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Rosenthal VD, Jin Z, Brown EC, Dongol R, De Moros DA, Alarcon-Rua J, Perez V, Stagnaro JP, Alkhawaja S, Jimenez-Alvarez LF, Cano-Medina YA, Valderrama-Beltran SL, Henao-Rodas CM, Zuniga-Chavarria MA, El-Kholy A, Agha H, Sahu S, Mishra SB, Bhattacharyya M, Kharbanda M, Poojary A, Nair PK, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Abdellatif-Daboor M, Chian-Wern T, Gan CS, Mohd-Basri MN, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Villegas-Mota I, Aleman-Bocanegra MC, Bat-Erdene I, Carreazo NY, Castaneda-Sabogal A, Janc J, Hlinkova S, Yildizdas D, Havan M, Koker A, Sungurtekin H, Dinleyici EC, Guclu E, Tao L, Memish ZA, Yin R. Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach. Am J Infect Control 2024; 52:580-587. [PMID: 38154739 DOI: 10.1016/j.ajic.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. METHODS We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. RESULTS During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months. CONCLUSIONS The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Infection Prevention, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Reshma Dongol
- Department of Infection Prevention, Grande International Hospital, Kathamandu, Nepal
| | - Daisy A De Moros
- Department of Infection Prevention, Hospital Del Nino Dr Jose Renan Esquivel De Panama, Panama, Panama
| | - Johana Alarcon-Rua
- Department of Infection Prevention, Clinica Sebastian De Belalcazar, Cali, Colombia
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, Fl, USA
| | - Juan P Stagnaro
- Department of Infection Prevention, Instituto Central De Medicina, Provincia De Buenos Aires, La Plata, Argentina
| | - Safaa Alkhawaja
- Department of Infection Prevention, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Yuliana A Cano-Medina
- Department of Infection Prevention, Instituto Del Corazon De Bucaramanga, Bogota, Colombia
| | - Sandra L Valderrama-Beltran
- Department of Infection Prevention, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Claudia M Henao-Rodas
- Department of Infection Prevention, Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
| | - Maria A Zuniga-Chavarria
- Department of Infection Prevention, Hospital Clinica Biblica, San Jose De Costa Rica, Costa Rica
| | - Amani El-Kholy
- Department of Infection Prevention, Dar Alfouad Hospital 6th Of October City, 6th Of October City, Egypt
| | - Hala Agha
- Department of Infection Prevention, Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | - Suneeta Sahu
- Department of Infection Prevention, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | - Shakti B Mishra
- Department of Infection Prevention, IMS And SUM Hospital, Bhubaneswar, India
| | - Mahuya Bhattacharyya
- Department of Infection Prevention, Advanced Medicare Research Institute Dhakuria Unit, Kolkata, India
| | - Mohit Kharbanda
- Department of Infection Prevention, Desun Hospital & Heart Institute Kolkata, Kolkata, India
| | - Aruna Poojary
- Department of Infection Prevention, Breach Candy Hospital Trust, Mumbai, India
| | - Pravin K Nair
- Department of Infection Prevention, Holy Spirit Hospital, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Infection Prevention, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Infection Prevention, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Infection Prevention, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | | | - Tai Chian-Wern
- Department of Infection Prevention, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Chin Seng Gan
- Department of Infection Prevention, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mat Nor Mohd-Basri
- Department of Infection Prevention, International Islamic University Malaysia Department Of Anesthesia And Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Blanca E Hernandez-Chena
- Department of Infection Prevention, Hospital General Regional 6 De Ciudad Madero, Madero, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Prevention, Hospital Regional De Alta Especialidad De Ixtapaluca, Ixtapaluca, Mexico
| | - Isabel Villegas-Mota
- Department of Infection Prevention, Instituto Nacional De Perinatologia Unidad De Cuidados Intensivos Neonatales, Mexico City, Mexico
| | - Mary C Aleman-Bocanegra
- Department of Infection Prevention, Hospital San José De Monterrey Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ider Bat-Erdene
- Department of Infection Prevention, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Nilton Y Carreazo
- Department of Infection Prevention, Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - Sona Hlinkova
- Department of Infection Prevention, Catholic University In Ruzomberok Faculty Of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Infection Prevention, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Merve Havan
- Department of Infection Prevention, Ankara University Faculty Of Medicine, Ankara, Turkey
| | - Alper Koker
- Department of Infection Prevention, Akdeniz University Medical School, Antalya, Turkey
| | - Hulya Sungurtekin
- Department of Infection Prevention, Pamukkale University Hospital, Denizli, Turkey
| | - Ener C Dinleyici
- Department of Infection Prevention, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ertugrul Guclu
- Department of Infection Prevention, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Lili Tao
- Department of Infection Prevention, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziad A Memish
- Department of Infection Prevention, King Saud Medical City, Ministry of Health, Riyadh, Arabia
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Rosenthal VD, Jin Z, Yin R, Sahu S, Rajhans P, Kharbanda M, Nair PK, Mishra SB, Chawla R, Arjun R, Sandhu K, Rodrigues C, Dongol R, Myatra SN, Mohd-Basri MN, Chian-Wern T, Bhakta A, Bat-Erdene I, Acharya SP, Alvarez GA, Moreno LAA, Gomez K, da Jimenez-Alvarez LF, Henao-Rodas CM, Valderrama-Beltran SL, Zuniga-Chavarria MA, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Aleman-Bocanegra MC, Villegas-Mota MI, De Moros DA, Castaneda-Sabogal A, Carreazo NY, Alkhawaja S, Agha HM, El-Kholy A, Abdellatif-Daboor M, Dursun O, Okulu E, Havan M, Yildizdas D, Deniz SSO, Guclu E, Hlinkova S, Ikram A, Tao L, Omar AA, Elahi N, Memish ZA, Petrov MM, Raka L, Janc J, Horhat-Florin G, Medeiros EA, Salgado E, Dueñas L, Coloma M, Perez V, Brown EC. Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe. J Crit Care 2024; 80:154500. [PMID: 38128216 DOI: 10.1016/j.jcrc.2023.154500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. METHODS We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods. RESULTS 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention. CONCLUSIONS This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Prasad Rajhans
- Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
| | | | | | | | - Rajesh Chawla
- Indraprastha Apollo Hospital Delhi, New Delhi, India
| | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Mat Nor Mohd-Basri
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Malaysia
| | - Tai Chian-Wern
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Arpita Bhakta
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Hala Mounir Agha
- Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | | | | | - Oguz Dursun
- Akdeniz University Medical School, Antalya, Turkey
| | - Emel Okulu
- Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
| | - Merve Havan
- Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Sona Hlinkova
- Catholic University in Ruzomberok Faculty of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Aamer Ikram
- Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Lul Raka
- National Institute for Public Health, Prishtina, Kosovo
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - George Horhat-Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Monica Coloma
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, Fl, USA
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Rosenthal VD, Yin R, Jin Z, Perez V, Kis MA, Abdulaziz-Alkhawaja S, Valderrama-Beltran SL, Gomez K, Rodas CMH, El-Sisi A, Sahu S, Kharbanda M, Rodrigues C, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Arjun R, Tai CW, Bhakta A, Mat Nor MB, Aguirre-Avalos G, Sassoe-Gonzalez A, Bat-Erdene I, Acharya SP, Aguilar-de-Moros D, Carreazo NY, Duszynska W, Hlinkova S, Yildizdas D, Kılıc EK, Dursun O, Odek C, Deniz SSO, Guclu E, Koksal I, Medeiros EA, Petrov MM, Tao L, Salgado E, Dueñas L, Daboor MA, Raka L, Omar AA, Ikram A, Horhat-Florin G, Memish ZA, Brown EC. Examining the impact of a 9-component bundle and the INICC multidimensional approach on catheter-associated urinary tract infection rates in 32 countries across Asia, Eastern Europe, Latin America, and the Middle East. Am J Infect Control 2024:S0196-6553(24)00105-6. [PMID: 38437883 DOI: 10.1016/j.ajic.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. METHODS We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. RESULTS Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001). CONCLUSIONS Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Infection Control, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, USA
| | - Matthew A Kis
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
| | | | - Sandra L Valderrama-Beltran
- Department of Infection Control, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Katherine Gomez
- Department of Infection Control, Clinica Sebastian de Belalcazar, Cali, Colombia
| | - Claudia M H Rodas
- Department of Infection Control, Fundacion Hospital San Jose De Buga, Guadalajara de Buga, Colombia
| | - Amal El-Sisi
- Department of Pediatric Cardiac ICU, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Suneeta Sahu
- Department of Critical Care, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | | | - Camilla Rodrigues
- Department of Infection Control, Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Critical Care, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Critical Care, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Rajalakshmi Arjun
- Department of Critical Care, Kerala Institute Of Med Sciences Thiruvananthapuram, Thiruvananthapuram, India
| | - Chian-Wern Tai
- Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Arpita Bhakta
- Department of Critical Care, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lampur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Critical Care, International Islamic University Malaysia Department of Anesthesia and Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Control, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico
| | - Ider Bat-Erdene
- Department for Quality and Safety, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Subhash P Acharya
- Department of Infection Control, Grande International Hospital, Kathamandu, Nepal
| | - Daisy Aguilar-de-Moros
- Department of Infection Control, Hospital del Nino Dr Jose Renan Esquivel de Panama, Panama, Panama
| | - Nilton Yhuri Carreazo
- Department of Infection Control, Universidad Peruana de Ciencias Aplicadas Hospital de Emergencias Pediatricas, Lima, Peru
| | - Wieslawa Duszynska
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Sona Hlinkova
- Department of Critical Care, Catholic University In Ruzomberok, Faculty of Health, Central Military Hospital SNP Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Balcali Hospital, Adana, Turkey
| | - Esra K Kılıc
- Department of Critical Care, Ankara Training And Research Hospital, Ankara, Turkey
| | - Oguz Dursun
- Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey
| | - Caglar Odek
- Department of Critical Care, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Suna S O Deniz
- Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey
| | - Ertugrul Guclu
- Department of Critical Care, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Iftihar Koksal
- Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Eduardo A Medeiros
- Department of Infection Control, Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lili Tao
- Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Estuardo Salgado
- Department of Infection Control, Hospital Marie Curie, Quito, Ecuador
| | - Lourdes Dueñas
- Department of Critical Care, Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Mohammad A Daboor
- Department of Infection Control, King Hussein Cancer Center, Amman, Jordan
| | - Lul Raka
- Department of Public Health, National Institute For Public Health, Prishtina, Kosovo
| | - Abeer A Omar
- Department of Infection Control, Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Aamer Ikram
- Department of Critical Care, Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - George Horhat-Florin
- Department of Critical Care, University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania,Timisoara, Romania
| | - Ziad A Memish
- Department of Infection Control, King Saud Medical City, Ministry of Health, Ryhad, Saudi Arabia
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, USA
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4
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Rosenthal VD, Yin R, Nercelles P, Rivera-Molina SE, Jyoti S, Dongol R, Aguilar-De-Moros D, Tumu N, Alarcon-Rua J, Stagnaro JP, Alkhawaja S, Jimenez-Alvarez LF, Cano-Medina YA, Valderrama-Beltran SL, Henao-Rodas CM, Zuniga-Chavarria MA, El-Kholy A, Agha HM, Sahu S, Anusandhan SO, Bhattacharyya M, Kharbanda M, Poojary A, Nair PK, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Zand F, Abdellatif-Daboor M, Tai CW, Gan CS, Mat Nor MB, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Villegas-Mota I, Aleman-Bocanegra MC, Bat-Erdene I, Carreazo NY, Castaneda-Sabogal A, Janc J, Belskiy V, Hlinkova S, Yildizdas D, Havan M, Koker A, Sungurtekin H, Dinleyici EC, Guclu E, Tao L, Memish ZA, Jin Z. International Nosocomial Infection Control Consortium (INICC) report of health care associated infections, data summary of 45 countries for 2015 to 2020, adult and pediatric units, device-associated module. Am J Infect Control 2024:S0196-6553(23)00879-9. [PMID: 38185380 DOI: 10.1016/j.ajic.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Reporting on the International Nosocomial Infection Control Consortium study results from 2015 to 2020, conducted in 630 intensive care units across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East. METHODS Prospective intensive care unit patient data collected via International Nosocomial Infection Control Consortium Surveillance Online System. Centers for Disease Control and Prevention/National Health Care Safety Network definitions applied for device-associated health care-associated infections (DA-HAI). RESULTS We gathered data from 204,770 patients, 1,480,620 patient days, 936,976 central line (CL)-days, 637,850 mechanical ventilators (MV)-days, and 1,005,589 urinary catheter (UC)-days. Our results showed 4,270 CL-associated bloodstream infections, 7,635 ventilator-associated pneumonia, and 3,005 UC-associated urinary tract infections. The combined rates of DA-HAIs were 7.28%, and 10.07 DA-HAIs per 1,000 patient days. CL-associated bloodstream infections occurred at 4.55 per 1,000 CL-days, ventilator-associated pneumonias at 11.96 per 1,000 MV-days, and UC-associated urinary tract infections at 2.91 per 1,000 UC days. In terms of resistance, Pseudomonas aeruginosa showed 50.73% resistance to imipenem, 44.99% to ceftazidime, 37.95% to ciprofloxacin, and 34.05% to amikacin. Meanwhile, Klebsiella spp had resistance rates of 48.29% to imipenem, 72.03% to ceftazidime, 61.78% to ciprofloxacin, and 40.32% to amikacin. Coagulase-negative Staphylococci and Staphylococcus aureus displayed oxacillin resistance in 81.33% and 53.83% of cases, respectively. CONCLUSIONS The high rates of DA-HAI and bacterial resistance emphasize the ongoing need for continued efforts to control them.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA; Department of Infection Prevention, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | | | - Sara E Rivera-Molina
- Department of Infection Prevention, Hospital Maria Especialidades Pediátricas, Tegucigalpa, Honduras
| | - Somani Jyoti
- Department of Infection Prevention, National University Hospital, Singapore, Singapore
| | - Reshma Dongol
- Department of Infection Prevention, Grande International Hospital, Kathamandu, Nepal
| | - Daisy Aguilar-De-Moros
- Department of Infection Prevention, Hospital Del Nino Dr Jose Renan Esquivel De Panama, Panama, Panama
| | - Nellie Tumu
- Department of Infection Prevention, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Johana Alarcon-Rua
- Department of Infection Prevention, Clinica Sebastian De Belalcazar, Cali, Colombia
| | - Juan P Stagnaro
- Department of Infection Prevention, Instituto Central De Medicina, Provincia De Buenos Aires, La Plata, Argentina
| | - Safaa Alkhawaja
- Department of Infection Prevention, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Yuliana A Cano-Medina
- Department of Infection Prevention, Instituto Del Corazon De Bucaramanga, Bogota, Colombia
| | - Sandra L Valderrama-Beltran
- Department of Infection Prevention, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Claudia M Henao-Rodas
- Department of Infection Prevention, Department of Infection Prevention, Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
| | - Maria A Zuniga-Chavarria
- Department of Infection Prevention, Hospital Clinica Biblica, San Jose De Costa Rica, Costa Rica
| | - Amani El-Kholy
- Department of Infection Prevention, Dar Alfouad Hospital 6th Of October City, 6th Of October City, Egypt
| | - Hala Mounir Agha
- Department of Infection Prevention, Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | - Suneeta Sahu
- Department of Infection Prevention, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | - Siksha O Anusandhan
- Department of Infection Prevention, IMS And SUM Hospital, Bhubaneswar, India
| | - Mahuya Bhattacharyya
- Department of Infection Prevention, Advanced Medicare Research Institute Dhakuria Unit, Kolkata, India
| | - Mohit Kharbanda
- Department of Infection Prevention, Desun Hospital & Heart Institute Kolkata, Kolkata, India
| | - Aruna Poojary
- Department of Microbiology, Breach Candy Hospital Trust, Mumbai, India
| | - Pravin K Nair
- Department of Infection Prevention, Holy Spirit Hospital, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Infection Prevention, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Infection Prevention, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Infection Prevention, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Farid Zand
- Department of Infection Prevention, Nemazee Hospital Shiraz University Of Medical Sciences, Shiraz, Iran
| | | | - Chian-Wern Tai
- Department of Infection Prevention, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Chin S Gan
- Department of Infection Prevention, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Infection Prevention, International Islamic University Malaysia Department Of Anesthesia And Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Blanca E Hernandez-Chena
- Department of Infection Prevention, Hospital General Regional 6 De Ciudad Madero, Madero, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Prevention, Hospital Regional De Alta Especialidad De Ixtapaluca, Ixtapaluca, Mexico
| | - Isabel Villegas-Mota
- Department of Infection Prevention, Instituto Nacional De Perinatologia Unidad De Cuidados Intensivos Neonatales, Mexico City, Mexico
| | - Mary C Aleman-Bocanegra
- Department of Infection Prevention, Hospital San José De Monterrey Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ider Bat-Erdene
- Department of Infection Prevention, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Nilton Y Carreazo
- Department of Infection Prevention, Hospital De Emergencias Pediatricas, Lima, Peru
| | | | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - Vladislav Belskiy
- Department of Infection Prevention, Privolzhskiy District Medical Center, Nizhniy Novgorod, Russia
| | - Sona Hlinkova
- Department of Infection Prevention, Catholic University In Ruzomberok Faculty Of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Infection Prevention, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Merve Havan
- Department of Infection Prevention, Ankara University Faculty Of Medicine, Ankara, Turkey
| | - Alper Koker
- Department of Infection Prevention, Akdeniz University Medical School, Antalya, Turkey
| | - Hulya Sungurtekin
- Department of Infection Prevention, Pamukkale University Hospital, Denizli, Turkey
| | - Ener C Dinleyici
- Department of Infection Prevention, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ertugrul Guclu
- Department of Infection Prevention, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Lili Tao
- Department of Infection Prevention, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziad A Memish
- Department of Infection Prevention, King Saud Medical City, Ministry of Health, Riyadh, Arabia
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
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Zou X, Zhou X, Lei T. Enhancing the efficacy of hospital infection management using the tool of quality control circle. Asian J Surg 2023; 46:5555-5556. [PMID: 37596218 DOI: 10.1016/j.asjsur.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023] Open
Affiliation(s)
- Xumin Zou
- Department of Hospital Infection-Control, Wuyi County Hospital of Traditional Chinese Medicine, Wuyi, Zhejiang, 321200, PR China.
| | - Xinyang Zhou
- Department of General Surgery, The First People's Hospital of Wuyi County, Wuyi, Zhejiang, 321200, PR China
| | - Taoying Lei
- Department of Surgical Nursing, The First People's Hospital of Wuyi County, Wuyi, Zhejiang, 321200, PR China
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Morgado SM, Fonseca ÉL, Freitas FS, Bighi NS, Oliveira PPC, Monteiro PM, Lima LS, Santos BP, Sousa MAR, Assumpção AO, Mascarenhas LA, Vicente ACP. Outbreak of high-risk XDR CRAB of international clone 2 (IC2) in Rio Janeiro, Brazil. J Glob Antimicrob Resist 2023; 34:91-98. [PMID: 37419183 DOI: 10.1016/j.jgar.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Among the high-risk clones of Acinetobacter baumannii, called international clones (ICs), IC2 represents the main lineage causing outbreaks worldwide. Despite the successful global spread of IC2, the occurrence of IC2 is rarely reported in Latin America. Here, we aimed to evaluate the susceptibility and genetic relatedness of isolates from a nosocomial outbreak in Rio de Janeiro/Brazil (2022) and perform genomic epidemiology analyses of the available genomes of A. baumannii. METHODS Sixteen strains of A. baumannii were subjected to antimicrobial susceptibility tests and genome sequencing. These genomes were compared phylogenetically with other IC2 genomes from the NCBI database, and virulence and antibiotic resistance genes were searched. RESULTS The 16 strains represented carbapenem-resistant A. baumannii (CRAB) with an extensively drug-resistant profile. In silico analysis established the relationship between the Brazilian CRAB genomes and IC2/ST2 genomes in the world. The Brazilian strains belonged to three sub-lineages, associated with genomes from countries in Europe, North America, and Asia. These sub-lineages presented three distinct capsules, KL7, KL9, and KL56. The Brazilian strains were characterised by the co-presence of blaOXA-23 and blaOXA-66, in addition to the genes APH(6), APH(3"), ANT(3"), AAC(6'), armA, and the efflux pumps adeABC and adeIJK. A large set of virulence genes was also identified: adeFGH/efflux pump; the siderophores barAB, basABCDFGHIJ, and bauBCDEF; lpxABCDLM/capsule; tssABCDEFGIKLM/T6SS; and pgaABCD/biofilm. CONCLUSION Widespread extensively drug-resistant CRAB IC2/ST2 is currently causing outbreaks in clinical settings in southeastern Brazil. This is due to at least three sub-lineages characterised by an enormous apparatus of virulence and resistance to antibiotics, both intrinsic and mobile.
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Affiliation(s)
- Sérgio M Morgado
- Laboratory of Molecular Genetics of Microorganisms, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Érica L Fonseca
- Laboratory of Molecular Genetics of Microorganisms, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Fernanda S Freitas
- Laboratory of Molecular Genetics of Microorganisms, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Nathalia S Bighi
- Laboratory of Molecular Genetics of Microorganisms, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Priscila P C Oliveira
- Hospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Priscilla M Monteiro
- Hospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Lorena S Lima
- Hospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Bianca P Santos
- Hospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Maria A R Sousa
- Hospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Adriana O Assumpção
- Hospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Luiz A Mascarenhas
- Hospital Infection Control Committee, São Francisco na Providência de Deus Hospital, Rio de Janeiro, Brazil
| | - Ana Carolina P Vicente
- Laboratory of Molecular Genetics of Microorganisms, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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7
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Dong X, Wang S, Ren K. Application of composite antibacterial nanoparticle non-woven fabric in sterilization of hospital infection. Prev Med 2023:107597. [PMID: 37385411 DOI: 10.1016/j.ypmed.2023.107597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
The use of disinfection materials and instruments is an important part of surgical operation. Hospital environment and surgical equipment need comprehensive sterilization treatment. This process is the key to the success of the operation, and it is also one of the first ways to control the hospital to avoid infection during the operation. The selection of scientific and reasonable sterilization methods for infection will directly affect the safety of medical treatment. In order to improve the antibacterial properties of medical non-woven fabrics, this paper combines two antibacterial methods of sterilization and antibacterial adhesion, and uses the principle of nanotechnology to design that the non-woven fabrics have good blood compatibility in the sterilization process. Then, a new composite antibacterial nanoparticle antibacterial solution is prepared from the synthesized nano‑silver solution, and the antibacterial solution is attached to the non-woven fabric, so that the nano‑silver particles with antibacterial effect are fixed on the surface of the fabric, and its antibacterial effect is measured through the antibacterial test, and excellent hospital infection sterilization technology is prepared and applied to the non-woven fabric products. The fusion experiment of platelets and red blood cells shows that the prepared surface technology combined with antibacterial adhesion and sterilization can effectively fuse with platelets and red blood cells, and can also effectively prevent the adhesion of platelets and red blood cells, and shows good blood compatibility, which is applicable to the sterilization process of hospital infection.
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Affiliation(s)
- Xin Dong
- Department of Disinfection Supply Center of the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
| | - Shuang Wang
- Department of Cardiovascular Medicine, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Kaiqi Ren
- Department of Disinfection Supply Center of the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
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8
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Steinle EC, Pinesso JAM, Bellançon LB, de Paula Ramos S, Seixas GF. The association of oral health with length of stay and mortality in the intensive care unit. Clin Oral Investig 2023:10.1007/s00784-023-05008-z. [PMID: 37017755 DOI: 10.1007/s00784-023-05008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES To analyze the relationship between the oral and systemic health status of adult patients admitted to the intensive care unit (ICU) with the length of stay and mortality. MATERIAL AND METHODS A daily oral examination and oral hygiene were performed in patients admitted to an adult ICU. Dental and oral lesions, systemic health status, the need for mechanical ventilation, length of stay, and mortality were registered. Multivariate linear and logistic regression analyses were performed to identify associations between length of stay and death of patients, respectively, with oral and systemic health status. RESULTS In total, 207 patients were included, 107 (51.7%) male. Ventilated patients presented an increased length of stay (p < 0.001), mortality (p < 0.0001), number of medications (p < 0.0001), edentulism (p = 0.001), mucous lesions and bleeding (p < 0.0001), oropharyngitis (p = 0.03), and drooling (p < 0.001) compared to non-ventilated patients. The number of days in the ICU was associated with mechanical ventilation (p = 0.04), nosocomial pneumonia (p = 0001), end-stage renal disease (p < 0.0007), death (p < 0.0001), mucous bleeding (p = 0.01), tongue coating (p = 0.001), and cheilitis (p = 0.01). Mortality was associated with length of stay in the ICU (p < 0.0001), number of medications (p < 0.0001), and the need for mechanical ventilation (p = 0.006). CONCLUSION ICU patients present poor oral health. Soft tissue biofilm and mucous ulcerations were associated with the length of stay in the ICU, but not with the mortality rate. CLINICAL RELEVANCE Mucous lesions are associated with an increased length of stay in the ICU, and critically ill patients should receive oral care to control oral foci of infection and mucous lesions.
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Affiliation(s)
- Erika Caroline Steinle
- Research Group On Tissue Regeneration, Adaptation, and Repair, Center of Biological Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Jessica Antonia Montovani Pinesso
- Research Group On Tissue Regeneration, Adaptation, and Repair, Center of Biological Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Leonardo Bernardi Bellançon
- Research Group On Tissue Regeneration, Adaptation, and Repair, North Parana University, Rua Marselha, Londrina, 678, Brazil
| | - Solange de Paula Ramos
- Research Group On Tissue Regeneration, Adaptation, and Repair, Center of Biological Sciences, State University of Londrina, Londrina, PR, Brazil
| | - Gabriela Fleury Seixas
- Research Group On Tissue Regeneration, Adaptation, and Repair, North Parana University, Rua Marselha, Londrina, 678, Brazil.
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Agnew E, Davies KA, Viprey VF, Evans S, Davis GL, Hope R, Wilcox MH, Wingen-Heimann SM, Robotham JV. Impact of testing on Clostridioides difficile infection in hospitals across Europe: a mathematical model. Clin Microbiol Infect 2023:S1198-743X(23)00057-5. [PMID: 36773769 DOI: 10.1016/j.cmi.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES The prevalence of Clostridioides difficile infection (CDI) has been shown to vary markedly between European countries, both in hospitals and in the community. Determining the true prevalence has proven challenging. Without systematic testing in hospitals, the unchecked transmission of CDI can lead to large outbreaks in more susceptible cohorts. We investigate the success of CDI surveillance and control measures across Europe, by examining the dynamics of disease spread from the community into a hospital setting. We focus on national differences, such as variability in testing and sampling, disease prevalence in communities and hospitals, and antimicrobial usage. METHODS We developed a stochastic, compartmental, dynamic mathematical model parameterized using sampling and testing rate data from COMBACTE-CDI, a multicountry study in which all diarrhoeal stool samples (N = 3163) from European laboratories were tested for CDI, and data for antimicrobial usage and incidence of hospital cases sourced from the European Centre for Disease Prevention and Control. RESULTS The framework estimates the prevalence of CDI among hospital patients across European countries and explores how national differences impact the dynamics, transmission, and relative incidence of CDI within the hospital setting. The model illustrates the mechanisms influencing these national differences, namely, antimicrobial usage rates, national sampling and testing rates, and community prevalence of CDI. DISCUSSION Differential costs for testing and practicalities of scaling up testing mean every country needs to consider balancing CDI testing costs against the costs of treatment and care of patients with CDI.
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Affiliation(s)
- Emily Agnew
- Healthcare Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK.
| | - Kerrie A Davies
- COMBACTE-CDI European Coordinator Laboratory, Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK; European Society of Clinical Microbiology and Infectious Diseases Study Group for Clostridioides difficile, UK
| | - Virginie F Viprey
- COMBACTE-CDI European Coordinator Laboratory, Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Stephanie Evans
- Healthcare Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - Georgina L Davis
- COMBACTE-CDI European Coordinator Laboratory, Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Russell Hope
- Healthcare Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
| | - Mark H Wilcox
- COMBACTE-CDI European Coordinator Laboratory, Healthcare Associated Infections Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK; European Society of Clinical Microbiology and Infectious Diseases Study Group for Clostridioides difficile, UK
| | - Sebastian M Wingen-Heimann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; FOM University of Applied Sciences, Cologne, Germany
| | - Julie V Robotham
- Healthcare Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
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Boglione L, Corcione S, Shbaklo N, Lupia T, Scabini S, Mornese Pinna S, Borrè S, De Rosa FG. Predictors of mortality in patients with COVID-19 infection in different health-care settings: A retrospective analysis from a CORACLE study group. Infect Dis Health 2023; 28:3-9. [PMID: 35750606 PMCID: PMC9192942 DOI: 10.1016/j.idh.2022.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Despite the large number of hospitalized patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, few data are available about risk factors and mortality in subjects with nosocomially acquired respiratory infection of Coronavirus Disease 2019 (COVID-19). METHODS We retrospectively evaluated in a multicentric study -during the pre-vaccination era-all patients admitted with confirmed diagnosis of nosocomial COVID-19 (NC). Patients were classified according to provenance: hospital-acquired NC or long-term care (LTC) facilities. RESULTS Among overall 1047 patients evaluated with COVID-19, 137 had a confirmed diagnosis of NC (13%). 78 (56.9%) patients had hospital-acquired NC and 59 (43%) had LTC NC. Overall mortality was 35.8%, in hospital-acquired NC 24.4%, in LTC NC 50.8% (p < 0.001) (Log Rank test: p = 0.001). Timing of diagnosis was significantly different between hospital acquired and LTC NC (3.5 vs 10 days, p < 0.001). In multivariate analysis age, intensive-care unit admission, LTC provenance and sepsis were significant predictors of mortality in patients with NC infection. CONCLUSION Patients with NC are at higher risk of mortality (especially for LTC NC) and required preventive strategies, early diagnosis, and treatment to avoid COVID-19 cluster.
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Affiliation(s)
- Lucio Boglione
- University of Eastern Piedmont, Department of Translational Medicine, Novara, Italy.
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy; Tufts University School of Medicine, Boston, MA, USA
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, Italy
| | | | - Silvio Borrè
- Saint Andrea Hospital, Unit of Infectious Diseases, Vercelli, Italy
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Rosenthal VD, Yin R, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jimenez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Oñate JM, Aguilar-De-Moros D, Castaño-Guerra E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Xotlanihua LL, Aguilar-Moreno LA, Ojeda JSB, Tobar IFG, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Jin Z. Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections. J Epidemiol Glob Health 2022; 12:504-515. [PMID: 36197596 DOI: 10.1007/s44197-022-00069-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. METHODS A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. RESULTS Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06-1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15-1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01-1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02-1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01-1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96-7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11-1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10-4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27-1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24-1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59-1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68-7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14-5.65; p < 0.0001); and others. CONCLUSION Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. .,INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Nino Dr Jose Renan Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Nakade J, Nakamura Y, Katayama Y, Obata H, Takahashi Y, Zaimoku Y, Fujii Y, Iwata Y. Systematic active environmental surveillance successfully identified and controlled the Legionella contamination in the hospital. J Infect Chemother 2022; 29:43-47. [PMID: 36162645 DOI: 10.1016/j.jiac.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Legionella disease can manifest as severe respiratory tract infection with a high mortality rate and is sometimes associated with a hospital outbreak by a contaminated water supply. A patient with breast cancer admitted about a month before. High fever was observed 18 days after admission and the Legionella antigen test showed the positive result. METHODS Due to the incidence of Legionella infection, we demonstrated the active surveillance of Legionella contamination in the entire hospital. RESULTS Cultures of her environmental samples revealed that hot water in two bathrooms were contaminated with Legionella. In our hospital, the hot water is heated and pumped up on the roof and distributed to each room. The contaminated bathrooms were related to the same plumbing. Therefore, we further collected samples throughout the hot water system. Legionella was not detected in the central part of the system. However, we detected Legionella in the hot water sampled from other five rooms, which were also associated with the same plumbing of the two bathrooms. The temperature and chlorine concentration of the hot water were not high enough to inactivate Legionella at the end of the plumbing. After the adjustment of the water temperature and chlorine concentration, Legionella became undetectable. Our prompt and active surveillance successfully identified the plumbing of the hot water system as the source of Legionella contamination and took precautions against future outbreaks. CONCLUSIONS Monitoring of water temperature and chloride concentration at the end of the hot water circulation is important to prevent nosocomial Legionella disease.
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Affiliation(s)
- Junya Nakade
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoko Nakamura
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan; Division of Nursing, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yusuke Katayama
- Division of Nursing, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Obata
- Facilities Department, Takara-machi Facility Support Office, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshinori Takahashi
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Rheumatology, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitaka Zaimoku
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hematology, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yumi Fujii
- Department of Breast Surgery, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yasunori Iwata
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Nephrology and Laboratory Medicine, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan.
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Cunningham B, O'Neill V, Devereux M, McGann D, O'Hora J. Use of a door handle disinfection system to reduce the risks associated with microbial loads on fomites in a healthcare setting. J Hosp Infect 2022; 130:104-107. [PMID: 36113634 DOI: 10.1016/j.jhin.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022]
Abstract
Pathogenic organisms, including those that are multi-drug resistant, can survive for extended periods of time on surfaces. Numerous studies show that contaminated hand-touch sites, such as door handles, pose a serious risk for onward transfer to patients. Such surfaces, because of their frequent and common use, do not always receive sufficient cleaning attention. A proposed level of ≤2.5 colony forming units (Cfu's)/cm2 on fomites, could result in fewer transmissions. A door handle disinfection system, utilising an atomising pump (non-aerosol), automatically delivers a pulse of disinfectant to a door handle each time the door is used. Microbial levels on the handles of frequently used door locations, in a busy Rehab unit of an Orthopaedic Hospital were monitored over a 16-week period, to compare microbial loads with and without a door handle disinfection system in place. A sample of two disinfectant types, Steri-7 (Broad spectrum disinfectant) and Dew (Hypochlorous acid), were used in the study. A level of ≤2.5 Cfu/cm2 was recorded on 93% of samples collected where a door handle disinfection system was in use, with 66% of samples showing no microbes recovered. Where a level of >2.5 Cfu/cm2 was recorded, the door handle disinfection system reduced this to a negligible level by the time the next sample was taken, compared with several days where no system was in place. Door handle disinfection systems offer an effective solution to reducing microbial levels on frequently and commonly touched door handles, as an automated solution with minimal additional costs to resources.
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Affiliation(s)
| | - Vikki O'Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK.
| | | | - Dearbhla McGann
- National Orthopaedic Hospital Cappagh, Dublin, Republic of Ireland.
| | - Jane O'Hora
- National Orthopaedic Hospital Cappagh, Dublin, Republic of Ireland.
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14
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Wang K, Ho KF, Leung LYT, Chow KM, Cheung YY, Tsang D, Lai RWM, Xu RH, Yeoh EK, Hung CT. Risk of air and surface contamination of SARS-CoV-2 in isolation wards and its relationship with patient and environmental characteristics. Ecotoxicol Environ Saf 2022; 241:113740. [PMID: 35687998 PMCID: PMC9167918 DOI: 10.1016/j.ecoenv.2022.113740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 05/06/2023]
Abstract
Air and surface contamination of the SARS-CoV-2 have been reported by multiple studies. However, the evidence is limited for the change of environmental contamination of this virus in the surrounding of patients with COVID-19 at different time points during the course of disease and under different conditions of the patients. Therefore, this study aims to understand the risk factors associated with the appearance of SARS-CoV-2 through the period when the patients were staying in the isolation wards. In this study, COVID-19 patients admitted to the isolation wards were followed up for up to 10 days for daily collection of air and surface samples in their surroundings. The positivity rate of the environmental samples at different locations was plotted, and multiple multi-level mixed-effect logistic regressions were used to examine the association between the positivity of environmental samples and their daily health conditions and environmental factors. It found 6.6 % of surface samples (133/2031 samples) and 2.1 % of air samples (22/1075 samples) were positive, and the positivity rate reached to peak during 2-3 days after admission to the ward. The virus was more likely to present at bedrail, patients' personal items and medical equipment, while less likely to be detected in the air outside the range of 2 m from the patients. It also revealed that higher positivity rate is associated with lower environmental temperature, fever and cough at the day of sampling, lower Ct values of latest test for respiratory tract samples, and pre-existing respiratory or cardiovascular conditions. The finding can be used to guide the hospital infection control strategies by identifying high-risk areas and patients. Extra personal hygiene precautions and equipment for continuously environmental disinfection can be used for these high-risk areas and patients to reduce the risk of hospital infection.
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Affiliation(s)
- Kailu Wang
- Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kin-Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Larry Yung-Tim Leung
- Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. 999077, Hong Kong, China
| | - Yuk-Yam Cheung
- Public Health Laboratory Centre, Centre for Health Protection, Kowloon 999077, Hong Kong, China
| | - Dominic Tsang
- Public Health Laboratory Centre, Centre for Health Protection, Kowloon 999077, Hong Kong, China
| | - Raymond Wai-Man Lai
- Department of Microbiology, Prince of Wales Hospital, Shatin, N.T. 999077, Hong Kong, China
| | - Richard Huan Xu
- Department of Rehabilitation Science, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Chi-Tim Hung
- Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China.
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Kito Y, Kuwabara K, Ono K, Kato K, Yokoi T, Horiguchi K, Kato K, Hirose M, Ohara T, Goto K, Nakamura Y, Koike Y, Horiguchi T. Seasonal variation in the prevalence of Gram-negative bacilli in sputum and urine specimens from outpatients and inpatients. Fujita Med J 2022; 8:46-51. [PMID: 35520292 PMCID: PMC9069267 DOI: 10.20407/fmj.2021-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
Objectives To determine whether the prevalence of gram-negative bacilli (GNB; Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli) in sputum and urine specimens from outpatients and inpatients differed by season and according to temperature and humidity changes. Methods In this retrospective study, microbiologic data for adult patients from 2008 to 2019 were retrieved from the electronic database of a hospital in Japan. Data were categorized by specimen type (sputum and urine) and specimen collection (outpatient and inpatient). Associations between variables were assessed using Spearman's rank correlation coefficients. Differences between groups were assessed using Pearson's chi-square test and analysis of discrete variance. Results Among inpatients, the frequencies of P. aeruginosa and K. pneumoniae isolation from sputum specimens were higher in summer and autumn. The frequency of P. aeruginosa isolation from urine specimens was higher in autumn. These seasonal trends were observed in specimens from both outpatients and inpatients. No seasonal trend was observed in the frequency of E. coli isolation. Mean monthly temperature was positively correlated with the frequency of isolating P. aeruginosa (r=0.2198, p=0.0081) and K. pneumoniae (r=0.3443, p=0.00002) from sputum as well as with the frequency of isolating K. pneumoniae (r=0.1905, p=0.0222) from urine. Mean monthly humidity was positively correlated with the frequency of isolating K. pneumoniae (r=0.2602, p=0.0016) from sputum. Conclusions GNB were isolated more frequently in summer and autumn than in other seasons. These seasonal trends were observed for both outpatient and inpatient specimens. Seasonality should be considered for optimal infection control of GNB in hospitals.
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Affiliation(s)
- Yusuke Kito
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Kazunobu Kuwabara
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Kiyotaka Ono
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Kenichi Kato
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Tatsuyoshi Yokoi
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Kohki Horiguchi
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Keisuke Kato
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Hirose
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
| | - Tomomi Ohara
- Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Kenta Goto
- Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yumi Nakamura
- Department of Clinical Laboratory, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yoshikatsu Koike
- Pharmaceutical Department, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Takahiko Horiguchi
- Department of Respiratory Medicine II, Fujita Health University, School of Medicine, Nagoya, Aichi, Japan
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Habibi N, Uddin S, Behbehani M, Abdul Razzack N, Zakir F, Shajan A. SARS-CoV-2 in hospital air as revealed by comprehensive respiratory viral panel sequencing. Infect Prev Pract 2022; 4:100199. [PMID: 34977533 PMCID: PMC8711137 DOI: 10.1016/j.infpip.2021.100199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nosocomially acquired severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection has become the most significant pandemic of our lifetime. Though its transmission was essentially attributed to droplets from an infected person, with recent advancements in knowledge, aerosol transmission seems to be a viable pathway, as well. Because of the lower biological load in ambient aerosol, detection of SARS-CoV-2 is challenging. A few recent attempts of sampling large aerosol volumes and using next-generation sequencing (NGS) to detect the presence of SARS-CoV-2 in the air at very low levels gave positive results. These results suggest the potential of using this technique to detect the presence of SARS-CoV-2 and use it as an early warning signal for possible outbreak or recurrence of coronavirus disease 2019 (COVID-19). AIM To assess efficacy of comprehensive respiratory viral panel (CRVP) sequencing and RT-PCR for low-level identification of SARS-CoV-2 and other respiratory viruses in indoor air. METHODS A large volume of indoor aerosol samples from three major hospitals involved in COVID-19 care in Kuwait was collected. Viral RNA was isolated and subjected to comprehensive respiratory viral panel sequencing (CRVP) as per the standard protocol to detect the SARS-CoV-2 and other respiratory viruses in the hospital aerosol and monitor variations within the sequences. RT-PCR was also employed to estimate the viral load of SARS-CoV-2. FINDINGS 13 of 15 (86.7%) samples exhibited SARS-CoV-2 with a relative abundance of 0.2-33.3%. The co-occurrence of human adenoviruses (type C1, C2, C5, C4), respiratory syncytial virus (RSV), influenza B, and non-SARS-CoV-229E were also recorded. Alignment of SARS-CoV-2 sequences against the reference strain of Wuhan China revealed variations in the form of single nucleotide polymorphisms (SNPs-17), insertions and deletions (indels-1). These variations were predicted to create missense (16), synonymous (15), frameshift (1) and stop-gained (1) mutations with a high (2), low (15), and moderate (16) impact. CONCLUSIONS Our results suggest that using CRVP on a large volume aerosol sample was a valuable tool for detecting SARS-CoV-2 in indoor aerosols of health care settings. Owing to its higher sensitivity, it can be employed as a surveillance strategy in the post COVID times to act as an early warning system to possibly control future outbreaks.
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Affiliation(s)
- Nazima Habibi
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Saif Uddin
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Montaha Behbehani
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Nasreem Abdul Razzack
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Farhana Zakir
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
| | - Anisha Shajan
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait
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Chirico F, Nucera G, Sacco A, Taino G, Szarpak L, Imbriani M. Protecting hospitals from SARS-CoV-2 infection: A review-based comprehensive strategy for COVID-19 prevention and control. G Ital Med Lav Ergon 2022; 44:32-40. [PMID: 36346297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 05/18/2023]
Abstract
SUMMARY SARS-CoV-2-related infection can determine hospital-acquired infections among patients and healthcare workers. Aim of this paper was to review the literature for developing a strategy for protecting healthcare workers, patients, and visitors by COVID-19 hospital infection. A critical and rapid revision of the literature and international standards and Regulations on this topic allowed us to propose an evidencebased strategy in the framework of the workplace risk assessment for preventing nosocomial COVID-19 outbreaks. The virus' high transmissibility, the high prevalence of asymptomatic carriers and false-negative Covid-19 rates on naso- and oropharingeal swabs, put hospitals at high-risk of COVID-19 outbreaks. A comprehensive strategy based on standard precautions, administrative, environmental, and engineering controls, a screening protocol for patients on their admission to hospital, and a testing-based strategy for HCWs within health surveillance programs may prevent the onset of hospital outbreaks, which are a threat to community, patients and HCWs, compromising the sustainability of healthcare facilities.
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Affiliation(s)
- Francesco Chirico
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Sanitario Polifunzionale di Milano, Health Service Department, Italian State Police, Ministry of the Interior, Italy
| | - Gabriella Nucera
- Faculty of Medicine and Surgery, Nursing Science, University of Milan, Italy
- ASST Fatebenefratelli e Sacco, FatebeneFratelli Hospital, Department of Emergency, Milan, Italy
| | - Angelo Sacco
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- ASL Rome 2, Rome, Italy
| | - Giuseppe Taino
- IRCCS S. Maugeri Foundation, Hospital Unit of Occupational Medicine (UOOML), Pavia, Italy
| | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland and Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Marcello Imbriani
- IRCCS S. Maugeri Foundation, Hospital Unit of Occupational Medicine (UOOML), Pavia, Italy
- Department of Public Health, Experimental Medicine and Forensic, University of Pavia, Pavia, Italy
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Rosenthal VD, Myatra SN, Divatia JV, Biswas S, Shrivastava A, Al-Ruzzieh MA, Ayaad O, Bat-Erdene A, Bat-Erdene I, Narankhuu B, Gupta D, Mandal S, Sengupta S, Joudi H, Omeis I, Agha HM, Fathallala A, Mohahmed EH, Yesiler I, Oral M, Ozcelik M, Mehta Y, Sarma S, Chatterjee S, Belkebir S, Kanaa A, Jeetawi R, Mclaughlin SA, Shultz JM, Bearman G, Jin Z, Yin R. The impact of COVID-19 on health care-associated infections in intensive care units in low- and middle-income countries: International Nosocomial Infection Control Consortium (INICC) findings. Int J Infect Dis 2022; 118:83-8. [PMID: 35218928 DOI: 10.1016/j.ijid.2022.02.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study examines the impact of the COVID-19 pandemic on health care–associated infection (HAI) incidence in low- and middle-income countries (LMICs). Methods Patients from 7 LMICs were followed up during hospital intensive care unit (ICU) stays from January 2019 to May 2020. HAI rates were calculated using the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System applying the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) criteria. Pre–COVID-19 rates for 2019 were compared with COVID-19 era rates for 2020 for central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), mortality, and length of stay (LOS). Results A total of 7,775 patients were followed up for 49,506 bed days. The 2019 to 2020 rate comparisons were 2.54 and 4.73 CLABSIs per 1,000 central line days (risk ratio [RR] = 1.85, p = .0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR = 1.29, p = .10), and 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR = 1.14; p = .69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR = 1.42; p < .0001), respectively. Mean LOS for 2019 and 2020 were 6.02 and 7.54 days (RR = 1.21, p < .0001), respectively. Discussion This study documents an increase in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices.
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Di Mento G, Gona F, Russelli G, Cuscino N, Barbera F, Carreca AP, Di Carlo D, Cardinale F, Monaco F, Campanella M, Mularoni A, Grossi P, Conaldi PG, Douradinha B. A retrospective molecular epidemiological scenario of carbapenemase-producing Klebsiella pneumoniae clinical isolates in a Sicilian transplantation hospital shows a swift polyclonal divergence among sequence types, resistome and virulome. Microbiol Res 2021; 256:126959. [PMID: 34995971 DOI: 10.1016/j.micres.2021.126959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/24/2022]
Abstract
In this work, we assessed and characterized the epidemiological scenario of carbapenem-resistant Klebsiella pneumoniae strains (CR-Kp) at IRCCS-ISMETT, a transplantation hospital in Palermo, Italy, from 2008 to 2017. A total of 288 K. pneumoniae clinical isolates were selected based on their resistance to carbapenems. Molecular characterization was also done in terms of the presence of virulence and resistance genes. All patients were inpatients from our facility and clinical isolates were collected from several sources, either from infection or colonization cases. We observed that, in agreement with the Italian epidemiological scenario, initially only ST258 and ST512 clade II (but not from clade I) were identified from 2008 to 2011. From 2012 onwards, other STs have been observed, including the clinically relevant ST101 and ST307, but also others not previously observed in other Italian health settings, such as ST220 and ST753. The presence of genes involved in resistance and virulence was confirmed, and a heterogeneous genetic resistance profile throughout the years was observed. Our work highlights that resistance genes are rapidly disseminating between different and novel K. pneumoniae clones which, combined with resistance to multiple antibiotics, can derive into more aggressive and pathogenic multidrug-resistant strains of clinical importance. Our results stress the importance of continuous surveillance of CR Enterobacterales in health facilities so that novel STs carrying resistance and virulence genes that may become increasingly pathogenic can be identified and adequate therapies to adopted to avoid their dissemination and derived pathologies.
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Affiliation(s)
- Giuseppina Di Mento
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Floriana Gona
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Giovanna Russelli
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Nicola Cuscino
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Floriana Barbera
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Anna Paola Carreca
- Unità di Medicina Rigenerativa ed Immunologia, Fondazione Ri.MED, Palermo, Italy
| | - Daniele Di Carlo
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Francesca Cardinale
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Francesco Monaco
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Maria Campanella
- Dipartimento per la Cura e lo Studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Alessandra Mularoni
- Dipartimento per la Cura e lo Studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Paolo Grossi
- Dipartimento di Malattie Infettive e Tropicali, Università di Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Pier Giulio Conaldi
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Bruno Douradinha
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy; Unità di Medicina Rigenerativa ed Immunologia, Fondazione Ri.MED, Palermo, Italy.
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Rosenthal VD, Duszynska W, Ider BE, Gurskis V, Al-Ruzzieh MA, Myatra SN, Gupta D, Belkebir S, Upadhyay N, Zand F, Todi SK, Kharbanda M, Nair PK, Mishra S, Chaparro G, Mehta Y, Zala D, Janc J, Aguirre-Avalos G, Aguilar-De-Morós D, Hernandez-Chena BE, Gün E, Oztoprak-Cuvalci N, Yildizdas D, Abdelhalim MM, Ozturk-Deniz SS, Gan CS, Hung NV, Joudi H, Omar AA, Gikas A, El-Kholy AA, Barkat A, Koirala A, Cerero-Gudiño A, Bouziri A, Gomez-Nieto K, Fisher D, Medeiros EA, Salgado-Yepez E, Horhat F, Agha HMM, Vimercati JC, Villanueva V, Jayatilleke K, Nguyet LTT, Raka L, Miranda-Novales MG, Petrov MM, Apisarnthanarak A, Tayyab N, Elahi N, Mejia N, Morfin-Otero R, Al-Khawaja S, Anguseva T, Gupta U, Belskii VA, Mat WRW, Chapeta-Parada EG, Guanche-Garcell H, Barahona-Guzmán N, Mathew A, Raja K, Pattnaik SK, Pandya N, Poojary AA, Chawla R, Mahfouz T, Kanj SS, Mioljevic V, Hlinkova S, Mrazova M, Al-Abdely HM, Guclu E, Ozgultekin A, Baytas V, Tekin R, Yalçın AN, Erben N. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2013-2018, Adult and Pediatric Units, Device-associated Module. Am J Infect Control 2021; 49:1267-1274. [PMID: 33901588 DOI: 10.1016/j.ajic.2021.04.077] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND We report the results of INICC surveillance study from 2013 to 2018, in 664 intensive care units (ICUs) in 133 cities, of 45 countries, from Latin-America, Europe, Africa, Eastern-Mediterranean, Southeast-Asia, and Western-Pacific. METHODS Prospective data from patients hospitalized in ICUs were collected through INICC Surveillance Online System. CDC-NHSN definitions for device-associated healthcare-associated infection (DA-HAI) were applied. RESULTS We collected data from 428,847 patients, for an aggregate of 2,815,402 bed-days, 1,468,216 central line (CL)-days, 1,053,330 mechanical ventilator (MV)-days, 1,740,776 urinary catheter (UC)-days. We found 7,785 CL-associated bloodstream infections (CLAB), 12,085 ventilator-associated events (VAE), and 5,509 UC-associated urinary tract infections (CAUTI). Pooled DA-HAI rates were 5.91% and 9.01 DA-HAIs/1,000 bed-days. Pooled CLAB rate was 5.30/1,000 CL-days; VAE rate was 11.47/1,000 MV-days, and CAUTI rate was 3.16/1,000 UC-days. P aeruginosa was non-susceptible (NS) to imipenem in 52.72% of cases; to colistin in 10.38%; to ceftazidime in 50%; to ciprofloxacin in 40.28%; and to amikacin in 34.05%. Klebsiella spp was NS to imipenem in 49.16%; to ceftazidime in 78.01%; to ciprofloxacin in 66.26%; and to amikacin in 42.45%. coagulase-negative Staphylococci and S aureus were NS to oxacillin in 91.44% and 56.03%, respectively. Enterococcus spp was NS to vancomycin in 42.31% of the cases. CONCLUSIONS DA-HAI rates and bacterial resistance are high and continuous efforts are needed to reduce them.
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Reichert F, Enninger A, Plecko T, Zoller WG, Paul G. Pooled SARS-CoV-2 antigen tests in asymptomatic children and their caregivers: Screening for SARS-CoV-2 in a pediatric emergency department. Am J Infect Control 2021; 49:1242-1246. [PMID: 34314758 PMCID: PMC8310391 DOI: 10.1016/j.ajic.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
Background Universal admission screening for SARS-CoV-2 in children and their caregivers (CG) is critical to prevent hospital outbreaks. We evaluated pooled SARS-CoV-2 antigen tests (AG) to identify infectious individuals while waiting for polymerase chain reaction (PCR) test results. Methods This single-center study was performed from November 5, 2020 to March 1, 2021. Nasal mid-turbinate and oropharyngeal swabbing for AG and PCR testing was performed in children with 2 individual swabs that were simultaneously inserted. Nasopharyngeal swabs were obtained from their CG. AG swabs were pooled in a single extraction buffer tube and PCR swabs in a single viral medium. Results from an adult population were used for comparison, as no pooled testing was performed. Results During the study period, 710 asymptomatic children and their CG were admitted. Pooled AG sensitivity and specificity was 75% and 99.4% respectively for detection of infectious individuals. Four false negatives were observed, though 3 out of 4 false negative child-CG pairs were not considered infectious at admission. Unpooled AG testing in an adult population showed a comparable sensitivity and specificity of 50% and 99.7%. AG performed significantly better in samples with lower Ct values in the corresponding PCR (32.3 vs 21, P-value < .001). Conclusions Pooled SARS-CoV-2 AGs are an effective method to identify potentially contagious individuals prior admission, without adding additional strain to the child.
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Marchese V, Formenti B, Cola G, Gregori N, Albini E, De Palma G, Possenti I, Scala M, Castelli F, Matteelli A. Importance of mitigation measures for hospital transmission of SARS-CoV-2 at the onset of the epidemic: the experience of Brescia, Northern Italy. Infection 2021; 49:1241-1248. [PMID: 34524648 PMCID: PMC8441227 DOI: 10.1007/s15010-021-01692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022]
Abstract
Purpose Since the first Italian case of SARS-CoV-2 was detected in Lombardy (Northern Italy) Italy quickly became one of the worst-affected European countries, with a severe impact on health-care workers (HCWs). In the first epidemic, HCWs accounted for 12% of all national COVID-19 cases. We evaluated the burden of COVID-19 among HCWs and other non-health-care workers (nHCWs) in a large Italian hospital. Methods From March 1st to May 31st 2020, we performed a retrospective study at ASST Civil Hospital, in the Province of Brescia, Lombardy. The study population included all hospital personnel (n = 9265), categorized by professional status. Results A SARS-CoV-2 test was performed in 3572 workers (38.5%), with a positive result in 552 (5.9% of all hospital personnel). The temporal trend of SARS-CoV-2 cases in hospital staff broadly reflected that in the community, with a great majority of infections occurred during March 2020 (87.7%). From April onward, a steep decrease of positive cases was observed among hospital personnel, while in the community the decrease was much slower. Medical doctors (8.9%) and nurses (8.5%) were the most affected professional categories with a significantly higher risk of SARS-CoV-2 infection (OR 1.436 and OR 1.410, respectively p < 0.0001). HCWs in COVID-19 units presented a significantly higher risk of infection compared to HCWs in non-COVID units (p < 0.001). Conclusion HCWs were severely affected by the COVID-19 epidemic, probably associated with an overwhelming burden of work and lack of preparedness in prevention of nosocomial transmission of the infection. The rapid decrease of COVID-19 spread in the hospital, registered before the one in the community, suggests that the adopted preventive measures were effective.
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Affiliation(s)
- Valentina Marchese
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Beatrice Formenti
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gloria Cola
- Department of Infectious and Tropical Diseases, University of Brescia, Piazza Spedali Civili, 1, 25125, Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia, Piazza Spedali Civili, 1, 25125, Brescia, Italy
| | - Elisa Albini
- Section of Occupational Health, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe De Palma
- Section of Public Health and Human Sciences, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Irene Possenti
- Department of Statistical Sciences "Paolo Fortunati", University of Bologna, Bologna, Italy
| | - Marco Scala
- Department of Environmental Health Sciences, Instituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Matteelli
- University Department of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV Collaborative Activities and for TB Elimination Strategy, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy.
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da Silva PP, da Silva FA, Rodrigues CAS, Souza LP, de Lima EM, Pereira MHB, Candella CN, de Oliveira Alves MZ, Lourenço ND, Tassinari WS, Barcellos C, Gomes MZR. Geographical information system and spatial-temporal statistics for monitoring infectious agents in hospital: a model using Klebsiella pneumoniae complex. Antimicrob Resist Infect Control 2021; 10:92. [PMID: 34134752 PMCID: PMC8207788 DOI: 10.1186/s13756-021-00944-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background The emergence and spread of antimicrobial resistance and infectious agents have challenged hospitals in recent decades. Our aim was to investigate the circulation of target infectious agents using Geographic Information System (GIS) and spatial–temporal statistics to improve surveillance and control of healthcare-associated infection and of antimicrobial resistance (AMR), using Klebsiella pneumoniae complex as a model. Methods A retrospective study carried out in a 450-bed federal, tertiary hospital, located in Rio de Janeiro. All isolates of K. pneumoniae complex from clinical and surveillance cultures of hospitalized patients between 2014 and 2016, identified by the use of Vitek-2 system (BioMérieux), were extracted from the hospital's microbiology laboratory database. A basic scaled map of the hospital’s physical structure was created in AutoCAD and converted to QGis software (version 2.18). Thereafter, bacteria according to resistance profiles and patients with carbapenem-resistant K. pneumoniae (CRKp) complex were georeferenced by intensive and nonintensive care wards. Space–time permutation probability scan tests were used for cluster signals detection. Results Of the total 759 studied isolates, a significant increase in the resistance profile of K. pneumoniae complex was detected during the studied years. We also identified two space–time clusters affecting adult and paediatric patients harbouring CRKp complex on different floors, unnoticed by regular antimicrobial resistance surveillance. Conclusions In-hospital GIS with space–time statistical analysis can be applied in hospitals. This spatial methodology has the potential to expand and facilitate early detection of hospital outbreaks and may become a new tool in combating AMR or hospital-acquired infection. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00944-5.
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Affiliation(s)
- Priscila Pinho da Silva
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz - Fundação Oswaldo Cruz, Avenida Brasil, 4365, Pavilhão Leônidas Deane, 6º andar, sala 607, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Fabiola A da Silva
- Department of Engineering, Hospital Federal Dos Servidores Do Estado (HFSE), Rio de Janeiro, RJ, Brazil.,Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | | | | | - Claudio Neder Candella
- Department of Engineering, Hospital Federal Dos Servidores Do Estado (HFSE), Rio de Janeiro, RJ, Brazil
| | | | | | - Wagner S Tassinari
- Department of Mathematics, The Federal Rural University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, Brazil
| | - Christovam Barcellos
- Institute of Scientific and Technological Communication and Information in Health, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
| | - Marisa Zenaide Ribeiro Gomes
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz - Fundação Oswaldo Cruz, Avenida Brasil, 4365, Pavilhão Leônidas Deane, 6º andar, sala 607, Rio de Janeiro, RJ, 21040-900, Brazil. .,Hospital Infection Control Committee, HFSE, Rio de Janeiro, RJ, Brazil.
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Rodriguez A, Arrizabalaga-Asenjo M, Fernandez-Baca V, Lainez MP, Al Nakeeb Z, Garcia JD, Payeras A. Seroprevalence of SARS-CoV-2 antibody among healthcare workers in a university hospital in Mallorca, Spain, during the first wave of the COVID-19 pandemic. Int J Infect Dis 2021; 105:482-486. [PMID: 33647507 PMCID: PMC7910131 DOI: 10.1016/j.ijid.2021.02.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To estimate the SARS-CoV-2 antibody seroprevalence in healthcare workers (HCWs) at a university hospital in Mallorca, Spain. METHODS All HCWs received an e-mail inviting them to take part in the study. Participants had a nasopharyngeal swab test performed for reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) and serological tests to detect SARS-CoV-2 antibodies (primary study). Additionally, they were invited to complete a questionnaire on their exposure to COVID-19 individuals and their COVID-19-related symptoms (secondary study). Prevalence of antibodies (IgG, IgM, or both) and 95% confidence intervals (CIs) were calculated. RESULTS Seventy-nine percent of the hospital's HCWs (N = 2210) took part in the primary study. Antibodies were detected in 61 participants, a prevalence of 2.8% (95% CI: 2.5-3.1). The prevalence was slightly higher in nurses (3.4%), registrars (3.9%), and wardens (3.4%). Thirty-nine percent of the primary study participants completed the secondary study questionnaire. Those with positive antibody test results had closer contact with COVID-19 individuals (60% vs. 92%; p < 0.001). CONCLUSION After the first wave of the COVID-19 pandemic in Spain, the seroprevalence of SARS-CoV-2 antibodies in our university hospital HCWs was around 2.8%, which is slightly higher than the seroprevalence in the general population in our region. We believe it would be advisable to perform additional seroprevalence studies during the second wave of the epidemic.
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Affiliation(s)
- Adrian Rodriguez
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain.
| | - Maria Arrizabalaga-Asenjo
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain; Research Group in Infectious Diseases and HIV, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Victoria Fernandez-Baca
- Microbiology Department, Son Llatzer University Hospital, Balearic Islands, Spain; Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Maria Pilar Lainez
- Department of Occupational Health, Son Llatzer University Hospital, Balearic Islands, Spain
| | - Zaid Al Nakeeb
- Medical Coordination, Son Llatzer University Hospital, Balearic Islands, Spain
| | - Jose Daniel Garcia
- Medical Coordination, Son Llatzer University Hospital, Balearic Islands, Spain
| | - Antoni Payeras
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain; Research Group in Infectious Diseases and HIV, Health Research Institute of the Balearic Islands (IdISBa), Spain
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25
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de Cássia Artuni Rossi M, Corrêa TQ, Blanco KC, Bagnato VS, Salvio AG. Physiotherapy elastic band disinfection by UV-C irradiation in an intensive care unit. Photodiagnosis Photodyn Ther 2021; 34:102262. [PMID: 33771756 DOI: 10.1016/j.pdpdt.2021.102262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/19/2021] [Accepted: 03/15/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The transmission of healthcare-associated pathogens is mainly related to the massive flow of patients with infections in hospitals, presenting surfaces as potential transmission sources of these microorganisms. The physiotherapist who works in the intensive care area has become a specialist in daily routine in critical care with ventilatory support and post-surgical recovery. Furthermore, for this, the instruments are used in the patient's hands and body. Chemicals such as chlorine derivatives, triclosan, chlorhexidine and, 70 % alcohol are currently used to decontaminate surfaces. This study evaluated ultraviolet C (UV-C) irradiation efficiency in the physiotherapy object's disinfection in daily use in the Hospital Intensive Care Unit (ICU). METHODS the microbiological quantification carried out using the elastic band during physiotherapy in a cross-sectional study with 21 patients. The methodology compared the cleaning protocol (70 % alcohol) with a new irradiation method in elastic band in the ICU. RESULTS The results showed microbial reductions in the elastic band using both 70 % alcohol and UV-C irradiation (254 nm), with 60 s of illumination, totaling a light dose of 0.78 J/cm2; however, the UV-C irradiation showed better results. CONCLUSION This study showed that disinfection by UV-C irradiation could be introduced in an intensive care hospital environment for physiotherapeutic conduct.
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Affiliation(s)
- Mariana de Cássia Artuni Rossi
- Physiotherapist of Amaral Carvalho Hospital, Jau, Sao Paulo, Brazil; Applied Biotechnology Laboratory, Sao Paulo State University-UNESP, Botucatu, Sao Paulo, Brazil
| | - Thaila Quatrini Corrêa
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil
| | - Kate Cristina Blanco
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil.
| | - Vanderlei Salvador Bagnato
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil
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Xu N, Liu C, Feng Y, Li F, Meng X, Lv Q, Lan C. Influence of the Internet of Things management system on hand hygiene compliance in an emergency intensive care unit. J Hosp Infect 2020; 109:101-106. [PMID: 33346043 DOI: 10.1016/j.jhin.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hand hygiene is a critical strategy for infection prevention in all healthcare settings. Automated electronic monitoring systems are expected to improve hand hygiene performance. AIM To investigate the impact of the Internet of Things (IoT) management system on hand hygiene compliance among medical staff in an emergency intensive care unit (EICU). METHODS This retrospective observational study was conducted between July 1st, 2017 and February 28th, 2018 in a 19-bed EICU. The changes in hand hygiene compliance among 54 members of medical staff and the incidence of hospital infections were compared, counted, and analysed before and after implementing the IoT management system in the EICU that was initiated on November 1st, 2017. FINDINGS After the application of the IoT management system, the hand hygiene compliance rates among the members of the medical staff before (29.5% (3347/11,338) vs 57.9% (4690/8094), P < 0.001) and after (59.9% (9915/16,556) vs 73.8% (17,194/23 286), P < 0.001) the contact with patients and surrounding environment significantly improved. However, hand hygiene compliance among three cleaning staff did not significantly improve after the application. Moreover, there was no significant difference in healthcare-acquired infection rates (2.535% (9/355) vs 2.047% (7/342), P = 0.667) nor in the detection rates of the four major multidrug-resistant bacteria in the EICU before and after the application of the IoT management system (P > 0.05). CONCLUSION The IoT management system significantly improved hand hygiene compliance among medical staff, except cleaners, in the EICU of one provincial hospital; however, the rates of nosocomial infection did not significantly decrease. The quality of hand hygiene implementation needs to be improved.
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Affiliation(s)
- N Xu
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - C Liu
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Y Feng
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - F Li
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - X Meng
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Q Lv
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - C Lan
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
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Lee KD, Lee SB, Lim JK, Kang YM, Kim IB, Moon HJ, Lee WJ. Providing essential clinical care for non-COVID-19 patients in a Seoul metropolitan acute care hospital amidst ongoing treatment of COVID-19 patients. J Hosp Infect 2020; 106:673-677. [PMID: 33011308 PMCID: PMC7528870 DOI: 10.1016/j.jhin.2020.09.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/14/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
We assessed infection control efforts by comparing data collected over 20 weeks during a pandemic under a dual-track healthcare system. A decline in non-COVID-19 patients visiting the emergency department by 37.6% (P<0.01) was observed since admitting COVID-19 cases. However, patients with acute myocardial infarction (AMI), stroke, severe trauma and acute appendicitis presenting for emergency care did not decrease. Door-to-balloon time (34.3 (± 11.3) min vs 22.7 (± 8.3) min) for AMI improved significantly (P<0.01) while door-to-needle time (55.7 (± 23.9) min vs 54.0 (± 18.0) min) in stroke management remained steady (P=0.80). Simultaneously, time-sensitive care involving other clinical services, including patients requiring chemotherapy, radiation therapy and haemodialysis did not change.
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Affiliation(s)
- K D Lee
- Department of Infectious Diseases, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - S B Lee
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - J K Lim
- Department of Laboratory Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Y M Kang
- Department of Infectious Diseases, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - I B Kim
- Department of Emergency Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - H J Moon
- New Horizon Cancer Institute, Myongji Hospital, Goyang, Republic of Korea
| | - W J Lee
- Department of General Surgery, Myongji Hospital, Goyang, Republic of Korea.
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Rosenthal VD, Gupta D, Rajhans P, Myatra SN, Muralidharan S, Mehta Y, Kharbanda M, Rodrigues C, Dwivedy A, Shah S, Poojary A, Todi SK, Chabukswar S, Bhattacharyya M, Ramachandran B, Ramakrishnan N, Purkayasta SK, Sakle AS, Kumar S, Warrier AR, Kavathekar MS, Sahu S, Mubarak A, Modi N, Jaggi N, Gita N, Mishra SB, Sahu S, Jawadwala B, Zala D, Zompa T, Mathur P, Nirkhiwale S, Vadi S, Singh S, Agarwal M, Sen N, Karlekar A, Punia DP, Kumar S, Gopinath R, Nair PK, Chakravarthy M, Sandhu K, Kambam C, Mohanty SK, Varaiya A, Pandya N, Subhedar VR, Vanajakshi MR, Singla D, Patel M. Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 204 intensive care units of 57 hospitals in 19 cities of India: International Nosocomial Infection Control Consortium (INICC) findings. Am J Infect Control 2020; 48:1001-8. [PMID: 32151486 DOI: 10.1016/j.ajic.2019.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied in developing countries, and data on their incidence by number of device-days are not available. METHODS Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013 to May 31, 2019 in 204 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 57 hospitals in 19 cities of India. We applied US INICC definition criteria and reported methods using the INICC Surveillance Online System. RESULTS We followed 7,513 ICU patients for 296,893 bed-days and 295,795 short term peripheral venous catheter (PVC)-days. We identified 863 PVCR-BSIs, amounting to a rate of 2.91/1,000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 4.14%, and 11.59% in patients with PVCR-BSI. The length of stay in patients with PVC but without PVCR-BSI was 4.13 days, and 5.9 days in patients with PVCR-BSI. The micro-organism profile showed 68% of gram negative bacteria: Escherichia coli (23%), Klebsiella spp (15%), Pseudomonas aeruginosa (5%), and others. The predominant gram-positive bacteria were Staphylococcus aureus (10%). CONCLUSIONS PVCR-BSI rates found in our ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs.
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Lima EM, Cid PA, Beck DS, Pinheiro LHZ, Tonhá JPS, Alves MZO, Lourenço ND, Santos RQ, Asensi MD, Marques JA, Bandeira CS, Rodrigues CAS, Gomes Junior SCS, Gomes MZR. Predictive factors for sepsis by carbapenem resistant Gram-negative bacilli in adult critical patients in Rio de Janeiro: a case-case-control design in a prospective cohort study. Antimicrob Resist Infect Control 2020; 9:132. [PMID: 32795380 PMCID: PMC7426895 DOI: 10.1186/s13756-020-00791-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Studies have investigated risk factors for infections by specific species of carbapenem-resistant Gram-negative bacilli (CR-GNB), but few considered the group of GNB species and most of them were performed in the setting of bacteremia or hospital infection. This study was implemented to identify risk factors for sepsis by CR- and carbapenem-susceptible (CS) GNB in intensive care unit (ICU) patients to improve management strategies for CR-GNB sepsis. Methods We developed a case-case-control study from a prospective cohort of patients with systemic inflammatory response syndrome (SIRS), sepsis-2 or sepsis-3 criteria in which blood and other sample cultures were collected and antimicrobial therapy was instituted, in an adult clinical-surgical ICU, at tertiary public hospital in Rio de Janeiro, from August 2015 through March 2017. Results Among the total of 629 ICU admissions followed by 7797 patient-days, after applying inclusion and exclusion criteria we identified 184 patients who developed recurrent or single hospital-acquired sepsis. More than 90% of all evaluable cases of sepsis and 87% of control group fulfilled the modified sepsis-3 definition. Non-fermenting bacilli and ventilator-associated pneumonia predominated as etiology and source of CR-GNB sepsis. While Enterobacteriaceae and intra-abdominal surgical site plus urinary-tract infections prevailed in CS-GNB than CR-GNB sepsis. Carbapenemase production was estimated in 76% of CR-GNB isolates. Multivariate logistic regression analysis revealed previous infection (mostly hospital-acquired bacterial infection or sepsis) (OR = 4.28; 95% CI 1.77–10.35), mechanical ventilation (OR = 4.21; 95% CI 1.17–15.18), carbapenem use (OR = 3.42; 95% CI 1.37–8.52) and length of hospital stay (OR = 1.03; 95% CI 1.01–1.05) as independent risk factors for sepsis by CR-GNB. While ICU readmission (OR = 6.92; 95% CI 1.72–27.78) and nosocomial diarrhea (OR = 5.32; 95% CI 1.07–26.45) were factors associated with CS-GNB sepsis. Conclusions The investigation of recurrent and not only bacteremic episodes of sepsis was the differential of this study. The results are in agreement with the basic information in the literature. This may help improve management strategies and future studies on sepsis by CR-GNB.
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Affiliation(s)
- Elisangela M Lima
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil.,Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Patrícia A Cid
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Debora S Beck
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Luiz Henrique Z Pinheiro
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - João Pedro S Tonhá
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Marcio Z O Alves
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Newton D Lourenço
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Roberto Q Santos
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Marise D Asensi
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - José Aurélio Marques
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Carolina S Bandeira
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Caio Augusto S Rodrigues
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | | | - Marisa Z R Gomes
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil. .,Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil. .,Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil.
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Robertson C, Pan J, Kavanagh K, Ford I, McCowan C, Bennie M, Marwick C, Leanord A. Cost burden of Clostridioides difficile infection to the health service: A retrospective cohort study in Scotland. J Hosp Infect 2020; 106:554-561. [PMID: 32717202 DOI: 10.1016/j.jhin.2020.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is associated with high healthcare demands and related costs. AIM To evaluate the healthcare and economic burden of CDI in hospitalized patients with community- (HOCA-CDI) or hospital-associated CDI (HOHA-CDI) in the National Health Service in Scotland. METHODS A retrospective cohort study was conducted, examining data between August 2010 and July 2013 from four patient-level Scottish datasets, linked to death data. Data examined included prior antimicrobial prescriptions in the community, hospitalizations, length of stay and mortality. Each CDI case was matched to three hospital-based controls on the basis of age, gender, hospital and date of admission. Descriptive economic evaluations were based on bed-day costs for different types of wards. FINDINGS Overall, 3304 CDI cases were included in the study. CDI was associated with additional median lengths of stay of 7.2 days for HOCA-CDI and 12.0 days for HOHA-CDI compared with their respective, matched controls. The 30-day mortality rate was 6.8% for HOCA-CDI and 12.4% for HOHA-CDI. Overall, recurrence within 90 days of the first CDI episode occurred in 373/2740 (13.6%) survivors. The median additional expenditure for each initial CDI case compared with matched controls was £1713. In the 6 months after the index hospitalization, the cost associated with a CDI case was £5126 higher than for controls. CONCLUSION Using routinely collected national data, we demonstrated the substantial burden of CDI on healthcare services, including lengthy hospital stays and readmissions, which increased the costs of managing patients with CDI compared with matched controls.
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Affiliation(s)
- C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - C McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Public Health and Intelligence, NHS National Services Scotland, Edinburgh, UK
| | - C Marwick
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - A Leanord
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK; NHS Greater Glasgow and Clyde, Glasgow, UK.
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Rosenthal VD, Bat-Erdene I, Gupta D, Rajhans P, Myatra SN, Muralidharan S, Mehta Y, Rai V, Hung NV, Luxsuwong M, Tapang ARD, Guo X, Trotter A, Kharbanda M, Rodrigues C, Dwivedy A, Shah S, Poojary A, Todi SK, Chabukswar S, Bhattacharyya M, Ramachandran B, Ramakrishnan N, Purkayasta SK, Sakle AS, Kumar S, Warrier AR, Kavathekar MS, Sahu S, Mubarak A, Modi N, Jaggi N, Gita N, Mishra SB, Sahu S, Jawadwala B, Zala D, Zompa T, Mathur P, Nirkhiwale S, Vadi S, Singh S, Agarwal M, Sen N, Karlekar A, Punia DP, Kumar S, Gopinath R, Nair PK, Gan CS, Chakravarthy M, Sandhu K, Kambam C, Mohanty SK, Varaiya A, Pandya N, Subhedar VR, Vanajakshi MR, Singla D, Tuvshinbayar M, Patel M, Ye G, Lum LCS, Zaini RHM, Batkhuu B, Dayapera KM, Nguyet LT, Berba R, Buenaflor MCS, Ng JA, Siriyakorn N, Thu LTA. Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings. J Vasc Access 2020; 22:34-41. [PMID: 32406328 DOI: 10.1177/1129729820917259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. METHODS Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). CONCLUSIONS Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.
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Affiliation(s)
| | - Ider Bat-Erdene
- Infection Control Professionals of Mongolia, and Intermed Hospital, Ulaanbaatar, Mongolia
| | - Debkishore Gupta
- BM Birla Heart Research Centre, Kolkata, India.,The Calcutta Medical Research Institute, Kolkata, India
| | | | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - S Muralidharan
- G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | | | - Vineya Rai
- Adult Intensive Care Unit, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | - Xiuqin Guo
- Dong E Peoples Hospital, Shandong, P.R. China
| | | | | | - Camilla Rodrigues
- P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | - Sweta Shah
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | | | | | | | | | | | | | - Siva Kumar
- Kovai Medical Center and Hospital, Coimbatore, India
| | | | | | | | - Aisha Mubarak
- Kerala Institute of Medical Sciences, Thiruvananthapuram, India
| | - Nikhil Modi
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | | | | | | | | | - Tenzin Zompa
- Max Super Speciality Hospital, Dehradun, Dehradun, India
| | | | | | | | - Sanjeev Singh
- Amrita Institute of Medical Sciences and Research Center, Kochi, India
| | | | | | - Anil Karlekar
- Escorts Heart Institute & Research Centre, New Delhi, India
| | - D P Punia
- Mahatma Gandhi Hospital, Jaipur, India
| | | | | | | | - Chin Seng Gan
- Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Kavita Sandhu
- Max Super Speciality Hospital, Saket, New Delhi, India
| | | | | | - Ami Varaiya
- Dr. Balabhai Nanavati Super Speciality Hospital, Mumbai, India
| | | | | | - M R Vanajakshi
- Columbia Asia Referral Hospital-Yeshwanthpur, Bangalore, India
| | | | | | - Mayur Patel
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | | | - Lucy Chai See Lum
- Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | - Regina Berba
- Philippine General Hospital, Manila, Philippines
| | | | | | | | - Le Thi Anh Thu
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.,For a list of the remaining co-authors of this study, see Appendix 1
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Rosenthal VD, Belkebir S, Zand F, Afeef M, Tanzi VL, Al-Abdely HM, El-Kholy A, Aziz AlKhawaja SA, Demiroz AP, Sayed AF, Elahi N, Gamar-Elanbya MO, Abidi K, Ben-Jaballah N, Salama MF, Helali NJ, Abdel-Halim MM, Demaisip NL, Ahmed H, Diab HH, Molano AM, Sawan FA, Kelany A, Altowerqi R, Rushdi H, Alkamaly MA, Bohlega E, Aldossary HA, Abdelhady KM, Ikram A, Madco M, Caminade Y, Alazmi M, Mahfouz T, Abdelaziz-Yousef RH, Ibrahim A, Elawady B, Asad T, Shyrine L, Leblebicioglu H. Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 246 intensive units of 83 hospitals in 52 cities of 14 countries of Middle East: Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates-International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health 2020; 13:1134-41. [PMID: 32295756 DOI: 10.1016/j.jiph.2020.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 01/29/2020] [Accepted: 03/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied, and data on their incidence by number of device-days is not available. METHODS Prospective, surveillance study on PVCR-BSI conducted from September 1st, 2013 to 31st Mays, 2019 in 246 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 83 hospitals in 52 cities of 14 countries in the Middle East (Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates). We applied U.S. RESULTS We followed 31,083 ICU patients for 189,834 bed-days and 202,375 short term peripheral venous catheter (PVC)-days. We identified 470 PVCR-BSIs, amounting to a rate of 2.32/1000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 10.38%, and 29.36% in patients with PVC and PVCR-BSI. The mean length of stay in patients with PVC but without PVCR-BSI was 5.94 days, and 16.84 days in patients with PVC and PVCR-BSI. The microorganism profile showed 55.2 % of gram-positive bacteria, with Coagulase-negative Staphylococci (31%) and Staphylococcus aureus (14%) being the predominant ones. Gram-negative bacteria accounted for 39% of cases, and included: Escherichia coli (7%), Klebsiella pneumoniae (8%), Pseudomonas aeruginosa (5%), Enterobacter spp. (3%), and others (29.9%), such as Serratia marcescens. CONCLUSIONS PVCR-BSI rates found in our ICUs were much higher than rates published from USA, Australia, and Italy. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs.
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Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, Myatra SN, Afeef M, Tanzi VL, Muralidharan S, Gurskis V, Al-Abdely HM, El-Kholy A, AlKhawaja SAA, Sen S, Mehta Y, Rai V, Hung NV, Sayed AF, Guerrero-Toapanta FM, Elahi N, Morfin-Otero MDR, Somabutr S, De-Carvalho BM, Magdarao MS, Velinova VA, Quesada-Mora AM, Anguseva T, Ikram A, Aguilar-de-Moros D, Duszynska W, Mejia N, Horhat FG, Belskiy V, Mioljevic V, Di-Silvestre G, Furova K, Gamar-Elanbya MO, Gupta U, Abidi K, Raka L, Guo X, Luque-Torres MT, Jayatilleke K, Ben-Jaballah N, Gikas A, Sandoval-Castillo HR, Trotter A, Valderrama-Beltrán SL, Leblebicioglu H, Riera F, López M, Maurizi D, Desse J, Pérez I, Silva G, Chaparro G, Golschmid D, Cabrera R, Montanini A, Bianchi A, Vimercati J, Rodríguez-del-Valle M, Domínguez C, Saul P, Chediack V, Piastrelini M, Cardena L, Ramasco L, Olivieri M, Gallardo P, Juarez P, Brito M, Botta P, Alvarez G, Benchetrit G, Caridi M, Stagnaro J, Bourlot I, García M, Arregui N, Saeed N, Abdul-Aziz S, ALSayegh S, Humood M, Mohamed-Ali K, Swar S, Magray T, Aguiar-Portela T, Sugette-de-Aguiar T, Serpa-Maia F, Fernandes-Alves-de-Lima L, Teixeira-Josino L, Sampaio-Bezerra M, Furtado-Maia R, Romário-Mendes A, Alves-De-Oliveira A, Vasconcelos-Carneiro A, Anjos-Lima JD, Pinto-Coelho K, Maciel-Canuto M, Rocha-Batista M, Moreira T, Rodrigues-Amarilo N, Lima-de-Barros T, Guimarães KA, Batista C, Santos C, de-Lima-Silva F, Santos-Mota E, Karla L, Ferreira-de-Souza M, Luzia N, de-Oliveira S, Takeda C, Azevedo-Ferreira-Lima D, Faheina J, Coelho-Oliveira L, do-Nascimento S, Machado-Silva V, Bento-Ferreira, Olszewski J, Tenorio M, Silva-Lemos A, Ramos-Feijó C, Cardoso D, Correa-Barbosa M, Assunção-Ponte G, Faheina J, da-Silva-Escudero D, Servolo-Medeiros E, Andrade-Oliveira-Reis M, Kostadinov E, Dicheva V, Petrov M, Guo C, Yu H, Liu T, Song G, Wang C, Cañas-Giraldo L, Marin-Tobar D, Trujillo-Ramirez E, Andrea-Rios P, Álvarez-Moreno C, Linares C, González-Rubio P, Ariza-Ayala B, Gamba-Moreno L, Gualtero-Trujill S, Segura-Sarmiento S, Rodriguez-Pena J, Ortega R, Olarte N, Pardo-Lopez Y, Luis Marino Otela-Baicue A, Vargas-Garcia A, Roncancio E, Gomez-Nieto K, Espinosa-Valencia M, Barahona-Guzman N, Avila-Acosta C, Raigoza-Martinez W, Villamil-Gomez W, Chapeta-Parada E, Mindiola-Rochel A, Corchuelo-Martinez A, Martinez A, Lagares-Guzman A, Rodriguez-Ferrer M, Yepes-Gomez D, Muñoz-Gutierrez G, Arguello-Ruiz A, Zuniga-Chavarria M, Maroto-Vargas L, Valverde-Hernández M, Solano-Chinchilla A, Calvo-Hernandez I, Chavarria-Ugalde O, Tolari G, Rojas-Fermin R, Diaz-Rodriguez C, Huascar S, Ortiz M, Bovera M, Alquinga N, Santacruz G, Jara E, Delgado V, Salgado-Yepez E, Valencia F, Pelaez C, Gonzalez-Flores H, Coello-Gordon E, Picoita F, Arboleda M, Garcia M, Velez J, Valle M, Unigarro L, Figueroa V, Marin K, Caballero-Narvaez H, Bayani V, Ahmed S, Alansary A, Hassan A, Abdel-Halim M, El-Fattah M, Abdelaziz-Yousef R, Hala A, Abdelhady K, Ahmed-Fouad H, Mounir-Agha H, Hamza H, Salah Z, Abdel-Aziz D, Ibrahim S, Helal A, AbdelMassih A, Mahmoud AR, Elawady B, El-sherif R, Fattah-Radwan Y, Abdel-Mawla T, Kamal-Elden N, Kartsonaki M, Rivera D, Mandal S, Mukherjee S, Navaneet P, Padmini B, Sorabjee J, Sakle A, Potdar M, Mane D, Sale H, Abdul-Gaffar M, Kazi M, Chabukswar S, Anju M, Gaikwad D, Harshe A, Blessymole S, Nair P, Khanna D, Chacko F, Rajalakshmi A, Mubarak A, Kharbanda M, Kumar S, Mathur P, Saranya S, Abubakar F, Sampat S, Raut V, Biswas S, Kelkar R, Divatia J, Chakravarthy M, Gokul B, Sukanya R, Pushparaj L, Thejasvini A, Rangaswamy S, Saini N, Bhattacharya C, Das S, Sanyal S, Chaudhury B, Rodrigues C, Khanna G, Dwivedy A, Binu S, Shetty S, Eappen J, Valsa T, Sriram A, Todi S, Bhattacharyya M, Bhakta A, Ramachandran B, Krupanandan R, Sahoo P, Mohanty N, Sahu S, Misra S, Ray B, Pattnaik S, Pillai H, Warrier A, Ranganathan L, Mani A, Rajagopal S, Abraham B, Venkatraman R, Ramakrishnan N, Devaprasad D, Siva K, Divekar D, Satish Kavathekar M, Suryawanshi M, Poojary A, Sheeba J, Patil P, Kukreja S, Varma K, Narayanan S, Sohanlal T, Agarwal A, Agarwal M, Nadimpalli G, Bhamare S, Thorat S, Sarda O, Nadimpalli P, Nirkhiwale S, Gehlot G, Bhattacharya S, Pandya N, Raphel A, Zala D, Mishra S, Patel M, Aggarwal D, Jawadwal B, Pawar N, Kardekar S, Manked A, Tamboli A, Manked A, Khety Z, Singhal T, Shah S, Kothari V, Naik R, Narain R, Sengupta S, Karmakar A, Mishra S, Pati B, Kantroo V, Kansal S, Modi N, Chawla R, Chawla A, Roy I, Mukherjee S, Bej M, Mukherjee P, Baidya S, Durell A, Vadi S, Saseedharan S, Anant P, Edwin J, Sen N, Sandhu K, Pandya N, Sharma S, Sengupta S, Palaniswamy V, Sharma P, Selvaraj M, Saurabh L, Agarwal M, Punia D, Soni D, Misra R, Harsvardhan R, Azim A, Kambam C, Garg A, Ekta S, Lakhe M, Sharma C, Singh G, Kaur A, Singhal S, Chhabra K, Ramakrishnan G, Kamboj H, Pillai S, Rani P, Singla D, Sanaei A, Maghsudi B, Sabetian G, Masjedi M, Shafiee E, Nikandish R, Paydar S, Khalili H, Moradi A, Sadeghi P, Bolandparvaz S, Mubarak S, Makhlouf M, Awwad M, Ayyad O, Shaweesh A, Khader M, Alghazawi A, Hussien N, Alruzzieh M, Mohamed Y, ALazhary M, Abdul Aziz O, Alazmi M, Mendoza J, De Vera P, Rillorta A, de Guzman M, Girvan M, Torres M, Alzahrani N, Alfaraj S, Gopal U, Manuel M, Alshehri R, Lessing L, Alzoman H, Abdrahiem J, Adballah H, Thankachan J, Gomaa H, Asad T, AL-Alawi M, Al-Abdullah N, Demaisip N, Laungayan-Cortez E, Cabato A, Gonzales J, Al Raey M, Al-Darani S, Aziz M, Al-Manea B, Samy E, AlDalaton M, Alaliany M, Alabdely H, Helali N, Sindayen G, Malificio A, Al-Dossari H, Kelany A, Algethami A, Mohamed D, Yanne L, Tan A, Babu S, Abduljabbar S, Al-Zaydani M, Ahmed H, Al Jarie A, Al-Qathani A, Al-Alkami H, AlDalaton M, Alih S, Alaliany M, Gasmin-Aromin R, Balon-Ubalde E, Diab H, Kader N, Hassan-Assiry I, Kelany A, Albeladi E, Aboushoushah S, Qushmaq N, Fernandez J, Hussain W, Rajavel R, Bukhari S, Rushdi H, Turkistani A, Mushtaq J, Bohlega E, Simon S, Damlig E, Elsherbini S, Abraham S, Kaid E, Al-Attas A, Hawsawi G, Hussein B, Esam B, Caminade Y, Santos A, Abdulwahab M, Aldossary A, Al-Suliman S, AlTalib A, Albaghly N, HaqlreMia M, Kaid E, Altowerqi R, Ghalilah K, Alradady M, Al-Qatri A, Chaouali M, Shyrine E, Philipose J, Raees M, AbdulKhalik N, Madco M, Acostan C, Safwat R, Halwani M, Abdul-Aal N, Thomas A, Abdulatif S, Ali-Karrar M, Al-Gosn N, Al-Hindi A, Jaha R, AlQahtani S, Ayugat E, Al-Hussain M, Aldossary A, Al-Suliman S, Al-Talib A, Albaghly N, Haqlre-Mia M, Briones S, Krishnan R, Tabassum K, Alharbi L, Madani A, Al-Hindi A, Al-Gethamy M, Alamri D, Spahija G, Gashi A, Kurian A, George S, Mohamed A, Ramapurath R, Varghese S, Abdo N, Foda-Salama M, Al-Mousa H, Omar A, Salama M, Toleb M, Khamis S, Kanj S, Zahreddine N, Kanafani Z, Kardas T, Ahmadieh R, Hammoud Z, Zeid I, Al-Souheil A, Ayash H, Mahfouz T, Kondratas T, Grinkeviciute D, Kevalas R, Dagys A, Mitrev Z, Bogoevska-Miteva Z, Jankovska K, Guroska S, Petrovska M, Popovska K, Ng C, Hoon Y, Hasan YM, Othman-Jailani M, Hadi-Jamaluddin M, Othman A, Zainol H, Wan-Yusoff W, Gan C, Lum L, Ling C, Aziz F, Zhazali R, Abud-Wahab M, Cheng T, Elghuwael I, Wan-Mat W, Abd-Rahman R, Perez-Gomez H, Kasten-Monges M, Esparza-Ahumada S, Rodriguez-Noriega E, Gonzalez-Diaz E, Mayoral-Pardo D, Cerero-Gudino A, Altuzar-Figueroa M, Perez-Cruz J, Escobar-Vazquez M, Aragon D, Coronado-Magana H, Mijangos-Mendez J, Corona-Jimenez F, Aguirre-Avalos G, Lopez-Mateos A, Martinez-Marroquin M, Montell-Garcia M, Martinez-Martinez A, Leon-Sanchez E, Gomez-Flores G, Ramirez M, Gomez M, Lozano M, Mercado V, Zamudio-Lugo I, Gomez-Gonzalez C, Miranda-Novales M, Villegas-Mota I, Reyes-Garcia C, Ramirez-Morales M, Sanchez-Rivas M, Cureno-Diaz M, Matias-Tellez B, Gonzalez-Martinez J, Juarez-Vargas R, Pastor-Salinas O, Gutierrez-Munoz V, Conde-Mercado J, Bruno-Carrasco G, Manrique M, Monroy-Colin V, Cruz-Rivera Z, Rodriguez-Pacheco J, Cruz N, Hernandez-Chena B, Guido-Ramirez O, Arteaga-Troncoso G, Guerra-Infante F, Lopez-Hurtado M, Caleco JD, Leyva-Medellin E, Salamanca-Meneses A, Cosio-Moran C, Ruiz-Rendon R, Aguilar-Angel L, Sanchez-Vargas M, Mares-Morales R, Fernandez-Alvarez L, Castillo-Cruz B, Gonzalez-Ma M, Zavala-Ramír M, Rivera-Reyna L, del-Moral-Rossete L, Lopez-Rubio C, Valadez-de-Alba M, Bat-Erdene A, Chuluunchimeg K, Baatar O, Batkhuu B, Ariyasuren Z, Bayasgalan G, Baigalmaa S, Uyanga T, Suvderdene P, Enkhtsetseg D, Suvd-Erdene D, Chimedtseye E, Bilguun G, Tuvshinbayar M, Dorj M, Khajidmaa T, Batjargal G, Naranpurev M, Bat-Erdene A, Bolormaa T, Battsetseg T, Batsuren C, Batsaikhan N, Tsolmon B, Saranbaatar A, Natsagnyam P, Nyamdawa O, Madani N, Abouqal R, Zeggwagh A, Berechid K, Dendane T, Koirala A, Giri R, Sainju S, Acharya S, Paul N, Parveen A, Raza A, Nizamuddin S, Sultan F, Imran X, Sajjad R, Khan M, Sana F, Tayyab N, Ahmed A, Zaman G, Khan I, Khurram F, Hussain A, Zahra F, Imtiaz A, Daud N, Sarwar M, Roop Z, Yusuf S, Hanif F, Shumaila X, Zeb J, Ali S, Demas S, Ariff S, Riaz A, Hussain A, Kanaan A, Jeetawi R, Castaño E, Moreno-Castillo L, García-Mayorca E, Prudencio-Leon W, Vivas-Pardo A, Changano-Rodriguez M, Castillo-Bravo L, Aibar-Yaranga K, Marquez-Mondalgo V, Mueras-Quevedo J, Meza-Borja C, Flor J, Fernandez-Camacho Y, Banda-Flores C, Pichilingue-Chagray J, Castaneda-Sabogal A, Caoili J, Mariano M, Maglente R, Santos S, de-Guzman G, Mendoza M, Javellana O, Tajanlangit A, Tapang A, Sg-Buenaflor M, Labro E, Carma R, Dy A, Fortin J, Navoa-Ng J, Cesar J, Bonifacio B, Llames M, Gata H, Tamayo A, Calupit H, Catcho V, Bergosa L, Abuy M, Barteczko-Grajek B, Rojek S, Szczesny A, Domanska M, Lipinska G, Jaroslaw J, Wieczoreka A, Szczykutowicza A, Gawor M, Piwoda M, Rydz-Lutrzykowska J, Grudzinska M, Kolat-Brodecka P, Smiechowicz K, Tamowicz B, Mikstacki A, Grams A, Sobczynski P, Nowicka M, Kretov V, Shalapuda V, Molkov A, Puzanov S, Utkin I, Tchekulaev A, Tulupova V, Vasiljevic S, Nikolic L, Ristic G, Eremija J, Kojovic J, Lekic D, Simic A, Hlinkova S, Lesnakova A, Kadankunnel S, Abdo-Ali M, Pimathai R, Wanitanukool S, Supa N, Prasan P, Luxsuwong M, Khuenkaew Y, Lamngamsupha J, Siriyakorn N, Prasanthai V, Apisarnthanarak A, Borgi A, Bouziri A, Cabadak H, Tuncer G, Bulut C, Hatipoglu C, Sebnem F, Demiroz A, Kaya A, Ersoz G, Kuyucu N, Karacorlu S, Oncul O, Gorenek L, Erdem H, Yildizdas D, Horoz O, Guclu E, Kaya G, Karabay O, Altindis M, Oztoprak N, Sahip Y, Uzun C, Erben N, Usluer G, Ozgunes I, Ozcelik M, Ceyda B, Oral M, Unal N, Cigdem Y, Bayar M, Bermede O, Saygili S, Yesiler I, Memikoglu O, Tekin R, Oncul A, Gunduz A, Ozdemir D, Geyik M, Erdogan S, Aygun C, Dilek A, Esen S, Turgut H, Sungurtekin H, Ugurcan D, Yarar V, Bilir Y, Bayram N, Devrim I, Agin H, Ceylan G, Yasar N, Oruc Y, Ramazanoglu A, Turhan O, Cengiz M, Yalcin A, Dursun O, Gunasan P, Kaya S, Senol G, Kocagoz A, Al-Rahma H, Annamma P, El-Houfi A, Vidal H, Perez F, D-Empaire G, Ruiz Y, Hernandez D, Aponte D, Salinas E, Vidal H, Navarrete N, Vargas R, Sanchez E, Ngo Quy C, Thu T, Nguyet L, Hang P, Hang T, Hanh T, Anh D. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control 2020; 48:423-432. [PMID: 31676155 DOI: 10.1016/j.ajic.2019.08.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied. RESULTS Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher. CONCLUSIONS Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.
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Alkhawaja S, Saeed NK, Rosenthal VD, Abdul-Aziz S, Alsayegh A, Humood ZM, Ali KM, Swar S, Magray TAS. Impact of International Nosocomial Infection Control Consortium's multidimensional approach on central line-associated bloodstream infection rates in Bahrain. J Vasc Access 2019; 21:481-489. [PMID: 31820669 DOI: 10.1177/1129729819888426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infections are serious life-threatening infections in the intensive care unit setting. METHODS To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection rates in Bahrain from January 2013 to December 2016, we conducted a prospective, before-after surveillance, cohort, observational study in one intensive care unit in Bahrain. During baseline, we performed outcome and process surveillance of central line-associated bloodstream infection on 2320 intensive care unit patients, applying Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. During intervention, we implemented IMA through ISOS, including (1) a bundle of infection prevention interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on central line-associated bloodstream infection rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the central line-associated bloodstream infection rate. RESULTS During baseline, 672 central line days and 7 central line-associated bloodstream infections were recorded, accounting for 10.4 central line-associated bloodstream infections per 1000 central line days. During intervention, 13,020 central line days and 48 central line-associated bloodstream infections were recorded. After the second year, there was a sustained 89% cumulative central line-associated bloodstream infection rate reduction to 1.2 central line-associated bloodstream infections per 1000 central line days (incidence density rate, 0.11; 95% confidence interval 0.1-0.3; p, 0.001). The average extra length of stay of patients with central line-associated bloodstream infection was 23.3 days, and due to the reduction of central line-associated bloodstream infections, 367 days of hospitalization were saved, amounting to a reduction in hospitalization costs of US$1,100,553. CONCLUSION Implementing IMA was associated with a significant reduction in the central line-associated bloodstream infection rate in Bahrain.
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Affiliation(s)
- Safaa Alkhawaja
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
| | | | | | - Sana Abdul-Aziz
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
| | - Ameena Alsayegh
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
| | | | | | - Saleh Swar
- Salmaniya Medical Center, Ministry of Health, Manama, Bahrain
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Chen Y, He Y, Zhang W, Huang Y, Fu J, Fu F, Zhou Y. Pathogenic characteristics of nosocomial infections in patients with cerebrovascular diseases and characteristics and treatment of pathogenic bacteria in different seasons. J Infect Public Health 2020; 13:800-5. [PMID: 31831394 DOI: 10.1016/j.jiph.2019.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/14/2019] [Accepted: 11/24/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study is to explore the bacterial distribution characteristics of air and bed environment in patients with cerebrovascular diseases and to analyze the relationship between bacterial distribution and nosocomial infection in patients with cerebrovascular diseases. METHODS In this study, the inpatients with cerebrovascular diseases who suffer from nosocomial infection are taken as the research objects. The pathogenic characteristics of the air environment in the ward and the environment in the bed unit are monitored, and the samples of cerebrovascular patients are collected for identification and drug sensitivity detection. The changes of the number of pathogens in different seasons are statistically compared, and the drug sensitivity test results of various pathogens are analyzed. RESULTS In large wards, the number of pathogens in the air environment in winter is significantly higher than that in spring. In summer, the number of pathogens in pillow environment is significantly more than that in small wards. Gram-negative bacilli are the main pathogens in the four seasons, followed by Gram-positive cocci and less fungal infections. Among them, Staphylococcus aureus is the main Gram-positive coccus, which is sensitive to vancomycin and other therapeutic drugs, and resistant to erythromycin and other therapeutic drugs. Gram-negative bacteria are mainly Klebsiella pneumoniae and Pseudomonas aeruginosa. K. pneumoniae is sensitive to imipenem, tekacillin, meropenem and ceftitam, and resistant to ampicillin. P. aeruginosa is sensitive to cefuroxime ester, cefazolin and cefuroxime sodium. It is resistant to ampicillin, ceftitam, compound sinomine and ampicillin plus sulbactam. Candida albicans is the main fungus, which is sensitive to ketoconazole, fluconazole, amphotericin and nystatin. CONCLUSION The number of pathogenic bacteria in the ward environment of patients with cerebrovascular disease is affected by the size of the room and season. The main pathogenic bacteria are Gram-negative bacilli, followed by Gram-positive cocci and less fungal infections.
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Touimi GB, Bennani L, Berrada S, Benboubker M, Bennani B. Evaluation of hygienic conditions of food contact surfaces in a hospital kitchen in Morocco. Iran J Microbiol 2019; 11:527-534. [PMID: 32148685 PMCID: PMC7048956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Food in healthcare settings are complementary to medical treatment, hence it should be produced in good sanitary conditions. In fact, hospitalized and immune-compromised patients are more likely to have foodborne infections than the rest of the community. The aim of our study is to evaluate the microbiological quality of food contact surfaces in a hospital kitchen in Morocco. MATERIALS AND METHODS A total of 238 samples was collected from kitchen surfaces and analyzed for total aerobic mesophilic bacteria (AMC), Enterobacteriaceae and Staphylococcus aureus count and the presence of Salmonella spp., Pseudomonas spp. and Listeria monocytogenes. RESULTS The bacteriological analysis shows that the highest rates of compliance with good hygienic conditions were obtained in baking worktops (77%) and serving meal worktops (50%) and the vegetables cutting boards (45.83%). In contrary, some surfaces show a low level of compliance, such as the raw meat cutting boards (96%). The isolated bacteria were S. aureus, coagulase-negative staphylococci, Escherichia coli, Serratia marcescens, Serratia odorifera, Raoultela ornithiaolytica and Pseudomonas aeroguinosa. CONCLUSION The actual results indicate that the high levels of bacterial counts on kitchen surfaces, presents an evident need to improve the hygienic process and adopt an HACCP system in this facility.
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Affiliation(s)
- Ghita Benjelloun Touimi
- Departement of Fundamental Sciences, Laboratory of Human Pathology Biomedecine and environnement, Faculty of Medicine and Pharmacy of Fez (FMPF), Sidi Mohammed Ben Abdellah University (USMBA), Fez, Morocco,Departement of Fundamental Sciences, Faculty of Sciences and Techniques of Fez (FSTF), USMBA, Fez, Morocco
| | - Laila Bennani
- Departement of Fundamental Sciences, Laboratory of Human Pathology Biomedecine and environnement, Faculty of Medicine and Pharmacy of Fez (FMPF), Sidi Mohammed Ben Abdellah University (USMBA), Fez, Morocco,Departement of Fundamental Sciences, The Superior Institute of Nursing Professions and Health Technology of Fez (ISPITS), Fez, Morocco
| | - Sanae Berrada
- Departement of Fundamental Sciences, The Superior Institute of Nursing Professions and Health Technology of Fez (ISPITS), Fez, Morocco
| | | | - Bahia Bennani
- Departement of Fundamental Sciences, Laboratory of Human Pathology Biomedecine and environnement, Faculty of Medicine and Pharmacy of Fez (FMPF), Sidi Mohammed Ben Abdellah University (USMBA), Fez, Morocco,Corresponding author: Bahia Bennani, PhD, Departement of Fundamental Sciences, Laboratory of Human Pathology Biomedecine and environnement, Faculty of Medicine and Pharmacy of Fez (FMPF), Sidi Mohammed Ben Abdellah University (USMBA), Fez, Morocco., Tel: +212-661730763, Fax: +212-535619321,
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Schneider A, Coope C, Michie S, Puleston R, Hopkins S, Oliver I. Implementing a toolkit for the prevention, management and control of carbapenemase-producing Enterobacteriaceae in English acute hospitals trusts: a qualitative evaluation. BMC Health Serv Res 2019; 19:689. [PMID: 31606053 PMCID: PMC6790044 DOI: 10.1186/s12913-019-4492-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is an increasing problem in hospitals world-wide. Following other countries, English hospitals experienced outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a bacterial infection commonly resistant to last resort antibiotics. One way to improve CPE prevention, management and control is the production of guidelines, such as the CPE toolkit published by Public Health England in December 2013. The aim of this research was to investigate the implementation of the CPE toolkit and to identify barriers and facilitators to inform future policies. METHODS Acute hospital trusts (N = 12) were purposively sampled based on their self-assessed CPE colonisation rates and time point of introducing local CPE action plans. Following maximum variation sampling, 44 interviews with hospital staff were conducted between April and August 2017 using a semi-structured topic guide based on the Capability, Opportunity, Motivation and Behaviour Model and the Theoretical Domains Framework, covering areas of influences on behaviour. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS The national CPE toolkit was widely disseminated within infection prevention and control teams (IPCT), but awareness was rare among other hospital staff. Local plans, developed by IPCTs referring to the CPE toolkit while considering local circumstances, were in place in all hospitals. Implementation barriers included: shortage of isolation facilities for CPE patients, time pressures, and competing demands. Facilitators were within hospital and across-hospital collaborations and knowledge sharing, availability of dedicated IPCTs, leadership support and prioritisation of CPE as an important concern. Participants using the CPE toolkit had mixed views, appreciating its readability and clarity about patient management, but voicing concerns about the lack of transparency on the level of evidence and the practicality of implementation. They recommended regular updates, additional clarifications, tailored information and implementation guidance. CONCLUSIONS There were problems with the awareness and implementation of the CPE toolkit and frontline staff saw room for improvement, identifying implementation barriers and facilitators. An updated CPE toolkit version should provide comprehensive and instructive guidance on evidence-based CPE prevention, management and control procedures and their implementation in a modular format with sections tailored to hospitals' CPE status and to different staff groups.
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Affiliation(s)
- Annegret Schneider
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK. .,National Institute for Health Research Health Protection Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
| | - Caroline Coope
- National Institute for Health Research Health Protection Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.,Field Service South West, National Infection Service, Public Health England, 2 Rivergate, Bristol, BS1 6EH, UK
| | - Susan Michie
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,National Institute for Health Research Health Protection Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Richard Puleston
- Field Service East Midlands, National Infection Service, Public Health England, Nottingham, NG24LA, UK
| | - Susan Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Isabel Oliver
- National Institute for Health Research Health Protection Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.,Field Service South West, National Infection Service, Public Health England, 2 Rivergate, Bristol, BS1 6EH, UK
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Shoen HRC, Rose SJ, Ramsey SA, de Morais H, Bermudez LE. Analysis of Staphylococcus infections in a veterinary teaching hospital from 2012 to 2015. Comp Immunol Microbiol Infect Dis 2019; 66:101332. [PMID: 31437674 DOI: 10.1016/j.cimid.2019.101332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/27/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022]
Abstract
Records of all Diagnostic laboratory submissions from 2012 to 2015 were examined and subjected to analysis according to species, location of infection, species of bacteria, and antibiotic resistance/susceptibility. A total of 23.8% of all culture isolates were Staphylococcus sp. Of those Staphylococcus, 43% were isolated from surgical site infections. Staphylococcus pseudintermedius accounted for approximately 28% of all staphylococcus cultures, while methicillin-resistant (MR) S. pseudintermedius accounted for 8% of all staphylococcus cultures. Environmental samples were also collected by swabbing surfaces in the intensive care unit (ICU) and anesthesia prep room at the OSU VTH. Isolated bacterial colonies were subjected to PCR for species identification and for the presence of the mecA gene. Ability of horizontal transfer in vitro of the mecA gene was evaluated by incubating the mecA positive bacterium, with the mecA negative bacterium, and then plated onto agar plates infused with known concentration of oxacillin. Colonies were then subjected to PCR for species and mecA identification. Horizontal transfer of the mecA gene was demonstrated and confirmed via PCR from MR S. epidermidis to MS S. pseudintermedius in an in vitro model that mimicked the veterinary hospital environment. Biofilms were established using four Staphylococcus species isolated from swabbing the Intensive Care Unit (ICU) and anesthesia prep room and were resistant when exposed to the current cleaning agent. Staphylococcus species makeup nearly ¼ of all infections at OSU VDL during the four years of the study, and MS S. pseudintermedius was shown to acquire the mecA gene from an environmental strain.
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Affiliation(s)
- Hanna R C Shoen
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, United States
| | - Sasha J Rose
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, United States
| | - Stephen A Ramsey
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, United States; School of Electrical Engineering and Computer Science, College of Engineering, United States
| | - Helio de Morais
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, United States
| | - Luiz E Bermudez
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR, United States; Department of Microbiology, College of Science, Oregon State University, Corvallis, OR, United States.
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Quintanilha JCF, Duarte NDC, Lloret GR, Visacri MB, Mattos KPH, Dragosavac D, Falcão ALE, Moriel P. Colistin and polymyxin B for treatment of nosocomial infections in intensive care unit patients: pharmacoeconomic analysis. Int J Clin Pharm 2018; 41:74-80. [PMID: 30552622 DOI: 10.1007/s11096-018-0766-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/06/2018] [Indexed: 12/15/2022]
Abstract
Background The emergence and rapid spread of multidrug-resistant gram-negative bacteria related to nosocomial infections is a growing worldwide problem, and polymyxins have become important due to the lack of new antibiotics. Objectives To evaluate the outcomes and pharmacoeconomic impact of using colistin and polymyxin B to treat nosocomial infections. Setting Neurosurgical, cardiovascular, or transplantation intensive care unit (ICU) at the Clinical Hospital of the University of Campinas (São Paulo, Brazil). Method A retrospective cohort study was conduct in patients in the ICU. The renal function was determined daily during treatment by measuring the serum creatinine. A cost minimization analysis was performed to compare the relative costs of treatment with colistin and polymyxin B. Main outcomes measure The outcomes were 30-day mortality and frequency and onset of nephrotoxicity after beginning treatment. Results Fifty-one patients treated with colistin and 51 with polymyxin B were included. 30-day mortality was observed in 25.49% and 33.33% of patients treated with colistin and polymyxin B, respectively; Nephrotoxicity was observed in 43.14% and 54.90% of patients in colistin and polymyxin B groups, respectively; and onset time of nephrotoxicity was 9.86 ± 13.22 days for colistin and 10.68 ± 9.93 days for polymyxin B group. Colistin treatment had a lower cost per patient compared to the cost for polymyxin B treatment (USD $13,389.37 vs. USD $13,639.16, respectively). Conclusion We found no difference between 30-day mortality and nephrotoxicity between groups; however, colistin proved to be the best option from a pharmacoeconomic point of view.
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Affiliation(s)
- Júlia Coelho França Quintanilha
- School of Medical Sciences, University of Campinas (UNICAMP), Tessália Vieira de Camargo 126, 13083-887, Campinas, SP, Brazil
| | - Natalia da Costa Duarte
- School of Medical Sciences, University of Campinas (UNICAMP), Tessália Vieira de Camargo 126, 13083-887, Campinas, SP, Brazil
| | - Gustavo Rafaini Lloret
- School of Medical Sciences, University of Campinas (UNICAMP), Tessália Vieira de Camargo 126, 13083-887, Campinas, SP, Brazil
| | - Marília Berlofa Visacri
- School of Medical Sciences, University of Campinas (UNICAMP), Tessália Vieira de Camargo 126, 13083-887, Campinas, SP, Brazil
| | - Karen Prado Herzer Mattos
- School of Medical Sciences, University of Campinas (UNICAMP), Tessália Vieira de Camargo 126, 13083-887, Campinas, SP, Brazil
| | - Desanka Dragosavac
- School of Medical Sciences, University of Campinas (UNICAMP), Tessália Vieira de Camargo 126, 13083-887, Campinas, SP, Brazil
| | - Antonio Luis Eiras Falcão
- School of Medical Sciences, University of Campinas (UNICAMP), Tessália Vieira de Camargo 126, 13083-887, Campinas, SP, Brazil
| | - Patricia Moriel
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Cândido Portinari 200, 13083-871, Campinas, SP, Brazil.
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Eljaaly K, Enani MA, Al-Tawfiq JA. Impact of carbapenem versus non-carbapenem treatment on the rates of superinfection: A meta-analysis of randomized controlled trials. J Infect Chemother 2018; 24:915-920. [PMID: 30197092 DOI: 10.1016/j.jiac.2018.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/29/2018] [Accepted: 08/09/2018] [Indexed: 12/19/2022]
Abstract
Imipenem and meropenem are the recommended antipseudomonal carbapenems for nosocomial pneumonia per clinical practice guidelines. However, these agents have a relatively broader spectrum of activity than other antibiotics and need to be reserved. Carbapenems might cause higher rate of superinfection. The aim of this study was to compare the rate of superinfection between patients who received imipenem or meropenem versus those who received non-carbapenem treatment. PubMed, EMBASE, Cochrane Library databases and two trial registries were searched for relevant randomized controlled trials of hospitalized adults with pneumonia through February 24, 2017 without date or language restrictions. Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using random-effects models. The primary outcome was based on the intention-to-treat analysis while clinically evaluable patients were analyzed as secondary outcome. Eight RCTs were included in this meta-analysis. A statistically higher risk of superinfection with low heterogeneity (RR = 1.690, 95% CI 1.247-2.291, p = 0.001, I2 = 0%) was associated with the two carbapenems compared to non-carbapenems. However, in comparison with non-carbapenems, superinfection with imipenem was significantly higher (RR = 1.694, 95% CI 1.234-2.325, p = 0.001, I2 = 0%), while it was non-significant with meropenem (RR = 1.647, 95% CI 0.552-4.919, p = 0.371, I2 = 0%). Superinfection was statistically higher in both double-blind and open-label studies and when carbapenems were compared to other antipseudomonal beta-lactams. This meta-analysis identified significantly higher superinfection with imipenem compared to non-carbapenems. The findings confirm the theory of higher superinfections with broader spectrum agents and provide additional support for reserving carbapenems for the treatment of infections caused by multidrug-resistant organisms.
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Affiliation(s)
- Khalid Eljaaly
- Department of Clinical Pharmacy, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Infectious Diseases, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Mushira A Enani
- Medical Specialties Department, Section of Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Department of Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Al-Mousa HH, Omar AA, Rosenthal VD, Salama MF, Aly NY, El-Dossoky Noweir M, Rebello FM, Narciso DM, Sayed AF, Kurian A, George SM, Mohamed AM, Ramapurath RJ, Varghese ST, Orellano PW. Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of ventilator-associated pneumonia in intensive care units of two hospitals in Kuwait. J Infect Prev 2018; 19:168-176. [PMID: 30013621 PMCID: PMC6039914 DOI: 10.1177/1757177418759745] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/21/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in three intensive care units (ICUs) from two hospitals in Kuwait City from January 2014 to March 2015. DESIGN A prospective, before-after study on 2507 adult ICU patients. During baseline, we performed outcome surveillance of VAP applying CDC/NHSN definitions. During intervention, we implemented the IMA through the INICC Surveillance Online System (ISOS), which included: (1) a bundle of infection prevention interventions; (2) education; (3) outcome surveillance; and (4) feedback on VAP rates and consequences. Logistic regression analysis was performed to estimate the effect of the intervention on VAP, controlling for potential bias. RESULTS During baseline, 1990 mechanical ventilator (MV)-days and 14 VAPs were recorded, accounting for 7.0 VAPs per 1000 MV-days. During intervention, 9786 MV-days and 35 VAPs were recorded, accounting for 3.0 VAPs per 1000 MV-days. The VAP rate was reduced by 57.1% (incidence-density ratio = 0.51; 95% CI = 0.28-0.93; p = 0.042). Logistic regression showed a significant reduction in VAP rate during the intervention phase (OR = 0.39, 95% CI = 0.18-0.83), with 61% effectiveness. CONCLUSIONS Implementing IMA through ISOS was associated with a significant reduction in the VAP rate in Kuwait ICUs.
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Affiliation(s)
| | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | | | - Mona Foda Salama
- Mubarak Al Kabir Hospital, Kuwait City, Kuwait
- Microbiology and Medical Immunology Department, Mansoura Faculty of Medicine, University of Mansoura, Egypt
| | - Nasser Yehia Aly
- Farwaniya Hospital, Kuwait City, Kuwait
- Department of Tropical Medicine and Hygiene, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | | | | | | | | | | | | | | | | | | | - Pablo Wenceslao Orellano
- International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
- Universidad Tecnológica Nacional, Facultad Regional San Nicolás and Consejo Nacional de Investigaciones Científicas y Técnicas, San Nicolás, Argentina
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López-Camacho E, Paño-Pardo JR, Ruiz-Carrascoso G, Wesselink JJ, Lusa-Bernal S, Ramos-Ruiz R, Ovalle S, Gómez-Gil R, Pérez-Blanco V, Pérez-Vázquez M, Gómez-Puertas P, Mingorance J. Population structure of OXA-48-producing Klebsiella pneumoniae ST405 isolates during a hospital outbreak characterised by genomic typing. J Glob Antimicrob Resist 2018; 15:48-54. [PMID: 29940334 DOI: 10.1016/j.jgar.2018.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/01/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the structure of a broad and sustained hospital outbreak of OXA-48-producing Klebsiella pneumoniae (KpO48) belonging to sequence type 405 (ST405). METHODS Whole-genome sequencing and comparison of ten ST405 KpO48 isolates obtained from clinical samples in our hospital was performed. Using stringent criteria, 36 single nucleotide polymorphisms (SNPs) were detected (range 0-21 in pairwise comparisons), and allele-specific PCR was used to call the SNPs among a larger set of isolates. RESULTS Several haplotypes were identified within the population. The haplotypes did not show a spatial structure, but a temporal evolution of sequential haplotype replacements was observed. CONCLUSIONS The dispersed spatial distribution suggests a reservoir formed by a large pool of colonised patients, and the temporal replacement pattern suggests that the sustained outbreak was composed of several small outbreaks that appeared and rapidly dispersed to several units.
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Affiliation(s)
- Elena López-Camacho
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - José Ramón Paño-Pardo
- Unidad de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Spain
| | - Guillermo Ruiz-Carrascoso
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Jan-Jaap Wesselink
- Biomol-Informatics, S.L., Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Silvia Lusa-Bernal
- Biomol-Informatics, S.L., Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Ricardo Ramos-Ruiz
- Madrid Science Park, Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Susana Ovalle
- Madrid Science Park, Campus Universidad Autónoma de Madrid, C/Faraday 7, 28049 Madrid, Spain
| | - Rosa Gómez-Gil
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Verónica Pérez-Blanco
- Servicio de Medicina Preventiva, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - María Pérez-Vázquez
- Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
| | - Paulino Gómez-Puertas
- Centro de Biología Molecular 'Severo Ochoa' (CSIC-UAM), Campus Universidad Autónoma de Madrid C/Nicolás Cabrera 1, 28049 Madrid, Spain
| | - Jesús Mingorance
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Spain.
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Rosenthal VD, Desse J, Maurizi DM, Chaparro GJ, Orellano PW, Chediack V, Cabrera R, Golschmid D, Silva CG, Vimercati JC, Stagnaro JP, Perez I, Spadaro ML, Montanini AM, Pedersen D, Paniccia TL, Ríos Aguilera AM, Cermesoni R, Mele JI, Alda E, Paldoro AE, Ortta AR, Cooke B, García MC, Obed MN, Domínguez CV, Saúl PA, Rodríguez del Valle MC, Bianchi AC, Alvarez G, Pérez R, Oyola C. Impact of the International Nosocomial Infection Control Consortium's multidimensional approach on rates of ventilator-associated pneumonia in 14 intensive care units in 11 hospitals of 5 cities within Argentina. Am J Infect Control 2018; 46:674-679. [PMID: 29329916 DOI: 10.1016/j.ajic.2017.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. METHODS A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. RESULTS We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days-with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days-with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). CONCLUSIONS Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina.
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Zarpellon MN, Viana GF, Mitsugui CS, Costa BB, Tamura NK, Aoki EE, Helbel C, Nishiyama SAB, Saalfeld SMDS, Tognim MCB. Epidemiologic surveillance of multidrug-resistant bacteria in a teaching hospital: A 3-year experience. Am J Infect Control 2018; 46:387-392. [PMID: 29217187 DOI: 10.1016/j.ajic.2017.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this prospective study was to verify the effectiveness of a multidisciplinary surveillance program that was implemented in a teaching hospital in southern Brazil, to prevent and control the spread of multidrug-resistant organisms. METHODS The program implemented involved establishment of prevention guidelines, hand-hygiene promotion, isolation of patients colonized or infected by such organisms, enforced contact precautions, and terminal cleaning and disinfection of isolation rooms. A microbiology service, previously provided by an external laboratory, was established in the hospital. Detection of bacteria-resistant genes and molecular typing were performed also. RESULTS Statistically significant differences were observed between the pre- and post-intervention periods (P = .00198). Control measures were effective in blocking the dissemination of a previously endemic clone of Acinetobacter baumannii. Changes were observed in the dissemination pattern, from a monoclonal to a polyclonal mode. The incidence of vancomycin-resistant Enterococcus during the surveillance period was low. Only 2 isolates of BLAKPC-positive Klebsiella pneumoniae (distinct profiles), and 5 isolates of BLASPM-positive Pseudomonas aeruginosa (a single cluster), were detected. CONCLUSIONS These results indicate that the surveillance program implemented was effective in preventing the spread of multidrug-resistant organisms in the hospital.
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Affiliation(s)
- Mirian Nicéa Zarpellon
- Department of Basic Health Sciences, State University of Maringá, Maringá, Paraná, Brazil; Maringá University Hospital, State University of Maringá, Maringá, Paraná, Brazil
| | - Giselle Fukita Viana
- Department of Basic Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | - Nathalie Kira Tamura
- Maringá University Hospital, State University of Maringá, Maringá, Paraná, Brazil
| | - Elisabeth Eyko Aoki
- Maringá University Hospital, State University of Maringá, Maringá, Paraná, Brazil
| | - Cesar Helbel
- Maringá University Hospital, State University of Maringá, Maringá, Paraná, Brazil
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Dippenaar R, Smith J. Impact of pulsed xenon ultraviolet disinfection on surface contamination in a hospital facility's expressed human milk feed preparation area. BMC Infect Dis 2018; 18:91. [PMID: 29471796 PMCID: PMC5824443 DOI: 10.1186/s12879-018-2997-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expressed human milk (EHM) feed preparation areas represent a potential source of unintentional nosocomial infection. Daily disinfection of environmental surfaces remains an essential intervention to mitigate nosocomial infections. The inefficiency of conventional cleaning and disinfection contributes to an increased risk for the acquisition of multi-drug resistant pathogens. "Non touch" technologies such as the pulsed xenon ultraviolet (PX-UVD) light device have documented sustained reduction in surface bacterial colonization and reduced cross contamination. METHODS The impact of a PX-UVD on surface colony forming units per square centimeter (cfu/cm2) in feed preparation areas was evaluated following its implementation as standard care. A quasi-experimental study was performed documenting bacterial colonization from 6 high risk feed preparation areas in a community care hospital in South Africa. Pre and post conventional cleaning neutralizing rinse swabs were collected fortnightly over a 16 week control period prior to the introduction of the PX-UVD and compared to a matching set of samples for the PX-UVD period. RESULTS A 90% reduction in total surface bioburden was noted from the control period (544 cfu/cm2) compared to the corresponding PX-UVD period (50 cfu/cm2). Sub -analysis of both the Pre-clean Control: Pre-clean PX-UVD counts as well as the Post-clean Control: Post-clean PX-UVD counts noted significant improvements (p < 0.001). A statistically significant improvement was noted between pre-and post-cleaning total surface bioburden following exposure to the PX-UVD (p = 0.0004). The introduction of the PX-UVD was associated with a sustained reduction in the pre clean bioburden counts with a risk trend (per week) 0.19, (95% CI [0.056, 0.67], p = 0.01). DISCUSSION The use of a PX-UVD as adjunct to standard cleaning protocols was associated with a significant decrease in surface bioburden. The study demonstrated the inefficiency of conventional cleaning. Persistence of potentially pathological species in both periods highlights current health sector challenges.
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Affiliation(s)
- Ricky Dippenaar
- Department of Neonatology, Netcare Blaauwberg & N1 City Hospital, Waterville Crescent, Sunningdale, Western Cape, 7441, South Africa.
| | - Johan Smith
- Department of Paediatrics & Child Health, Stellenbosch University & Tygerberg Children's Hospital, Tygerberg, Western Cape, 7505, South Africa
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46
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Tran T, Chiem K, Jani S, Arivett BA, Lin DL, Lad R, Jimenez V, Farone MB, Debevec G, Santos R, Giulianotti M, Pinilla C, Tolmasky ME. Identification of a small molecule inhibitor of the aminoglycoside 6'-N-acetyltransferase type Ib [AAC(6')-Ib] using mixture-based combinatorial libraries. Int J Antimicrob Agents 2018; 51:752-761. [PMID: 29410367 DOI: 10.1016/j.ijantimicag.2018.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/13/2018] [Accepted: 01/24/2018] [Indexed: 11/28/2022]
Abstract
The aminoglycoside, 6'-N-acetyltransferase type Ib [AAC(6')-Ib] is the most widely distributed enzyme among AAC(6')-I-producing Gram-negative pathogens and confers resistance to clinically relevant aminoglycosides, including amikacin. This enzyme is therefore an ideal target for enzymatic inhibitors that could overcome resistance to aminoglycosides. The search for inhibitors was carried out using mixture-based combinatorial libraries, the scaffold ranking approach, and the positional scanning strategy. A library with high inhibitory activity had pyrrolidine pentamine scaffold and was selected for further analysis. This library contained 738,192 compounds with functionalities derived from 26 different amino acids (R1, R2 and R3) and 42 different carboxylic acids (R4) in four R-group functionalities. The most active compounds all contained S-phenyl (R1 and R3) and S-hydromethyl (R2) functionalities at three locations and differed at the R4 position. The compound containing 3-phenylbutyl at R4 (compound 206) was a robust enzymatic inhibitor in vitro, in combination with amikacin it potentiated the inhibition of growth of three resistant bacteria in culture, and it improved survival when used as treatment of Galleria mellonella infected with aac(6')-Ib-harboring Klebsiella pneumoniae and Acinetobacter baumannii strains.
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Affiliation(s)
- Tung Tran
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA
| | - Kevin Chiem
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA
| | - Saumya Jani
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA
| | - Brock A Arivett
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN; Department of Chemistry, Middle Tennessee State University, Murfreesboro, TN
| | - David L Lin
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA
| | - Rupali Lad
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA
| | - Verónica Jimenez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA
| | - Mary B Farone
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN
| | | | - Radleigh Santos
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, FL
| | - Marc Giulianotti
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, FL
| | | | - Marcelo E Tolmasky
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA.
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Schreiber PW, Köhler N, Cervera R, Hasse B, Sax H, Keller PM. Detection limit of Mycobacterium chimaera in water samples for monitoring medical device safety: insights from a pilot experimental series. J Hosp Infect 2017; 99:284-289. [PMID: 29175077 DOI: 10.1016/j.jhin.2017.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND A growing number of Mycobacterium chimaera infections after cardiosurgery have been reported by several countries. These potentially fatal infections were traced back to contaminated heater-cooler devices (HCDs), which use water as a heat transfer medium. Aerosolization of water contaminated with M. chimaera from HCDs enables airborne transmission to patients undergoing open chest surgery. Infection control teams test HCD water samples for mycobacterial growth to guide preventive measures. The detection limit of M. chimaera in water samples, however, has not previously been investigated. AIM To determine the detection limit of M. chimaera in water samples using laboratory-based serial dilution tests. METHODS An M. chimaera strain representative of the international cardiosurgery-associated M. chimaera outbreak was used to generate a logarithmic dilution series. Two different water volumes, 50 and 1000mL, were inoculated, and, after identical processing (centrifugation, decantation, and decontamination), seeded on mycobacteria growth indicator tube (MGIT) and Middlebrook 7H11 solid media. FINDINGS MGIT consistently showed a lower detection limit than 7H11 solid media, corresponding to a detection limit of ≥1.44 × 104cfu/mL for 50mL and ≥2.4cfu/mL for 1000mL water samples. Solid media failed to detect M. chimaera in 50mL water samples. CONCLUSION Depending on water volume and culture method, major differences exist in the detection limit of M. chimaera. In terms of sensitivity, 1000mL water samples in MGIT media performed best. Our results have important implications for infection prevention and control strategies in mitigation of the M. chimaera outbreak and healthcare water safety in general.
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Affiliation(s)
- P W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
| | - N Köhler
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - R Cervera
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - B Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - H Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - P M Keller
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, University of Zurich, Zurich, Switzerland
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48
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Ceradini J, Tozzi AE, D'Argenio P, Bernaschi P, Manuri L, Brusco C, Raponi M. Telemedicine as an effective intervention to improve antibiotic appropriateness prescription and to reduce costs in pediatrics. Ital J Pediatr 2017; 43:105. [PMID: 29149862 PMCID: PMC5693570 DOI: 10.1186/s13052-017-0423-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
Implementation of antimicrobial stewardship program is a pivotal practice element for healthcare institution. We developed a remote infectious disease consultancy program via telemedicine in a high-specialized pediatric cardiac hospital. A consultation for antibiotic strategy for each patient was available via telemedicine in addition to biweekly discussion of all clinical cases. Aim of this study was to evaluate the impact of the remote stewardship program in terms of a) appropriateness of antibiotic prescription; b) incidence of multi-resistant infection; and c) cost. A ‘before - after’ study was performed comparing the period immediately before starting the program and one year after. There was a trend in the reduction of nosocomial infectious disease rate (9.5 vs 6.5 per 1000 person days), with a reduction in the overall antibiotic cost (25,000 vs 15,000 EUR) and in the average antibiotics packages used per admission (9 vs 6.7 packages). A significant reduction in the multi-drug resistant isolation rate was observed (104 vs 79 per 1000 person days, p = 0.01). In conclusion, the infectious disease meeting via telemedicine has been an effective tool for economic and professional development and multidisciplinary management of complex patients. The appropriate use of antibiotics reduced the multi-drug resistant bacteria selection, thus improving patient safety.
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Affiliation(s)
- Jacopo Ceradini
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | | | - Patrizia D'Argenio
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Paola Bernaschi
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Lucia Manuri
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Carla Brusco
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Massimiliano Raponi
- Bambino Gesù Children's Hospital IRCCS, piazza Sant'Onofrio 4, 00165, Rome, Italy
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Braun G, Cayô R, Matos AP, de Mello Fonseca J, Gales AC. Temporal evolution of polymyxin B-resistant Klebsiella pneumoniae clones recovered from blood cultures in a teaching hospital during a 7-year period. Int J Antimicrob Agents 2017; 51:522-527. [PMID: 28887199 DOI: 10.1016/j.ijantimicag.2017.08.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/17/2017] [Accepted: 08/26/2017] [Indexed: 11/16/2022]
Abstract
The polymyxins have become one of the last resorts to treat serious infections caused by KPC-2-producing Klebsiella pneumoniae worldwide. However, the increase of polymyxin consumption has favored the emergence of resistance to these compounds. In this study, we observed an increase in polymyxin B resistance rates from 0 to 30.6% among 224 K. pneumoniae isolates recovered from blood cultures between 2009 and 2015. Only gentamicin, tigecycline and fosfomycin remained active against the polymyxin B-resistant K. pneumoniae (PMB-R-KPN) isolates, which were classified as extensively drug-resistant (XDR; 83.3%), multidrug-resistant (MDR; 13.9%), or pan-drug resistant (2.8%). Most PMB-R-KPN clones belonged to CC258 (ST11, ST258, ST340, and ST437). A C7/ST258 XDR clone carrying distinct resistance determinants (blaSHV-11, blaTEM-1, blaCTX-M-15, blaCTX-M-14, blaKPC-2, and rmtB-1) was introduced in 2014. Twelve of 36 PMB-R-KPN isolates showed disruption of mgrB. No mcr-1-positive isolate was found. The rapid detection of PMB-R-KPN isolates allied to implementation of effective infection control measures are of crucial importance to avoid the dissemination of high-risk PMB-R-KPN clones.
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Affiliation(s)
- Graziela Braun
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil; Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná-Unioeste, Cascavel, PR, Brazil
| | - Rodrigo Cayô
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Adriana Pereira Matos
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Juliane de Mello Fonseca
- Laboratório Especial de Microbiologia Clínica-LEMC, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil
| | - Ana Cristina Gales
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil; Laboratório Especial de Microbiologia Clínica-LEMC, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, SP, Brazil.
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Zhu QR, Yang L, Ma HY, Xie WQ, Cong LM, Xu LW. [Screening on key techniques used for surveillance and disposal of public health emergencies]. Zhonghua Liu Xing Bing Xue Za Zhi 2017. [PMID: 28647984 DOI: 10.3760/cma.j.issn.0254-6450.2017.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the key techniques used for surveillance and disposal of infectious diseases, food poisoning and hospital infection to improve the ability of surveillance and disposal on public health emergency. Methods: Framework on surveillance and disposal of infectious diseases, food poisoning and hospital infection was set up, based on literature review and expert group discussion. Delphi method and technique for order preference by similarity to ideal solution comprehensive evaluation method were used for ordering preference by similarity, to screen key techniques set for surveillance and disposal of the above said events. Results: Framework to be used for selecting key techniques was designed, based on the classification of emergency events, processing cycle of emergency events and level of techniques. Twenty six public health experts were selected for a 2-round consultation, with their authority as 0.796. Ten key techniques with important significance for surveillance and disposal of infectious diseases, food poisoning and hospital infection were selected from each event. Among these key techniques, the early-warning system was recognized as the key technique, important for the surveillance and disposal of all three emergency events. Items as technology used for unknown pathogenic microorganism detection, personal protection, gene sequencing and tracing technology, microorganism molecular typing technology, nucleic acid detection technology etc. were the key techniques and need to develop for the surveillance and disposal of infectious diseases and iatrogenic infection. Data regarding key technologies on security and privacy, early warning and forecasting, field rapid detection were sorted out that all in need to improve the surveillance programs on disposal of infectious diseases and food poisoning. Data exchange appeared another key technique on infectious diseases, with toxin detection and other 5 techniques the key techniques for food poisoning. Data collection, standardization and other 3 techniques appeared as the key techniques on iatrogenic infection. Conclusions: Key techniques were selected in this study to meet the requirements of surveillance, disposal of infectious disease, food poisoning and iatrogenic infection. Authority of the experts got improved in the two-round consultation, ensuring the reliability of the results of screening and providing a scientific basis for the further research and priority development of the key techniques.
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Affiliation(s)
- Q R Zhu
- Medical College, Hangzhou Normal University, Hangzhou 310036, China
| | - L Yang
- Medical College, Hangzhou Normal University, Hangzhou 310036, China
| | - H Y Ma
- Medical College, Hangzhou Normal University, Hangzhou 310036, China
| | - W Q Xie
- Medical College, Hangzhou Normal University, Hangzhou 310036, China
| | - L M Cong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - L W Xu
- Medical College, Hangzhou Normal University, Hangzhou 310036, China
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