Validity and reliability of the pediatric pressure ulcer prediction and evaluation tool in the Turkish population: Comparison with Braden QD-T.

Determinants of birth asphyxia among neonates admitted to neonatal intensive care units in hospitals of the Wolaita zone, Southern Ethiopia: A case-control study

Empiric treatment with broad-spectrum antibiotics exerts condensed pressure in intensive care units (ICUs) for the selection of multidrug-resistant bacteria. Multidrug-resistant gram-negative bacteria became the focus of interest owing to limited treatment options and negative effects on patient survival. Cumulative antibiograms can guide selection of correct empiric treatment, de-escalation treatment according to antibiogram results and development of policies in fight against antibiotic resistance. In this study, we aimed to determine the antibiotic resistance rates of gram-negative bacilli in the intensive care units of the public hospitals in the region where we are connected by using the cumulative antibiogram result and to show the change of resistance over the years and to determine whether there is any difference between the hospitals. Gram-negative bacilli were isolated from ICUs of state hospitals in the second Istanbul State Hospitals Association area during 2014-2016. Isolates were identified using Vitek MS (bioMérieux, France) system and tested for antibiotic susceptibility with Vitek 2 (bioMérieux, France) system according to the Clinical and Laboratory Standards Institute (CLSI) criteria followed during those years. Cumulative antibiogram reports for these strains were prepared according to the CLSI M39-A4 guide. Gram-negative bacilli were divided into three groups: non-fermentative, urinary enteric, and non-urinary enteric bacilli. Total number of strains isolated during three years from these groups were 2626, 1390 and 2011, respectively. Annual trends of susceptibility during the aforementioned years were evaluated. Hospitals were also classified into five groups and differences were evaluated in the susceptibility profiles of these hospitals. Among the non-fermentative bacilli, Acinetobacter baumannii complex was the most commonly isolated species and the most resistant bacteria against antibiotics. The susceptibility rates of A.baumannii complex against the beta-lactam group of antibiotics were < 10%. Colistin susceptibility rates of A.baumannii complex and Pseudomonas aeruginosa isolates were over 98%. Among the non-urinary enteric bacilli, K.pneumoniae was the most commonly isolated species displaying maximum antibiotic resistance. Susceptibility rates for colistin, which is the last resort for treating resistant gram-negative bacteria, ranged between 73% and 80%. Escherichia coli, which was the second most common isolated species among non-urinary bacilli, had susceptibility rates over 90% to carbapenems along with colistin and tigecycline. Although E.coli was the most commonly isolated species among urinary enteric bacilli, K.pneumoniae and Proteus mirabilis were the most resistant isolates. A statistically significant decrease in susceptibility rates against all antibiotics was observed in P.mirabilis isolates between the years 2015-2016. Carbapenem susceptibility rates decreased below 70%. E.coli, Serratia spp., and Stenotrophomonas maltophilia had similar susceptibility profiles among different hospitals, indicating homogenous distribution, whereas other species had different profiles, indicating a more heterogenic distribution, among hospitals. The reports of this study were generated according to a standard guide and they clearly revealed the seriousness of antibiotic resistance in our region which represents approximately one-fourth area of Istanbul. When all the results were considered, best empiric treatment option for enteric bacilli except K.pneumoniae was carbapenems. For K.pneumoniae infections there is no reliable choice other than colistin but a de-escalation treatment can be planned according to antibiogram results. Similarly colistin is the first choice in empiric treatment of infecitons due to non-enteric bacilli. However, the heterogeneity of the susceptibility profile observed in the hospitals, which are geographically close to each other, indicated the difference in the flora of the intensive care unit of hospitals. It would be appropriate to prepare cumulative antibiogram reports similar to those in the present study, to prevent complications, reduce costs and improve patient prognosis in the intensive care units of hospitals and these reports should become part of the infection control policies applied in hospitals.

To investigate the current state of sedation, analgesia and blood glucose management in intensive care units (ICUs) of county hospitals in Guizhou Province of China, and to provide the evidences for improving quality control in critical care medicine. In March 2018, 3-4 ICUs of hospitals in every prefecture (one hospital per county) in Guizhou Province were visited to do the field survey. The patients' nursing records within 24 hours after ICU admission were reviewed, and the information such as gender, age, major diagnosis at the ICU admission, the time of admission, were collected. Moreover, the conditions about sedation and analgesia drug use and monitoring, blood pressure, blood glucose as well as and the usage of insulin and ventilator were recorded. Because not all the needed information of every ICU or patient was obtained, only the numbers of the ICUs and patients whose required information had been obtained were analyzed. Twenty-eight county hospitals in nine prefectures of Guizhou Province and 152 ICU patients were surveyed. There was a median of 5 (4, 7) patients stayed in every ICU on the day of survey. A total of 152 patients were enrolled, with 102 male (67.1%) and 50 female (32.9%); the median age was 65.0 (51.5, 74.8) years old; the major diagnosis at ICU admission was mainly cerebral diseases which accounted for 50.0% (76/152), and the second place was digestive system diseases which accounted for 13.8% (21/152); 53.8% (78/145) of patients were admitted to ICUs during 08:00-18:00. The percentages of ICUs which had patients received sedation and analgesia were 92.6% (25/27) and 88.9% (24/27) respectively, while only 44.4% (12/27) and 18.5% (5/27) of them were evaluated the depth of sedation and the level of pain respectively. There was 49.0% (71/145) of patients received sedation, and 33.8% (24/71) of them was evaluated by sedation scores; 49.7% (72/145) of patients received analgesia, and 13.9% (10/72) of them were evaluated by pain scores. The proportions of invasive mechanical ventilation in the patients with sedation or analgesia were both higher than those in the patients without sedation or analgesia [sedation compared with non-sedation: 85.9% (61/71) vs. 21.6% (16/74), analgesia compared with non-analgesia: 87.5% (63/72) vs. 19.2% (14/73), both P < 0.01]. The incidence of hypotension was similar between the sedated patients and the non-sedated patients [55.9% (38/68) vs. 40.3% (29/72), P > 0.05], while the incidence of hypotension was higher in the patients with analgesia as compared with that in the patients without analgesia with significant difference [56.9% (41/72) vs. 38.2% (26/68), P < 0.05]. Within 24 hours after ICU admission, there were 40.7% (59/145) and 5.5% (8/145) of patients had hyperglycemia (random blood glucose level ≥ 11.1 mmol/L) or hypoglycemia (random blood glucose level ≤ 3.9 mmol/L) respectively. No insulin was used to control the blood glucose level in the patients who had hypoglycemia or did not have hyperglycemia. However, only 23.7% (14/59) of patients with hyperglycemia were treated with insulin, the initiation of insulin therapy was triggered when median blood glucose level was 19.8 (16.8, 24.5) mmol/L. The evaluation of analgesia and sedation in the ICUs of county hospitals in Guizhou Province was seriously inadequate and needed to be strengthened urgently. Moreover, the strategy of blood glucose management was also needed to be improved.

ObjectiveTo evaluate the incidence of potential drug-drug interactions in an intensive care unit of a hospital, focusing on antimicrobial drugs.MethodsThis cross-sectional study analyzed electronic prescriptions of patients admitted to the intensive care unit of a teaching hospital between January 1 and March 31, 2014 and assessed potential drug-drug interactions associated with antimicrobial drugs. Antimicrobial drug consumption levels were expressed in daily doses per 100 patient-days. The search and classification of the interactions were based on the Micromedex® system.ResultsThe daily prescriptions of 82 patients were analyzed, totaling 656 prescriptions. Antimicrobial drugs represented 25% of all prescription drugs, with meropenem, vancomycin and ceftriaxone being the most prescribed medications. According to the approach of daily dose per 100 patient-days, the most commonly used antimicrobial drugs were cefepime, meropenem, sulfamethoxazole + trimethoprim and ciprofloxacin. The mean number of interactions per patient was 2.6. Among the interactions, 51% were classified as contraindicated or significantly severe. Highly significant interactions (clinical value 1 and 2) were observed with a prevalence of 98%.ConclusionThe current study demonstrated that antimicrobial drugs are frequently prescribed in intensive care units and present a very high number of potential drug-drug interactions, with most of them being considered highly significant.

Background:High utilization and irrational use of antibiotics in an intensive care unit increases microbial resistance, morbidity, mortality, and costs.Objective:This study aimed to evaluate the utilization, sensitivity and cost analysis of antibiotics used in the medical intensive care unit of a tertiary care teaching hospital of Nepal.Methods:A prospective cohort study was conducted on patients admitted to the medical intensive care unit at a tertiary care teaching hospital in central Nepal from July to September 2016. Antibiotic utilization, defined daily dose per 100 bed-days and the cost of antibiotics per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0.Results:A total of 365 antibiotics were prescribed in 157 patients during the study period, with an average of 2.34 prescriptions per patient. Total antibiotic utilization in terms of defined daily dose per 100 bed-days was 49.5. Piperacillin/tazobactam (45.2%) was the most commonly prescribed antibiotic, and meropenem was the most expensive antibiotics (US$4440.70). The median (interquartile range) cost of antibiotics used per patient was US$47.67 (US$63.73). Escherichia coli, Acinetobacter, and Pseudomonas sp. were the common organisms isolated and were found to be resistant to some of the commonly used antibiotics.Conclusion:This study suggests that the utilization and cost of antibiotics are high in medical intensive care unit of the hospital and E. coli was resistant to multiple antibiotics. The findings highlight an urgent need for the implementation of antibiotic stewardship program in order to improve antibiotic utilization in such hospital settings.

Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil

AIM:To determine average personal exposure to nitrous oxide for anaesthesiologists and nurses working in operating rooms (ORs) and intensive care units (ICU) in Clinical Hospital in Shtip, ENT University Clinic in Skopje and General Hospital in Kochani.METHODS:To determine TWA exposure nitrous oxide concentration was continuously measured over 8 hours shift within breathing zone of the subjects involved, using the handheld electrochemical instrument with data logging option. Results obtained were statistically processed.RESULTS:Highest TWA exposures (well above RELs) were found for nurses and anaesthesiologists in ORs in CH – Shtip, because of high workload in substandard conditions. TWA exposures in CH – Kochani were found to be significantly lower although in substandard conditions, mostly due to lower workload. TWA exposures found in ORs in ENT UC – Skopje is within RELs due to good work practices and proper ORs equipment.CONCLUSIONS:Study indicated significant exposure of personal working in substandard ORs in CH – Shtip. Applying proper work practices and maintain control equipment (general ventilation and scavenging systems) in operation, could provide for safe work environment.

Infection is one of the primary causes of human mortality. In the intensive care units a serious complication of infection is sepsis and its complications severe sepsis and septic shock.Sepsis is a common and a life-threatening illness, which is considered as a serious public health problem. The incidence of sepsis differs from one place to another place across the world. We aim is to estimate the incidence of sepsis in main hospitals of Ismailia city and to compare this result with results from studies in intensive care units in hospitals in other cities and countries. An observational that has been done in intensive care units of main hospital in Ismailia city. This study showed that cumulative incidence of sepsis to be 5.5% in a period of seven months which is lower than the incidence of severe sepsis in SOAP study and some other studies conducted in United Kingdom, France, Australia and New Zealand.

Most people develop mild or moderate symptoms of COVID-19, but some people develop severe symptoms, leading to hospitalizations. The objective of the research was to analyze the prevalence of confirmed cases of COVID-19, hospitalization for this disease in Intensive Care Units, and the occupancy rate of beds resulting from the same in these units in the municipality of Rondonopolis, Mato Grosso. This was a cross-sectional, descriptive study with a quantitative approach, with data from secondary sources of epidemiological bulletins in Rondonopolis, Mato Grosso, from June 2020 to May 2021. The average number of hospitalized cases per month and the occupancy rate of intensive care beds were calculated. All cases reported with COVID-19 and hospitalized in the Intensive Care Unit of public hospitals in the municipality were included. Analyses were performed with R Software and the chi-square goodness-of-fit test and Kendall's correlation were performed. A total of 28,443 new cases of COVID-19 were reported during the study period, with the highest average of hospitalizations in the intensive care unit in the public health network was in May 2021 (n=51.1) and the bed occupancy rate was in September 2020 (129.17%). In all regions analyzed in comparison with this study, the ICUs operated in a state of calamity with high occupancy rates. A relationship between the increase in the number of cases and hospitalizations and occupancy rates of Intensive Care Units was identified, which are findings that indicate the need to control COVID-19.

Introduction: Staphylococcus aureus is a highly significant pathogen responsible for infections and fatalities among patients in the intensive care unit (ICU) of hospitals. This study aimed to determine the frequency of antibiotic resistance in S. aureus strains isolated from urine, blood, and wound samples of hospitalized patients in the ICU of hospitals in Ahvaz, Iran. Methods: A total of 113 samples were collected during the sampling process. These samples were cultured on blood agar and eosin methylene blue (EMB) agar, followed by an incubation period at 37° C for 24 hours. The identification of S. aureus was based on the appearance of grayish-white colonies and a series of tests, including Gram stain, catalase, Mannitol salt agar, DNase, and tube coagulase tests. The isolates were analyzed using antibiograms to test for susceptibility to oxacillin, cefoxitin, linezolid, ciprofloxacin, clindamycin, trimethoprim, sulfamethoxazole, rifampicin, penicillin, and erythromycin. Results: The prevalence of S. aureus was highest in blood samples (49.55%) and lowest in urine samples (32.12%). All strains of tested S. aureus were sensitive to the antibiotic linezolid, while 90% of methicillin resistance S. Aureus (MRSA) found in blood samples were sensitive to rifampicin. The highest prevalence of S. aureus was found in Golestan hospital, accounting for 21.23%. The antibiotics with the highest resistance against MRSA in blood culture samples were penicillin (100%), clindamycin (88.9%), ciprofloxacin (81.81%), erythromycin (80.7%), and trimethoprim-sulfamethoxazole (73.52%). The polymerase chain reaction (PCR) results for gene prevalence revealed that 110 isolates contained this gene, while 3 isolates lacked it. Using the national multiplex PCR method for SCC typing, 47 isolates (7.42%) expressed SCC III, and 33 isolates (30%) expressed SCC II. Conclusion: The study findings revealed significant resistance to certain antibiotics in the hospital strains of S. aureus. Likely, the misuse of antibiotics, taken without a physician’s prescription contributes to this complication.

The COVID-19 pandemic remains a major public health challenge. Most patients infected with the SARS-CoV2 virus are critical patients requiring admission to intensive care units (ICU) and qualified nursing care. However, the experiences of nurses from China and Italy showed that one of the biggest obstacles in the care of patients with the disease occurred within the scope of the organization of trained and qualified teams, staff dimensioning, management of supplies and equipment, and attention to the mental health of these professionals. Faced with this pandemic scenario, professional nurses face important challenges concerning care and the quality of nursing services in intensive care. The objective of this research will be to identify the impact caused by the COVID-19 pandemic on the life habits of professionals from the Nursing teams who work in the Intensive Care Units in the municipality of Campos dos Goytacazes-RJ. This is a cross-sectional study to be carried out between October and December 2021. Data collection will be carried out through an online questionnaire (Google Forms®) whose sample will consistof professionals from the Nursing teams (nurses and nursing technicians), working in the Intensive Care Units of Private and Public Hospitals in the city of Campos dos Goytacazes-RJ. Subsequently, the data obtained will be analyzed using descriptive statistics in the SPSS® software. This study aims to contribute to improving the quality of life and health of nursing professionals working in ICUs and, consequently, the quality of care and patient safety. Furthermore, it is expected that the results corroborate the need to implement health protection strategies for these professionals in the context of the pandemic.

To identify the perception of nurses with regard to the process of providing care to patients in the context of hospice care. Qualitative study using the methodological framework Collective Subject Discourse. A total of 18 nursing professionals of the adult intensive care unit of a public hospital in São Paulo, Brazil were interviewed between June and August 2012. The process of providing care to terminal patients is permeated by negative, conflictive and mixed feelings. As regards communication, while the participants acknowledge its importance as a therapeutic resource, they also admit a lack of professional qualification. The interviewees have difficulties to deal with care provided to terminal patients. The qualification of these professionals needs to be improved, starting in the undergraduate program.

Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread?

Weight gain in low birth-weight babies remains a challenge to the management of the neonatal period in low and middle-income countries like Ethiopia. Therefore, this study aimed to determine the time to adequate weight gain and its predictors among low-birth-weight preterm neonates admitted to neonatal intensive care unit of public hospitals in Bahir Dar City. An institution-based retrospective follow-up study was conducted from March 4 to April 3, 2023, using three years of data. About 344 low-birth-weight preterm babies were recruited and followed up until 28 days of age. Model goodness-of-fit was checked by Cox Snell residuals test. The Cox-Proportional Hazards Model was used to assess predictors of weight gain with a statistically significant level of P-value < 0.05. The median weight gain time was 15 days with an overall incidence density rate of 6.3 per 100 person-day of observation (95% CI 0.055, 0.071). Absence of medical problems of mothers (AHR: 1.63, 95% CI 1.015, 4.614), spontaneous vaginal mode of delivery (AHR: 1.53, 95% CI 1.028, 2.593), and long duration of labor (AHR: 3.18, 95% CI 1.579, 6.413) were significant predictors. The time of adequate weight gain was long. Early detection and management of significant predictors is recommended.

BackgroundYellow Fever (YF) is still a major threat in developing countries and a cause of outbreaks in Africa and Latin America, despite a highly efficacious vaccine. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. In our study, we included all patients who were admitted to Intensive Care Units of Hospital das Clínicas, University of São Paulo Medical School during the 2018 YF outbreak. The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral parameters such as viral load and genotype among these cases, and determine markers associated with fatal outcome.MethodsAcute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by RT–qPCR and then sequenced. Patients were classified in two groups: survival or death.ResultsIn the univariate analysis the following variables were associated with outcome: ALT, AST, AST/ALT ratio, total bilirubin, CKD-EPI, ammonia, lipase, factor V, INR, lactate, and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase (OR 1.018, 95% CI 1.007 to 1.030, P = 0.002), and factor V (OR −0.955, 95% CI 0.929 to 0.982, P = 0.001). The estimated lipase and factor V cut-off values that maximized sensitivity and specificity for death prediction were 147.5 U/L (AUC = 0.879), and 56.5% (AUC = 0.913). Patients who were discharged from the hospital continued to be followed-up in the outpatient clinic. Seven patients had their urine and blood screened weekly for YFV until the test was negative. After the onset of symptoms, viremia and viruria were present for a maximum period of 28 days and 47 days, respectively.ConclusionYF acute severe cases show a generalized involvement of different organs (liver, spleen, heart, kidneys, intestines, and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.DisclosuresAll authors: No reported disclosures.