Cases Of Nosocomial Pneumonia Research Articles

Nosocomial Pneumonia in Georgia: A Study of Extended Spectrum Beta-Lactamase (ESBL)-Producing Versus Non-extended ESBL Gram-Negative Bacterial Profiles.

Nosocomial pneumonia is a significant healthcare challenge, particularly in the face of rising antimicrobial resistance among Gram-negative bacteria. The production of extended spectrum beta-lactamase (ESBL) exacerbates treatment complexities. This study investigates the prevalence and resistance patterns of ESBL-producing and non-ESBL Gram-negative bacteria in nosocomial pneumonia cases in Georgian hospitals to inform antibiotic stewardship and treatment strategies. To our knowledge, this is the first study of its kind conducted in Georgia, offering critical insights into bacterial resistance in this region. This prospective observational study analyzed a total of 357 pulmonary samples from patients diagnosed with nosocomial pneumonia in Georgian hospitals between December 2022 and February 2024. Gram-negative bacterial identification and ESBL determination were performed using the combination disk method, adhering to European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. The analyses were conducted at TEST-IMP Laboratory and the Richard Lugar Center for Public Health Research to investigate the prevalence and resistance patterns of ESBL-producing versus non-ESBL Gram-negative bacteria. Among the 256 Gram-negative isolates, 201 (78.5%) were ESBL producers. Pseudomonas aeruginosa (63.7%), Acinetobacter baumannii (18.4%), and Klebsiella pneumoniae (17.9%) were the most prevalent. Non-ESBL producers accounted for 21.5% but exhibited notable beta-lactamase activity. The remaining 101 samples were evaluated as an additional analysis, revealing the distribution of Gram-positive bacteria and fungi as outlined in the results. However, the primary emphasis of this study remains on the resistance patterns and prevalence of Gram-negative pathogens. The study highlights a concerning prevalence of ESBL-producing bacteria in nosocomial pneumonia cases, emphasizing the urgent need for improved antibiotic stewardship and infection control practices in Georgian hospitals. Non-ESBL producers displayed susceptibility to advanced antibiotics, presenting potential therapeutic opportunities, though vigilance is required to prevent further resistance development.

OriPlex: Origami-enabled multiplexed detection of respiratory pathogens

Origami biosensors leverage paper foldability to develop total analysis systems integrated in a single piece of paper. This capability can also be utilized to incorporate additional features that would be difficult to achieve with rigid substrates. In this article, we report a new design for 3D origami biosensors called OriPlex, which leverages the foldability of filter paper for the multiplexed detection of bacterial pathogens. OriPlex immunosensors detect pathogens by folding nanoparticle reservoirs containing different types of nanoprobes. This releases antibody-coated nanoparticles in a central channel where targets are captured through physical interactions. The OriPlex concept was demonstrated by detecting the respiratory pathogens Pseudomonas aeruginosa (PA) and Klebsiella pneumoniae (KP) with a limit of detection of 3.4·103 cfu mL−1 and 1.4·102 cfu mL−1, respectively, and with a turn-around time of 25 min. Remarkably, the OriPlex biosensors allowed the multiplexed detection of both pathogens spiked into real bronchial aspirate (BAS) samples at a concentration of 105 cfu mL−1 (clinical infection threshold), thus demonstrating their suitability for diagnosing lower tract respiratory infections. The results shown here pave the way for implementing OriPlex biosensors as a screening test for detecting superbugs requiring personalized antibiotics in suspected cases of nosocomial pneumonia.

A complication during chemotherapy of recurrence of acute lymphoblastic leukemia in a child

Acute lymphoblastic leukemia (ALL) is one of the most common malignant diseases of the hematopoiesis system in childhood, characterized by uncontrolled proliferation of a tumor clone from lymphocyte progenitor cells. At the same time, as a result of total immunosuppression, the most common complications are infectious. The purpose of the work: to describe a clinical case of nosocomial pneumonia, formed against the background of chemotherapy relapse of ALL. Materials and methods. A retrospective analysis of the medical records of patient L., 6 years old, who was being treated at the Department of Pediatric Pulmonology of the UKB No. 1 of the Razumovsky SSMU with the main diagnosis: Nosocomial polysegmental pneumonia with obstructive syndrome, acute course. Complications: 1. RF III art., 2. Pulmonary edema, 3. Exudative pleurisy. Background: ALL III phenotype; late bone marrow relapse, isolated (30.12.2022). Results. At the age of 2 (2019) - he made his ALL debut, received induction courses, and achieved remission within the prescribed consolidation period. In 2022, a reinduction course was conducted, and it was removed from the D-register. Relapse of leukemia (28.12.2022) - hospitalized in the V.Ya. Shustov UCB No. 3, 1 block of anti-relapse therapy of ALL in combination with hemotransfusion, massive antibacterial (AB) therapy was performed. On the 23rd day of hospitalization in the hematology clinic, nosocomial 2-sided polysegmental pneumonia was diagnosed, complicated by pulmonary edema, exudative pleurisy, RF III art. On 23.01.2023, the patient was urgently taken to the children’s Intensive care Unit (DORIT) in extremely serious condition UKB No. 1 named after S.R. Peacemakers SSMU, where over the next 15 bed days he received: erythrocyte suspension transfusion, oxygen therapy, combined AB therapy, GCS, bronchodilator and mucolytic therapy, against which the condition improved: symptoms of intoxication, DN were stopped, the inflammatory process in the lungs was resolved. For further treatment of relapse, ALL was transferred to the hematology clinic. Conclusion: The course of chemotherapy for relapse of ALL in the patient provoked a severe infectious complication - nosocomial pneumonia with DN III art., pulmonary edema, pleurisy. Timely diagnosis of pneumonia and intensive therapy in DORIT conditions contributed to a favorable outcome of the infectious process in the lungs. Taking into account the above, the tactics of ALL management were changed - allogeneic transplantation of hematopoietic stem cells from a haploidentical donor (father) was performed, 19.07.2023 - engraftment was achieved.

1426. Integrating artificial intelligence and dynamic programming to identify microbial clusters through antimicrobial susceptibility sequence analysis

Abstract Background The spread of infectious diseases and antimicrobial resistance poses a significant threat, especially in developing countries where traditional DNA fingerprinting techniques are often not available. We propose a novel approach using dynamic programming algorithms to compare antimicrobial susceptibility sequences and identify clusters of related microbes. Methods We selected pathogens from specific infections and tested them with a range of antimicrobials, recording the test results as either sensitive (S), resistant (R), or unknown (U) to each drug. These results were combined into a sequence, or ATB string, for each pathogen (Fig. 1). To compare the sequences, we used dynamic programming (Fig. 2) to calculate the minimum edit distance between each pair of sequences. The edit distance reflects the number of atomic changes needed to transform one sequence into the other. In this case, atomic changes include insertion, deletion, substitution, and matching of individual test results (Fig. 3). We created a matrix of pairwise similarities by comparing all ATB strings. A cluster of similar strains was identified based on a cutoff in the edit distance matrix, such as a distance of less than 1. The method, which is available in the SACIH+ system (https://plus.sacihweb.com), was used to analyze the same strain of specific healthcare infections from a public hospital in Belo Horizonte, Brazil, diagnosed between Jan 2022 and Mar 2023.Figure 1.Antimicrobial testing and ATB string generation for selected pathogens. Antimicrobial testing and ATB string generation for selected pathogens.Figure 2.Sequence comparison using dynamic programming. Sequence comparison using dynamic programming. Results We analyzed S. aureus strains from surgical site infection - SSI (23 cases), pneumonia - PNEU (29 cases), and bloodstream infection - BSI (13 cases). Identified 4 SSI, 10 PNEU clusters (Fig. 4 and 5), and 4 BSI clusters using edit distance matrix. For K. pneumoniae strains from 21 BSI, 22 PNEU, and 34 urinary tract infection - UTI cases, found 5 clusters for PNEU and UTI, and 7 clusters for BSI (Fig. 6).Figure 3.Minimum edit distance calculation for sequence comparison. Minimum edit distance calculation for sequence comparison.Figure 4.Clustering of Staphylococcus aureus strains from 29 nosocomial pneumonia cases. Clustering of Staphylococcus aureus strains from 29 nosocomial pneumonia cases.Figure 5.Identification of a large cluster with 16 identical Staphylococcus aureus strains from 29 nosocomial pneumonia cases.Identification of a large cluster with 16 identical Staphylococcus aureus strains from 29 nosocomial pneumonia cases. Conclusion Our novel approach using dynamic programming to compare antimicrobial susceptibility sequences has shown promise in identifying clusters of related microorganisms, even without traditional DNA fingerprinting methods. The method represents a valuable tool for tracking the spread of infectious diseases, especially in settings where traditional methods are not available.Figure 6.Clustering of Klebsiella pneumoniae strains from 21 bloodstream infection cases.Clustering of Klebsiella pneumoniae strains from 21 bloodstream infection cases. Disclosures All Authors: No reported disclosures

Diagnosis and Treatment of Inguinal Hernias after Surgical Treatment of Prostate Cancer, Current State of the Problem.

(1) Purpose: To compare and evaluate the immediate and long-term results of the use of various hernioplasties for the treatment of inguinal hernias after surgical treatment of prostate cancer; to determine the possibility of performing transabdominal preperitoneal (TAPP) hernioplasty and total extraperitoneal (eTEP) hernioplasty in patients with inguinal hernia during surgical treatment of prostate cancer. (2) Method: This study is a clinical analytical prospective study, without the use of randomization. The study included 220 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 100) and group B (n = 120)). Patients in group A received eTEP, and those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups. (3) Results: Group A: five patients had a scrotal hematoma, in 10 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 15%. In group B, the following postoperative complications were reported: one case of intestinal injury, six cases of acute urinary retention, eight cases of scrotal hematoma and 12 cases of nosocomial pneumonia or infectious complications from the postoperative wound were admitted. The overall incidence of early postoperative complications was 22.5%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ2 (3) = 2.54, p > 0.05). (4) Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss, the severity of pain syndrome, postoperative complication incidence and recurrence incidence (p > 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was much longer compared to group B (p < 0.05).

Protocol for an international, multicentre, prospective, observational study of nosocomial pneumonia in intensive care units: the PneumoINSPIRE study

Background: Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate. Objective: To describe the epidemiology, diagnostic strategies and treatment modalities for nosocomial pneumonia in contemporary ICU settings across multiple countries around the world. Design, setting and patients: PneumoINSPIRE is a large, multinational, prospective cohort study of adult ICU patients diagnosed with nosocomial pneumonia. Participating ICUs from at least 20 countries will collect data on 10 or more consecutive ICU patients with nosocomial pneumonia. Site-specific information, including hospital policies on antibiotic therapy, will be recorded along with patient-specific data. Variables that will be explored include: aetiology and antimicrobial resistance patterns, treatment-related parameters (including time to initiation of antibiotic therapy, and empirical antibiotic choice, dose and escalation or de-escalation), pneumonia resolution, ICU and hospital mortality, and risk factors for unfavourable outcomes. The concordance of ventilator-associated pneumonia diagnosis with accepted definitions will also be assessed. Results and conclusions: PneumoINSPIRE will provide valuable information on current diagnostic and management practices relating to ICU nosocomial pneumonia, and identify research priorities in the field. Trial registration:ClinicalTrials.gov identifier NCT02793141.

Financial impact of including dentists in UCIs for reducing cases of Nosocomial Pneumonia

It is a study of Financial Impact Analysis, where the financial consequences arising from the possibility of inclusion of the dentist in the Intensive Care Units (ICU), within the reality of the Unified Health System (SUS), were evaluated in Brazil. It was based on a quick review of the literature and economic evaluation with reference to the year 2018. Information on costs and hospitalizations were collected from the official databases of the Ministry of Health, the Federal Council of Medicine and the Union of Dentists of the State of São Paulo. Only the direct medical costs related to the hospitalizations were calculated. Scenarios were simulated for a time horizon of 1 year (2018) and a sensitivity analysis was made for a more optimistic scenario (values 20% lower) and another less optimistic (values 20% higher). On average, the presence of a dentist in the ICU reduces the development of pneumonia cases by 56% and 8.18 days, which represents a savings of 34.92% in hospitalization costs in the evaluated scenario. In Brazil, when hiring dentists in all ICUs, each avoided case would contribute to savings of R$ 7,949.45 (1US$ = R$ 4,02 in 30/10/2019), ranging from R$ 6,359.56 to R$ 9,539.35 in the optimistic and pessimistic scenarios, respectively, where each case avoided is higher than the dentist's monthly salary. It would be necessary to spend R$ 142,060,140.00 on hiring the dentist to cover the ICUs, making the final savings more than 865 million reais. It is concluded that the inclusion of the Dental Surgeon (DS) in ICU teams would have a positive economic impact, with savings in hospitalization costs from the perspective of SUS. The COVID-19 pandemic in Brazil, depending on the State's action in containment strategies, could require 2.17 times more in the bests of scenarios where the action of total suppression would be used. Such a situation requires emergency measures, and the role of the dentist is a strategy that can support the health system.Key messages Dental care in the ICU is an important and cost-effectiveness strategy for the control of microorganisms that act in the evolution of the pneumonia nosocomial.Such a situation requires emergency measures, and the role of the dentist is a strategy that can support the health system.

Neumonía intrahospitalaria asociada a ventilación mecánica en un hospital del estado de Tabasco, México

Objective: To evaluate the cases of nosocomial pneumonia in patients with mechanical ventilation (NAVM), from the regional hospital of high specialty Gustavo Adolfo Rovirosa Pérez in the emergency area, from January 2016 to December 2017. Methods: A quantitative, observational, retrospective and transversal study was carried out. The variables of interest were taken from critical patients admitted to the emergency department, with mechanical ventilation requirements that developed pneumonia 48 hours after the start of ventilatory support. 97 clinical files were reviewed, 30 met the inclusion criteria, a format for the collection and elaboration of the database was elaborated, for the analysis of the variables, the statistical software Spss version 22 was used. Results: The distribution of VAP by gender was higher in men (62.9%) than in women (37.1%) and the ages ranged between 18 and 86 years. The main cause of admission diagnoses was severe TBI (71.4%), followed by cranial-facial trauma (20%) and moderate TBI with poor secretion management (8.6%). Of the total of analyzed files, 35 corresponded to NAVM, with an average evolution of 2 to 5 days and up to more than 20 days. 88.6% presented fever and all patients with leukocytosis with a minimum value of 15,000. On chest radiographs, infiltrates and condensation zones were observed in 48.6% of the cases; in the case of the affected hemithorax, the most frequent was the right (62.9%), followed by bilateral (22.9%) and left (14.3%) injuries. Conclusions: The development of VAP, is related to the time of exposure to orointubation. Clinical signs and radiographic changes are related to the suspicion of this type of pneumonia and practically in all cases, they presented admission diagnoses related to some type of trauma.

S-Nitroso-N-acetylpenicillamine impregnated endotracheal tubes for prevention of ventilator-associated pneumonia.

The chances of ventilator-associated pneumonia (VAP) increases 6-20 folds when an endotracheal tube (ETT) is placed in a patient. VAP is one of the most common hospital-acquired infections and comprises 86% of the nosocomial pneumonia cases. This study introduces the idea of nitric oxide-releasing ETTs (NORel-ETTs) fabricated by the incorporation of the nitric oxide (NO) donor S-nitroso-N-acetylpenicillamine (SNAP) into commercially available ETTs via solvent swelling. The impregnation of SNAP provides NO release over a 7-day period without altering the mechanical properties of the ETT. The NORel-ETTs successfully reduced the bacterial infection from a commonly found pathogen in VAP, Pseudomonas aeruginosa, by 92.72 ± 0.97% when compared with the control ETTs. Overall, this study presents the incorporation of the active release of a bactericidal agent in ETTs as an efficient strategy to prevent the risk of VAP.

Molecular characterization of methicillin-resistant Staphylococcus aureus clinical strains from the endotracheal tubes of patients with nosocomial pneumonia

BackgroundAmong all cases of nosocomial pneumonia, Staphylococcus aureus is the second most prevalent pathogen (17.8%). In Europe, 29.9% of the isolates are oxacillin-resistant. The changing epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infections and the decreasing susceptibility to first-line antibiotics leave clinicians with few therapeutic options. The objective of our study was to determine the antimicrobial susceptibility, the associated molecular mechanisms of resistance and the epidemiological relatedness of MRSA strains isolated from the endotracheal tubes (ETT) of intubated critically ill patients in the intensive care unit (ICU) with nosocomial pneumonia caused by Staphylococcus aureus.MethodsThe antimicrobial susceptibility to vancomycin, linezolid, ciprofloxacin, clindamycin, erythromycin, chloramphenicol, fusidic acid, gentamicin, quinupristin-dalfopristin, rifampicin, sulfamethoxazole/trimethoprim, and tetracycline were measured. Resistance mechanisms were then analyzed by polymerase chain reaction and sequencing. Molecular epidemiology was carried out by multi-locus sequence typing.ResultsS. aureus isolates were resistant to ciprofloxacin, erythromycin, gentamicin, tetracycline, clindamycin, and fusidic acid. The most frequent mutations in quinolone-resistant S. aureus strains were S84L in the gyrA gene, V511A in the gyrB gene, S144P in the grlA gene, and K401R/E in the grlB gene. Strains resistant to erythromycin carried the ermC, ermA, and msrA genes; the same ermC and ermA genes were detected in strains resistant to clindamycin. The aac(6′)-aph(2″) gene was related to gentamicin resistance, while resistance to tetracycline was related to tetK (efflux pump). The fusB gene was detected in the strain resistant to fusidic acid. The most frequent sequence types were ST22, ST8, and ST217, which were distributed in four clonal complexes (CC5, CC22, CC45, and CC59).ConclusionsHigh levels of resistance to second-line antimicrobials threatens the treatment of nosocomial respiratory infections due to methicillin-resistant S. aureus with decreased susceptibility to linezolid and vancomycin. The wide genotypic diversity found reinforces the central role of ICU infection control in preventing nosocomial transmission.

The putative bacterial oxygen sensor Pseudomonas prolyl hydroxylase (PPHD) suppresses antibiotic resistance and pathogenicity in Pseudomonas aeruginosa

The putative bacterial oxygen sensor Pseudomonas prolyl hydroxylase (PPHD) suppresses antibiotic resistance and pathogenicity in Pseudomonas aeruginosa

An overview of guidelines for the management of hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria.

Multidrug-resistant (MDR) Gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are associated with poor clinical outcomes. These pathogens represent a global threat with few therapeutic options. In this review, we discuss current guidelines for the empiric management of HAP/VAP caused by MDR Gram-negative pathogens. The incidence of MDR Gram-negative bacteria is rising among cases of nosocomial pneumonia, such that it is now becoming a significant challenge for clinicians. Adherence to international guidelines may ensure early and adequate antimicrobial therapy, guided by local microbiological data and awareness of the risk factors for MDR bacteria. Due to the increasing prevalence of HAP/VAP caused by MDR Gram-negative pathogens, management should be guided by the local ecology and the patient's risk factors for MDR pathogens. The main risk factors are prior hospitalization for at least 5 days, prior use of broad-spectrum antibiotics, prior colonization with resistant pathogens, admission to hospital settings with high rates of MDR pathogens, and septic shock at the time of diagnosis with nosocomial pneumonia.

Incidence and risk factors of non-device-associated pneumonia in an acute-care hospital.

To update current estimates of non-device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia. Cohort study. Academic teaching hospital. All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non-device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology. From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40-3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07-2.05), or paralysis (HR, 1.72; 95% CI, 1.09-2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18-2.00) or in the ICU (HR, 1.49; 95% CI, 1.06-2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation. The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non-device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.

Linezolid versus vancomycin cost in the treatment of staphylococcal pneumonia

ObjectiveStaphylococcusaureus is involved in around 20% of nosocomial pneumonia cases. Vancomycin used to be the reference antibiotic in this indication, but new molecules have been commercialized, such as linezolid. Previous studies comparing vancomycin and linezolid were based on models. Comparing their real costs from a hospital perspective was needed. MethodsWe performed a bicentric retrospective analysis with a cost-minimization analysis. The hospital antibiotic acquisition costs were used, as well as the laboratory test and administration costs from the health insurance cost scale. The cost of each hospital stay was evaluated using the national cost scale per diagnosis related group (DRG), and was then weighted by the stay duration. ResultsFifty-eight patients were included. All bacteria identified in pulmonary samples were S. aureus. The cost of nursing care per stay with linezolid was €234.10 (SD=91.50) vs. €381.70 (SD=184.70) with vancomycin (P=0.0029). The cost of laboratory tests for linezolid was €172.30 (SD=128.90) per stay vs. €330.70 (SD=198.40) for vancomycin (P=0.0005). The acquisition cost of linezolid per stay was not different from vancomycin based on the price of the generic drug (€54.92 [SD=20.54] vs. €40.30 [SD=22.70]). After weighting by the duration of stay observed, the mean cost per hospital stay was €47,411.50 for linezolid and €57,694.0 for vancomycin (NSD). ConclusionThese results, in favor of linezolid, support other former pharmacoeconomic study based on models. The mean cost per hospitalization stay was not statistically different between the two study groups, but a trend in favor of linezolid is emerging.

Ligadura del conducto arterioso en recién nacidos prematuros: experiencia del Hospital Nacional de la Mujer

Introducción. El ductus arterioso es una estructura que en la vida fetal se origina del sexto arco aórtico izquierdo embrionario y su función es primordial para la vida del feto. Posterior al nacimiento, su permeabilidad y persistencia se considera una cardiopatía y debe tratarse. Materiales y métodos. Se revisaron 18 expedientes médicos de pacientes con ductus arterioso de repercusión hemodinámica sometidos a cirugía. Todos los pacientes fueron abordados por la técnica de toracotomía lateral izquierda y se realizó doble ligadura al conducto. El tiempo postoperatorio y sus cuidados se cumplieron en la unidad de cuidados intensivos neonatales. Resultados. El total de pacientes operados fue de 18. El rango de pesos del grupo operado se encontraba entre 696 y los 2000 gramos. La edad gestacional se encontraba entre las 24 a 34 semanas. Se operaron 12 pacientes del sexo femenino y 6 masculinos. Se presentaron complicaciones postoperatorias en 5 casos. Tres pacientes tuvieron falla cardíaca que se trató de forma oportuna y dos casos terminaron con un ductus arterioso permeable residual luego de la ligadura. Fallecieron 3 pacientes sometidos a cirugía, pero la causa de muerte se debió a procesos infecciosos (un caso de neumonía nosocomial y dos por sepsis). Conclusiones. Valorando los riesgos versus los beneficios de la ligadura del ductus arterioso permeable, esta medida de tratamiento ha resultado ser una opción válida, ya que en El Salvador no se cuentan con medicamentos en presentación parenteral (indometacina-ibuprofeno) para el cierre farmacológico de esta cardiopatía.&#x0D; Palabras clave: prematurez, ligadura, ductus arterioso, El Salvador.

Inhibition of inflammasome activation by a clinical strain of Klebsiella pneumoniae impairs efferocytosis and leads to bacterial dissemination

Klebsiella pneumoniae is a Gram-negative bacterium responsible for severe cases of nosocomial pneumonia. During the infectious process, both neutrophils and monocytes migrate to the site of infection, where they carry out their effector functions and can be affected by different patterns of cell death. Our data show that clinical strains of K. pneumoniae have dissimilar mechanisms for surviving within macrophages; these mechanisms include modulation of microbicidal mediators and cell death. The A28006 strain induced high IL-1β production and pyroptotic cell death in macrophages; by contrast, the A54970 strain induced high IL-10 production and low IL-1β production by macrophages. Pyroptotic cell death induced by the A28006 strain leads to a significant increase in bacterial sensitivity to hydrogen peroxide, and efferocytosis of the pyroptotic cells results in efficient bacterial clearance both in vitro and in vivo. In addition, the A54970 strain was able to inhibit inflammasome activation and pyroptotic cell death by inducing IL-10 production. Here, for the first time, we present a K. pneumoniae strain able to inhibit inflammasome activation, leading to bacterial survival and dissemination in the host. The understanding of possible escape mechanisms is essential in the search for alternative treatments against multidrug-resistant bacteria.

1267. Nonventilator Hospital Acquired Pneumonia (NV-HAP) Prevention Initiative in Colombia, Bogotá

BackgroundPneumonia is the second most common healthcare-associated infection worldwide. Non ventilator – Hospital Acquired Pneumonia (NV-HAP) affects more people than VAP, has a comparable mortality rate (18.7% vs. 18.9%), and has higher total costs ($156 million vs. $86 million), respectively. The objective of this study was to describe the result of the implementation of a bundle of measures for the prevention of NV-HAP in adult patients in a University Hospital in Colombia.MethodsDescriptive study. In a period of 2 years, a care bundle for prevention of NV-HAP was implemented in adult patients in a university hospital that consisted of: (1) identification of patients at risk (patients over 60 years of age, or with altered consciousness, or swallowing disorder, or patients with tracheostomy), (2) marking the patient with a sticker on the head of the bed, and (3) implementation of the following measures: head of the bed elevation to 30°–45°, oral care every 12 hours, chlorhexidine oral rinse decontamination every 12 hours and aspiration of secretions as needed. In the first 6 months, training was carried out for all staff, the monthly adherence to the strategy was measured.ResultsDuring 2016, 1,045 patients were included, with 10,011 observations, bundle adherence during the first year was 33%. in the second year, 1,400 patiens were included, with 13,198 observations, the bundle adherence increased to 90% throughout the hospital. The rate of NV-HAP decreased from 4.2 (96 cases) to 3.4 (89 cases) per 1,000 patient-days, in the second year compared with the previous intervention year.ConclusionThe strategy of prevention of NV-HAP decreased the cases of nosocomial pneumonia in a university hospital, through the education a high adherence to the strategy was achieved. Studies with a better design should be done to confirm the findings.Disclosures All authors: No reported disclosures.

Characteristics and factors associated with nosocomial pneumonia among patients undergoing continuous renal replacement therapy (CRRT): A case–control study

ObjectivesContinuous renal replacement therapy (CRRT) is a specialized type of dialysis. However, the characteristics and factors associated with nosocomial pneumonia in patients undergoing CRRT have received little attention to date. Therefore, this study investigated the characteristics of and factors contributing to nosocomial pneumonia in patients receiving CRRT. MethodsThe clinical data of 1160 patients undergoing CRRT during the period January 2008 to December 2015 were analyzed retrospectively. Of these 1160 cases, 145 (12.5%) were included in the nosocomial pneumonia group, while 1015 were included in the control group. ResultsThe primary pathogen in the 145 cases of nosocomial pneumonia in the CRRT patients was Staphylococcus aureus (58.57%); the morbidity rate was 12.5%. Multivariate logistic regression analysis revealed that age (odds ratio (OR) 2.209), initial curative time (OR 1.960), underlying diseases (OR 1.820), consciousness disorder (OR 1.616), organ failure (OR 2.154), the Acute Physiology and Chronic Health Evaluation II score (APACHE II) (OR 1.186), and the Charlson Comorbidity Index score (CCI) (OR 1.278) were risk factors for nosocomial pneumonia (all p<0.05). Conversely, the serum white blood cell count (OR 0.585), albumin (OR 0.673), and hemoglobin (OR 0.712) levels were protective factors (all p<0.05). ConclusionsResults from this study indicate that by modifying risk factors, such as providing adequate nutrition, earlier treatment of underlying diseases, and controlling organ failure, the risks associated with nosocomial pneumonia may be reduced.

Utility of procalcitonin in predicting mortality among cases of hospital-acquired pneumonia: a North Indian study

Bckground Data regarding the role of biomarkers like procalcitonin (PCT) in predicting treatment outcomes in hospital-acquired pneumonia (HAP) are limited in an Indian setting. We set out to determine the usefulness of PCT in predicting mortality among the cases of nosocomial pneumonia, at an 800-bed, apex tertiary care centre, in Kashmir (North India). Patients and methods Of the 318 confirmed cases of HAP, 60 consenting cases were selected randomly. Quantitative determination of PCT was done using immunofluorescence assays. Levels greater than 0.5 ng/ml were taken as positive. Data were collected on clinical parameters, and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores pneumonia severity index were calculated. Appropriate blood and respiratory cultures were performed. Results Of the 60 cases included in the study, 19 (32%) died during the hospital stay, of which 14 (74%) deaths occurred in PCT-positive cases (P=0.001). The median PCT level was higher in the in-hospital mortality group (1.07 vs. 0.25), with a mean value of 1.2±2.8 vs. 1.2±2.5 in the group with no mortality (P=0.000). Using multivariate analysis, positive PCT level was strongly associated with in-hospital mortality (odds ratio: 6.767, 95%CI: 1.992–22.984, P=0.002) and APACHE-II score greater than 20 (n=14, odds ratio=4.5, 95%CI=1.448–13.984, P=0.009). Using receiver operating characteristic analysis, PCT had apropos discrimination power for in-hospital mortality (0.713 of area under the curve) and higher APACHE-II scores (0.753 of area under the curve). Using Cox regression model for mortality in PCT-positive group, the calculated hazard ratio was 3.273 (95%CI: 1.076–9.951, P=0.037). Conclusion PCT might have a vital role in the management of HAP, as a predictor of the poor treatment outcome.

Healthcare Resource Utilization and Cost Related to Nosocomial Pneumonia Caused by Staphylococcus aureus and Pseudomonas aeruginosa in France: A 2010-2011 Population-Based Cohort Study Using a National Claims Database

Background: Nosocomial pneumonia is a leading cause of hospital-acquired infection. However, evidence is limited regarding resource utilization and healthcare costs associated with nosocomial pneumonia in France. Methods: This retrospective case-control study used a nationwide hospital claims database for cases of nosocomial pneumonia caused by P. aeruginosa or Pseudomonas aeruginosa. Hospital stay costs were retrieved during index hospitalization and at 30-days and 90-days post-discharge. Cost was calculated using Diagnosis Related Group (DRG) codes and daily cost estimates. Results: Of 7,793 patients discharged with S. aureus or P. aeruginosa pneumonia between January 2010 and December 2011, 1,453 and 1,449 cases were included, respectively. Cases were matched with controls in terms of DRG root, age, gender, Charlson comorbidity score, and hospital region. Cases demonstrated significantly higher Charlson comorbidity scores (p<0.01) and almost four times higher mean index hospitalization duration (p<0.001), critical care unit stays (p<0.001), mechanical ventilation procedures (p<0.001), and mortality (p<0.001) compared to matched controls. Univariate analysis indicated significantly higher cost of treating cases compared to controls in terms of DRG (S. aureus cohort: €21,540 vs. €6,426; P. aeruginosa cohort: €20,732 vs. €6,172; p<0.001) and daily valuation costs (S. aureus cohort: €28,063 vs. €5,976; P. aeruginosa cohort: €30,827 vs. €5,819; p<0.001). Multivariate analysis showed that nosocomial pneumonia increased mean DRG costs at 90 days by €13,500 to €16,700 for S. aureus cohort, and by €13,300 to €20,200 for P. aeruginosa cohort. Conclusions: Nosocomial pneumonia due to S. aureus or P. aeruginosa was associated with considerable patient morbidity and hospital costs in France.