6%. Based on the subgroup analysis by survey period and WHO region, the highest incidence of UTI was reported in the African Region [3.6%] and among studies conducted between 1996 and 2001 [3.7%]. This study revealed the overall pooled incidence of UTI was 1.6%. The highest incidence of UTI (3.6%) was reported in the African region. This indicates that there is a need to implement safety measures.
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Affiliation(s)
| | - Addisu Alemu
- Haramaya University College of Health and Medical Science, Harar, Ethiopia
| | | | | | - Fila Ahmed
- Haramaya University College of Health and Medical Science, Harar, Ethiopia
| | - Baredin Mohammed
- Haramaya University College of Health and Medical Science, Harar, Ethiopia
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13
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BALASAR B, UĞUR Ö, EROĞLU E. Evaluation of healthcare-associated infections in general intensive care unit in Meram State Hospital. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: Healthcare-associated infections are a major source of concern in all areas of hospitals, particularly in intensive care units. The goal of our study was to look at the current situation and evaluate the measures that can be taken based on the data obtained by examining the rates and factors of healthcare-associated infections in the general intensive care units of our hospital over a one-year period.
Materials and Methods: Between January 2020 and December 2020, 665 patients who were followed up and treated in the general intensive care unit of Meram State Hospital were followed up in terms of healthcare-associated infections, and their outcomes were evaluated.
Results: 5354 hospitalization days of 665 patients who were followed up in the general intensive care units for a year were evaluated, and it was determined that 53 of the patients developed healthcare-associated infections. Twenty-two (41.5%) of patients with healthcare-associated infections were female, while 31 (58.5%) were male. It was discovered that the patients' mean age was 71,7±14 (19-94). The infection rate was calculated to be 5.86 and the density to be 7.28. Furthermore, the rates of invasive device-associated nosocomial infection are as follows: 1.02 for central line-associated bloodstream infections, 0.56 for catheter-associated urinary tract infections, and 0 for ventilator-associated pneumonia.
Conclusion: Healthcare-associated infections are a significant cause of mortality and morbidity in intensive care units. Due to the improvement in medical care and the increase in life expectancy in parallel with this, effective surveillance practices are of critical importance.
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Affiliation(s)
- Barış BALASAR
- Konya Meram State Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Türkiye
| | - Ömer UĞUR
- Konya Meram State Hospital, Department of Anesthesiology and Reanimation, Konya, Türkiye
| | - Esma EROĞLU
- Konya Meram State Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Türkiye
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14
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Taušan Ð, Rančić N, Kostić Z, Ljubenović N, Rakonjac B, Šuljagić V. An assessment of burden of hospital-acquired pneumonia among abdominal surgical patients in tertiary university hospital in Serbia: A matched nested case-control study. Front Med (Lausanne) 2022; 9:1040654. [PMID: 36569168 PMCID: PMC9780448 DOI: 10.3389/fmed.2022.1040654] [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: 09/09/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background In the population of abdominal surgical patients hospital-acquired pneumonia (HAP) significantly increases morbidity and mortality. Patients and methods Through regular hospital surveillance of patients who received abdominal operations, we identified postoperative HAP from 2007 to 2019. In an initial nested case-control study, every surgical patient with HAP was compared with three control patients without HAP. Control patients were matched to the cases by age, gender, the American Society of Anesthesiologists score, and type of surgical operation. Also, the patients with HAP, who died were compared with those who survived. Results Multivariate logistic regression analysis (MLRA) revealed that other postoperative infections, length of intensive care unit stay, use of H2RA, use of PPI/ H2RA, multiple transfusion, and use of vancomycin in surgical prophylaxis were independent RFs for occurrence of HAP. Also, MLRA identified that age, lenght of hospital stay, use of mechanical ventilation and ceftriaxone in HAP therapy were indepedenttly associated with poor outcome of HAP. All Acinetobacter baumannii isolates were resistant to aminoglycoside antimicrobial agents and showed carbapenem resistance. The most frequently used antibiotics in patients with HAP and without HAP were vancomycin and metronidazole, respectively. Conclusion Our study provided an insight into the burden of HAP in abdominal surgical patients, and highlighted several priority areas and targets for quality improvement.
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Affiliation(s)
- Ðorde Taušan
- Pulmonology Clinic, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Rančić
- Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia,Medical Faculty, University of Defence, Belgrade, Serbia
| | - Zoran Kostić
- Medical Faculty, University of Defence, Belgrade, Serbia,Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
| | - Nenad Ljubenović
- Institute of Epidemiology, Military Medical Academy, Belgrade, Serbia
| | - Bojan Rakonjac
- Institute of Medical Microbiology, Military Medical Academy, Belgrade, Serbia
| | - Vesna Šuljagić
- Medical Faculty, University of Defence, Belgrade, Serbia,Department of Healthcare-Associated Infection Prevention and Control, Military Medical Academy, Belgrade, Serbia,*Correspondence: Vesna Šuljagić
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15
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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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Data mining for adverse drug reaction signals of daptomycin based on real-world data: a disproportionality analysis of the US Food and Drug Administration adverse event reporting system. Int J Clin Pharm 2022; 44:1351-1360. [PMID: 36178607 DOI: 10.1007/s11096-022-01472-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous reports on daptomycin's adverse drug reactions (ADRs) have been insufficient, often because of limited data. Pharmacovigilance risk signal detection is innovative and has been applied to the safety monitoring and reevaluation of drugs post-marketing. AIM The study aimed to promote safe daptomycin prescribing by mining and evaluating the daptomycin ADR signals from the US Food and Drug Administration Adverse Event Reporting System (FAERS). METHOD A disproportionality analysis (reporting odds ratio ROR and proportional reporting ratio PRR) was utilized for FAERS data mining from the first quarter of 2004 to the second quarter of 2021 (the most recent quarterly data at the time of the study). Preferred Terms of ADR reports were categorized by System Organ Class (SOC) based on the Medical Dictionary for Regulatory Activities. RESULTS This study retrieved 12,221 cases within the reporting period. A total of 140 repetitive signals were obtained by ROR and PRR, of which 53 new ADR signals were not recorded in the drug labels/datasheets. The top three ADR reports were "blood creatine phosphokinase elevation" (ROR, 56.66, 95% confidence interval (CI) 51.07-62.87, PRR 51.94), "eosinophilic pneumonia" (ROR 696.71, 95%CI 603.21-804.70, PRR 657.57), and "rhabdomyolysis" (ROR 22.85, 95%CI 19.94-26.18, PRR 21.83). The highest ROR of "antimicrobial susceptibility test resistant" was found at 9808.14. Reports of rare adverse events, such as "necrotizing fasciitis and compartment syndrome," have emerged. The significant SOCs were "Infections and Infestations" and "Investigations." CONCLUSION New daptomycin ADR signals were detected. Clinicians should monitor these potential ADRs in patients receiving daptomycin.
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Kozłowski B, Kubiak-Pulkowska J, Pałka J, Bożiłow D, Zając M, Deptuła A. Healthcare-associated infections in COVID-19 ICU patients - two-centre study. Cent Eur J Public Health 2022; 30:196-200. [DOI: 10.21101/cejph.a7135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/21/2022] [Indexed: 11/15/2022]
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18
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Homenta H, Julyadharma J, Susianti H, Noorhamdani N, Santosaningsih D. Molecular Epidemiology of Clinical Carbapenem-Resistant Acinetobacter baumannii-calcoaceticus complex Isolates in Tertiary Care Hospitals in Java and Sulawesi Islands, Indonesia. Trop Med Infect Dis 2022; 7:tropicalmed7100277. [PMID: 36288018 PMCID: PMC9607243 DOI: 10.3390/tropicalmed7100277] [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: 09/08/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (A. baumannii)-calcoaceticus complex (CRAb-cc) is an important pathogen causing nosocomial infections worldwide; however, molecular epidemiology of the A. baumannii-calcoaceticus complex in Indonesian hospitals is scarce. This study aimed to determine the clonal relatedness of CRAb-cc in two tertiary care hospitals in Malang and Manado in Indonesia. The CRAb-cc isolates from routine clinical cultures in two tertiary care hospitals in Malang and Manado were identified using the Vitek2® system (bioMérieux, Lyon, France). Multi-locus variable-number tandem-repeat analysis (MLVA) typing, multi-locus sequence typing (MLST), clonal complex (CC), and phylogenetic tree analysis were conducted for a subset of isolates. Seventy-three CRAb-cc isolates were collected. The CRAb-cc isolates were frequently found among lower-respiratory-tract specimens. We detected the MLVA type (MT) 1, MT3, and MT4 CRAB-cc isolates belonging to the sequence type (ST) 642, and CC1 was the predominant clone in this study. In conclusion, we identified the clonal relatedness of A. baumannii-calcoaceticus complex isolates in two tertiary care hospitals in Malang and Manado in Indonesia. Further study is required to investigate the clinical importance and distribution of ST642 in Indonesian hospitals for developing prevention and control measures.
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Affiliation(s)
- Heriyannis Homenta
- Doctoral Program in Medical Science, Faculty of Medicine, Universitas Brawijaya, Malang 65145, Indonesia
- Department of Clinical Microbiology, Faculty of Medicine, Sam Ratulangi University, Manado 95163, Indonesia
| | - Julyadharma Julyadharma
- Laboratory of Clinical Microbiology, Prof. Dr. R. D. Kandou Hospital, Manado 95163, Indonesia
| | - Hani Susianti
- Department of Clinical Pathology, Faculty of Medicine, Brawijaya University, Malang 65145, Indonesia
- Department of Clinical Pathology, Dr. Saiful Anwar Hospital, Malang 65112, Indonesia
| | - Noorhamdani Noorhamdani
- Department of Clinical Microbiology, Faculty of Medicine, Brawijaya University, Malang 65145, Indonesia
| | - Dewi Santosaningsih
- Department of Clinical Microbiology, Faculty of Medicine, Brawijaya University, Malang 65145, Indonesia
- Department of Clinical Microbiology, Dr. Saiful Anwar Hospital, Malang 65112, Indonesia
- Correspondence:
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Muribeca ADJB, Gomes PWP, Paes SS, da Costa APA, Gomes PWP, Viana JDS, Reis JDE, Pamplona SDGSR, Silva C, Bauermeister A, Santos LDS, da Silva MN. Antibacterial Activity from Momordica charantia L. Leaves and Flavones Enriched Phase. Pharmaceutics 2022; 14:1796. [PMID: 36145544 PMCID: PMC9505480 DOI: 10.3390/pharmaceutics14091796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Momordica charantia L. (Cucurbitaceae) is a plant known in Brazil as "melão de São Caetano", which has been related to many therapeutic applications in folk medicine. Herein, we describe antibacterial activities and related metabolites for an extract and fractions obtained from the leaves of that species. An ethanolic extract and its three fractions were used to perform in vitro antibacterial assays. In addition, liquid chromatography coupled to mass spectrometry and the molecular networking approach were used for the metabolite annotation process. Overall, 25 compounds were annotated in the ethanolic extract from M. charantia leaves, including flavones, terpenes, organic acids, and inositol pyrophosphate derivatives. The ethanolic extract exhibited low activity against Proteus mirabilis (MIC 312.5 µg·mL-1) and Klebsiella pneumoniae (MIC 625 µg·mL-1). The ethyl acetate phase showed interesting antibacterial activity (MIC 156.2 µg·mL-1) against Klebsiella pneumoniae, and it was well justified by the high content of glycosylated flavones. Therefore, based on the ethyl acetate phase antibacterial result, we suggest that M. charantia leaves could be considered as an alternative antibacterial source against K. pneumoniae and can serve as a pillar for future studies as well as pharmacological application against the bacteria.
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Affiliation(s)
- Abraão de Jesus B. Muribeca
- Institute of Exact and Natural Sciences, Federal University of Pará, Augusto Corrêa, 01, Guamá, Belém 66075-110, PA, Brazil
| | - Paulo Wender P. Gomes
- Collaborative Mass Spectrometry Innovation Center, University of California San Diego, La Jolla, San Diego, CA 92093, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, San Diego, CA 92093, USA
| | - Steven Souza Paes
- Institute of Exact and Natural Sciences, Federal University of Pará, Augusto Corrêa, 01, Guamá, Belém 66075-110, PA, Brazil
| | - Ana Paula Alves da Costa
- Department of Natural Science, Campus XIX, State University of Pará, Rodovia PA 154, Km 28, Cajú, Salvaterra 66860-000, PA, Brazil
| | - Paulo Weslem Portal Gomes
- Institute of Biology, University of Campinas, Monteiro Lobato, 255, Barão Geraldo, Campinas 13083-862, SP, Brazil
| | - Jéssica de Souza Viana
- Institute of Exact and Natural Sciences, Federal University of Pará, Augusto Corrêa, 01, Guamá, Belém 66075-110, PA, Brazil
| | - José Diogo E. Reis
- Institute of Exact and Natural Sciences, Federal University of Pará, Augusto Corrêa, 01, Guamá, Belém 66075-110, PA, Brazil
| | | | - Consuelo Silva
- Institute of Exact and Natural Sciences, Federal University of Pará, Augusto Corrêa, 01, Guamá, Belém 66075-110, PA, Brazil
- Pharmaceutical Science Post-Graduation Program, Faculty of Pharmacy, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Anelize Bauermeister
- Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-900, SP, Brazil
| | - Lourivaldo da Silva Santos
- Institute of Exact and Natural Sciences, Federal University of Pará, Augusto Corrêa, 01, Guamá, Belém 66075-110, PA, Brazil
| | - Milton Nascimento da Silva
- Institute of Exact and Natural Sciences, Federal University of Pará, Augusto Corrêa, 01, Guamá, Belém 66075-110, PA, Brazil
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20
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Tilahun M. Multi-Drug Resistance Profile, Prevalence of Extended-Spectrum Beta-Lactamase and Carbapenemase-Producing Gram Negative Bacilli Among Admitted Patients After Surgery with Suspected of Surgical Site Nosocomial Infection North East Ethiopia. Infect Drug Resist 2022; 15:3949-3965. [PMID: 35924020 PMCID: PMC9341454 DOI: 10.2147/idr.s376622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
- Correspondence: Mihret Tilahun, Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie and Borumeda, PO.BOX 1145, Ethiopia, Tel +251 920988307, Fax +251 333115250, Email
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21
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Duszynska W, Idziak M, Smardz K, Burkot A, Grotowska M, Rojek S. Frequency, Etiology, Mortality, Cost, and Prevention of Respiratory Tract Infections—Prospective, One Center Study. J Clin Med 2022; 11:jcm11133764. [PMID: 35807049 PMCID: PMC9267472 DOI: 10.3390/jcm11133764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is the most monitored form of respiratory tract infections (RTIs). A small number of epidemiological studies have monitored community-acquired pneumonia (CAP), non-ventilator hospital-acquired pneumonia (NV-HAP) and ventilator-associated tracheobronchitis (VAT) in intensive care units (ICUs). The objective of this study was to assess the frequency, etiology, mortality, and additional costs of RTIs. Methods: One-year prospective RTI surveillance at a 30-bed ICU. The study assessed the rates and microbiological profiles of CAP, VAP, NV-HAP, VAT, and VAP prevention factors, the impact of VAP and NV-HAP on the length of ICU stays, and the additional costs of RTI treatment and mortality. Results: Among 578 patients, RTIs were found in 30%. The CAP, NV-HAP, VAP, and VAT rates/100 admissions were 5.9, 9.0, 8.65, and 6.05, respectively. The VAP incidence density/1000 MV-days was 10.8. The most common pathogen of RTI was Acinetobacter baumannii MDR. ICU stays were extended by VAP and NV-HAP for 17.8 and 3.7 days, respectively, and these RTIs increased the cost of therapy by 13,029 and 2708 EUR per patient, respectively. The mortality rate was higher by 11.55% in patients with VAP than those without device-associated and healthcare-associated infections (p = 0.0861). Conclusions: RTIs are a serious epidemiological problem in patients who are admitted and treated in ICU, as they may affect one-third of patients. Hospital-acquired RTIs extend hospitalization time, increase the cost of treatment, and worsen outcomes.
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Affiliation(s)
- Wieslawa Duszynska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
- Correspondence: ; Tel.: +48-717332302
| | - Marta Idziak
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
| | - Klaudia Smardz
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (K.S.); (A.B.)
| | - Anna Burkot
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (K.S.); (A.B.)
| | - Malgorzata Grotowska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
| | - Stanislaw Rojek
- Department of Anaesthesiology and Intensive Therapy, Specialist Hospital in Walbrzych, A. Sokolowskiego Street 4, 58-309 Walbrzych, Poland;
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Guzek A, Rybicki Z, Woźniak-Kosek A, Tomaszewski D. Bloodstream Infections in the Intensive Care Unit: a Single-Center Retrospective Bacteriological Analysis Between 2007 and 2019. Pol J Microbiol 2022; 71:263-277. [PMID: 35716169 PMCID: PMC9252137 DOI: 10.33073/pjm-2022-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/14/2022] [Indexed: 11/05/2022] Open
Abstract
Hospital-acquired bloodstream infections are a severe worldwide problem associated with significant morbidity and mortality. This retrospective, single-center study aimed to analyze bloodstream infections in patients hospitalized in the intensive care unit of the Military Institute of Medicine, Poland. Data from the years 2007-2019 were analyzed. When the infection was suspected, blood samples were drawn and analyzed microbiologically. When bacterial growth was observed, an antimicrobial susceptibility/resistance analysis was performed. Among 12,619 analyzed samples, 1,509 were positive, and 1,557 pathogens were isolated. In 278/1,509 of the positive cases, a central line catheter infection was confirmed. Gram-negative bacteria were the most frequently (770/1,557) isolated, including Acinetobacter baumannii (312/770), Klebsiella pneumoniae (165/770; 67/165 were the isolates that expressed extended spectrum beta-lactamases (ESBL), 5/165 isolates produced the New Delhi metallo-β-lactamases (NDM), 4/165 isolates expressed Klebsiella pneumoniae carbapenemase (KPC), and 1/165 isolate produced OXA48 carbapenemase), Pseudomonas aeruginosa (111/770; 2/111 isolates produced metallo-β-lactamase (MBL), and Escherichia coli (69/770; 11/69 - ESBL). Most Gram-positive pathogens were staphylococci (545/733), mainly coagulase-negative (368/545). Among 545 isolates of the staphylococci, 58 represented methicillin-resistant Staphylococcus aureus (MRSA). Fungi were isolated from 3.5% of samples. All isolated MRSA and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) strains were susceptible to vancomycin, methicillin-sensitive Staphylococcus aureus (MSSA) isolates - to isoxazolyl penicillins, and vancomycin-resistant Enterococcus (VRE) - to linezolid and tigecycline. However, colistin was the only therapeutic option in some infections caused by A. baumannii and KPC-producing K. pneumoniae. P. aeruginosa was still susceptible to cefepime and ceftazidime. Echinocandins were effective therapeutics in the treatment of fungal infections.
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Affiliation(s)
- Aneta Guzek
- Department of Laboratory Diagnostics, Section of Microbiology, Military Institute of Medicine, Warsaw, Poland
| | - Zbigniew Rybicki
- Department of Anesthesiology and Intensive Therapy, Military Institute of Medicine, Warsaw, Poland
| | | | - Dariusz Tomaszewski
- Department of Anesthesiology and Intensive Therapy, Military Institute of Aviation Medicine, Warsaw, Poland
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Pawlik J, Tomaszek L, Mazurek H, Mędrzycka-Dąbrowska W. Risk Factors and Protective Factors against Ventilator-Associated Pneumonia-A Single-Center Mixed Prospective and Retrospective Cohort Study. J Pers Med 2022; 12:jpm12040597. [PMID: 35455713 PMCID: PMC9025776 DOI: 10.3390/jpm12040597] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Understanding the factors associated with the development of ventilator-associated pneumonia (VAP) in critically ill patients in the intensive care unit (ICU) will allow for better prevention and control of VAP. The aim of the study was to evaluate the incidence of VAP, as well as to determine risk factors and protective factors against VAP. Design: Mixed prospective and retrospective cohort study. Methods: The cohort involved 371 critically ill patients who received standard interventions to prevent VAP. Additionally, patients in the prospective cohort were provided with continuous automatic pressure control in tapered cuffs of endotracheal or tracheostomy tubes and continuous automatic subglottic secretion suction. Logistic regression was used to assess factors affecting VAP. Results: 52 (14%) patients developed VAP, and the incidence density of VAP per 1000 ventilator days was 9.7. The median days to onset of VAP was 7 [4; 13]. Early and late onset VAP was 6.2% and 7.8%, respectively. According to multivariable logistic regression analysis, tracheotomy (OR = 1.6; CI 95%: 1.1 to 2.31), multidrug-resistant bacteria isolated in the culture of lower respiratory secretions (OR = 2.73; Cl 95%: 1.83 to 4.07) and ICU length of stay >5 days (OR = 3.32; Cl 95%: 1.53 to 7.19) were positively correlated with VAP, while continuous control of cuff pressure and subglottic secretion suction used together were negatively correlated with VAP (OR = 0.61; Cl 95%: 0.43 to 0.87). Conclusions: Tracheotomy, multidrug-resistant bacteria, and ICU length of stay >5 days were independent risk factors of VAP, whereas continuous control of cuff pressure and subglottic secretion suction used together were protective factors against VAP.
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Affiliation(s)
- Jarosław Pawlik
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland; (J.P.); or (L.T.)
| | - Lucyna Tomaszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland; (J.P.); or (L.T.)
- National Institute of Tuberculosis and Lung Diseases, 34-700 Rabka-Zdroj, Poland
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, National Institute of Tuberculosis and Lung Diseases, 34-700 Rabka-Zdroj, Poland;
- Institute of Health, State University of Applied Sciences in Nowy Sącz, 33-300 Nowy Sącz, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland
- Correspondence:
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Marami D, Abate D, Letta S. Urinary tract infection, antimicrobial susceptibility pattern of isolates, and associated factors among women with a post-fistula at public health facilities, Harar, eastern Ethiopia: A cross-sectional study. SAGE Open Med 2022; 10:20503121221079309. [PMID: 35223031 PMCID: PMC8874165 DOI: 10.1177/20503121221079309] [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: 07/14/2021] [Accepted: 01/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Urinary tract infection remains one of the major public health problems among post-fistula patients worldwide, particularly in sub-Saharan Africa. Besides, antimicrobial resistance impedes the effective infection prevention and treatment of ever-increasing bacteria. There was a paucity of data on urinary tract infections and the antimicrobial susceptibility profile of bacteria among post-fistula patients. Objective: To determine the prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among women with post-fistula attending public health facilities, Harar, eastern Ethiopia. Methods: An institutional-based cross-sectional study was conducted among 146 consecutively enrolled women with post-fistula from February 2017 to December 2018. Risk factors were collected using a structured questionnaire. The midstream urine was collected, cultured and bacteria species were identified by using standard culture methods. Antimicrobial susceptibility testing was done by the disk diffusion technique. The association between independent and outcome variables was computed by using logistic regression analysis. A p-value < 0.05 was considered statistically significant. Results: The prevalence of urinary tract infections was 28.8% (95% confidence interval: 23.4, 33.6). Escherichia coli (19.1%), Pseudomonas aeruginosa (14.3%), and Proteus species (11.9%) were the commonest isolates. E. coli showed (75%) resistance to trimethoprim–sulfamethoxazole, amoxicillin (62.5%), and ciprofloxacin (62.5%). Staphylococcus aureus was shown 80% resistance to amoxicillin and erythromycin. Giving birth to a single baby (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.8), illness by a fistula for less than 3 years (adjusted odds ratio: 0.2, 95% confidence interval: 0.1, 0.6), and lack of a previous history of catheterization (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.9) decrease the odds of having urinary tract infections. Conclusion: Gram-negative organisms were the commonest cause of urinary tract infections in women with post-fistula. E. coli and P. aeruginosa showed higher resistance to most antimicrobials in the panels. Fistula patients need to be screened for urinary tract infections before antimicrobial treatment is indicated.
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Affiliation(s)
- Dadi Marami
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Degu Abate
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mohd Asri NA, Ahmad S, Mohamud R, Mohd Hanafi N, Mohd Zaidi NF, Irekeola AA, Shueb RH, Yee LC, Mohd Noor N, Mustafa FH, Yean CY, Yusof NY. Global Prevalence of Nosocomial Multidrug-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:1508. [PMID: 34943720 PMCID: PMC8698758 DOI: 10.3390/antibiotics10121508] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 12/18/2022] Open
Abstract
The emergence of nosocomial multidrug-resistant Klebsiella pneumoniae is an escalating public health threat worldwide. The prevalence of nosocomial infections due to K. pneumoniae was recorded up to 10%. In this systematic review and meta-analysis, which were conducted according to the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis, 1092 articles were screened from four databases of which 47 studies fulfilled the selected criteria. By performing a random-effect model, the pooled prevalence of nosocomial multidrug-resistant K. pneumoniae was estimated at 32.8% (95% CI, 23.6-43.6), with high heterogeneity (I2 98.29%, p-value < 0.001). The estimated prevalence of this pathogen and a few related studies were discussed, raising awareness of the spread of multidrug-resistant K. pneumoniae in the healthcare setting. The emergence of nosocomial multidrug-resistant K. pneumoniae is expected to increase globally in the future, and the best treatments for treating and preventing this pathogen should be acknowledged by healthcare staff.
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Affiliation(s)
- Nur Ain Mohd Asri
- Health Campus, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.M.A.); (N.F.M.Z.); (F.H.M.)
- Department of Plant Sciences, Kuliyyah of Science, International Islamic University Malaysia, Kuantan 25200, Malaysia;
| | - Suhana Ahmad
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (S.A.); (R.M.)
| | - Rohimah Mohamud
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (S.A.); (R.M.)
| | - Nurmardhiah Mohd Hanafi
- Department of Plant Sciences, Kuliyyah of Science, International Islamic University Malaysia, Kuantan 25200, Malaysia;
| | - Nur Fatihah Mohd Zaidi
- Health Campus, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.M.A.); (N.F.M.Z.); (F.H.M.)
| | - Ahmad Adebayo Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (A.A.I.); (R.H.S.)
| | - Rafidah Hanim Shueb
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (A.A.I.); (R.H.S.)
| | - Leow Chiuan Yee
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Glugor 11800, Malaysia;
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Fatin Hamimi Mustafa
- Health Campus, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.M.A.); (N.F.M.Z.); (F.H.M.)
| | - Chan Yean Yean
- Health Campus, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.M.A.); (N.F.M.Z.); (F.H.M.)
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (A.A.I.); (R.H.S.)
| | - Nik Yusnoraini Yusof
- Health Campus, Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.M.A.); (N.F.M.Z.); (F.H.M.)
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Antimicrobial resistance profiles and associated factors of Acinetobacter and Pseudomonas aeruginosa nosocomial infection among patients admitted at Dessie comprehensive specialized Hospital, North-East Ethiopia. A cross-sectional study. PLoS One 2021; 16:e0257272. [PMID: 34780494 PMCID: PMC8592406 DOI: 10.1371/journal.pone.0257272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Hospital admitted patients are at increased risk of nosocomial infections (NIs) with multi-drug resistant (MDR) pathogens which are prevalent in the hospital environment. Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) are common causes of NIs worldwide. The objective of this study is to determine antimicrobial resistance profiles and associated factors of Acinetobacter spp and P. aeruginosa NIs among hospitalized patients. Methods A cross-sectional study was conducted at Dessie comprehensive specialized hospital, North-East Ethiopia, from February 1 to April 30, 2020. A total of 254 patients who were suspected of the bloodstream, urinary tract, or surgical site nosocomial infections were enrolled consecutively. Socio-demographic and other variables of interest were collected using a structured questionnaire. Specimens were collected and processed following standard microbiological procedures. Antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Data were analyzed with SPSS version 23 and p-value < 0.05 was considered statistically significant. Results Overall, 13% of patients had nosocomial Acinetobacter spp and/or P. aeruginosa infections. The culture positivity rate was 16(6.3%) for Acinetobacter spp and 18(7.1%) for P. aeruginosa. Patients admitted in the surgical ward (Adjusted odds ratio (AOR):10.66;95% confidence interval (CI):1.22–93.23), pediatric ward (AOR:14.37;95%CI:1.4–148.5), intensive care unit (AOR:41.93;95%CI:4.7–374.7) and orthopedics (AOR:52.21;95%CI:7.5–365) were significantly at risk to develop NIs compared to patients admitted in the medical ward. Patients who took more than two antimicrobial types at admission were 94% (AOR:0.06; 95% CI:0.004–0.84) times more protected from NIs compared to those who did not take any antimicrobial. About 81% of Acinetobacter spp and 83% of P. aeruginosa isolates were MDR. Amikacin and meropenem showed promising activity against Acinetobacter spp and P. aeruginosa isolates. Conclusion The high prevalence of MDR Acinetobacter spp and P. aeruginosa nosocomial isolates enforce treating of patients with NIs based on antimicrobial susceptibility testing results.
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Brinkwirth S, Ayobami O, Eckmanns T, Markwart R. Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020. Euro Surveill 2021; 26:2001628. [PMID: 34763754 PMCID: PMC8646982 DOI: 10.2807/1560-7917.es.2021.26.45.2001628] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/17/2021] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital-acquired infections (HAI) caused by Enterococcus spp., especially vancomycin-resistant Enterococcusspp. (VRE), are of rising concern.AimWe summarised data on incidence, mortality and proportion of HAI caused by enterococci in the World Health Organization European Region.MethodsWe searched Medline and Embase for articles published between 1 January 2010 and 4 February 2020. Random-effects meta-analyses were performed to obtain pooled estimates.ResultsWe included 75 studies. Enterococcus spp. and VRE accounted for 10.9% (95% confidence interval (CI): 8.7-13.4; range: 6.1-17.5) and 1.1% (95% CI: 0.21-2.7; range: 0.39-2.0) of all pathogens isolated from patients with HAI. Hospital wide, the pooled incidence of HAI caused by Enterococcus spp. ranged between 0.7 and 24.8 cases per 1,000 patients (pooled estimate: 6.9; 95% CI: 0.76-19.0). In intensive care units (ICU), pooled incidence of HAI caused by Enterococcus spp. and VRE was 9.6 (95% CI: 6.3-13.5; range: 0.39-36.0) and 2.6 (95% CI: 0.53-5.8; range: 0-9.7). Hospital wide, the pooled vancomycin resistance proportion among Enterococcus spp. HAI isolates was 7.3% (95% CI: 1.5-16.3; range: 2.6-11.5). In ICU, this proportion was 11.5% (95% CI: 4.7-20.1; range: 0-40.0). Among patients with hospital-acquired bloodstream infections with Enterococcus spp., pooled all-cause mortality was 21.9% (95% CI: 15.7-28.9; range: 14.3-32.3); whereas all-cause mortality attributable to VRE was 33.5% (95% CI: 13.0-57.3; range: 14.3-41.3).ConclusionsInfections caused by Enterococcus spp. are frequently identified among hospital patients and associated with high mortality.
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Affiliation(s)
- Simon Brinkwirth
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | - Olaniyi Ayobami
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | - Robby Markwart
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
- Jena University Hospital, Institute of General Practice and Family Medicine, Jena, Germany
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28
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Elnasser ZA, Obeidat HM, Bani-Salem ME, Amarin ZO, Banni-Issa AF, Kaplan NM. Is methicillin-resistant Staphylococcus aureus a common pathogen in ventilation-associated pneumonia?: The experience of a tertiary teaching hospital in Jordan. Medicine (Baltimore) 2021; 100:e26069. [PMID: 34011126 PMCID: PMC8136984 DOI: 10.1097/md.0000000000026069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/27/2021] [Indexed: 01/05/2023] Open
Abstract
Ventilator-associated pneumonia is a life threatening device related infection in intensive care units. Methicillin-resistant Staphylococcus aureus is considered a common contagious pathogen causing pneumonia and sepsis.To assess the prevalence of S aureus in comparison to other pathogens, and their antibacterial sensitivity profile in ventilator-associated pneumonia.Data regarding ventilator-associated pneumonia of adults admitted to the intensive care unit, at the Jordan University of Science and Technology Hospital, between 2012 and 2018 were extracted from the computerized system. Microorganisms and their susceptibility profiles were identified according to the Clinical and Laboratory Standards Institute.There were 547 isolates, of which 35 (6.4%) were Gram positive, 59% were methicillin resistant. Gram-negative isolates were present in 507 (92.6%) isolates, of which 82% were multidrug resistant, and 1% were Candida species.Gram-negative bacterial infections were significantly associated with ventilation usage. S aureus was not the predominant pathogen.
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Affiliation(s)
| | | | | | | | - Ali F. Banni-Issa
- King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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Chmielarczyk A, Pomorska-Wesołowska M, Romaniszyn D, Wójkowska-Mach J. Healthcare-Associated Laboratory-Confirmed Bloodstream Infections-Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2785. [PMID: 33803428 PMCID: PMC7967254 DOI: 10.3390/ijerph18052785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. OBJECTIVES The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland. PATIENTS AND METHODS Data on 4218 LC-BSIs were collected between 2016-2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations. RESULTS Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was Staphylococcus (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while Escherichia coli (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant Staphylococcus aureus (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but S. aureus with resistance to macrolides, lincosamides and streptogramins B (MLSB) in surgery was 66.7%. The highest prevalence of E. faecalis with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while E. faecium-HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more. CONCLUSIONS The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis.
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Affiliation(s)
- Agnieszka Chmielarczyk
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.C.); (D.R.)
| | - Monika Pomorska-Wesołowska
- Department of Microbiology, Analytical and Microbiological Laboratory of Ruda Slaska, KORLAB NZOZ, 41-700 Ruda Slaska, Poland;
| | - Dorota Romaniszyn
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.C.); (D.R.)
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.C.); (D.R.)
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30
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Rafa E, Wałaszek MZ, Wałaszek MJ, Domański A, Różańska A. The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2238. [PMID: 33668288 PMCID: PMC7956275 DOI: 10.3390/ijerph18052238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Healthcare-associated infections (HAIs) are a serious problem of modern medicine. Patients hospitalized in intensive care units (ICUs) develop HAI significantly more often than patients in other hospital units. MATERIALS AND METHODS Analysis involved HAIs from three ICUs in southern Poland. The study was conducted in 2016-2019 on the basis of methodology recommended by the Healthcare-Associated Infections Surveillance Network (HAI-Net) and European Centre for Disease Prevention and Control (ECDC). The objective was to analyse HAIs, their clinical forms, and microbiological agents. RESULTS The study included 3028 patients hospitalized for 26,558 person-days (pds) in ICU. A total of 540 HAIs were detected; incidence per 100 hospitalizations was 17.8%, incidence density per 1000 pds was 20.3. The mortality of patients with HAI was 16%, and in Clostridioidesdifficile infection (CDI), the mortality was 28%. The most common clinical form of HAI was bloodstream infection (BSI): 209 cases (incidence rate 6.9%), followed by pneumonia (PN): 131 (incidence rate 4.3%), and urinary tract infection (UTI): 110 cases (incidence rate 3.6%). The most frequently isolated bacteria were Klebsiella pneumoniae 16.4%, Acinetobacter baumannii 14.4%, Staphylococcus aureus 11.8%, and Escherichia coli 11.4%. CONCLUSIONS A two-fold higher incidence rate of BSI was detected compared to the average incidence in European countries. BSI of unknown source (BSI-UNK) was predominant. K. pneumoniae and A. baumannii bacteria were the most often isolated microorganisms causing HAI. Infection control based on incidence rate for each type of infection is necessary in ICU to assess the epidemiological situation.
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Affiliation(s)
- Elżbieta Rafa
- State Higher Vocational School in Nowy Sącz, 33-300 Kraków, Poland;
| | - Marta Z. Wałaszek
- State Higher Vocational School in Tarnów, St. Luke Provincial Hospital in Tarnów, 33-100 Tarnów, Poland;
| | | | - Adam Domański
- Department of Distributed Systems and IT Equipment, Electronics and Computer Science, Faculty of Automatic Control, The Silesian Technical University, 44-100 Gliwice, Poland;
| | - Anna Różańska
- Chair of Microbiology, Jagiellonian University Medical College, Czysta str. 18, 31-121 Kraków, Poland
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Litwin A, Rojek S, Gozdzik W, Duszynska W. Pseudomonas aeruginosa device associated - healthcare associated infections and its multidrug resistance at intensive care unit of University Hospital: polish, 8.5-year, prospective, single-centre study. BMC Infect Dis 2021; 21:180. [PMID: 33593280 PMCID: PMC7885137 DOI: 10.1186/s12879-021-05883-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa has recently shown to be one of the most important strains of bacteria and alert pathogens in Europe among Intensive Care Unit patients that provide serious therapeutic problems because of its multidrug resistance. METHODS The purpose of this microbiological study was data analysis of device associated- healthcare associated infections (DA-HAIs) in an ICU in terms of the incidents of P.aeruginosa strain infections and its susceptibility within an 8.5-year observation. RESULTS Among 919 isolated strains responsible for 799 DA-HAIs (17,62 ± 1,98/1000 patient-days) in 4010 ICU patients P.aeruginosa was the pathogen in 108/799 (13.52%) cases. Incidence rate (density) of: VAP/1000 MV- days, UTI /1000 UC- days and CLA-BSI/1000 CL- days were 11,15 ± 2.5, 6.82 ± 0.81, 2.35 ± 1.54.respectivelly. P.aeruginosa was the pathogen most frequently responsible for VAP 69/108 (63.88%). Mean frequency of VAP, UTI and CLA-BSI with P.aeruginosa etiology was 69/493 (14.28%), 32/299 (11.1%) and 7/127 (5.77%) respectively. The mean density of P.aeruginosa infection amounted to 2.43/1000 patient-days. The decrease was observed in the total number of DA-HAIs caused by the P.aeruginosa from 15.75% and 3.23/1000 patient-days in 2011 to 5.0% and 1.17/1000 in 2016 (p = 0.0104, p = 0.0348). Starting from 2016 to 2019 incidence and density of P.aeruginosa DA-HAIs increased to 12.33% and 2.63/1000 (p = 0.1388, p = 0.0818). P.aeruginosa was susceptible to ceftazidime, cefepime, amikacin, meropenem, ciprofloxacin, colistin, in 55.55, 58.33, 70.37, 53.73, 50, and 100% respectively. MDR characterised it in 40% in 2011 and 66.7% in 2019, (p = 0.177). CONCLUSIONS The study revealed a changeable prevalence of P. aeruginosa strain infections; however their frequency was never highest in our ICU patients as it presented in the last years in Europe. The study showed a significant decrease in 2016 and increase in 2019, a nearly 3-fold increase of P.aeruginosa infections among Gram-negative strain infections, and a 2-fold increase of the P.aeruginosa DA-HAIs frequency between 2016 and 2019 as well as an increased resistance. Microbiological analysis of DA-HAIs in each hospital should be a standard method used in hospital infection control and antibiotic policy. In the case of P.aeruginosa, in order to minimize transmission, preventive infection methods should be assessed mainly in case of VAP.
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Affiliation(s)
- Agnieszka Litwin
- Microbiology Laboratory, University Hospital Wroclaw, Borowska Street 213, Wroclaw, Poland
| | - Stanislaw Rojek
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367, Wroclaw, Poland
| | - Waldemar Gozdzik
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367, Wroclaw, Poland
| | - Wieslawa Duszynska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367, Wroclaw, Poland.
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Szczypta A, Talaga-Ćwiertnia K, Kielar M, Krzyściak P, Gajewska A, Szura M, Bulanda M, Chmielarczyk A. Investigation of Acinetobacter baumannii Activity in Vascular Surgery Units through Epidemiological Management Based on the Analysis of Antimicrobial Resistance, Biofilm Formation and Genotyping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041563. [PMID: 33562194 PMCID: PMC7915860 DOI: 10.3390/ijerph18041563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Abstract
Background/Objectives: The genus Acinetobacter demonstrates resistance to antibiotics and has been shown to spread in the hospital environment causing epidemic outbreaks among hospitalized patients. The objectives of the present study was to investigate the antibiotic resistance, biofilm formation, and clonality among Acinetobacter baumannii strains. Materials and Methods: The study involved 6 (I Outbreak) and 3 (II Outbreak) A. baumannii strains isolated from patients hospitalized in vascular surgery unit. Results: All tested A. baumannii strains were extensively drug resistant (XDR) and all the isolates were carbapenem-resistant and among them, all carried the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene. All of the investigated strains had the ability to form a biofilm, but all of them produced less biofilm than the reference strain. Multi-locus sequence typing (MLST) showed that all strains belonged to the ST2 clone. Pulsed-field gel electrophoresis (PFGE) divided the tested outbreak strains into two clones (A and B). Conclusion: This study shows a nosocomial spread of XDR A. baumannii ST2 having the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene, low biofilm formers, that was prevalent in the vascular surgery unit. To identify the current situation of vascular surgery departments targeted epidemiological investigation was needed. Effective implementation of infection control prevented the spread of the epidemic outbreaks.
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Affiliation(s)
- Anna Szczypta
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland;
- The Bonifratri Order Hospital of St. John Grande, 31-061 Kraków, Poland;
| | - Katarzyna Talaga-Ćwiertnia
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, 31-008 Kraków, Poland; (P.K.); (M.B.)
- Correspondence: ; Tel.: +48-12-633-0877 (ext. 231)
| | - Małgorzata Kielar
- Medical Diagnostic Laboratory with a Bacteriological Unit, St. Louis Regional Specialised Children’s Hospital, 31-503 Kraków, Poland;
| | - Paweł Krzyściak
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, 31-008 Kraków, Poland; (P.K.); (M.B.)
| | | | - Mirosław Szura
- The Bonifratri Order Hospital of St. John Grande, 31-061 Kraków, Poland;
- Jagiellonian University Medical College, Department of Clinical and Experimental Surgery, 31-008 Kraków, Poland
| | - Małgorzata Bulanda
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, 31-008 Kraków, Poland; (P.K.); (M.B.)
| | - Agnieszka Chmielarczyk
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Bacteriology, Microbial Ecology and Parasitology, 31-008 Kraków, Poland;
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Alebel M, Mekonnen F, Mulu W. Extended-Spectrum β-Lactamase and Carbapenemase Producing Gram-Negative Bacilli Infections Among Patients in Intensive Care Units of Felegehiwot Referral Hospital: A Prospective Cross-Sectional Study. Infect Drug Resist 2021; 14:391-405. [PMID: 33564247 PMCID: PMC7867495 DOI: 10.2147/idr.s292246] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Owing to the specific risk profile of its residents, intensive care units (ICUs) are the best place for selection pressure and the epicenter for resistance development and dissemination. Infections with β-lactamase releasing Gram-negative bacilli (GNB) at ICUs are an emerging global threat. This study dogged the magnitude of extended-spectrum β-lactamase (ESBL) and carbapenemase releasing Gram-negative bacilli infections and associated factors among patients in the ICUs of Felegehiwot Referral Hospital, Ethiopia. Methods A cross-sectional study was done through February to June 2020. Wound swabs, urine, blood and sputum samples were collected from patients in the ICUs symptomatic for infections while excluding those under coma and shock. Bacterial species were verified using standard microbiological methods. Carbapenemase and ESBL production were identified using modified carbapenem inactivation and combined disk diffusion methods, respectively. Multivariable analysis was calculated for factors associated with ESBL production. P-value < 0.05 was taken as cut-off for statistical significance. Results Out of 270 patients in the ICU, 67 (24.8%) and 14 (5.2%) had infections with ESBL and carbapenemase releasing GNB, respectively. The most frequent ESBL producing isolates were P. aeruginosa (100%), E. cloacae (100%), K. pneumoniae (82.8%) and E. coli (64%). The predominant carbapenemase producer isolates were K. pneumoniae (27.6%) and E. cloacae (33.3%). Overall, 77 (81.1%) of species were multi-drug resistant. All GNB species were 100% resistant to tetracycline and ampicillin. They are also resistant to cefuroxime, ceftazidime, sulfamethoxazole-trimethoprim and cefotaxime. Prior hospitalization (AOR = 5.5, CI = 2.63-11.46), support with medical care devices (AOR = 23.7, CI = 4.6-12) and arterial intravenous catheterization (AOR = 2.7, CI = 1.3-5.3) had significant association with β-lactamase producing GNB infection. Conclusion Infection with ESBL and carbapenemase producing Gram-negative bacilli linked with an alarming degree of multi-drug resistant isolates is a major healthcare threat among patients in ICUs. Hence, strict adherence to infection prevention practices and wise use of antibiotics are recommended to slow the spread of antimicrobial resistance.
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Affiliation(s)
- Mekonnen Alebel
- Department of Clinical Laboratory Science, Chagni Hospital, Chagni, Ethiopia
| | - Feleke Mekonnen
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Damavandi DS, Javan M, Moshashaei H, Forootan M, Darvishi M. Microbial Contamination after Cardiac Surgery in a Hospital Cardiac Surgery Ward. J Med Life 2020; 13:342-348. [PMID: 33072206 PMCID: PMC7550159 DOI: 10.25122/jml-2019-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Surgery site infection is one of the most common postoperative complications which is associated with increased morbidity, mortality and admission costs. It is considered a priority to determine the level of nosocomial infection and its control in reflecting the quality of care. Therefore, this study aimed to evaluate the microbial contamination after cardiac surgery at a hospital cardiac surgery ward of Besat Hospital, Tehran. In this cross-sectional descriptive-analytic study (2013-2017), 610 patients underwent surgery at the Department of Cardiac Surgery of Besat Hospital. All necessary information such as urine culture, surgical site, histopathologic examination for the diagnosis of microbial contamination and microorganisms were collected from the patient records and inserted in the questionnaire. The data were analyzed using SPSS (version 25). The incidence of nosocomial infections following cardiac surgery reportedly ranged from 17% to 23%. Accordingly, pneumonia (51.2%) and local infections (22%) were the most common infections in the studied population. The mortality rate in our population was 11.4%. Moreover, 64.3% of the total mortality cases were reported in patients with sepsis. The mean age and duration of admission of patients with catheter infection were significantly higher than other subjects. Given the relatively high prevalence of the infection and its importance, it is necessary to take more serious measures to prevent and control these infections.
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Affiliation(s)
| | - Mina Javan
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Hamidreza Moshashaei
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Mojgan Forootan
- Department of Gastroenterology, Gastrointestinal and Liver Diseases Research Center (RCGLD),Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine,AJA University of Medical Sciences, Tehran, Iran
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Shu H, Li L, Wang Y, Guo Y, Wang C, Yang C, Gu L, Cao B. Prediction of the Risk of Hospital Deaths in Patients with Hospital-Acquired Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii Infection: A Multi-Center Study. Infect Drug Resist 2020; 13:4147-4154. [PMID: 33244244 PMCID: PMC7683351 DOI: 10.2147/idr.s265195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To predict the risk of hospital deaths in patients with hospital-acquired pneumonia (HAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) infection. Patients and Methods A total of 366 patients who were diagnosed with HAP caused by MDR-AB infection were enrolled between January 2013 and December 2016. The sociological characteristics and clinical data of these cases were collected. Univariate and multivariate logistic analyses were used to explore the risk factors of hospital deaths before medication and after drug withdrawal. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to assess the predictive effectiveness of the models with or without the adjustment. Results Hospital deaths occurred in 142 cases (38.80%). The results showed that acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores before medication and after drug withdrawal were associated with the risk of hospital deaths. Adjusting the covariants including the age, autoimmune disease, venous cannula, transfer of patients from other hospitals, and APACHE II score at admission, then no differences were discovered in predicting the hospital deaths between adjusted APACHE II and adjusted SOFA scores before medication (AUC: 0.808 vs 0.803, P =0.614) and after drug withdrawal (AUC: 0.876 vs 0.878, P =0.789). Conclusion Before medication or after drug withdrawal, the adjusted APACHE II and adjusted SOFA scores all performed well in determining the predictive effectiveness of the hospital deaths in patients with HAP caused by MDR-AB infection, indicating that the appropriate infection control may reduce the occurrence of nosocomial deaths and improve the prognosis.
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Affiliation(s)
- Hongmei Shu
- Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Department of Respiration, Anqing Municipal Hospital, Anqing Hospital of Anhui Medical University, Anhui 246000, People's Republic of China
| | - Lijuan Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yimin Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yiqun Guo
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Chunlei Wang
- Laboratory of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Laboratory of Clinical Microbiology and Infectious Diseases, China-Japan Friendship Hospital, Beijing, People's Republic of China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; National Clinical Research Center of Respiratory Disease, Clinical Center for Pulmonary Infection, Capital Medical University, Tsinghua University-Peking University Joint Center for Life Sciences, Beijing 100029, People's Republic of China
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Duszynska W, Rosenthal VD, Szczesny A, Zajaczkowska K, Fulek M, Tomaszewski J. Device associated -health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015-2017). BMC Infect Dis 2020; 20:761. [PMID: 33066740 PMCID: PMC7562760 DOI: 10.1186/s12879-020-05482-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Device-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients' condition, length of hospitalisation, mortality and therapy cost. METHODS The study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA). RESULTS During study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14-33) days, while without infections it was 6.0 (3-11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733-1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2-76.8 and 29-100, respectively. CONCLUSIONS DA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.
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Affiliation(s)
- Wieslawa Duszynska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L.Pasteura Street 1, 50-367 Wroclaw, Poland
| | | | - Aleksander Szczesny
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L.Pasteura Street 1, 50-367 Wroclaw, Poland
| | - Katarzyna Zajaczkowska
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
| | - Michal Fulek
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
| | - Jacek Tomaszewski
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
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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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Zhou T, Yang W, Yang Q, Xuan B, Zhang L, Li X, Zhou F. Distribution, diagnosis, and analysis of related risk factors of multidrug-resistant organism in patients with malignant neoplasms. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2648-2655. [PMID: 33165442 PMCID: PMC7642715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In this study, we sought to investigate the distribution characteristics, early diagnosis, and related risk factors of multidrug-resistant organism (MDRO) in patients with malignant tumors. METHODS A total of 278 patients with malignant tumors and infections were selected in the Department of Oncology for retrospective study, including 128 MDRO patients and 150 non-MDRO patients. The markers of bacterial culture were detected, and the serum procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) levels were measured in patients' blood samples. The diagnostic value of PCT, CRP, and SAA for MDRO was evaluated, the distribution of MDRO in different years and different infection sites was analyzed, and the related risk factors of MDRO infection were studied. RESULTS The PCT, CRP, and SAA in the MDRO group were significantly higher than those of the non-MDRO group (all P<0.001). The area under the curve of receiver operating characteristics for the diagnosis of MDRO by PCT, CRP, and SAA. The combination of the three was 0.792, 0.811, 0.755, and 0.842, respectively. The distribution of MDRO strains in different years was statistically different (P<0.05), as well as the distribution of MDRO in different infection sites (P<0.05). Multivariate regression analysis demonstrated that invasive operation, excessive bed rest, hypoproteinemia, PCT, and SAA were independent risk factors for MDRO infection in patients with malignant tumors (all P<0.05). CONCLUSION The combination of CRP, PCT, and SAA displays a value for early diagnosis of MDRO infection. MDRO infections in malignant tumors mainly include carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Escherichia coli. There are differences in terms of MDRO strains in different years and different infection sites, and there are many risk factors regarding MDRO infection in patients with malignant tumors. Intervention should be taken in order to reduce the rate of MDRO infection.
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Affiliation(s)
- Tang Zhou
- Department of Laboratory, Traditional Chinese Medical Hospital of ZhujiZhuji, Zhejiang Province, China
| | - Wenchao Yang
- Department of Hospital-Acquired Infection Control, Traditional Chinese Medical Hospital of ZhujiZhuji, Zhejiang Province, China
| | - Qijun Yang
- Department of Pharmacy, Zhuji Second People’s HospitalZhuji, Zhejiang Province, China
| | - Bixia Xuan
- Department of Pharmacy, Traditional Chinese Medical Hospital of ZhujiZhuji, Zhejiang Province, China
| | - Liuping Zhang
- Department of Cardiovascular Medicine, Traditional Chinese Medical Hospital of ZhujiZhuji, Zhejiang Province, China
| | - Xiaofang Li
- Department of Pharmacy, Traditional Chinese Medical Hospital of ZhujiZhuji, Zhejiang Province, China
| | - Fang Zhou
- Department of Pediatrics, Traditional Chinese Medical Hospital of ZhujiZhuji, Zhejiang Province, China
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Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196943. [PMID: 32977435 PMCID: PMC7579392 DOI: 10.3390/ijerph17196943] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/30/2022]
Abstract
Introduction: In recent years, an increase in healthcare-associated infections (HAIs) caused by resistant pathogens, which is a clinically troublesome trend, has been observed. The aim of the study was to analyze the microbial factors of HAIs and the drug resistance of microorganisms to selected antibiotics and their consumption. Material and Methods: The retrospective study included 3708 patients hospitalized in the intensive care unit (ICU) of the University Teaching Hospital in Wroclaw, who were diagnosed with 742 HAIs in the period from 1 January 2011 to 31 December 2018. The aim of the study was the analysis of microorganisms isolated in the respective clinical forms of HAIs, including the occurrence of “alert pathogens”, presence of multidrug-resistant (MDR) strains, and consumption of selected antibiotics. Findings: During the study period, 846 microorganisms were cultured in patients with HAIs, and among them, Acinetobacter baumannii MDR represented 31.8%; Klebsiella pneumoniae ESBLs, 11.3%; Pseudomonas aeruginosa MDR, 4.1% and MRSA, 2.2%; and Enterococcus spp. vancomycin-resistant enterococci (VRE), 1.3%. Among all the pathogens, Gram-negative bacteria (GNB) were dominant (71.6%). Gram-positive bacteria and fungi accounted for 21.6% and 7%, respectively. The total number of strains responsible for ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and central line-associated blood stream infection (CLA-BSI) was as follows: 458 (54.1%), 274 (32.4%), and 114 (13.5%), respectively. Among the etiological factors of VAP, there was a prevalence of A. baumannii MDR (41.9%), as well as in the case of UTI (21.9%). With regards to CLA-BSI, MRCNS (29.8%) was the dominant pathogen. The “alert pathogens” accounted for 54.7% of all the analyzed strains. The MDR strains represented 72.6% and 9.7% among A. baumannii and P. aeruginosa, respectively. In the years 2011 vs. 2018, an increase in infections with MDR bacilli was observed, 34.6% vs. 61.0% (p = 0.0008), respectively, including A. baumannii MDR 16.54% vs. 34.56 % (p = 0.0009) and Enterobacterales ESBL+/AMPC 11.8% vs. 15.44 % (p = 0.3921). Resistance to methicillin was confirmed in 35.2% of S. aureus strains. Resistance to vancomycin was found among 30.9% of Enterococcus spp. The observed period was marked by an increase in the consumption of carbapenems: 197.7 vs. 235.9 defined daily dose (DDD)/1000 patients-days. Conclusions: Gram-negative bacteria were found to be dominant pathogens in healthcare-associated infections. The most frequently cultured pathogens were multidrug-resistant A. baumannii, K. pneumoniae ESBL(+), and P. aeruginosa. The study showed an increase in the incidence of “alert pathogens” and MDR bacilli, as well as the tendency of a growing resistance to antibiotics during the observed period. Microbiological analysis of HAIs and the consumption of antibiotics is the necessary element of the proper antibiotic policy in hospitals.
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Otero ML, Menezes RC, Ferreira IBB, Issa FL, Agareno G, Carmo TA, Arriaga MB, Fukutani KF, Pamplona Neto L, Agareno S, Filgueiras Filho NM, Akrami KM, Andrade BB. Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections. Infect Drug Resist 2020; 13:2811-2817. [PMID: 32848430 PMCID: PMC7430765 DOI: 10.2147/idr.s264276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil. Methods Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI. Results A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23–39.27, OR: 2.48, 95% CI 1.17–5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality. Conclusion Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.
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Affiliation(s)
- Matheus L Otero
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Rodrigo C Menezes
- Curso de Medicina, União Metropolitana Para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil
| | | | - Francine L Issa
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Gabriel Agareno
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Thomas Azevedo Carmo
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - María B Arriaga
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | - Kiyoshi F Fukutani
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | | | - Sydney Agareno
- Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Nivaldo M Filgueiras Filho
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Universidade Do Estado Da Bahia (UNEB), Salvador, Bahia, Brazil.,Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Kevan M Akrami
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA
| | - Bruno B Andrade
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil.,Escola Bahiana De Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
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Ayobami O, Willrich N, Harder T, Okeke IN, Eckmanns T, Markwart R. The incidence and prevalence of hospital-acquired (carbapenem-resistant) Acinetobacter baumannii in Europe, Eastern Mediterranean and Africa: a systematic review and meta-analysis. Emerg Microbes Infect 2020; 8:1747-1759. [PMID: 31805829 PMCID: PMC6913636 DOI: 10.1080/22221751.2019.1698273] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Due to therapeutic challenges, hospital-acquired infections (HAIs) caused by Acinetobacter baumannii (HA-AB), particularly carbapenem-resistant strains (HA-CRAB) pose a serious health threat to patients worldwide. This systematic review sought to summarize recent data on the incidence and prevalence of HA-AB and HA-CRAB infections in the WHO-defined regions of Europe (EUR), Eastern Mediterranean (EMR) and Africa (AFR). A comprehensive literature search was performed using MEDLINE, EMBASE and GMI databases (01/2014-02/2019). Random-effects meta-analyses were performed to determine the pooled incidence of HA-AB and HA-CRAB infections as well as the proportions of A. baumannii among all HAIs. 24 studies from 3,340 records were included in this review (EUR: 16, EMR: 6, AFR: 2). The pooled estimates of incidence and incidence density of HA-AB infection in intensive care units (ICUs) were 56.5 (95% CI 33.9-92.8) cases per 1,000 patients and 4.4 (95% CI 2.9-6.6) cases per 1,000 patient days, respectively. Five studies conducted at a hospital-wide level or in specialized clinical departments/wards (ICU + non-ICU patients) showed HA-AB incidences between 0.85 and 5.6 cases per 1,000 patients. For carbapenem-resistant A. baumannii infections in ICUs, the pooled incidence and incidence density were 41.7 (95% CI 21.6-78.7) cases per 1,000 patients and 2.1 (95% CI 1.2-3.7) cases per 1,000 patient days, respectively. In ICUs, A. baumannii and carbapenem-resistant A. baumannii strains accounted for 20.9% (95% CI 16.5-26.2%) and 13.6% (95% CI 9.7-18.7%) of all HAIs, respectively. Our study highlights the persistent clinical significance of hospital-acquired A. baumannii infections in the studied WHO regions, particularly in ICUs.
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Affiliation(s)
- Olaniyi Ayobami
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Niklas Willrich
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Thomas Harder
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Tim Eckmanns
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
| | - Robby Markwart
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch-Institute, Berlin, Germany
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Kózka M, Sega A, Wojnar-Gruszka K, Tarnawska A, Gniadek A. Risk Factors of Pneumonia Associated with Mechanical Ventilation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E656. [PMID: 31963947 PMCID: PMC7014112 DOI: 10.3390/ijerph17020656] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5%-15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP.
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Affiliation(s)
- Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Jagiellonian University Collegium Medicum in Krakow, 31-501 Kraków, Poland; (M.K.); (K.W.-G.)
| | - Aurelia Sega
- Department of Clinical Nursing, Faculty of Health Sciences, Jagiellonian University Collegium Medicum in Krakow, 31-501 Kraków, Poland; (M.K.); (K.W.-G.)
| | - Katarzyna Wojnar-Gruszka
- Department of Clinical Nursing, Faculty of Health Sciences, Jagiellonian University Collegium Medicum in Krakow, 31-501 Kraków, Poland; (M.K.); (K.W.-G.)
| | | | - Agnieszka Gniadek
- Department of Epidemiological Nursing, Faculty of Health Sciences, Jagiellonian University Collegium Medicum in Krakow, 31-501 Kraków, Poland;
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Zhang M, Yang H, Mou X, Wang L, He M, Zhang Q, Wu K, Cheng J, Wu W, Li D, Xu Y, Chao J. An interactive nomogram to predict healthcare-associated infections in ICU patients: A multicenter study in GuiZhou Province, China. PLoS One 2019; 14:e0219456. [PMID: 31306445 PMCID: PMC6629073 DOI: 10.1371/journal.pone.0219456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To develop and validate an interactive nomogram to predict healthcare-associated infections (HCAIs) in the intensive care unit (ICU). Methods A multicenter retrospective study was conducted to review 2017 data from six hospitals in Guizhou Province, China. A total of 1,782 ICU inpatients were divided into either a training set (n = 1,189) or a validation set (n = 593). The patients’ demographic characteristics, basic clinical features from the previous admission, and their need for bacterial culture during the current admission were extracted from electronic medical records of the hospitals to predict HCAI. Univariate and multivariable analyses were used to identify independent risk factors of HCAI in the training set. The multivariable model’s performance was evaluated in both the training set and the validation set, and an interactive nomogram was constructed according to multivariable regression model. Moreover, the interactive nomogram was used to predict the possibility of a patient developing an HCAI based on their prior admission data. Finally, the clinical usefulness of the interactive nomogram was estimated by decision analysis using the entire dataset. Results The nomogram model included factor development (local economic development levels), length of stay (LOS; days of hospital stay), fever (days of persistent fever), diabetes (history of diabetes), cancer (history of cancer) and culture (the need for bacterial culture). The model showed good calibration and discrimination in the training set [area under the curve (AUC), 0.871; 95% confidence interval (CI), 0.848–0.894] and in the validation set (AUC, 0.862; 95% CI, 0.829–0.895). The decision curve demonstrated the clinical usefulness of our interactive nomogram. Conclusions The developed interactive nomogram is a simple and practical instrument for quantifying the individual risk of HCAI and promptly identifying high-risk patients.
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Affiliation(s)
- Man Zhang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
| | - Huai Yang
- GuiZhou Healthcare Associated Infection Training Base, Center for Infectious Diseases, GuiZhou Provincial People’s Hospital, Guiyang, China
| | - Xia Mou
- GuiZhou Healthcare Associated Infection Training Base, Center for Infectious Diseases, GuiZhou Provincial People’s Hospital, Guiyang, China
| | - Lu Wang
- Center for Infectious Diseases, Qiandongnan Prefecture People’s Hospital, Kaili, China
| | - Min He
- Center for Infectious Diseases, Anshun City People's Hospital, Anshun, China
| | - Qunling Zhang
- Center for Infectious Diseases, Shuigang Hospital, Liupanshui, China
| | - Kaiming Wu
- Center for Infectious Diseases, Guizhou ShuiCheng Gold Mine Indestry Group general Hospital, Liupanshui, China
| | - Juan Cheng
- Center for Infectious Diseases, Longli County People's Hospital, Qiannan Prefecture, China
| | - Wenjuan Wu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Dan Li
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
| | - Yan Xu
- GuiZhou Healthcare Associated Infection Training Base, Center for Infectious Diseases, GuiZhou Provincial People’s Hospital, Guiyang, China
| | - Jianqian Chao
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
- * E-mail:
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Panjaitan NSD, Horng YT, Cheng SW, Chung WT, Soo PC. EtcABC, a Putative EII Complex, Regulates Type 3 Fimbriae via CRP-cAMP Signaling in Klebsiella pneumoniae. Front Microbiol 2019; 10:1558. [PMID: 31354661 PMCID: PMC6629953 DOI: 10.3389/fmicb.2019.01558] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/21/2019] [Indexed: 01/09/2023] Open
Abstract
Biofilm formation by Klebsiella pneumoniae on indwelling medical devices increases the risk of infection. Both type 1 and type 3 fimbriae are important factors in biofilm formation by K. pneumoniae. We found that a putative enzyme II (EII) complex of the phosphoenolpyruvate (PEP):carbohydrate phosphotransferase system (PTS), etcA (EIIA)-etcB (EIIB)-etcC (EIIC), regulated biofilm and type 3 fimbriae formation by K. pneumoniae STU1. In this study, the regulatory mechanism of etcABC in K. pneumoniae type 3 fimbriae formation was investigated. We found via quantitative RT-PCR that overexpression of etcABC enhanced the transcription level of the mrk operon, which is involved in type 3 fimbriae synthesis, and reduced the transcription level of the fim operon, which is involved in type 1 fimbriae synthesis. To gain further insight into the role of etcABC in type 3 fimbriae synthesis, we analyzed the region upstream of the mrk operon and found the potential cyclic 3′5′-adenosine monophosphate (cAMP) receptor protein (CRP) binding site. After crp was deleted in K. pneumoniae STU1 and two clinical isolates, these three crp mutant strains could not express MrkA, the major subunit of the fimbrial shaft, indicating that CRP positively regulated type 3 fimbriae synthesis. Moreover, a crp mutant overexpressing etcABC could not express MrkA, indicating that the regulation of type 3 fimbriae by etcABC was dependent on CRP. In addition, deletion of cyaA, which encodes the adenylyl cyclase that synthesizes cAMP, and deletion of crr, which encodes the glucose-specific EIIA, led to a reduction in lac operon regulation and therefore bacterial lactose uptake in K. pneumoniae. Exogenous cAMP but not etcABC overexpression compensated for the role of cyaA in bacterial lactose uptake. However, either etcABC overexpression or exogenous cAMP compensated for the role of crr in bacterial lac operon regulation that would eventually restore lactose uptake. We also found via ELISA and the luxCDABE reporter system that overexpression of etcABC increased intracellular cAMP levels and the transcription level of crp, respectively, in K. pneumoniae. In conclusion, overexpression of etcABC positively regulated cAMP production and cAMP-CRP activity to activate the mrk operon, resulting in increased type 3 fimbriae synthesis in K. pneumoniae.
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Affiliation(s)
| | - Yu-Tze Horng
- Department of Laboratory Medicine and Biotechnology, College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Shih-Wen Cheng
- Department of Laboratory Medicine and Biotechnology, College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Wen-Ting Chung
- Department of Laboratory Medicine and Biotechnology, College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Po-Chi Soo
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien City, Taiwan.,Department of Laboratory Medicine and Biotechnology, College of Medicine, Tzu Chi University, Hualien City, Taiwan
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Magalhães MC, Cruz RF, Silva GMM. Perfil microbiológico dos pacientes submetidos à cultura de vigilância ativa em um hospital universitário da Região Sudeste de Minas Gerais. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.16951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: Identificar o perfil microbiológico dos pacientes submetidos à cultura de vigilância ativa. Material e métodos: Estudo de prevalência realizado em um hospital universitário da Região Sudeste de Minas Gerais no período de março a dezembro de 2018, com os pacientes elegíveis pelos critérios pré-estabelecidos pelo Serviço de Controle de Infecção Hospitalar da referida unidade, submetidos à cultura de vigilância por meio de swab retal e nasal. Os critérios definidos foram: pacientes transferidos de outra instituição com permanência maior que 96 horas; pacientes transferidos de outra instituição com internação mínima de 48 horas e submetidos a algum dispositivo invasivo; realização de terapia renal substitutiva; passagem por Unidade de Terapia Intensiva (nos últimos 90 dias com permanência mínima de 72h;internação prévia nos últimos 90 dias com permanência mínima de 30 dias. O banco de dados foi estruturado e analisado por meio do Excel e as análises estatísticas pelo MedCalc. Resultados: Foram identificados 591 pacientes que atendiam aos critérios para a realização da cultura de vigilância, destes 25,4% foram positivos. Os critérios mais frequentes para realização de cultura foram: pacientes transferidos de outra instituição com permanência maior que 96 horas e pacientes com passagem por unidade de terapia intensiva nos últimos 90 dias com permanência mínima de 72h. Os Principais microrganismos identificados foram: Staphylococcus aureus resistente à o meticilina, Klebsiellapneumoniae e Acinetobacter baumannii resistentes à carbapenêmicos com 38,3%, 31,2% e 25,3%, respectivamente. Conclusão: A cultura de vigilância ativa contribuiu para a detecção precoce de microrganismos resistentes, permitindo a prevenção precoce, favorecendo a redução da disseminação cruzada. O banco de dados com resultados das culturas de vigilância é uma estratégia importante, pois caso ocorra reinternações desses pacientes, as equipes de controle de infecção e assistencial podem identificar aqueles já infectados/colonizados e instaurar as medidas de controle na admissão dos mesmos.
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Feretzakis G, Loupelis E, Sakagianni A, Skarmoutsou N, Michelidou S, Velentza A, Martsoukou M, Valakis K, Petropoulou S, Koutalas E. A 2-Year Single-Centre Audit on Antibiotic Resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae Strains from an Intensive Care Unit and Other Wards in a General Public Hospital in Greece. Antibiotics (Basel) 2019; 8:antibiotics8020062. [PMID: 31096587 PMCID: PMC6628132 DOI: 10.3390/antibiotics8020062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/27/2019] [Accepted: 05/13/2019] [Indexed: 12/15/2022] Open
Abstract
Hospital-acquired infections, particularly in the critical care setting, are becoming increasingly common during the last decade, with Gram-negative bacterial infections presenting the highest incidence among them. Multi-drug-resistant (MDR) Gram-negative infections are associated with high morbidity and mortality, with significant direct and indirect costs resulting from long hospitalization due to antibiotic failure. As treatment options become limited, antimicrobial stewardship programs aim to optimize the appropriate use of currently available antimicrobial agents and decrease hospital costs. Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae are the most common resistant bacteria encountered in intensive care units (ICUs) and other wards. To establish preventive measures, it is important to know the prevalence of Gram-negative isolated bacteria and antibiotic resistance profiles in each ward separately, compared with ICUs. In our single centre study, we compared the resistance levels per antibiotic of P. aeruginosa, A. baumannii and K.pneumoniae clinical strains between the ICU and other facilities during a 2-year period in one of the largest public tertiary hospitals in Greece. The analysis revealed a statistically significant higher antibiotic resistance of the three bacteria in the ICU isolates compared with those from other wards. ICU strains of P. aeruginosa presented the highest resistance rates to gentamycin (57.97%) and cefepime (56.67%), followed by fluoroquinolones (55.11%) and carbapenems (55.02%), while a sensitivity rate of 97.41% was reported to colistin. A high resistance rate of over 80% of A. baumannii isolates to most classes of antibiotics was identified in both the ICU environment and regular wards, with the lowest resistance rates reported to colistin (53.37% in ICU versus an average value of 31.40% in the wards). Statistically significant higher levels of resistance to most antibiotics were noted in ICU isolates of K. pneumoniae compared with non-ICU isolates, with the highest difference—up to 48.86%—reported to carbapenems. The maximum overall antibiotic resistance in our ICU was reported for Acinetobacter spp. (93.00%), followed by Klebsiella spp. (72.30%) and Pseudomonas spp. (49.03%).
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Affiliation(s)
- Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, 26335 Patras, Greece.
- IT Department, Sismanogleio General Hospital, 15126 Marousi, Greece.
- Department of Quality Control, Research and Continuing Education, Sismanogleio General Hospital, 15126 Marousi, Greece.
| | | | | | | | - Sophia Michelidou
- Intensive Care Unit, Sismanogleio General Hospital, 15126 Marousi, Greece.
| | - Aikaterini Velentza
- Microbiology Laboratory, Sismanogleio General Hospital, 15126 Marousi, Greece.
| | - Maria Martsoukou
- Microbiology Laboratory, Sismanogleio General Hospital, 15126 Marousi, Greece.
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Sousa A, Makino H, Bruno V, Candido S, Nogueira B, Menezes I, Nakazato L, Dutra V. Perfil de resistência antimicrobiana de Klebsiella pneumoniae isoladas de animais domésticos e silvestres. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RESUMO Klebsiella pneumoniae é um patógeno oportunista, responsável por diversos tipos de infecções nosocomiais, e é considerado um microrganismo multirresistente. Dados na literatura que forneçam informações a respeito da resistência desse microrganismo a antimicrobianos em amostras de animais são escassos. Dessa forma, o objetivo deste trabalho foi avaliar o perfil e o seu aumento das resistências a antimicrobianos dentro da medicina veterinária. Um total de 67 isolados de K. pneumoniae, provenientes de diferentes sítios de isolamento de animais domésticos (39/67) e silvestres (28/67), foi confirmado por sequenciamento do gene 16S rRNA. O maior percentual de isolamento de K. pneumoniae foi de amostras de urina, com 16% (11/67), fezes, com 15% (10/67), e pulmão, com 13,5% (09/67). No perfil de resistência, foram testadas 11 categorias de antibióticos, sendo a maior taxa de resistência ao metronidazol 97% (65/67), à ampicilina 94% (63/67), à amoxicilina 93% (62/67), às sulfonamidas 93% (62/67), à colistina 93% (62/67) e à nitrofurantoína 88% (59/67). Aqueles que apresentaram menor taxa de resistência foram: meropenem 3% (2/67), imipenem 6% (4/67) e amicacina 16% (11/67). Todos os isolados foram considerados bactérias multirresistentes (MRD), com o índice de resistência múltipla aos antibióticos (IRMA) variando de 0,15 a 0,85 e com 60 tipos de padrões de resistência. O resultado deste estudo reforça que os animais são reservatórios de K. pneumoniae multirresistentes.
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Affiliation(s)
| | - H. Makino
- Universidade Federal de Mato Grosso, Brazil
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Kołpa M, Wałaszek M, Różańska A, Wolak Z, Wójkowska-Mach J. Hospital-Wide Surveillance of Healthcare-Associated Infections as a Source of Information about Specific Hospital Needs. A 5-Year Observation in a Multiprofile Provincial Hospital in the South of Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1956. [PMID: 30205510 PMCID: PMC6164515 DOI: 10.3390/ijerph15091956] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/28/2018] [Accepted: 09/05/2018] [Indexed: 11/16/2022]
Abstract
Healthcare-associated infections (HAIs) are adverse complications of hospitalisation resulting in delayed recovery and increased costs. The aim of this study was an analysis of epidemiological factors obtained in the framework of constant, comprehensive (hospital-wide) infection registration, and identification of priorities and needs in infection control, both with regard to targeted surveillance, as well as preventative actions. The study was carried out according to the methodology recommended by the HAI-Net (Surveillance Network) coordinated by the European Centre for Disease Prevention and Control, in the multiprofile hospital in Southern Poland, between 2012 and 2016. A total of 159,028 patients were under observation and 2184 HAIs were detected. The incidence was 1.4/100 admissions (2.7/1000 patient-das of hospitalisation) and significantly differed depending on the type of the patient care: in intensive care units (ICU) 16.9%; in surgical units, 1.3%; non-surgical units, 1.0%; and paediatric units, 1.8%. The most common HAI was gastrointestinal infections (GIs, 28.9%), followed by surgical site infections (SSIs, 23.0%) and bloodstream infections (BSIs, 16.1%). The vast majority of GIs, BSIs, urinary tract infections, and incidents of pneumonia (PN) were detected in non-ICUs. As many as 33.2% of cases of HAI were not confirmed microbiologically. The most frequently detected etiologic agent of infections was Clostridium difficile-globally and in GI (49%). Comprehensive analysis of the results allowed to identify important elements of surveillance of infections, i.e., surveillance of GI, PN, and BSI not only in ICU, but also in non-ICU wards, indicating a need for implementing rapid actions to improve compliance with HAI prevention procedures.
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Affiliation(s)
- Małgorzata Kołpa
- State Higher Vocational School in Tarnów, St. Luke's Provincial Hospital in Tarnów, 33-100 Tarnów, Poland.
| | - Marta Wałaszek
- State Higher Vocational School in Tarnów, St. Luke's Provincial Hospital in Tarnów, 33-100 Tarnów, Poland.
| | - Anna Różańska
- Department of Microbiology, Jagiellonian University, Polish Society of Hospital Infections, 31-121 Kraków, Poland.
| | - Zdzisław Wolak
- State Higher Vocational School in Tarnów, St. Luke's Provincial Hospital in Tarnów, 33-100 Tarnów, Poland.
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Jagiellonian University, Polish Society of Hospital Infections, 31-121 Kraków, Poland.
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49
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High Prevalence and Endemicity of Multidrug Resistant Acinetobacter spp. in Intensive Care Unit of a Tertiary Care Hospital, Varanasi, India. J Pathog 2018; 2018:9129083. [PMID: 30057820 PMCID: PMC6051072 DOI: 10.1155/2018/9129083] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/31/2018] [Indexed: 01/14/2023] Open
Abstract
The increasing emergence of Acinetobacter spp. with healthcare associated infections (HCAI) in intensive care units (ICU) is alarming. This study was a laboratory-based audit to determine the prevalence of Acinetobacter spp. associated with HCAI in the adult ICU of a tertiary care hospital in Varanasi, north India, with special reference to antimicrobial resistance and resistance determinants over a period of 5 years. A total of 993 cases of HCAI were analyzed. Isolates were characterized as multidrug resistance and extended drug resistance (MDR/XDR) based on antimicrobial susceptibility records. Few (100) randomly selected isolates of Acinetobacter baumannii (A. baumannii) were tested for imipenem, meropenem, and polymyxin B susceptibility by minimum inhibitory concentration (MIC) and for the presence of class A and B carbapenemases by multiplex PCR. Active surveillance of ICU environment was also performed. High prevalence of Acinetobacter related hospital acquired pneumonia (HAP) with significant resistance to imipenem (p<0.05) and 88.02% MDR and 61.97% XDR was detected along with persistence in the ICU environment. The isolates harbored blaIMP (89%), blaVIM (51%), blaNDM-1 (34%), and blaOXA-23-like (93%) genes. Specific interventional measures should be adopted to control these imipenem resistant Acinetobacter spp. which have attained the level of endemicity in our ICU setup.
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Hurley JC. World-Wide Variation in Incidence of Staphylococcus aureus Associated Ventilator-Associated Pneumonia: A Meta-Regression. Microorganisms 2018; 6:microorganisms6010018. [PMID: 29495472 PMCID: PMC5874632 DOI: 10.3390/microorganisms6010018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/13/2018] [Accepted: 02/25/2018] [Indexed: 01/21/2023] Open
Abstract
Staphylococcus aureus (S. aureus) is a common Ventilator-Associated Pneumonia (VAP) isolate. The objective here is to define the extent and possible reasons for geographic variation in the incidences of S. aureus-associated VAP, MRSA-VAP and overall VAP. A meta-regression model of S. aureus-associated VAP incidence per 1000 Mechanical Ventilation Days (MVD) was undertaken using random effects methods among publications obtained from a search of the English language literature. This model incorporated group level factors such as admission to a trauma ICU, year of publication and use of bronchoscopic sampling towards VAP diagnosis. The search identified 133 publications from seven worldwide regions published over three decades. The summary S. aureus-associated VAP incidence was 4.5 (3.9–5.3) per 1000 MVD. The highest S. aureus-associated VAP incidence is amongst reports from the Mediterranean (mean; 95% confidence interval; 6.1; 4.1–8.5) versus that from Asian ICUs (2.1; 1.5–3.0). The incidence of S. aureus-associated VAP varies by up to three-fold (for the lowest versus highest incidence) among seven geographic regions worldwide, whereas the incidence of VAP varies by less than two-fold. Admission to a trauma unit is the most important group level correlate for S. aureus-associated VAP.
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Affiliation(s)
- James C Hurley
- Rural Health Academic Center, Melbourne Medical School, University of Melbourne, Ballarat, VIC 3350, Australia.
- Division of Internal Medicine, Ballarat Health Services, Ballarat, VIC 3350, Australia.
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