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Cohen N, Rosenberg T, Rimon A, Friedman S. Early removal of a permanent catheter during the acute management of the unstable pediatric hemato-oncology patient with suspected catheter-related bloodstream infection: a multi-disciplinary survey and review of the literature. Eur J Pediatr 2023; 182:795-802. [PMID: 36482088 DOI: 10.1007/s00431-022-04747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
UNLABELLED There are no guidelines for the optimal manner and timing of permanent central catheter removal in the hemodynamically unstable pediatric hemato-oncology patient with suspected catheter-related bloodstream infections (CRBSI). Our goals were to examine current practices of permanent central catheter management and choice of removal in the hemodynamically unstable pediatric patient with suspected CRBSI among practitioners in diverse subspecialties. We performed a literature review on the subject, and conducted a multi-disciplinary survey included pediatric oncologists, pediatric emergency medicine physicians, and pediatric intensive care physicians whom we queried about their choice of permanent central catheter management and removal while treating the hemodynamically unstable pediatric patient with suspected CRBSI. Most of the 78 responders (n = 47, 59%) preferred to utilize the existing permanent central catheter for initial intravenous access rather than an alternative access. There were no significant differences between physician subspecialties (p = 0.29) or training levels (p = 0.14). Significantly more pediatric emergency medicine physicians preferred not to remove the permanent central catheter at any time point compared to the pediatric hemato-oncologists, who preferred to remove it at some point during the acute presentation (44.4% vs. 9.4%, respectively, p = 0.02). CONCLUSION Our study findings reflect the need for uniform guidelines on permanent central catheter use and indications for its removal in the hemodynamically unstable pediatric patient. We suggest that permanent central catheter removal should be urgently considered in a deteriorating patient who failed to be stabilized with medical treatment. WHAT IS KNOWN • There are no guidelines for the optimal choice and timing of permanent central catheter removal in the hemodynamically unstable pediatric hemato-oncology patient with suspected catheter-related bloodstream infection (CRBSI). WHAT IS NEW • We found variations in practices among pediatricians from diverse subspecialties and conflicting data in the literature. • There is a need for prospective studies to provide uniform guidelines for optimal management of suspected CRBSI in the hemodynamically unstable pediatric patient.
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Affiliation(s)
- Neta Cohen
- Department of Pediatric Emergency Medicine, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tom Rosenberg
- Department of Pediatric Hematology-Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ayelet Rimon
- Department of Pediatric Emergency Medicine, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirley Friedman
- Pediatric Intensive Care Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Device Exposure and Patient Risk Factors’ Impact on the Healthcare-Associated Infection Rates in PICUs. CHILDREN 2022; 9:children9111669. [PMID: 36360398 PMCID: PMC9688919 DOI: 10.3390/children9111669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Healthcare-associated infections related to device use (DA-HAIs) are a serious public health problem since they increase mortality, length of hospital stay and healthcare costs. We performed a multicenter, prospective study analyzing critically ill pediatric patients admitted to 26 Spanish pediatric intensive care units (PICUs) over a 3-month period each year from 2014 to 2019. To make comparisons and evaluate the influence of HAI Zero Bundles (care bundles that intend to reduce the DA-HAI rates to zero) on PICU HAI rates, the analysis was divided into two periods: 2014–2016 and 2017–2019 (once most of the units had incorporated all the Zero Bundles). A total of 11,260 pediatric patients were included. There were 390 episodes of HAIs in 317 patients and the overall rate of HAIs was 6.3 per 1000 patient days. The DA-HAI distribution was: 2.46/1000 CVC days for central-line-associated bloodstream infections (CLABSIs), 5.75/1000 MV days for ventilator-associated pneumonia (VAP) and 3.6/1000 UC days for catheter-associated urinary tract infections (CAUTIs). Comparing the two periods, the HAI rate decreased (p = 0.061) as well as HAI episodes (p = 0.011). The results demonstrate that exposure to devices constitutes an extrinsic risk factor for acquiring HAIs. The multivariate analysis highlights previous bacterial colonization by multidrug-resistant (MDR) bacteria as the most important extrinsic risk factor for HAIs (OR 20.4; 95%CI 14.3–29.1). In conclusion, HAI Zero Bundles have been shown to decrease HAI rates, and the focus should be on the prompt removal of devices, especially in children with important intrinsic risk factors.
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Haldar R, Mandelia A, Mishra P, Mishra A, Siddiqui Y. Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience. J Pediatr Intensive Care 2022; 11:240-246. [DOI: 10.1055/s-0041-1723946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022] Open
Abstract
AbstractThe purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age (p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5–8] days) and CRBSI (6 [5–9] days) patients (p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization (p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.
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Affiliation(s)
- Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Mandelia
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashwani Mishra
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yousuf Siddiqui
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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4
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Ganesan V, Sundaramurthy R, Thiruvanamalai R, Sivakumar VA, Udayasankar S, Arunagiri R, Charles J, Chavan SK, Balan Y, Sakthivadivel V. Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them? Cureus 2021; 13:e19331. [PMID: 34909294 PMCID: PMC8651063 DOI: 10.7759/cureus.19331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background and objective The prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital. Materials and methods A prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting. Results The surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7). Conclusion DUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.
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Affiliation(s)
- Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Raja Sundaramurthy
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Rajendran Thiruvanamalai
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Vijay Anand Sivakumar
- Department of Anaesthesiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sridhurga Udayasankar
- Department of Paediatrics, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Ramesh Arunagiri
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Jhansi Charles
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sunil Kumar Chavan
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Yuvaraj Balan
- Department of Biochemistry, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
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Korang SK, Nava C, Mohana SP, Nygaard U, Jakobsen JC. Antibiotics for hospital-acquired pneumonia in neonates and children. Cochrane Database Syst Rev 2021; 11:CD013864. [PMID: 34727368 PMCID: PMC8562877 DOI: 10.1002/14651858.cd013864.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hospital-acquired pneumonia is one of the most common hospital-acquired infections in children worldwide. Most of our understanding of hospital-acquired pneumonia in children is derived from adult studies. To our knowledge, no systematic review with meta-analysis has assessed the benefits and harms of different antibiotic regimens in neonates and children with hospital-acquired pneumonia. OBJECTIVES To assess the beneficial and harmful effects of different antibiotic regimens for hospital-acquired pneumonia in neonates and children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trial registers to February 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised clinical trials comparing one antibiotic regimen with any other antibiotic regimen for hospital-acquired pneumonia in neonates and children. DATA COLLECTION AND ANALYSIS Three review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of the evidence using the GRADE approach. Our primary outcomes were all-cause mortality and serious adverse events; our secondary outcomes were health-related quality of life, pneumonia-related mortality, non-serious adverse events, and treatment failure. Our primary time point of interest was at maximum follow-up. MAIN RESULTS We included four randomised clinical trials (84 participants). We assessed all trials as having high risk of bias. We did not conduct any meta-analyses, as the included trials did not compare similar antibiotic regimens. Each of the four trials assessed a different comparison, as follows: cefepime versus ceftazidime; linezolid versus vancomycin; meropenem versus cefotaxime; and ceftobiprole versus cephalosporin. Only one trial reported our primary outcomes of all-cause mortality and serious adverse events. Three trials reported our secondary outcome of treatment failure. Two trials primarily included community-acquired pneumonia and hospitalised children with bacterial infections, hence the children with hospital-acquired pneumonia constituted subgroups of the total sample sizes. Where outcomes were reported, the certainty of the evidence was very low for each of the comparisons. We are unable to draw meaningful conclusions from the numerical results. None of the included trials assessed health-related quality of life, pneumonia-related mortality, or non-serious adverse events. AUTHORS' CONCLUSIONS The relative beneficial and harmful effects of different antibiotic regimens remain unclear due to the very low certainty of the available evidence. The current evidence is insufficient to support any antibiotic regimen being superior to another. Randomised clinical trials assessing different antibiotic regimens for hospital-acquired pneumonia in children and neonates are warranted.
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Affiliation(s)
- Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Chiara Nava
- Neonatal Intensive Care Unit, Ospedale "A. Manzoni", Lecco, Italy
| | - Sutharshini Punniyamoorthy Mohana
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrikka Nygaard
- Department of Pediatrics and Adolescence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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6
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Korang SK, Nava C, Nygaard U, Jakobsen JC. Antibiotics for hospital-acquired pneumonia in neonates and children. Hippokratia 2021. [DOI: 10.1002/14651858.cd013864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Chiara Nava
- Neonatal Intensive Care Unit; Ospedale "A. Manzoni"; Lecco Italy
| | - Ulrikka Nygaard
- Department of Pediatrics and Adolescence; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology; Holbaek Hospital; Holbaek Denmark
- Department of Regional Health Research, the Faculty of Health Sciences; University of Southern Denmark; Holbaek Denmark
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7
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Lowery AS, Gelbard A, Wootten C. The Incidence of Laryngotracheal Stenosis in Neonates With a History of Ventilator-Associated Pneumonia. Laryngoscope 2019; 130:2252-2255. [PMID: 31800102 DOI: 10.1002/lary.28371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/02/2019] [Accepted: 09/30/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Neonatal patients requiring prolonged intubation are susceptible to both infection and laryngotracheal stenosis (LTS). This study investigated the effect of ventilator-associated pneumonia (VAP) on the development of LTS in neonates. STUDY DESIGN Retrospective case-control study. METHODS The incidence of LTS in neonates with VAP was compared with the incidence of LTS in matched intubated controls without VAP. Patients were treated at a tertiary-care medical center from 2004 to 2014. Eligible patient records were assessed for the development of LTS. Demographics, medical comorbidities, infection characteristics, and treatment variables were compared using unpaired t test or χ2 test. Statistical significance was set a priori at P < .05. RESULTS When comparing the VAP patients with matched non-VAP controls, we found no significant differences in the incidence of LTS (VAP vs. non-VAP, 8.3% vs. 6.7%; P = .73). In subgroup analysis of the VAP cohort, LTS and non-LTS patients demonstrated similar VAP organisms on broncho-alveolar lavage (Klebsiella pneumoniae, Pseudomonas aeroginosa, Escherichia coli, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, and Enterobacter). Additionally, within the VAP cohort, LTS and non-LTS patients showed similar gestational age (LTS vs. non-LTS, 31.3 days vs. 28.1 days; P = .22), birth weight (LTS vs. non-LTS, 1.6 kg vs. 1.2 kg; P = .33), and similar intubation duration (LTS vs. non-LTS, 37.8 days vs. 27.5 days; P = .52). CONCLUSIONS In this neonatal cohort, VAP was not associated with an increased incidence of LTS. Given severity of the burden of LTS on the healthcare system, multi-institutional longitudinal investigation into contributing risk factors for neonatal LTS is warranted. LEVEL OF EVIDENCE NA Laryngoscope, 130:2252-2255, 2020.
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Affiliation(s)
- Anne Sun Lowery
- Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A.,Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Christopher Wootten
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Zhang Y, Zhong ZF, Chen SX, Zhou DR, Li ZK, Meng Y, Zhou JF, Hou TY. Prevalence of healthcare-associated infections and antimicrobial use in China: Results from the 2018 point prevalence survey in 189 hospitals in Guangdong Province. Int J Infect Dis 2019; 89:179-184. [PMID: 31580939 DOI: 10.1016/j.ijid.2019.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Limited data on healthcare-associated infections (HAIs) are available from the developing world, thus a point prevalence survey was conducted to determine the prevalence of HAIs and antimicrobial use in Guangdong Province, China. METHODS A standardized methodology for point prevalence surveys on HAIs and antimicrobial use has been developed by the Chinese Nosocomial Infection Control and Quality Improvement Center. The prevalence of HAIs, antimicrobial use, and baseline hospital-level variables were collected in 189 hospitals from June 2017 to May 2018. RESULTS Of 5 868 147 patients, 72 976 had one or more HAIs (1.24%), with 82 700 distinct HAIs. The prevalence rates of device-associated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bloodstream infection were 7.92, 2.06, and 0.63 per 1000 catheter-days, respectively. A total of 10 591 (0.18%) HAIs caused by multidrug-resistant organisms were identified. Carbapenem non-susceptibility rates were highest in Acinetobacter species (53.86%) and Pseudomonas aeruginosa (21.60%). Forty-six percent (2 712 258/5 868 147) of inpatients were receiving at least one antimicrobial during this survey. CONCLUSIONS This survey indicated the relatively lower prevalence of HAIs but higher antimicrobial using in Guangdong Province compared with other mid to low-income and high-income countries. Further studies are warranted to elucidate which HAI-related indicators are the best measures of HAI performance and thus allow improvements leading to better patient outcomes.
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Affiliation(s)
- Yu Zhang
- Department of Laboratory, Guangdong Provincial People's Hospital and Guangdong Academy of Medicine Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Centre, Guangzhou, Guangdong, China
| | - Zhen-Feng Zhong
- Guangdong Nosocomial Infection Control and Quality Improvement Centre, Guangzhou, Guangdong, China; Department of Infection Prevention and Control, Guangdong Zhongshan City People's Hospital, Zhongshan, China
| | - Shu-Xian Chen
- Guangdong Nosocomial Infection Control and Quality Improvement Centre, Guangzhou, Guangdong, China; Department of Infection Prevention and Control, Guangzhou First People's Hospital, Guangzhou, China
| | - Dian-Rong Zhou
- Department of Laboratory, Guangdong Provincial People's Hospital and Guangdong Academy of Medicine Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Centre, Guangzhou, Guangdong, China
| | - Zheng-Kang Li
- Department of Laboratory, Guangdong Provincial People's Hospital and Guangdong Academy of Medicine Sciences, Guangzhou, China
| | - Yue Meng
- Department of Laboratory, Guangdong Provincial People's Hospital and Guangdong Academy of Medicine Sciences, Guangzhou, China
| | - Jing-Fang Zhou
- Department of Laboratory, Guangdong Provincial People's Hospital and Guangdong Academy of Medicine Sciences, Guangzhou, China
| | - Tie-Ying Hou
- Department of Laboratory, Guangdong Provincial People's Hospital and Guangdong Academy of Medicine Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Centre, Guangzhou, Guangdong, China.
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Stoclin A, Rotolo F, Hicheri Y, Mons M, Chachaty E, Gachot B, Pignon JP, Wartelle M, Blot F. Ventilator-associated pneumonia and bloodstream infections in intensive care unit cancer patients: a retrospective 12-year study on 3388 prospectively monitored patients. Support Care Cancer 2019; 28:193-200. [PMID: 31001694 PMCID: PMC7224052 DOI: 10.1007/s00520-019-04800-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/03/2019] [Indexed: 01/03/2023]
Abstract
Purpose Some publications suggest high rates of healthcare-associated infections (HAIs) and of nosocomial pneumonia portending a poor prognosis in ICU cancer patients. A better understanding of the epidemiology of HAIs in these patients is needed. Methods A retrospective analysis of all the patients hospitalized for ≥ 48 h during a 12-year period in the 12-bed ICU of the Gustave Roussy hospital, monitored prospectively for ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) and for use of medical devices. Results During 3388 first stays in the ICU, 198 cases of VAP and 103 primary, 213 secondary, and 77 catheter-related BSIs were recorded. The VAP rate was 24.5/1000 ventilator days (95% confidence interval [CI] 21.2–28.0); the catheter-related BSI rate was 2.3/1000 catheter days (95% CI 1.8–2.8). The cumulative incidence during the first 25 days of exposure was 58.8% (95% CI 49.1–66.6%) for VAP, 8.9% (95% CI, 6.2–11.5%) for primary, 15.1% (95% CI 11.6–18.5%) for secondary and 5.0% (95% CI 3.2–6.8%) for catheter-related BSIs. VAP or BSIs were not associated with a higher risk of ICU mortality. Conclusions This is the first study to report HAI rates in a large cohort of critically ill cancer patients. Although both the incidence of VAP and the rate of BSI are higher than in general ICU populations, this does not impact patient outcomes. The occurrence of device-associated infections is essentially due to severe medical conditions in patients and to the characteristics of malignancy. Electronic supplementary material The online version of this article (10.1007/s00520-019-04800-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Stoclin
- Service de Médecine Intensive Réanimation, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France. .,Service de Réanimation Médico-Chirurgicale, Gustave Roussy, 114, rue Edouard Vaillant, 94805, Villejuif, France.
| | - F Rotolo
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France.,INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Y Hicheri
- Service de Médecine Intensive Réanimation, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France
| | - M Mons
- Service d'Information Médicale, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France
| | - E Chachaty
- Service de Microbiologie Médicale, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France
| | - B Gachot
- Service de Médecine Intensive Réanimation, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France
| | - J-P Pignon
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France.,INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - M Wartelle
- Direction du Système d'Information, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94805, France
| | - F Blot
- Service de Médecine Intensive Réanimation, Gustave Roussy, 114, rue Edouard Vaillant, Villejuif, 94805, France
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Shi Y, Jiang K, Zheng R, Fu J, Yan L, Gu Q, Zhang Y, Lin F. Design, Microwave‐Assisted Synthesis and in Vitro Antibacterial and Antifungal Activity of 2,5‐Disubstituted Benzimidazole. Chem Biodivers 2019; 16:e1800510. [DOI: 10.1002/cbdv.201800510] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Yanpeng Shi
- College of ChemistryJilin University Changchun 130012 P. R. China
| | - Kai Jiang
- School of life SciencesJilin University Changchun 130012 P. R. China
| | - Ran Zheng
- College of ChemistryJilin University Changchun 130012 P. R. China
| | - Jiaxu Fu
- College of ChemistryJilin University Changchun 130012 P. R. China
| | - Liuqing Yan
- College of ChemistryJilin University Changchun 130012 P. R. China
| | - Qiang Gu
- College of ChemistryJilin University Changchun 130012 P. R. China
| | - Yumin Zhang
- College of ChemistryJilin University Changchun 130012 P. R. China
| | - Feng Lin
- School of life SciencesJilin University Changchun 130012 P. R. China
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Merzougui L, Barhoumi T, Guizani T, Barhoumi H, Hannachi H, Turki E, Majdoub W. [Nosocomial infections in the Intensive Care Unit: annual incidence rate and clinical aspects]. Pan Afr Med J 2018; 30:143. [PMID: 30374389 PMCID: PMC6201599 DOI: 10.11604/pamj.2018.30.143.13824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/24/2018] [Indexed: 01/15/2023] Open
Abstract
Although the number of ICU beds is generally limited, the incidence rates of nosocomial infections is high. Managing infectious risk in ICU is a priority today; one of the strategic aims is the establishment of systems for epidemiological control. The aim of our study is to determine the incidence and the clinical aspects in order to identify the risk factors. We conducted a longitudinal descriptive impact assessment study enrolling patients hospedalized for more than 48 hours in general purpose Intensive Care Unit at the Ibn El JAZZAR Hospital, Kairouan over a period of 1 year, from 01/03/2013 to 28/02/2014. The study focused on 265 patients whose average age was 39±20 years (18-93 years) with a sex ratio(M/F) of 2.48. We identified 125 episodes of nosocomial infections in 81 patients corresponding to a total incidence of 30.6%. The incidence density rate was 55 infections per 1000 days of hospitalization. There was a clear predominance of pneumopathies, with an incidence of 27.73%, followed by urinary tract infections (9,73%), infections associated with central venous catheter (6.25%) and surgical site infections (2.34%). Mortality rate of patients was 28.7%, with a significant difference between infected patients (44.7% of cases) and non-infected patients (29.07%) (p < 10-3). Gram-negative bacteria were found in 80% of cases. Prevention must involve a global and multidisciplinary action.
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Affiliation(s)
- Latifa Merzougui
- Service d'Hygiène Hospitalière, CHU Ibn El Jazzar, 3100 Kairouan, Tunisie
| | - Tarek Barhoumi
- Service d'Hygiène Hospitalière, CHU Ibn El Jazzar, 3100 Kairouan, Tunisie
| | - Tayeb Guizani
- Service de Réanimation Polyvalente, 3100 CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Hafed Barhoumi
- Service de Réanimation Polyvalente, 3100 CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Hajer Hannachi
- Service d'Hygiène Hospitalière, CHU Ibn El Jazzar, 3100 Kairouan, Tunisie
| | - Elyess Turki
- Service de Médecine Légale, 3100 CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Wael Majdoub
- Service de Médecine Légale, 3100 CHU Ibn El Jazzar, Kairouan, Tunisie
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Kumar S, Sen P, Gaind R, Verma PK, Gupta P, Suri PR, Nagpal S, Rai AK. Prospective surveillance of device-associated health care-associated infection in an intensive care unit of a tertiary care hospital in New Delhi, India. Am J Infect Control 2018; 46:202-206. [PMID: 29046215 DOI: 10.1016/j.ajic.2017.08.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surveillance of health care-associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. In India, most of the surveillance of HAIs is reported from private sector hospitals that do not depict the situation of government sector hospitals. Other studies do not confirm with the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) surveillance criterion, or deal with ventilator-associated pneumonia (VAP) instead of ventilator-associated event (VAE). The aim of this study was to identify the incidences of 3 device-associated HAIs (DA-HAIs) (VAE, central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) by active surveillance using CDC's NHSN surveillance criteria and to identify the pathogens associated with these DA-HAIs. METHODS This was a prospective surveillance study (January 2015-December 2016) conducted in an intensive care unit (ICU) of a large, tertiary care, government hospital situated in Delhi, India. Targeted surveillance was done as per the CDC's NHSN 2016 surveillance criteria. RESULTS There were 343 patients admitted to the ICU that were included in the study. The surveillance data was reported over 3,755 patient days. A DA-HAIs attack rate of 20.1 per 100 admissions and incidence of 18.3 per 1,000 patient days was observed. The duration of use for each device for patients with DA-HAIs was significantly longer than for patients without DA-HAIs. The device utilization ratios of central line, ventilator, and urinary catheters were 0.57, 0.85, and 0.72, respectively. The crude excess length of stay for patients with DA-HAI was 13 days, and crude excess mortality rate was 11.8%. VAE, CLABSI, and CAUTI rates were 11.8, 7.4, and 9.7 per 1,000 device days, respectively. Among 69 DA-HAIs reported, pathogens could be identified for 49 DA-HAI cases. Klebsiella spp was the most common organism isolated, accounting 28.5% for all DA-HAI cases, followed by Enterococcus spp (24.4%). The most common organisms causing VAE, CAUTI, and CLABSI were Acinetobacter (6/15, 40%), Enterococcus spp (11/31, 35.4%), and Candida spp (5/19, 26.3%), respectively. Most of the gram-negative organisms were carbapenem resistant; however, none of the isolates were colistin resistant. CONCLUSIONS To reduce the risk of infection in hospitalized patients, DA-HAI surveillance is of primary importance because it effectively describes and addresses the importance and characteristics of the threatening situation created by DA-HAIs. The present surveillance shows high rates of ICU-onset DA-HAIs and high resistance patterns of organisms causing HAIs, representing a major risk to patient safety.
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Affiliation(s)
- Shilpee Kumar
- Department of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
| | - Poornima Sen
- Department of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Pardeep Kumar Verma
- Department of Anaesthesia, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Poonam Gupta
- Department of Anaesthesia, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Prem Rose Suri
- Department of Infection Control, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sunita Nagpal
- Department of Infection Control, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Anil Kumar Rai
- Department of ENT & Medical Superintendent, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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Intraoperative Disinfection by Pulse Irrigation with Povidone-Iodine Solution in Spine Surgery. Adv Orthop 2017; 2017:7218918. [PMID: 29098088 PMCID: PMC5642872 DOI: 10.1155/2017/7218918] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 11/23/2022] Open
Abstract
Background Deep wound infection in spine surgery is a debilitating complication for patients and increases costs. The objective of this prospective study was to evaluate the efficacy of wound pulse irrigation with a dilute povidone-iodine solution in the prevention of surgical site infection. Methods 50 patients undergoing spinal surgery were randomly divided into two groups (A and B) of 25 patients each. In group A, wounds were irrigated with dilute (3%) povidone-iodine solution through a low-pressure pulsatile device. In group B, wounds were irrigated with saline solution through a bulb syringe. In both groups, specimens for bacterial culture were harvested from surgical site before and after irrigation. Results In group A, no surgical site infection occurred; in group B, deep wound infection was observed in 3 patients. In both groups, before irrigation some cultures have been found positive for bacterial contamination. Conclusion Our study seems to support the idea that low-pressure pulsating lavage of surgical wounds with povidone-iodine diluted to a nontoxic concentration of 3% is an effective therapeutic adjunct measure to prevent surgical site infection in spine surgery. However, the number of the enrolled patients is small and a significant statistical analysis is not practicable. This trial is registered with NCT03249363.
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Esfahani BN, Basiri R, Mirhosseini SMM, Moghim S, Dolatkhah S. Nosocomial Infections in Intensive Care Unit: Pattern of Antibiotic-resistance in Iranian Community. Adv Biomed Res 2017; 6:54. [PMID: 28553627 PMCID: PMC5434675 DOI: 10.4103/2277-9175.205527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Bacterial infections are responsible for great number of mortality in Intensive Care Unit (ICU). Knowledge about prevalence of bacterial infections and their antibiotic-resistance pattern would be a great step for their treatment and management. Materials and Methods: Data about nosocomial infections in ICUs of Alzahra Hospital (referral hospital in Isfahan, center of Iran) were gathered during the years 2007–2010. A questionnaire was fulfilled for any specific patient with nosocomial infection containing demographic data of patient and also characteristics of the infection. Results: Out of all patients, 707 individuals (65.6%) were male and 370 (34.4%) were female. Our data revealed that Pseudomonas aeruginosa (13.9%), Klebsiella (11%), and Escherichia coli (6.4%) were the most prevalent bacterial infections. The most common sites of nosocomial infections in the ICU were respiratory system (399 cases, 37%), urinary system (230 cases, 21.4%), and blood (102 cases, 9.5%). The antibiotic-resistance of each bacteria in ICU ward was assessed and data were categorized in a table. There were less documentary about bacterial cultures in the year 2007 when compared with the next years. Conclusion: We found some differences (such as bacterial prevalence in ICU wards which caused nosocomial infections) in our local prevalence of nosocomial infections and also in their resistance pattern compared to other centers. Knowing about our data will help physicians to administer the most suitable antibiotics for treatment of nosocomial infections in our area.
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Affiliation(s)
- Bahram Nasr Esfahani
- Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rozita Basiri
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Sharareh Moghim
- Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Tchakoute CT, Liu J, Cohen B, Larson E. Risk Factors and Temporal Trends of Hospital-Acquired Infections (HAIs) Among HIV Positive Patients in Urban New York City Hospitals: 2006 to 2014. Rev Recent Clin Trials 2017; 12:44-50. [PMID: 27600109 PMCID: PMC5337446 DOI: 10.2174/1574887111666160906094140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND HIV-infected patients may be at a greater risk of Hospital-Acquired Infections (HAIs) but risks factors for HAIs have not been well described in this population. OBJECTIVE The aim of this study was to examine the incidence, temporal trends and risk factors of HAIs among adult HIV positive patients. METHODS This was a retrospective cohort study carried out in an academic health system in New York City which included four hospitals over a 9-year period from 2006 to 2014. Simple and multiple logistic regression models were built to determine risk factors associated with site-specific HAIs such as Urinary Tract Infections (UTIs), Pneumonia (PNUs) and Bloodstream Infections (BSIs). FINDINGS There were 10,575 HIV positive discharges and 1,328 had HAIs: 697 UTIs, 555 BSIs and 192 PNUs. The incidence rate of HAIs decreased from 19.8 to 15.1 new infections per 1000 persondays between 2006 and 2014 (p value<0.001). In addition to the expected risk factors of urinary catheter use for UTI and central venous line use for BSI, symptomatic HIV and renal failure were significant risk factors for both UTIs (95% CI OR: (1.24, 2.27) and (1.46, 2.11) respectively) and BSIs (95% CIs OR: (2.28, 4.18) and (1.81, 2.71) respectively). CONCLUSION HIV-infected patients had similar risk factors for HAIs as HIV-uninfected patients. Further research is required to address how patients' CD4 counts and viral loads affect their susceptibility to HAIs.
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Affiliation(s)
- Christophe T. Tchakoute
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Jianfang Liu
- Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032 USA
| | - Bevin Cohen
- Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032 USA
| | - Elaine Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
- Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032 USA
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Vonberg RP, Behnke M, Geffers C, Sohr D, Ruden H, Dettenkofer M, Gastmeier P. Device-Associated Infection Rates for Non–Intensive Care Unit Patients. Infect Control Hosp Epidemiol 2016; 27:357-61. [PMID: 16622812 DOI: 10.1086/503339] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 05/04/2005] [Indexed: 11/03/2022]
Abstract
Background.Reference data from intensive care units (ICUs) are not applicable to non-ICU patients because of the differences in device use rates, length of stay, and severity of underlying diseases among the patient populations. In contrast to the huge amount of data available for ICU patients, appropriate surveillance data for non-ICU patients have been missing in Germany.Objective.To establish a new module (“DEVICE-KISS”) of the German Nosocomial Infection Surveillance System for generating stratified reference data for non-ICU wards.Setting.Non-ICU patients from 42 German hospitals.Methods.Monthly patient-days, device-days and nosocomial infections (NIs) (using Centers for Disease Control and Prevention definitions) were counted. Device use rates were calculated, and NI rates were stratified by different medical specialities.Results.From July 2002 through June 2004, among the 77 wards, there were a total of 536,955 patient-days and 74,188 device-days (for CVC-associated primary bloodstream infections, there were 181,401 patient-days and 8,317 central vascular catheter [CVC]-days in 29 wards; for urinary catheter–associated urinary tract infections, there were 445,536 patient-days and 65,871 urinary catheter–days in 65 wards) and 483 NIs (36 bloodstream infections and 447 urinary tract infections). The mean device use rates were 4.6 device-days per 100 patient-days for CVCs (29 wards) and 14.8 device-days per 100 patient-days for urinary catheters (65 wards), respectively. Mean device-associated NI rates were 4.3 infections per 1,000 CVC-days for CVC-associated bloodstream infections and 6.8 infections per 1,000 urinary catheter–days for catheter-associated urinary tract infections.ConclusionsDEVICE-KISS allows non-ICUs to recognize an outlier position with regard to NIs by providing well-founded reference data for non-ICU patients.
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Affiliation(s)
- Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany.
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Inan D, Saba R, Yalcin AN, Yilmaz M, Ongut G, Ramazanoglu A, Mamikoglu L. Device-Associated Nosocomial Infection Rates in Turkish Medical-Surgical Intensive Care Units. Infect Control Hosp Epidemiol 2016; 27:343-8. [PMID: 16622810 DOI: 10.1086/503344] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 09/28/2004] [Indexed: 11/03/2022]
Abstract
Objective.To describe the incidence of device-associated nosocomial infections in medical-surgical intensive care units (MS ICUs) in a university hospital in Turkey and compare it with National Nosocomial Infections Surveillance (NNIS) system rates.Design.Prospective surveillance study during a period of 27 months. Device utilization ratios and device-associated infection rates were calculated using US Centers for Disease Control and Prevention and NNIS definitions.Setting.Two separate MS ICUs at Akdeniz University Hospital, Antalya, Turkey.Patients.All patients were included who presented with no signs and symptoms of infection within the first 48 hours after admission.Results.Data on 1,985 patients with a total of 16,892 patient-days were analyzed. The mean overall infection rate per 100 patients was 29.1 infections, and the mean infection rate per 1,000 patient-days was 34.2 infections. The rate of ventilator-associated pneumonia was 20.76 infections per 1,000 ventilator-days, the rate of catheter-associated urinary tract infection was 13.63 infections per 1,000 urinary catheter–days, and the rate of catheter-associated bloodstream infection was 9.69 infections per 1,000 central line–days. The most frequently isolated pathogens were Pseudomonas species among patients with ventilator-associated pneumonias (35.8% of cases), Candida species among patients with catheter-associated urinary tract infections (37.1% of cases), and coagulase-negative staphylococci among patients with catheter-associated bloodstream infections (20.0% of cases).Conclusion.We found both higher device-associated infection rates and higher device utilization ratios in our MS ICUs than those reported by the NNIS system. To reduce the rate of infection, implementation of infection control practices and comprehensive education are required, and an appropriate nationwide nosocomial infection and control system is needed in Turkey.
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Affiliation(s)
- Dilara Inan
- Department of Infectious Diseases and Clinical Microbiology, Tip Fakultesi, Infeksiyon Hastaliklari AD, University of Adkeniz, 07050 Antalya, Turkey.
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Lizan-Garcia M, Peyro R, Cortina M, Crespo MD, Tobias A. Nosocomial Infection Surveillance in a Surgical Intensive Care Unit in Spain, 1996-2000: A Time-Trend Analysis. Infect Control Hosp Epidemiol 2016; 27:54-9. [PMID: 16418988 DOI: 10.1086/499167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Accepted: 07/11/2005] [Indexed: 11/03/2022]
Abstract
Objective.To establish the occurrence, distribution, and secular time trend of nosocomial infections (NIs) in a surgical intensive care unit (ICU).Design and Setting.Follow-up study in a teaching hospital in Spain.Methods.In May 1995 we established an nosocomial infection surveillance system in our surgical ICU. We collected information daily for all patients who were in the ICU for at least 48 hours (546 patients from 1996 through 2000). We used the Centers for Disease Control and Prevention definitions and criteria for infections. Monthly, we determined the site-specific incidence densities of NIs, the rates of medical device use, and the Poisson probability distribution, which determined whether the case count equalled the number of expected cases (the mean number of cases during the previous year, with extreme values excluded). We compared yearly and monthly infection rates by Poisson regression, using site-specific NIs as a dependent variable and year and month as dummy variables. We tested annual trends with an alternative Poisson regression model fitting a single linear trend.Results.The average rate of catheter-associated urinary tract infections was 8.4 per 1000 catheter-days; that of ventilator-associated pneumonia, 21 per 1000 ventilator-days; and that of central line–associated bloodstream infections, 30 per 1000 central line–days. The rate of urinary tract infections did not change over the study period, but there was a trend toward decreases in the rates of central line–associated bloodstream infections and ventilator-associated pneumonia.Conclusion.An NI surveillance and control program contributed to a progressive decrease in NI rates.
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Affiliation(s)
- Maxima Lizan-Garcia
- Servicio Medicina Preventiva/Hospital General, C/ Hermanos Falco 3, Albacete, Spain.
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McKibben L, Horan TC, Tokars JI, Fowler G, Cardo DM, Pearson ML, Brennan PJ. Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2016; 26:580-7. [PMID: 16018435 DOI: 10.1086/502585] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Consumer demand for healthcare information, including data about the performance of healthcare providers, has increased steadily during the past decade. Many state and national initiatives are under way to mandate or induce healthcare organizations to publicly disclose information regarding institutional and physician performance. Mandatory public reporting of healthcare performance is intended to enable stakeholders, including consumers, to make more informed choices on healthcare issues.Public reporting of healthcare performance information has taken several forms. Healthcare performance reports (report cards and honor rolls) typically describe the outcomes of medical care in terms of mortality, selected complications, or medical errors and, to a lesser extent, economic outcomes. Increasingly, process measures (ie, measurement of adherence to recommended healthcare practices, such as hand hygiene) are being used as an indicator of how well an organization adheres to established standards of practice with the implicit assumption that good processes lead to good healthcare outcomes. National healthcare quality improvement initiatives, notably those of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the Centers for Medicare & Medicaid Services (CMS), and the Hospital Quality Alliance, use process measures in their public reporting initiatives.
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Affiliation(s)
- Linda McKibben
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Center for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Klevens RM, Tokars JI, Edwards J, Horan T. Sampling for Collection of Central Line–Day Denominators in Surveillance of Healthcare-Associated Bloodstream Infections. Infect Control Hosp Epidemiol 2016; 27:338-42. [PMID: 16622809 DOI: 10.1086/503338] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 12/08/2005] [Indexed: 11/03/2022]
Abstract
Objective.To determine the feasibility of estimating the number of central line-days at a hospital from a sample of months or individual days in a year, for surveillance of healthcare-associated bloodstream infections.Design.We used data reported to the National Nosocomial Infections Surveillance system in the adult and pediatric intensive care unit component for 1995-2003 and data from a sample of hospitals' daily counts of device use for 12 consecutive months. We calculated the percentile error as the central line-associated bloodstream infection percentile based on rates per line-days minus the percentile based on rates per estimated line-days.Setting and Participants.A total of 247 hospitals were used for sampling whole months and 12 hospitals were used for sampling individual days.Results.For a 1-month sample of central line–days data, the median percentile error was 3.3 (75th percentile, 7.9; 90th percentile, 15.4). The percentile error decreased with an increase in the number of months sampled. For a 3-month sample, the median percentile error was 1.4 (75th percentile, 4.3; 95th percentile, 8.3). Sampling individual days throughout the year yielded lower percentile errors than sampling an equivalent fraction of whole months. With 1 weekday sampled per week, the median percentile error ranged from 0.65 to 1.40, and the 90th percentile ranged from 2.8 to 5.0. Thus, for 90% of units, collecting data on line-days once a week provides an estimate within ± 5 percentile points of the true line-day rate.Conclusion.Sample-based estimates of central line-days can yield results that are acceptable for surveillance of healthcare-associated bloodstream infections.
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Affiliation(s)
- R M Klevens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Le Z, Li F, Fei C, Ye A, Xie X, Zhang J. Performance of the Sysmex UF-1000i urine analyser in the rapid diagnosis of urinary tract infections in hospitalized patients. J Infect Chemother 2016; 22:377-82. [PMID: 27006323 DOI: 10.1016/j.jiac.2016.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/18/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are the second most frequently encountered nosocomial infectious diseases, and they greatly increase the cost of medical care and prolong the duration of hospital stays. AIM We aimed to evaluate the performance of the Sysmex UF-1000i analyser for the rapid prediction of UTIs in hospitalized patients with or without indwelling catheters at a comprehensive teaching hospital that encounters complex disease types. METHODS Urine specimens (n = 1016) were cultured and examined for WBC, RBC, bacteria (BACT) and yeast-like cell (YLC) count using the Sysmex UF-1000i. The results were compared with the urine culture results. Receiver operating characteristic curve analysis was applied to determine BACT and YLC cutoff values for bacterial and fungal UTIs independently. The diagnostic ability of the UF-1000i was also compared for patients with and without indwelling catheters. FINDINGS A cutoff value of 38.7/μL was acceptable for ruling out bacterial UTIs. In this setting, we achieved a sensitivity of 90%, a negative predictive value of 94.5%, a false negative rate of 2.85% (29 cases), and avoided culturing in 52% of the samples. The BACT count presented a larger area under the curve for patients with indwelling catheters than for those without (0.939 vs. 0.861); however, no significant difference in the diagnostic ability of the two curves was found. CONCLUSION The Sysmex UF-1000i analyser could be a reliable method for excluding bacterial UTIs in hospitalized patients with or without urinary catheters and could help clinicians determine whether antibiotic therapy is necessary.
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Affiliation(s)
- Zhian Le
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Fengying Li
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Chunrong Fei
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Aiqing Ye
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Xinyou Xie
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Jun Zhang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
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Hatachi T, Tachibana K, Takeuchi M. Incidences and influences of device-associated healthcare-associated infections in a pediatric intensive care unit in Japan: a retrospective surveillance study. J Intensive Care 2015; 3:44. [PMID: 26509039 PMCID: PMC4621933 DOI: 10.1186/s40560-015-0111-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/21/2015] [Indexed: 11/24/2022] Open
Abstract
Background Device-associated healthcare-associated infections (DA-HAIs) are a major problem in pediatric intensive care units (PICUs). However, there are no data available regarding the incidences of DA-HAIs in PICUs in Japan and their influences on length of PICU stay and mortality. The objective of this study was to investigate the incidences of three common DA-HAIs in a PICU and their influences on length of PICU stay and mortality in Japan. Methods We performed a retrospective surveillance study over 12 months in a single PICU in Japan. First, we investigated the incidences of three common DA-HAIs: central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) by chart review, according to the surveillance definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. Second, we compared patient characteristics, morbidity, and mortality between the patients with and without DA-HAIs. Results Of all 426 patients admitted to the PICU, 73 % had a central venous catheter, 75 % had an endotracheal tube, and 81 % had a urinary catheter during their PICU stay; the device utilization ratios per patient-days for these were 0.78, 0.53, and 0.44, respectively. In total, 28 patients (6.6 %) acquired at least one of the three DA-HAIs investigated, with an overall incidence per 1000 patient-days of 11.2. The incidences of CLABSI, VAP, and CAUTI per 1000 device-days were 4.3, 3.5, and 13.6, respectively. The median length of PICU stay for the patients with DA-HAIs was 22.5 days, compared with 2 days for those without DA-HAIs. Although there was no statistical difference, the mortality of the patients with DA-HAIs was 7.1 %, whereas the mortality of the patients without DA-HAIs was 2.3 %. Conclusions This study showed the incidences of three common DA-HAIs in a PICU in Japan, and that they were associated with a longer length of PICU stay.
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Affiliation(s)
- Takeshi Hatachi
- Department of Intensive Care Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho, Izumi, Osaka 594-1101 Japan
| | - Kazuya Tachibana
- Department of Intensive Care Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho, Izumi, Osaka 594-1101 Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho, Izumi, Osaka 594-1101 Japan
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Dudeck MA, Edwards JR, Allen-Bridson K, Gross C, Malpiedi PJ, Peterson KD, Pollock DA, Weiner LM, Sievert DM. National Healthcare Safety Network report, data summary for 2013, Device-associated Module. Am J Infect Control 2015; 43:206-21. [PMID: 25575913 DOI: 10.1016/j.ajic.2014.11.014] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/19/2014] [Indexed: 01/05/2023]
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D'Agata EMC. Rapidly Rising Prevalence of Nosocomial Multidrug-Resistant, Gram-Negative Bacilli: A 9-Year Surveillance Study. Infect Control Hosp Epidemiol 2015; 25:842-6. [PMID: 15518026 DOI: 10.1086/502306] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractObjective:To examine and quantify the temporal trends of nosocomial multidrug-resistant, gram-negative bacilli.Design:A 9-year surveillance study was conducted. Multidrug resistance was defined as resistance to 3 or more antimicrobial classes.Setting:Tertiary-care institution.Results:From 1994 to 2002, multidrug-resistant, gram-negative bacilli increased from 1% to 16% for multidrug-resistantPseudomonas aeruginosa,4% to 13% for multidrug-resistantEnterobacterspecies, 0.5% to 17% for multidrug-resistantKlebsiellaspecies, 0% to 9% for multidrug-resistantProteusspecies, and 0.2% to 4% for multidrug-resistantEscherichia coli(P≤ .05). The most common pattern of multidrug resistance was co-resistance to quinolones, third-generation cephalosporins, and aminoglycosides.Conclusion:The rapid rise of multidrug-resistant, gram-negative bacilli may warrant infection control programs to include these pathogens in strategies aimed at limiting the emergence and spread of antimicrobial-resistant pathogens.
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Affiliation(s)
- Erika M C D'Agata
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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Kanafani ZA, Kara L, Hayek S, Kanj SS. Ventilator-Associated Pneumonia at a Tertiary-Care Center in a Developing Country: Incidence, Microbiology, and Susceptibility Patterns of Isolated Microorganisms. Infect Control Hosp Epidemiol 2015; 24:864-9. [PMID: 14649777 DOI: 10.1086/502151] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractObjective:Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country.Design:Prospective observational cohort study.Setting:The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries.Patients:All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed.Results:Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate.Conclusion:Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.
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Affiliation(s)
- Zeina A Kanafani
- Department of Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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El-Masri MM, Hammad TA, McLeskey SW, Joshi M, Korniewicz DM. Predictors of Nosocomial Bloodstream Infections Among Critically Ill Adult Trauma Patients. Infect Control Hosp Epidemiol 2015; 25:656-63. [PMID: 15357157 DOI: 10.1086/502457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To identify the independent predictors of nosocomial bloodstream infections (BSIs) among critically ill adult trauma patients.Design:A prospective, cohort design was used to study patients who met predetermined inclusion criteria. Basic descriptive and univariate statistical analyses were performed to identify unadjusted predictors. A forward stepwise multivariate logistic regression analysis was then conducted to identify independent predictors of nosocomial BSI.Setting:Level I university-affiliated shock trauma center.Patients:Three hundred sixty-one critically ill adult trauma patients, 55 of whom developed nosocomial BSIs (15.2%).Results:Data analysis of 45 variables indicated that only 9 were independent predictors of nosocomial BSI: presence of a chest tube, use of immunosuppressive agents, presence of microbial resistance, length of stay, presence of preexisting infection, percentage change of serum albumin levels, patient disposition, transfusion of 10 or more units of blood, and number of central venous catheters (CVCs) for patients who had 4 or more. The classification index of the final regression model at a cut-off point of 0.5 had a specificity of 97.4%, a sensitivity of 60%, a positive predictive value of 76.7%, a negative predictive value of 93%, and an overall precision of 91%.Conclusion:In this study, only 9 variables were independent predictors of nosocomial BSI. Our findings are specific to critically ill adult trauma patients and should be interpreted within the context of this particular population.
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Affiliation(s)
- Maher M El-Masri
- University of Windsor, Faculty of Nursing, 401 Sunset, CHN Room G110, Windsor, Ontario, Canada N9B 3P4
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Abstract
The “Guideline for Prevention of Intravascular Device-Related Infections” is designed to reduce the incidence of intravascular device-related infections by providing an over view of the evidence for recommendations considered prudent by consensus of Hospital Infection Control Practices Advisor y Committee (HICPAC) members. This two-part document updates and replaces the previously published Centers for Disease Control's (CDC) Guideline for Intravascular Infections (Am J Infect Control1983;11:183-199). Part I, “Intravascular Device-Related Infections: An Over view” discusses many of the issues and controversies in intravascular-device use and maintenance. These issues include definitions and diagnosis of catheter-related infection, appropriate barrier precautions during catheter insertion, inter vals for replacement of catheters, intravenous (IV) fluids and administration sets, catheter-site care, the role of specialized IV personnel, and the use of prophylactic antimi-crobials, flush solutions, and anticoagulants. Part II, “Recommendations for Prevention of Intravascular Device-Related Infections” provides consensus recommendations of the HICPAC for the prevention and control of intravascular device-related infections. A working draft of this document also was reviewed by experts in hospital infection control, internal medicine, pediatrics, and intravenous therapy. However, all recommendations contained in the guideline may not reflect the opinion of all reviewers.
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Vallés J, Fernández I, Alcaraz D, Chacón E, Cazorla A, Canals M, Mariscal D, Fontanals D, Morón A. Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients. Infect Control Hosp Epidemiol 2015; 29:847-53. [DOI: 10.1086/590259] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).Design.Prospective, randomized controlled trial.Setting.Intensive care unit in a teaching hospital.Methods.Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.Results.A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1 % vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.Conclusions.The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.
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Bhende S, Spangler D. In Vitro Assessment of Chlorhexidine Gluconate–Impregnated Polyurethane Foam Antimicrobial Dressing Using Zone of Inhibition Assays. Infect Control Hosp Epidemiol 2015; 25:664-7. [PMID: 15357158 DOI: 10.1086/502458] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To evaluate an antimicrobial dressing consisting of hydrophilic polyurethane foam with chlorhexidine gluconate for activity against several antibiotic-resistant clinical isolates as well as American Type Culture Collection reference strains using zone of inhibition assays.Methods:Sterile foam samples with chlorhexidine gluconate and untreated controls were transferred onto inoculated agar plates. Plates were incubated at 35°C to 37° C for 24 hours and examined for zones of inhibition around the foam samples.Results:Polyurethane foam with chlorhexidine gluconate showed antimicrobial activity in vitro against all of the challenge organisms including antibiotic-resistant clinical isolates.Conclusion:The data from this in vitro study support the hypothesis that polyurethane foam with chlorhexidine gluconate has an antimicrobial effect against antibiotic-resistant Staphylococcus and Enterococcus species, as well as Candida species.
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Affiliation(s)
- Shubhangi Bhende
- Corporate Microbiology and Sterilization Sciences, Ethicon, Inc., Somerville, New Jersey 08876, USA
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Predictors of Nosocomial Bloodstream Infections Among Critically Ill Adult Trauma Patients. Infect Control Hosp Epidemiol 2015. [DOI: 10.1017/s0195941700079959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To identify the independent predictors of nosocomial bloodstream infections (BSIs) among critically ill adult trauma patients.Design:A prospective, cohort design was used to study patients who met predetermined inclusion criteria. Basic descriptive and univariate statistical analyses were performed to identify unadjusted predictors. A forward stepwise multivariate logistic regression analysis was then conducted to identify independent predictors of nosocomial BSI.Setting:Level I university-affiliated shock trauma center.Patients:Three hundred sixty-one critically ill adult trauma patients, 55 of whom developed nosocomial BSIs (15.2%).Results:Data analysis of 45 variables indicated that only 9 were independent predictors of nosocomial BSI: presence of a chest tube, use of immunosuppressive agents, presence of microbial resistance, length of stay, presence of preexisting infection, percentage change of serum albumin levels, patient disposition, transfusion of 10 or more units of blood, and number of central venous catheters (CVCs) for patients who had 4 or more. The classification index of the final regression model at a cut-off point of 0.5 had a specificity of 97.4%, a sensitivity of 60%, a positive predictive value of 76.7%, a negative predictive value of 93%, and an overall precision of 91%.Conclusion:In this study, only 9 variables were independent predictors of nosocomial BSI. Our findings are specific to critically ill adult trauma patients and should be interpreted within the context of this particular population.
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Selected Aspects of the Socioeconomic Impact of Nosocomial Infections: Morbidity, Mortality, Cost, and Prevention. Infect Control Hosp Epidemiol 2015. [DOI: 10.1017/s019594170000480x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractApproximately 2 million nosocomial infections occur annually in the United States. These infections result in substantial morbidity, mortality, and cost. The excess duration of hospitalization secondary to nosocomial infections has been estimated to be 1 to 4 days for urinary tract infections, 7 to 8.2 days for surgical site infections, 7 to 21 days for bloodstream infections, and 6.8 to 30 days for pneumonia. The estimated mortalities associated with nosocomial bloodstream infections and pneumonia are 23.8% to 50% and 14.8% to 71% (overall), or 16.3% to 35% and 6.8% to 30% (attributable), respectively. The estimated average costs of these infections are $558 to $593 for each urinary tract infection, $2,734 for each surgical site infection, $3,061 to $40,000 for each bloodstream infection, and $4,947 for each pneumonia. Even minimally effective infection control programs are cost-effective. In countries with prospective payment systems based on diagnosis-related groups, hospitals lose from $583 to $4,886 for each nosocomial infection. As administrators focus on cost containment, increased support should be given to infection control programs so that preventable nosocomial infections and their associated expenditures can be averted.
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Nosocomial Infection Caused by Antibiotic-Resistant Organisms in the Intensive-Care Unit. Infect Control Hosp Epidemiol 2015. [DOI: 10.1017/s0195941700003829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractResistance to antimicrobial agents is an evolving process, driven by the selective pressure of heavy antibiotic use in individuals living in close proximity to others. The intensive care unit (ICU), crowded with debilitated patients who are receiving broad-spectrum antibiotics and being cared for by busy physicians, nurses, and technicians, serves as an ideal environment for the emergence of antibiotic resistance. Problem pathogens presently include multiply resistant gram-negative bacilli, methicillin-resistantStaphylococcus aureus, and the recently emerged vancomycin-resistant enterococci. The prevention of antimicrobial resistance in ICUs should focus on recognition via routine unit-based sur veillance, improved compliance with handwashing and barrier precautions, and antibiotic-use policies tailored to individual units within hospitals.
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Tokars JI, Klevens RM, Edwards JR, Horan TC. Measurement of the Impact of Risk Adjustment for Central Line–Days on Interpretation of Central Line–Associated Bloodstream Infection Rates. Infect Control Hosp Epidemiol 2015; 28:1025-9. [DOI: 10.1086/519935] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 04/05/2007] [Indexed: 11/04/2022]
Abstract
Objective.To describe methods to assess the practical impact of risk adjustment for central line-days on the interpretation of central line–associated bloodstream infection (BSI) rates, because collecting these data is often burdensome.Methods.We analyzed data from 247 hospitals that reported to the adult and pediatric intensive care unit component of the National Nosocomial Infections Surveillance System from 1995 through 2003. For each unit each year, we calculated the percentile error as the absolute value of the difference between the percentile based on a risk-adjusted or more-sophisticated measure (eg, the central line–day rate) and the percentile based on a crude or less-sophisticated measure (eg, the patient-day rate). Using rate per central line–day as the “gold standard,” we calculated performance characteristics (eg, sensitivity and predictive values) of rate per patient-day for finding central line–associated BSI rates higher or lower than the mean. Greater impact of risk adjustment is indicated by higher values for percentile error and lower values for performance characteristics.Results.The median percentile error was ± 7 (ie, the percentile based on central line-days could be 7% higher or lower than the percentile based on patient-days). This error was less than 10 percentile points for 62% of the unit-years, was between 10 and 19 percentile points for 22% of the unit-years, and was 20 percentile points or more for 15% of the unit-years. Use of the rate based on patient-days had a sensitivity of 76% and a positive predictive value of 61% for detecting a significantly high or low central line–associated BSI rate.Conclusions.We found that risk adjustment for central line–days has an important impact on the calculated central line–associated BSI percentile for some units. Similar methods can be used to evaluate the impact of other risk adjustment methods. Our results support current recommendations to use central line–days for surveillance of central line–associated BSI when comparisons are made among facilities.
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Mishra B, Lushnikova T, Wang G. Small lipopeptides possess anti-biofilm capability comparable to daptomycin and vancomycin. RSC Adv 2015; 5:59758-59769. [PMID: 26257894 DOI: 10.1039/c5ra07896b] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Antibiotic resistance, to a large extent, is related to the formation of bacterial biofilms. Thus, compounds with anti-biofilm capability are of practical importance. Inspired by the recent discovery of two amino acid lipopeptides from marine bacteria, we constructed a family of small lipopeptides with 2-3 amino acids. While no antimicrobial activity was found for anionic lipopeptides, cationic candidates are potent against Staphylococcus strains, such as methicillin-resistant Staphylococcus aureus (MRSA) USA200, USA300, USA400, UAMS-1, Newman, and Mu50. In the simplest design, two lysines (C14-KK) or three arginines (C14-RRR) attached to an acyl chain of 14 carbons were sufficient to make the compounds antimicrobial. These simple lipopeptides are inherently stable towards S. aureus V8 proteinase and fungal proteinase K, more soluble in water, and more selective than other lipopeptides containing a mixture of hydrophobic and cationic amino acids. Furthermore, the activity of C14-RRR was not compromised by salts, serum, or a change in pH. Live cell experiments revealed that these lipopeptides, with a detergent-like structure, killed bacteria rapidly by targeting cell membranes. Importantly, these compounds were also able to inhibit biofilm formation and could even disrupt preformed biofilms of clinically relevant MRSA strains with an in vitro efficacy comparable to daptomycin and vancomycin. These results indicate that small lipopeptides are potentially useful candidates for preventing or eliminating bacterial biofilms alone or in combination with daptomycin or vancomycin.
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Affiliation(s)
- Biswajit Mishra
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 986495 Nebraska Medical Center, Omaha, NE 68198-6495, USA
| | - Tamara Lushnikova
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 986495 Nebraska Medical Center, Omaha, NE 68198-6495, USA
| | - Guangshun Wang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 986495 Nebraska Medical Center, Omaha, NE 68198-6495, USA
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Luna CM, Rodriguez-Noriega E, Bavestrello L, Guzmán-Blanco M. Gram-negative infections in adult intensive care units of latin america and the Caribbean. Crit Care Res Pract 2014; 2014:480463. [PMID: 25525515 PMCID: PMC4265515 DOI: 10.1155/2014/480463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 11/02/2014] [Accepted: 11/04/2014] [Indexed: 12/29/2022] Open
Abstract
This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs). A systematic search of the biomedical literature (PubMed) was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela) signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%). Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor for resistance development and excessive mortality. Infection control strategies utilizing hygiene measures and antimicrobial stewardship programs reduced the rate of device-associated infections. To mitigate the poor health outcomes associated with infections by multidrug-resistant Gram-negative bacteria, urgent focus must be placed on infection control strategies and local surveillance programs.
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Affiliation(s)
- Carlos M. Luna
- Pulmonary Division, Department of Medicine, José de San Martin Hospital, University of Buenos Aires, Arenales 2557, Piso 1, Dep. A, 1425 Buenos Aires, Argentina
| | - Eduardo Rodriguez-Noriega
- Hospital Civil de Guadalajara “Fray Antonio Alcalde” and Institute of Infectious and Experimental Pathology, University Center of Health Sciences, University of Guadalajara, Guadalajara, JAL, Mexico
| | | | - Manuel Guzmán-Blanco
- Private Hospital Medical Center of Caracas and Vargas Hospital of Caracas, Caracas, Venezuela
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Selim S, El Kholy I, Hagagy N, El Alfay S, Aziz MA. Rapid identification of Pseudomonas aeruginosa by pulsed-field gel electrophoresis. BIOTECHNOL BIOTEC EQ 2014; 29:152-156. [PMID: 26019629 PMCID: PMC4433924 DOI: 10.1080/13102818.2014.981065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 05/07/2014] [Indexed: 11/28/2022] Open
Abstract
Twenty clinical Pseudomonas aeruginosa isolates recovered from patients admitted to The General Hospital in Ismailia Governorate (Egypt) were examined in this study. We analysed P. aeruginosa ATCC 9027 (as a control strain) and 19 of the isolates after digestion with SpeI restriction endonuclease. After this we conducted a pulsed-field gel electrophoresis (PFGE) and typed the obtained 10 unique patterns, designated as A, A1, B, B1, C, C1, D, D1, E and F. We evaluated the genetic relatedness between all strains, based on ≥87% band identity. As a result, the isolates were grouped in the 10 clusters as follows: patterns A, A1, B, B1, C contained two strains each and patterns C1, D, D1, E contained a single strain each; the five remaining strains were closely related (genomic pattern F). One isolate belonged to antibiotype ‘b’. The genotype patterns of the P. aeruginosa ATCC 9027 control strain and isolate no. 11 were closely related and had two different antibiotypes ‘d’ and ‘c’, respectively.
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Affiliation(s)
- Samy Selim
- Department of Clinical Laboratory Sciences, College of Applied Medical Science, Aljouf University , Sakaka , Saudi Arabia ; Department of Botany, Faculty of Science, Suez Canal University , Ismailia , Egypt
| | - Iman El Kholy
- Clinical Pathology Department, Ain Shams University Specialized Hospital, Ain Shams University , Cairo , Egypt
| | - Nashwa Hagagy
- Department of Botany, Faculty of Science, Suez Canal University , Ismailia , Egypt
| | - Sahar El Alfay
- Department of Botany, Faculty of Science, Suez Canal University , Ismailia , Egypt
| | - Mohamed Abdel Aziz
- Department of Botany, Faculty of Science, Suez Canal University , Ismailia , Egypt
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Chaudhary M, Bilal MF, Du W, Chu R, Rajpurkar M, McGrath EJ. The impact of ethanol lock therapy on length of stay and catheter salvage in pediatric catheter-associated bloodstream infection. Clin Pediatr (Phila) 2014; 53:1069-76. [PMID: 24807976 DOI: 10.1177/0009922814533591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ethanol lock therapy (ELT) with systemic antimicrobial therapy (SAT) is a treatment for catheter-associated bloodstream infections (CABSI). However, its impact on hospital length of stay (LOS) is unknown. OBJECTIVES Assess the impact of ELT on LOS, LOS attributable to CABSI (ALOS), and catheter salvage in pediatric hematology, oncology, stem cell transplant (HOSCT) CABSI. METHODS Retrospective review of HOSCT CABSI from January 2009 to July 2011. RESULTS A total of 124 CABSI episodes were reviewed in 66 patients. Mean LOS with ELT after 1 positive blood culture (BC) was 7.1 versus 12.3 days after ≥2 positive BC (P = .014). Mean ALOS was 1.6 days with ELT versus 2.9 days without ELT (P = .018). Mean ALOS with ELT after 1 positive BC was 3.75 days versus 5.8 days after ≥2 positive BC (P = .022). Catheter salvage rate: 41 of 48 (85%) with ELT versus 49 of 68 (72%) without ELT (P = .169). CONCLUSION Earlier initiation of ELT may decrease ALOS.
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Affiliation(s)
- Manu Chaudhary
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Wei Du
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | - Roland Chu
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | - Madhvi Rajpurkar
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | - Eric J McGrath
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
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Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, Balkhy H, Hu B, Alvarez-Moreno C, Medeiros EA, Apisarnthanarak A, Raka L, Cuellar LE, Ahmed A, Navoa-Ng JA, El-Kholy AA, Kanj SS, Bat-Erdene I, Duszynska W, Van Truong N, Pazmino LN, See-Lum LC, Fernández-Hidalgo R, Di-Silvestre G, Zand F, Hlinkova S, Belskiy V, Al-Rahma H, Luque-Torres MT, Bayraktar N, Mitrev Z, Gurskis V, Fisher D, Abu-Khader IB, Berechid K, Rodríguez-Sánchez A, Horhat FG, Requejo-Pino O, Hadjieva N, Ben-Jaballah N, García-Mayorca E, Kushner-Dávalos L, Pasic S, Pedrozo-Ortiz LE, Apostolopoulou E, Mejía N, Gamar-Elanbya MO, Jayatilleke K, de Lourdes-Dueñas M, Aguirre-Avalos G, Maurizi DM, Montanini A, Spadaro ML, Marcos LS, Botta P, Jerez FM, Chavez MC, Ramasco L, Colqui MI, Olivieri MS, Rearte AS, Correa GE, Juarez PD, Gallardo PF, Brito MP, Mendez GH, Valdez JR, Cardena LP, Harystoy JM, Chaparro GJ, Rodriguez CG, Toomey R, Caridi M, Viegas M, Bernan ML, Romani A, Dominguez CB, Davalos LK, Richtmann R, Silva CA, Rodrigues TT, Filho AM, Seerig Palme ED, Besen A, Lazzarini C, Cardoso CB, Azevedo FK, Pinheiro APF, Camacho A, De Carvalho BM, De Assis MJM, Carneiro APV, Canuto MLM, Pinto Coelho KH, Moreira T, Oliveira AA, Sousa Colares MM, De Paula Bessa MM, Gomes Bandeira TDJP, De Moraes RA, Campos DA, De Barros Araújo TML, Freitas Tenório MT, Amorim S, Amaral M, Da Luz Lima J, Pino Da Silva Neta L, Batista C, De Lima Silva FJ, Ferreira De Souza MC, Arruda Guimaraes K, Marcia Maluf Lopes J, Nogueira Napoles KM, Neto Avelar LLS, Vieira LA, Gustavo De Oliveira Cardo L, Takeda CF, Ponte GA, Eduardo Aguiar Leitão F, De Souza Kuchenbecker R, Pires Dos Santos R, Maria Onzi Siliprandi E, Fernando Baqueiro Freitas L, Martins IS, Casi D, Maretti Da Silva MA, Blecher S, Villins M, Salomao R, Oliveira Castro SR, Da Silva Escudero DV, Andrade Oliveira Reis M, Mendonca M, Furlan V, Claudio do Amaral Baruzzi A, Sanchez TE, Moreira M, Vasconcelos de Freitas W, Passos de Souza L, Velinova VA, Hadjieva N, Petrov MM, Karadimov DG, Kostadinov ED, Dicheva VJ, Wang C, Guo X, Geng X, Wang S, Zhang J, Zhu L, Zhuo S, Guo C, Lili T, Ruisheng L, Kun L, Yang X, Yimin L, Pu M, Changan L, Shumei Y, Kangxiong W, Meiyi L, Ye G, Ziqin X, Yao S, Liqiang S, Marino Cañas Giraldo L, Margarita Trujillo Ramirez E, Rios PA, Carlos Torres Millan J, Giovanny Chapeta Parada E, Eduardo Mindiola Rochel A, Corchuelo Martinez AH, Marãa Perez Fernandez A, Guzman NB, Guzman AL, Ferrer MR, Vega YL, Munoz HJ, Moreno GC, Romero Torres SL, Hernandez HT, Valderrama MarquezClaudia Linares IA, Valencia ME, Corrales LS, Bonilla SM, Ivan Marin Uribe J, Gomez DY, Martinez JO, Dary Burgos Florez L, Osorio J, Santofimio D, Cortes LM, Villamil-Gomez W, Gutierrez GM, Ruiz AA, Fuentes CG, Chinchilla AS, Hernandez IC, Ugalde OC, Garcell HG, Perez CM, Bardak S, Ozkan S, Mejia N, Puello Guerrero Glenny Mirabal AM, Delgado M, Severino R, Lacerda E, Tolari G, Bovera MM, Pinto DB, González PF, Santacruz G, Alquinga N, Zaruma C, Remache N, Morocho D, Arboleda M, Zapata MC, Garcia MF, Picoita F, Velez J, Valle M, Yepez ES, Tutillo DM, Mora RA, Padilla AP, Chango M, Cabezas K, Tenorio López S, Lucía Bonilla Escudero A, Sánchez GT, Alberto Gonzalez Flores H, Garcia MF, Ghazi IA, Hassan M, Ismail GA, Hamed R, Abdel-Halim MM, El-Fattah MA, Abdel-Aziz D, Seliem ZS, Elsherif RH, Dewdar RA, Mohmed AA, Abdel-Fatteh Ahmed L, De Jesus Machuca L, Bran De Casares C, Kithreotis P, Daganou M, Veldekis D, Kartsonaki M, Gikas A, Luque Torres MT, Padgett D, Rivera DM, Jaggi N, Rodrigues C, Shah B, Parikh K, Patel J, Thakkar R, Chakravarthy M, Gokul B, Sukanya R, Pushparaj L, Vini T, Rangaswamy S, Patnaik SK, Venkateshwar V, John B, Dalal S, Sahu S, Sahu S, Ray B, Misra S, Mohanty N, Mishra BM, Sahoo P, Parmar N, Mishra S, Pati BK, Singh S, Pati BS, Panda A, Banergee S, Padhihari D, Samal S, Sahu S, Varma K, Suresh Kumar VP, Gopalakrishnan R, Ramakrishnan N, Abraham BK, Rajagopal S, Venkatraman R, Mani AK, Devaprasad D, Ranganathan L, Francis T, Cherain KM, Ramachandran B, Krupanandan R, Muralidharan S, Karpagam M, Padmini B, Saranya S, Kumar S, Pandya N, Kakkar R, Zompa T, Saini N, Samavedam S, Jagathkar G, Nirkhiwale S, Gehlot G, Bhattacharya S, Sood S, Singh S, Singh S, Todi SK, Bhattacharyya M, Bhakta A, Basu S, Agarwal A, Agarwal M, Kharbanda M, Sengupta S, Karmakar A, Gupta D, Sarkar AK, Dey R, Bhattacharya C, Chandy M, Ramanan V, Mahajan A, Roy M, Bhattacharya S, Sinha S, Roy I, Gupta U, Mukherjee S, Bej M, Mukherjee P, Baidya S, Azim A, Sakle AS, Sorabjee JS, Potdar MS, Subhedar VR, Udwadia F, Francis H, Dwivedy A, Binu S, Shetty S, Nair PK, Khanna DK, Chacko F, Blessymole S, Mehta PR, Singhal T, Shah S, Kothari V, Naik R, Patel MH, Aggarwal DG, Jawadwala BQ, Pawar NK, Kardekar SN, Manked AN, Myatra S, Divatia J, Kelkar R, Biswas S, Raut V, Sampat S, Thool A, Karlekar A, Nandwani S, Gupta S, Singhal S, Gupta M, Mathur P, Kumar S, Sandhu K, Dasgupta A, Raha A, Raman P, Wadhera A, Badyal B, Juneja S, Mishra B, Sharma S, Mehrotra M, Shelgaonkar J, Padbidri V, Dhawale R, Sibin SM, Mane D, Sale HK, Mukhit Abdul Gaffar Kazi M, Chabukswar S, Mathew A, Gaikwad D, Harshe A, Nadimpalli G, Bhamare S, Thorat S, Sarda O, Nadimpalli P, Mendonca A, Malik S, Kamble A, Kumari N, Arora S, Munshi N, Divekar DG, Kavathekar MS, Kulkarni AK, Kavathekar MS, Suryawanshi MV, Bommala ML, Bilolikar A, Joshi KL, Pamnani C, Wasan H, Khamkar S, Steephen L, Rajalakshmi A, Thair A, Mubarak A, Sathish S, Kumar S, Sunil H, Sujith S, Dinesh, Sen N, Thool A, Shinde N, Alebouyeh M, Jahani-Sherafat S, Zali MR, Sarbazi MR, Mansouri N, Tajeddin E, Razaghi M, Seyedjavadi S, Tajeddin E, Rashidan M, Razaghi M, Masjedi M, Maghsudi B, Sabetian G, Sanaei A, Yousefipour A, Alebouyeh M, Assiri AM, Furukawa-Cinquini EM, Alshehri AD, Giani AF, Demaisip NL, Cortez EL, Cabato AF, Gonzales Celiz JM, Al-Zaydani Asiri IA, Mohammed YK, Abdullah Al Raey M, Omer Abdul Aziz A, Ali Al Darani S, Aziz MR, Basri RH, Al-Awadi DK, Bukhari SZ, Aromin RG, Ubalde EB, Molano AM, Abdullah Al Enizy H, Baldonado CF, Al Adwani FM, Marie Casuyon Pahilanga A, Tan AM, Joseph S, Nair DS, Al-Abdullah NA, Sindayen G, Malificio AA, Mohammed DA, Mesfer Al Ghamdi H, Silo AC, Valisto MBV, Foteinakis N, Ghazal SS, Joseph MV, Hakawi A, Hasani A, Jusufi I, Spahija G, Baftiu N, Gecaj-Gashi A, Aly NY, El-Dossoky Noweir M, Varghese ST, Ramapurath RJ, Mohamed AM, George SM, Kurian A, Sayed AF, Salama MF, Omar AA, Rebello FM, Narciso DM, Zahreddine NK, Kanafani Z, Kardas T, Molaeb B, Jurdi L, Al Souheil A, Ftouni M, Ayash H, Mahfouz T, Kondratas T, Grinkeviciute D, Kevalas R, Gailiene G, Dagys A, Petrovska M, Popovska K, Bogoevska-Miteva Z, Jankovska K, Guroska ST, Anguseva T, Wan Yusoff WN, Shiham Zainal Abidin A, Gan CS, Zainol H, Rai V, Kwong WK, Hasan MS, Sri La Sri Ponnampala S, Veerakumaran J, Assadian O, Phuong DM, Binh NG, Kaur K, Lim J, Tan LH, Manikavasagam J, Cheong YM, Magaña HC, Cesar Mijangos Méndez J, Jiménez FC, Esparza-Ahumada S, Morfin-Otero R, Rodriguez-Noriega E, Gutierrez-Martinez S, Perez-Gomez HR, León-Garnica G, Mendoza-Mujica C, Cecilia Culebro Burguet M, Portillo-Gallo JH, Almazán FA, Miramontes GI, Olivas MDRV, Aguilar Angel LA, Vargas MS, Orlando Flores Alvarado A, Carlos Mares Morales R, Carlos Fernandez Alvarez L, Armando Rincon Leon H, Navarro Fuentes KR, Mariela Perez Hernandez Y, Falcon GM, Vargas AG, Trujillo Juarez MA, Mulia AM, Alma Ulloa Camacho P, Martinez-Marroquin MY, Garcia MM, Martinez AM, Sanchez EL, Flores GG, Martínez MDRG, Alfonso Galindo Olmeda J, Olivarez G, Rodriguez EB, Magdalena Gutierrez Castillo M, Guadalupe Villa González M, Beatriz Sauceda Castañeda I, Rodriguez JM, Baatar O, Batkhuu B, Meryem K, Amina B, Abouqal R, Zeggwagh AA, Dendane T, Abidi K, Madani N, Mahmood SF, Memon BA, Bhutto GH, Paul N, Parveen A, Raza A, Mahboob A, Nizamuddin S, Sultan F, Nazeer H, Khan AA, Hafeez A, Lara L, Mapp T, Alvarez B, Rojas-Bonilla MI, Castano E, De Moros DA, Atarama RE, Calisto Pazos ME, Paucar A, Ramos MT, Jurado J, Moreno D, Cruz Saldarriaga ME, Ramirez E, La Hoz Vergara CE, Enrique Prudencio Leon W, Isidro Castillo Bravo L, Fernanda Aibar Yaranga K, Pichilingue Chagray JE, Marquez Mondalgo VA, Zegarra ST, Astete NS, Guevara FC, Pastrana JS, Enrique Prudencio Leon W, Linares Calderon CF, Jesus Mayorga Espichan M, Martin Santivanez Monge L, Changano Rodriguez MV, Rosa Diaz Tavera Z, Martin Ramirez Wong F, Chavez SM, Rosa Diaz Tavera Z, Martin Ramirez Wong F, Atencio-Espinoza T, Villanueva VD, Blanco-Abuy MT, Tamayo AS, Bergosa LD, Llames CMJP, Trajano MF, Bunsay SA, Amor JC, Berba R, Sg Buenaflor MC, Labro E, Mendoza MT, Javellana OP, Salvio LG, Rayco RG, Bermudez V, Kubler A, Zielinska M, Kosmider-Zurawska M, Barteczko-Grajek B, Szewczyk E, Dragan B, Mikaszewska-Sokolewicz MA, Lazowski T, Cancel E, Licker MS, Dragomirescu LA, Dumitrascu V, Sandesc D, Bedreag O, Papurica M, Muntean D, Kotkov I, Kretov V, Shalapuda V, Molkov A, Puzanov S, Utkin I, Tchekulaev A, Tulupova V, Nikolic L, Ristic G, Eremija J, Kojovic J, Lekic D, Vasiljevic S, Lesnakova A, Marcekova A, Furova K, Gamar Elanbya MO, Ali MA, Kadankunnel SK, Somabutr S, Pimathai R, Wanitanukool S, Luxsuwong M, Supa N, Prasan P, Thamlikitkul V, Jamulitrat S, Suwalak N, Phainuphong P, Asma B, Aida B, Sarra BH, Ammar K, Ertem GT, Bulut C, Hatipoglu CA, Erdinc FS, Demiroz AP, Ozcelik M, Meco BC, Oral M, Unal N, Guclu CY, Kendirli T, İnce E, Çiftçi E, Yaman A, Ödek Ç, Karbuz A, Kocabaş BA, Altın N, Cesur S, Atasay B, Erdeve O, Akduman H, Kahvecioglu D, Cakir U, Yildiz D, Kilic A, Arsan S, Arman D, Unal S, Gelebek Y, Zengin H, Sen S, Cabadak H, Erbay A, Yalcin AN, Turhan O, Cengiz M, Dursun O, Gunasan P, Kaya S, Ramazanoglu A, Ustun C, Yasayacak A, Akdeniz H, Sirmatel F, Otkun AM, Sacar S, Sener A, Turgut H, Sungurtekin H, Ugurcan D, Necan C, Yilmaz C, Ozdemir D, Geyik MF, Ince N, Danis A, Erdogan SY, Erben N, Usluer G, Ozgunes I, Uzun C, Oncul O, Gorenek L, Erdem H, Baylan O, Ozgultekin A, Inan A, Bolukcu S, Senol G, Ozdemir H, Gokmen Z, Ozdemir SI, Kaya A, Ersoz G, Kuyucu N, Karacorlu S, Kaya Z, Guclu E, Kaya G, Karabay O, Esen S, Aygun C, Ulger F, Dilek A, Yilmaz H, Sunbul M, Engin A, Bakir M, Elaldi N, Koksal I, Yildizdas D, Horoz OO, Willke A, Koç MM, Azak E, Elahi N, Annamma P, El Houfi A, Pirez Garcia MC, Vidal H, Perez F, Empaire GD, Ruiz Y, Hernandez D, Aponte D, Salinas E, Diaz C, Guzmán Siritt ME, Gil De Añez ZD, Bravo LM, Orozco N, Mejías E, Hung NV, Anh NQ, Chau NQ, Thu TA, Phuong DM, Binh NG, Thi Diem Tuyet L, Thi Van Trang D, Hong Thoa VT, Tien NP, Anh Thu LT, Hang PT, My Hanh TT, Thuy Hang TT, Phuong Anh DP. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control 2014; 42:942-56. [PMID: 25179325 DOI: 10.1016/j.ajic.2014.05.029] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022]
Abstract
We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.
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Diagnosis and Management of Fungal Urinary Tract Infections. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ventilator-associated pneumonia in children after cardiac surgery. Pediatr Cardiol 2014; 35:627-31. [PMID: 24259009 DOI: 10.1007/s00246-013-0830-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022]
Abstract
Ventilator-associated pneumonia (VAP) is a nosocomially acquired infection that has a significant burden on intensive care units (ICUs). We investigated the incidence of VAP in children after cardiac surgery and its impact on morbidity and mortality. A prospective cross-sectional review was performed in the postoperative cardiac patients in pediatric cardiac intensive care unit (PCICU) patients from March 2010 until the end of September 2010. The patients were divided into two groups: the VAP group and the non-VAP group, Demographic data and perioperative risk variables were collected for all patients. One hundred thirty-seven patients were recruited, 65 (48%) female and 72 (52%) male. VAP occurred in 9 patients (6.6%). Average body weights in the VAP and non-VAP groups were 5.9 ± 1.24 and 7.3 ± 0.52 kg, respectively. In our PCICU, the mechanical ventilation (MV) use ratio was 26% with a VAP-density rate of 29/1000 ventilator days. Univariate analyses showed that the risk variables to develop VAP are as follows: prolonged cardiopulmonary bypass (CPB) time, use of total parenteral nutrition (TPN), and prolonged ICU stay (p < 0.002 for all). Thirty-three percent of VAP patients had Gram-negative bacilli (GNB). VAP Patients require more MV hours, longer stay, and more inhaled nitric oxide. Mortality in the VAP group was 11% and in the non-VAP group was 0.7 % (p = 0.28). VAP incidence is high in children after cardiac surgery mainly by GNB. VAP increases with longer CPB time, administration of TPN, and longer PCICU stay. VAP increases morbidity in postoperative cardiac patients.
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Gupta A, Kapil A, Kabra SK, Lodha R, Sood S, Dhawan B, Das BK, Sreenivas V. Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit. Am J Infect Control 2014; 42:111-5. [PMID: 24485367 DOI: 10.1016/j.ajic.2013.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ongoing educational programs targeting health care professionals have shown positive outcomes by reducing the morbidity and mortality associated with health care-associated infections (HAIs). We undertook this study to measure the impact of such a program in a pediatric critical care unit of a developing country. METHODS This prospective study was conducted in 2 time periods of 6 months each, with an educational intervention for resident doctors and nurses in between. The rates of ventilator-associated pneumonia (VAP) during the preintervention and postintervention periods were estimated by active surveillance. RESULTS The incidence density of VAP was reduced by 28% (20.2 vs 14.6 per 1,000 ventilator-days; P = .21, Z test) despite a significant increase in the ventilator utilization ratio during the postintervention period (0.64 vs 0.88; P < .0001, Pearson's χ² test). There was a statistically significant reduction in mortality among patients who received mechanical ventilation for ≥48 hours in the postintervention period (49.3% vs 31.4%; P = .029, Pearson's χ² test). CONCLUSIONS Educational programs have a positive impact on reducing the morbidity and mortality associated with HAIs. Incidence rates based on device-days should be compared by keeping the variations in device utilization ratio in mind.
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Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal K Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Dudeck MA, Weiner LM, Allen-Bridson K, Malpiedi PJ, Peterson KD, Pollock DA, Sievert DM, Edwards JR. National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module. Am J Infect Control 2013; 41:1148-66. [PMID: 24274911 PMCID: PMC4629786 DOI: 10.1016/j.ajic.2013.09.002] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Margaret A Dudeck
- Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia.
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Nangino GDO, Oliveira CDD, Correia PC, Machado NDM, Dias ATB. Financial impact of nosocomial infections in the intensive care units of a charitable hospital in Minas Gerais, Brazil. Rev Bras Ter Intensiva 2013; 24:357-61. [PMID: 23917933 PMCID: PMC4031814 DOI: 10.1590/s0103-507x2012000400011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 11/18/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Infections in intensive care units are often associated with a high morbidity and mortality in addition to high costs. An analysis of these aspects can assist in optimizing the allocation of relevant financial resources. METHODS This retrospective study analyzed the hospital administration and quality in intensive care medical databases [Sistema de Gestão Hospitalar (SGH)] and RM Janus®. A cost analysis was performed by evaluating the medical products and materials used in direct medical care. The costs are reported in the Brazilian national currency (Real). The cost and length of stay analyses were performed for all the costs studied. The median was used to determine the costs involved. Costs were also adjusted by the patients' length of stay in the intensive care unit. RESULTS In total, 974 individuals were analyzed, of which 51% were male, and the mean age was 57±18.24 years. There were 87 patients (8.9%) identified who had nosocomial infections associated with the intensive care unit. The median cost per admission and the length of stay for all the patients sampled were R$1.257,53 and 3 days, respectively. Compared to the patients without an infection, the patients with an infection had longer hospital stays (15 [11-25] versus 3 [2-6] days, p<0.01), increased costs per patient in the intensive care unit (median R$9.763,78 [5445.64 - 18,007.90] versus R$1.093,94 [416.14 - 2755.90], p<0.01) and increased costs per day of hospitalization in the intensive care unit (R$618,00 [407.81 - 838.69] versus R$359,00 [174.59 - 719.12], p<0.01). CONCLUSION Nosocomial infections associated with the intensive care unit were determinants of increased costs and longer hospital stays. However, the study design did not allow us to evaluate specific aspects of cause and effect.
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Uchino M, Ikeuchi H, Matsuoka H, Bando T, Ichiki K, Nakajima K, Takahashi Y, Tomita N, Takesue Y. Catheter-associated bloodstream infection after bowel surgery in patients with inflammatory bowel disease. Surg Today 2013; 44:677-84. [DOI: 10.1007/s00595-013-0683-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 03/04/2013] [Indexed: 12/13/2022]
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Are central line bundles and ventilator bundles effective in critically ill neonates and children? Intensive Care Med 2013; 39:1352-8. [DOI: 10.1007/s00134-013-2927-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 04/04/2013] [Indexed: 01/30/2023]
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Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell G, Anttila A, Pollock DA, Edwards JR. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013; 41:286-300. [PMID: 23538117 DOI: 10.1016/j.ajic.2013.01.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Margaret A Dudeck
- Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA 30329, USA.
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Population pharmacokinetic analysis of colistin in burn patients. Antimicrob Agents Chemother 2013; 57:2141-6. [PMID: 23439640 DOI: 10.1128/aac.00271-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Colistin is increasingly used as a salvage therapy for nosocomial infections caused by multidrug-resistant Gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. However, the available pharmacokinetic (PK) data for colistin are limited to guide dosing. The aim of this study was to develop a population PK model of colistin and to identify the optimal dosage regimens for burn patients. Fifty patients with burns ranging from 4% to 85% of total body surface area who had been treated with colistimethate sodium (CMS) were studied. CMS, which is hydrolyzed in vivo to an active metabolite, was intravenously administered every 12 h. Blood samples were collected at 0, 1, 2, 4, 6, and 8 h after more than five infusions to measure the colistin concentration using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) system. The population PK model was developed using nonlinear mixed effect modeling (NONMEM, v. 6.2). A one-compartment linear PK model for colistin best described the data. The covariates included in the final model were creatinine clearance for the relative fraction of CMS converted into colistin and the presence of edema for the turnover rate constant of CMS converted into colistin. A steady-state 24-h area under the concentration-time curve was simulated from 1,000 virtual patients receiving 150 mg colistin base activity every 12 h using the final model. Relative to previous studies with critically ill patients, the elimination half-life of colistin (6.6 h) was much shorter, and continuous renal replacement therapy was not a significant covariate for any PK parameters.
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Bacterial diversity in two Neonatal Intensive Care Units (NICUs). PLoS One 2013; 8:e54703. [PMID: 23372757 PMCID: PMC3553055 DOI: 10.1371/journal.pone.0054703] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 12/18/2012] [Indexed: 11/19/2022] Open
Abstract
Infants in Neonatal Intensive Care Units (NICUs) are particularly susceptible to opportunistic infection. Infected infants have high mortality rates, and survivors often suffer life-long neurological disorders. The causes of many NICU infections go undiagnosed, and there is debate as to the importance of inanimate hospital environments (IHEs) in the spread of infections. We used culture-independent next-generation sequencing to survey bacterial diversity in two San Diego NICUs and to track the sources of microbes in these environments. Thirty IHE samples were collected from two Level-Three NICU facilities. We extracted DNA from these samples and amplified the bacterial small subunit (16S) ribosomal RNA gene sequence using 'universal' barcoded primers. The purified PCR products were pooled into a single reaction for pyrosequencing, and the data were analyzed using QIIME. On average, we detected 93+/-39 (mean +/- standard deviation) bacterial genera per sample in NICU IHEs. Many of the bacterial genera included known opportunistic pathogens, and many were skin-associated (e.g., Propionibacterium). In one NICU, we also detected fecal coliform bacteria (Enterobacteriales) in a high proportion of the surface samples. Comparison of these NICU-derived sequences to previously published high-throughput 16S rRNA amplicon studies of other indoor environments (offices, restrooms and healthcare facilities), as well as human- and soil-associated environments, found the majority of the NICU samples to be similar to typical building surface and air samples, with the notable exception of the IHEs which were dominated by Enterobacteriaceae. Our findings provide evidence that NICU IHEs harbor a high diversity of human-associated bacteria and demonstrate the potential utility of molecular methods for identifying and tracking bacterial diversity in NICUs.
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