Bloodstream infections in NNICU: Blight on ICU stay

Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review

Background

Intensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework.

Main body of the abstract

Articles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective.

Conclusions

Compared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings.

Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk)

The Effect of a Guide Based Application Bundle on the Catheter-Related Infection

Aim

Central venous catheters are used extensively in intensive care units but can sometimes lead to catheter related blood stream infections. This study was carried out to determine the effect of guideline-based care bundle on possible catheter-related bloodstream infection in the application and care of central venous catheter in patients receiving follow-up and treatment in anesthesia intensive care unit.

Method

The study is a retrospective and experimental one. The study population consisted of patients who were treated in an anesthesia intensive care unit of a university hospital between June 2015 and June 2016, to whom the central line was inserted in this unit by the team working in the unit and who required central line insertion for at least 48 hours. The patients in the study population also comprised the study sample. The guideline-based application and care bundle was administered under the supervision of the researcher in the intensive care unit and the patients were evaluated on a daily basis for bloodstream infection.

Results

When comparing data obtained from the study with data from the previous period, it was found that the guideline-based application and care bundle decreased the catheter-related bloodstream infection rate from 10.59/1000 to 2.88/1000 and this reduction was considered statistically significant (p<0.05).

Conclusion

According to this study's data, the guideline-based care bundle is an effective and useful way to reduce infection.