Frequency Of Nosocomial Infections Research Articles

Pattern and Frequency of Nosocomial Infections in the Pediatric Intensive Care Unit at East Jeddah General Hospital, Saudi Arabia.

Background Because of the use of invasive devices and procedures in critically sick patients, patients in the pediatric intensive care unit (PICU) are particularly vulnerable to nosocomial infections. Although a significant illness may necessitate admission to the PICU, infections can also emerge after admission. Nosocomial infection is a major public health issue related to increased morbidity, death, and healthcare costs. This study aimed to determine the pattern, frequency, and outcomes of nosocomial infections among children who were admitted to the PICU. Methodology This retrospective, cross-sectional study was conducted in the pediatric population aged from one month to 14 years old who acquired infections after 48 hours of admission to the PICU at East Jeddah General Hospital, Saudi Arabia from 2021 to 2022. The data were collected from medical and laboratory records. Results A total of 51 patients developed 145 nosocomial infections. Central line-associated bloodstream infections (CLABSIs) were the most commonly reported type of nosocomial infections (28.3%). The majority of the isolated organisms (58.7%) were gram-negative, followed by fungal infections (35.1%) and gram-positive organisms (6.2%). The death rate for patients with nosocomial infections was 29.4%. Increased death rates among individuals with CLABSIs and gram-negative isolates were observed to be significantly correlated (p = 0.001). Conclusions Our findings suggest that regular surveillance systems were necessary to assess the relationship between these well-known risk variables with PICU, implying that preventing these infections through particular treatments could be cost-effective and contribute to the safety of healthcare systems.

The composition of planktonic prokaryotic communities in a hospital building water system depends on both incoming water and flow dynamics.

In recent years, the frequency of nosocomial infections has increased. Hospital water systems support the growth of microbes, especially opportunistic premise plumbing pathogens. In this study, planktonic prokaryotic communities present in water samples taken from hospital showers and hand basins, collected over three different sampling phases, were characterized by 16S rRNA gene amplicon sequencing. Significant differences in the abundance of various prokaryotic taxa were found through univariate and multivariate analysis. Overall, the prokaryotic communities of hospital water were taxonomically diverse and dominated by biofilm forming, corrosion causing, and potentially pathogenic bacteria. The phyla Proteobacteria, Actinobacteriota, Bacteroidota, Planctomycetota, Firmicutes, and Cyanobacteria made up 96% of the relative abundance. The α-diversity measurements of prokaryotic communities showed no difference in taxa evenness and richness based on sampling sites (shower or hand basins), sampling phases (months), and presence or absence of Vermamoeba vermiformis. However, β-diversity measurements showed significant clustering of prokaryotic communities based on sampling phases, with the greatest difference observed between the samples collected in phase 1vs phase 2/3. Importantly, significant difference was observed in prokaryotic communities based on flow dynamics of the incoming water. The Pielou's evenness diversity index revealed a significant difference (Kruskal Wallis, p < 0.05) and showed higher species richness in low flow regime (< 13 minutes water flushing per week and ≤ 765 flushing events per six months). Similarly, Bray-Curtis dissimilarity index found significant differences (PERMANOVA, p < 0.05) in the prokaryotic communities of low vs medium/high flow regimes. Furthermore, linear discriminant analysis effect size showed that several biofilm forming (e.g., Pseudomonadales), corrosion causing (e.g., Desulfobacterales), extremely environmental stress resistant (e.g., Deinococcales), and potentially pathogenic (e.g., Pseudomonas) bacterial taxa were in higher amounts under low flow regime conditions. This study demonstrated that a hospital building water system consists of a complex microbiome that is shaped by incoming water quality and the building flow dynamics arising through usage.

Effects of different doses of methylprednisolone on clinical outcomes in patients with severe community-acquired pneumonia: a study protocol for a randomized controlled trial

BackgroundThe specific use of methylprednisolone in severe community-acquired pneumonia (SCAP) has not yet formed a consensus. It is not clear whether the clinical efficacy of methylprednisolone in SCAP is dose-dependent, and how to balance the best efficacy with the least complications. The aim of this study is to evaluate the efficacy and safety of different doses of methylprednisolone in the adjuvant treatment for patients with SCAP.Methods/designThis is a prospective, randomized, double-blind, parallel group, placebo-controlled trial to evaluate the efficacy and safety of different doses of methylprednisolone in the adjuvant treatment for patients with SCAP. Patients with diagnosed SCAP are randomized to the following four groups at a 1:1:1:1 ratio: group 1 (control group)—standard ICU patient care+100ml of normal saline once a day for 5 days; group 2—standard ICU patient care+40mg of methylprednisolone (dissolved in normal saline with a final volume of 100ml) once a day for 5 days; group 3—standard ICU patient care+80mg of methylprednisolone (dissolved in normal saline with a final volume of 100ml) once a day for 5 days; and group 4—standard ICU patient care+120mg of methylprednisolone (dissolved in normal saline with a final volume of 100ml) once a day for 5 days. The primary outcome is PaO2/FiO2 ratio at day 5 following randomization. The secondary outcomes are 28-day mortality, ventilator-free days at 28 days, mechanical ventilation duration at 28 days, endotracheal intubation rate, time for temperature recovery, duration of vasopressors use, serum CRP and interleukin-6 level at day 5 following randomization, hospital stay, frequency of nosocomial infections, gastrointestinal hemorrhage, and hyperglycemia.DiscussionThe results of our study may find the optimal dose of glucocorticoid in the adjuvant treatment of SCAP and provide evidence-based proof for clinicians to treat patients with SCAP. Since coronavirus disease 2019 (COVID-19) also belongs to community-acquired pneumonia, perhaps the results of our study will help to determine the appropriate dose of methylprednisolone in COVID-19 treatment.Trial registrationChinese Clinical Trial Registry ChiCTR2100045056. Registered on 4 April 2021.

Nosocomial Infection in Patients with Severe and Critical COVID-19

The aim of the study was to determine the etiology and frequency of nosocomial infections in patients with severe and critical COVID-19.Material and methods. A retrospective, single-center study included 168 patients with COVID-19 admitted to the intensive care unit (ICU). All episodes of infection, clinical and laboratory characteristics, and outcome were documented in patients.Results. Hospital-acquired infections were detected in 82 (48.8%) of 168 patients, more frequently in men (p = 0.028). A total of 232 episodes of nosocomial infections were observed including ventilator-associated pneumonia (48.2%), bloodstream infection (39.2%), nosocomial pneumonia/tracheobronchitis (13.4%), and urinary tract infection (5.2%). The main causative agents of nosocomial infections were resistant strains of Acinetobacter baumannii and Klebsiella pneumoniae. Infections developed on the average on day 6 [3; 9] of ICU stay and were associated with the initial severity of the patients assessed by SOFA (p=0.016), SpO2 (p=0.005), lymphopenia severity (p=0.003), Neutrophil-Lymphocyte Ratio (p=0.004), C-reactive protein (p=0.01), aspartate aminotransferase (AST) level (p=0.022), or vitamin D (p=0.035) levels. Patients diagnosed with infection were more likely than those without infections to require mechanical ventilation (67.6% vs 32.4%, p &lt; 0.001), high-flow oxygen therapy (50.0% vs 31.0%, p = 0.020), renal replacement therapy (36.8% vs 9.3%, p = 0.003), and had longer ICU length of stay (13 [9; 18] vs 4 [2; 8], p &lt; 0.001), hospital length of stay (19 [14; 29] vs 15 [11; 20], p = 0.001) and mortality (47 (57.3%) vs 25 (29.0%), p &lt; 0.001).Conclusion. In patients with severe and critical COVID-19 a high incidence of nosocomial infections was found, which negatively affected the outcome. In more than half of the cases, the infection was caused by resistant strains of Gram-negative bacilli. Procalcitonin is a useful biomarker for identifying bacterial infection in patients with COVID-19.

Late Neonatal Bacterial Infection at the Brazzaville Teaching Hospital

Background: Late Neonatal Bacterial Infection (LNNBI) is a clinical and biological manifestations related to penetration and growth of specific causative bacteria in bloodstream occurring on the 4th-28th day of life. LNNBI still represents an important cause of mortality and morbidity among infants. Objectives: To determine the frequency of late bacterial infections in newborns, to describe the clinical and biological profiles and to identify the main responsible germs. Methods: Descriptive study data collection, conducted over a period of 10 months at the Brazzaville Teaching Hospital, of interest to newborns admitted from the 4th day of life for suspicion of neonatal infection, and those admitted for any other pathology and having presented an infection 48 hours after hospitalization, and in whom a bacterial culture and/or an inflammatory assessment confirmed or suspected infection. Results: During the study period, 1682 newborns were hospitalized, and 86 were hospitalized for a late neonatal bacterial infection, i.e. a frequency of 5.1%. There were 67 (77.9%) community infections and 19 (22.1%) nosocomial infections. The frequency of nosocomial infection was 1.1%. The main signs were fever in 65 cases (75.6%), and respiratory distress in 37 cases (43%). The most frequent localizations were bacteremia 32 (37.2%), pulmonary 21 (24.4%), digestive and meningeal in 11 cases (12.8%) each. The most common germ Klebsiella in 10 (50%) newborns was resistant to the usual antibiotics. The evolution was favorable in 71 cases (82.5%), and death occurred in 12 cases (14%). Conclusion: Late neonatal bacterial infection is common. The main responsible germs are gram-negative bacilli, in particular Klebsiella multi-resistant.

Retrospective Study of Nosocomial Infections in the Orthopaedic and Rehabilitation Clinic of the Medical University of Lublin in the Years 2018-2020.

Nosocomial infections appear in patients treated in hospital, which are not the initial cause of admission. A retrospective study concerning nosocomial infections was conducted to provide data about the amount, frequency and types of nosocomial infections in the rehabilitation ward in the Orthopaedics and Rehabilitation Clinic of Lublin. The study was conducted on a group of 49 patients that were admitted or transferred to the ward over a period of 20 months in the years 2018–2020. The patients and therefore the infections were divided by age, sex, time of hospitalization and the underlying disease. The study also provided data about the most frequent infection types in these patients, as well as the most commonly used drugs to treat those infections. The results showed that in fact all of the examined factors have an impact on the frequency of nosocomial infections appearance rates. Furthermore, results in the study showed that factors examined by the study also have an impact on what type of infection was present in these groups of patients.

Rotavirüs Gastroenteritli Çocuklarda Nötrofil/ Lenfosit Oranı, Trombosit/Lenfosit Oranı Ve Ortalama Trombosit Hacminin Değerlendirilmesi

ABSTRACT&#x0D; Rotavirus is most common agent responsible for acute gastroenteritis in Turkey as its in the world. There are no studies about the relationship between hematologic parameters and clinic of rotavirus gastroenteritis in children. The aim of this study is to compare the values of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and mean platelet volume in patients with rotavirus gastroenteritis with healthy controls. Patients with acute rotavirus gastroenteritis, who were admitted to our Department of Pediatric Health and Diseases between January 2016 and January 2017, were included in this study. Patients' data were reviewed, retrospectively. Age, gender, seasonal distribution, symptoms, duration of hospitalization, course of disease, type of acute gastroenteritis, frequency of nosocomial infections and complications were investigated. 210 patients diagnosed with rotavirus gastroenteritis were included in the study. 116 (55.2%) of the patients were male and 94 (44.8%) were female. The mean age of our patients was 39.09±17.64 months. There was no statistically significant difference between genders in terms of mean ages. Mean hospitalization time of patients was 3.75±2.03 days. In our study, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and mean platelet volume values were found statistically higher in patients with rotavirus-associated gastroenteritis than in healthy subjects. We think that these parameters will be indicative to predict the course of the disease and complications.

Nosocomial Infections at Three Regional Tertiary Hospitals in Trinidad and Tobago

Objective: The main objectives of this research were to conduct and provide accurate and original findings related to the epidemiological study of nosocomial infections at three regional tertiary hospitals in Trinidad and Tobago. Specifically, the researcher determined; the frequency of nosocomial infections (NI), the frequency of multiple drug resistance among bacterial organisms associated with NI, infection control measures practiced at the research hospitals and the cost of such NI in terms of morbidity and mortality Synopsis: This study estimated the rate of nosocomial infections (NI) among patients at three major regional hospitals in Trinidad and Tobago and evaluated the frequency of pathogens associated with nosocomial infections. Approximately 450 of 126, 668 patients had nosocomial infections and the most frequent type of nosocomial pathogens were: Staphylococcus sp. (22.5%), Pseudomonas aeruginosa sp. (12.7%), Acinetobacter (11.8%) and Klebsiella sp. (11.6%). Methods: A one-year prospective cross-sectional study was carried out. The nosocomial pathogens were retrieved from the microbiology laboratory. Antimicrobial susceptibility test by the disk diffusion method were done on all bacterial isolates. Data was analysed using SPSS version 20.0. Results: This research revealed that 450 inpatients suffered nosocomial infections, with thirty (30) mortalities during the twelve (12) months that the study lasted (June 2013 to May 2014) at three regional hospitals of Trinidad and Tobago. The incidence of nosocomial infections was 5.8% and the nosocomial infection rate was 3.6 per 1000 (450/126,668). The highest rate (30.1%) was observed in the Intensive Care Unit (82/272 admissions). The most frequent type of nosocomial infection was Skin and Soft Tissue Infections 168 (37.3%). Staphylococcus sp. (22.5%), Pseudomonas aeruginosa sp. (12.7%), Acinetobacter (11.8%) and Klebsiella sp. (11.6%) were the most frequently occurring nosocomial pathogens. Conclusion: Consistency in performing good hygiene practices is vital for reducing the high nosocomial rate found at the research sites. Prediction of these infections is very important as a part of clinical surveillance programs to take preventive measures in advance. The antimicrobial susceptibility pattern rate (ASPR) showed that only 8.3 % (5/60) of the isolates were antibiotic-susceptible strains.

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia: a cross-sectional study

BackgroundMulti-drug resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa are major causes of nosocomial infections globally. They are the current World Health Organization critical priority pathogens for resistance, Antimicrobial resistance (AMR) surveillance and discovery of new antibiotics. However, there is paucity of data on nosocomial infections (NIs) caused by such superbugs in Ethiopia. Therefore, this study determined the magnitude and profile of nosocomial MDR A. baumannii and P. aeruginosa infections among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia.MethodsA cross-sectional study was conducted at Felegehiwot referral hospital from April 1 to July 31, 2018. A total of 238 patients with blood stream, urinary tract and surgical site NIs were enrolled conveniently. Either blood, urine and wound swab specimens were collected and processed using standard bacteriological procedures. A. baumannii and P. aeruginosa isolates were identified using standard bacteriological techniques and confirmed by automated Vitek2 Compact. Antimicrobial susceptibility testing on isolates was performed using the disk diffusion technique. The results were interpreted as per the standard zone sizes of Clinical and Laboratory Standards Institute.Chi-square test was done to determine associations among variables. P value < 0.05 was considered statistical significant.ResultsThe median age of participants was 29 years. Overall,20(8.4%) of patients had nosocomial MDR A. baumannii and P. aeruginosa infections. The proportion of nosocomial MDR blood stream, urinary tract and surgical site infections were 13(8.9%), 5(8.3%) and 2 (6.3%), respectively. Patients with NI had lower mean age (24.9 years) (P = 0.035). All isolates of NIs were from patients with intravenous catheterization. The frequency of NI was 9(3.8%) for MDR A. baumannii and 11(4.6%) for MDR P.aeruginosa. A. baumannii and P. aeruginosa isolates were 100% MDR. All isolates of A. baumannii and P. aeruginosa were 100% resistant to ampicillin and piperacillin.A. baumannii isolates were 33.3 and 44.5% resistance against meropenem and ciprofloxacin, respectively while P.aeruginosa isolates revealed 36.4 and 45.5% resistance against ciprofloxacin and meropenem, respectively.ConclusionsHealth care associated infections of MDR A.baumannii and P. aeruginosa are critical problems in the study area. Therefore, urgent focused interventions required to contain the spreading of MDR NIs. Treatment of NIs for patients on health care should be guided by antimicrobial susceptibility testing.

Carbapenem resistance rates in Gram-negative bacteria in nosocomial infections: A retrospective study from a tertiary hospital

Aim: Just like the rest of the world, the frequency of nosocomial infections is increasing in our country. The aim of this study is to evaluate the change in carbapenem resistance rates of Gram-negative bacteria isolated from health care related infections over the years.Materials and Methods: The study was performed retrospectively between January 2014 and December 2017. Obtained from clinics with hospital surveillance; according to criteria for the diagnosis of nosocomial infections set by the Centers for Disease Control and Prevention (CDC); Gram-negative factors were examined in patients. Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli strains were evaluated.Results: Carbapenem resistance of A. baumannii strains was 90.7% in 2014 and was 95.9% in 2017. Among the E. coli strains, the rate of carbapenem resistance of 4.1% in 2014, was 7.5% in 2017. While the resistance rate among K. pneumoniae strains was 32.2% in 2014, this rate increased to 48.9% in 2017. Among the P. aeruginosa species, the carbapenem resistance rate was 26.3% in 2014, increased to 38.4% in 2017.Conclusion: In the study, we determined that carbapenem resistance was very high in Acinetobacter spp strains while the resistance rate for Klebsiella spp strains has increased dramatically over the years. Knowing the data will be a guide for the clinicians in selecting empirical antibiotic agents, especially in critical intensive care unit patients, and will guide the development of infection control programs and antibiotic control programs in order to reduce the rate of resistance.

Bacterial Infections and Relevant Factors in Neonates Hospitalized at Intensive Care Unit

Background: Among the most common causes of death in preterm infants are neonatal infections, which remain high despite antibiotic therapy and preservative measures. The control of hospital infections is now a global priority, and many factors contribute to the spread of these infections. This study aimed to determine the frequency of bacterial infections in neonates and identify the common causes of infection in neonates admitted to the neonatal intensive care unit (NICU) of Alzahra Hospital in Isfahan, Iran. Methods: In this cross-sectional study, the population consisted of all neonates who were admitted to the NICU of Al-Zahra Hospital in Isfahan, Iran, from April 2017 to March 2018. Neonates who had a positive culture (blood, cerebrospinal fluid, urine, eye discharge, and tracheal tube secretions) were enrolled. The data were collected by a structured questionnaire, including maternal and neonatal information. Results: In this study, 56 newborns admitted to the NICU of Alzahra Hospital in Isfahan were studied. Their age range was within 5-28 days (18.88±8.41). Thirty-two (57.1%) neonates were male, and 24 (42.9%) newborns were female. In total, 26 (46.4%) neonates had prematurity that was the most common reason for hospitalization. The most isolated microorganisms were Staphylococcus epidermidis, Enterococcus, Klebsiella, Enterobacteriaceae, Candida spp., Acinetobacter, Streptococcus pneumoniae, E. coli, and Streptococcus viridans, respectively. Conclusion: According to the results of this study, the frequency of nosocomial infections in the NICU of Alzahra Hospital in Isfahan was 7.4%. The findings of this study highlighted the importance of paying more attention to controlling and preventing hospital infections in NICUs.

Nutritional situation of enterally fed patients in neurological early rehabilitation and impact of nutritional status on functional outcome

Studies focusing on the nutritional status of neurological and neurosurgical early rehabilitation (NNER) patients are limited. The aim of the current study was to determine the nutritional status of NNER patients upon admission, to observe weight changes and to investigate the influence of nutritional status on complications and outcome. 109 enterally fed NNER patients were included in this prospective observational study. Weight changes, complications, neurological outcome scores (Early Rehabilitation Index [ERI], Barthel-Index [BI]) and the length of stay (LOS) were recorded. In addition, daily energy requirement was calculated and compared with daily intake to identify under-/optimally- and oversupplied patients. A general weight loss was observed in the study group. Weight changes during rehabilitation differed between men and women as well as between under- and oversupplied patients. Nutritional supply during rehabilitation had no influence on the LOS and the change of neurological outcome scores, but significant differences in the frequency of nosocomial infections was observed between under-/optimally- and oversupplied patients. The nutritional status (weight group on admission) had a crucial impact on neurological outcome scores, indicated by lower BI at discharge in normal-compared to underweight patients. In addition, underweight+undersupplied patients showed a significantly lower improvement of the BI than underweight+oversupplied patients. To the contrary, underweight+oversupplied patients had a higher BI improvement than underweight+optimally supplied patients. The nutritional status upon admission in combination with the nutritional supply during rehabilitation appears to have an impact on changes of neurological outcome scores.

Mortalidad en pacientes hospitalizados en el servicio de medicina interna de un Hospital Universitario en Bogotá

Justificación: la mortalidad intrahospitalaria hace parte de los indicadores de calidad en atención en salud, su análisis permite el desarrollo de proyectos para el mejoramiento de los servicios. &#x0D; Material y métodos: se realizó un estudio de corte transversal retrospectivo, evaluando los egresos hospitalarios de medicina interna del año 2015 en el Hospital Universitario Clínica San Rafael (HUCSR). Se estableció la tasa de mortalidad y sus causas. También se realizó un análisis descriptivo de las principales características sociodemográficas y clínicas de la población, la significancia estadística se estableció en p=0.05.&#x0D; Resultados: se presentaron 152 muertes de 1817 egresos hospitalarios para una tasa de mortalidad de 8.3%. El 54.7% fueron hombres; la mediana de edad de 71 años, el rango fue de 18-106 años. Las comorbilidades más frecuentes fueron en 67% hipertensión arterial, 39% cáncer, 32% EPOC. No se presentaron diferencias estadísticamente significativas entre hombres y mujeres. Las principales causas de muerte fueron en 43% enfermedades infecciosas, seguida de neoplasia sólida en 27% y finalmente de origen cardiovascular en 17%. La frecuencia de infección nosocomial en la población fue de 21%.&#x0D; Conclusiones: la mortalidad en los pacientes adultos hospitalizados por medicina interna en el HUCSR es de 8.3% y está dentro del margen reportado por la literatura. En estos pacientes es alta la frecuencia de comorbilidades como la hipertensión arterial 67%, cáncer (39%) y la falla cardiaca (30%).

Biochemical Characterization of Aspergillus fumigatus AroH, a Putative Aromatic Amino Acid Aminotransferase.

The rise in the frequency of nosocomial infections is becoming a major problem for public health, in particular in immunocompromised patients. Aspergillus fumigatus is an opportunistic fungus normally present in the environment directly responsible for lethal invasive infections. Recent results suggest that the metabolic pathways related to amino acid metabolism can regulate the fungus-host interaction and that an important role is played by enzymes involved in the catabolism of L-tryptophan. In particular, in A. fumigatus L-tryptophan regulates Aro genes. Among them, AroH encodes a putative pyridoxal 5'-phosphate-dependent aminotransferase. Here we analyzed the biochemical features of recombinant purified AroH by spectroscopic and kinetic analyses corroborated by in silico studies. We found that the protein is dimeric and tightly binds the coenzyme forming a deprotonated internal aldimine in equilibrium with a protonated ketoenamine form. By setting up a new rapid assay method, we measured the kinetic parameters for the overall transamination of substrates and we demonstrated that AroH behaves as an aromatic amino acid aminotransferase, but also accepts L-kynurenine and α-aminoadipate as amino donors. Interestingly, computational approaches showed that the predicted overall fold and active site topology of the protein are similar to those of its yeast ortholog, albeit with some differences in the regions at the entrance of the active site, which could possibly influence substrate specificity. Should targeting fungal metabolic adaptation be of therapeutic value, the results of the present study may pave the way to the design of specific AroH modulators as potential novel agents at the host/fungus interface.

Nosocomial infection in a tertiary military hospital in Dhaka

Background: Microbial agents in the hospital environment and other patients increase the morbidity and mortality of the hospitalized patients and cause increase in cost of care, wastage of scarce medical resources prolonged hospitalization and render non availability of scarce hospital beds to the needy.Objective: To find out the prevalence of Nosocomial Infection (NI), its risk factors and pattern of organisms.Method: This descriptive cross sectional study was conducted among the surgical patients of all age and sex at Combined Military Hospital, Dhaka. The study was conducted from 5 April 2014 to 12 April 2015.Results: A total of 360 respondents were available in different surgical wards during data collection period and 30 respondents developed nosocomial infection, thus the prevalence rate was 8.33%. The mean age of the respondents was 36.89 years with standard deviation of (±) 14.54 years. Among the nosocomial infection cases, 53.33% were surgical site infections and 50% were caused by Escherichia coli. The study found that frequency of nosocomial infection was more common among those who required assistance for most activities (40%), who had visitors more than 3 per day (81.3%), who had underlying illness like diabetes mellitus (25%), who had invasive devices (9.5%), who were admitted in ICU (12.9%), who received immunosuppressive therapy (23.5%), who had immunosuppressive conditions (28.1%), who had emergency operation (34.8%), and who had undergone general surgery (19.0%). Findings suggest that association between nosocomial infection and number of visitors, admission in ICU, immunosuppressive conditions, use of immunosuppressive therapy, use of invasive devices, and different functional state of patients were statistically significant (p&lt;0.05).Conclusion: Measures are required for increasing awareness of hospital staffs, formulation of policy on use and duration of use of invasive devices establishing a surveillance system and controlling visitors for effective control of nosocomial infection.Bang Med J (Khulna) 2017; 50 : 8-12

Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.

Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065–4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081–1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.

Surgical Site Infections Incidence, their Predictors and Causative Organisms in a Teaching Hospital

Purposes: Nosocomial infections (NCIs) are infections that generally occur 48 hours after hospitalization. Surgical site infections (SSIs) are the major contributor to patient morbidity, health care costs and death. The rational for this study was to assess the frequency of NCIs in surgical wards and investigate possible predictors for SSIs. Methods: It was an observational and prospective study for the purpose of providing structured opportunities for Hospital administration and health professionals in countering SSIs. The total number of patients were 1611 including Saudis and non-Saudi nationals. Each patient was followed up from the time of admission until discharge (with a maximum period of 30 days postoperatively). Surgical wounds were inspected at the time of the first dressing and weekly thereafter for 30 days. Also, swabs from a deeper part of the wound were taken from the infected surgical sites, and routinely from the surface of non–infected sites. The specimens were gram stained and examined for the presence of organisms (cultured aerobically and anaerobically). Findings: The main findings were: SSIs causative organisms were Staphylococcus aureus (25% incidence) followed by Echeriashia coli (23% incidence). The incidence rate of surgical site infections was 11.4%. The presences of co-morbidities were a risk factor for SSIs in this study and a higher level of education was related to decreases in SSIs. Recommendations: This article recommended proper nursing care, sterilization and disinfection of instruments and equipment with careful handling of intensive procedures to control infection which will improve the efficiency and quality of surgical care.

Nosocomial infections and infections with multidrug-resistant pathogens - frequency and mortality

There is no agreement about the frequency of nosocomial infections and infections caused by multidrug resistant organisms (MDRO) in Germany. The aim of this review is to generate updated estimates of the national burden of these infections and to discuss them in an international context. The most important sources of this analysis are the data of the national prevalence studies conducted in various European countries and in the U.S. It can be assumed that there are between 400,000 and 600,000 patients with nosocomial infections each year in Germany. The mortality attributable to them is between 6000 and 15,000 patients. About 30,000 to 35,000 patients develop nosocomial infections caused by MDRO. Currently there are no robust data how many patients die each year because of MDRO infections. According to the best available estimate, the annual number may be between 1000 and 4000 cases. The problems of nosocomial infections and the increase of antimicrobial resistance are highly relevant and should not be belittled. However, an overestimation of this dangerous trend may lead to inappropriate use of limited resources.

Evaluation of Nosocomial Infections in a Teaching Hospital

Background: Nosocomial infections (NIs) have increasingly resulted in death and patients have to bear high treatment costs. Healthcare personnel could play a prominent role in prevention and control of NIs. Objectives: The aim of this study was to evaluate NIs in patients admitted to a teaching hospital in Ahvaz, southwest of Iran, during 2013. Patients and Methods: The present study was a cross-sectional study conducted in Razi Hospital, Ahvaz during 12 months from March 2013 to March 2014. All patients hospitalized with no signs and symptoms of infection within 48 hours of admission and presenting signs and symptoms of infection after 48 hours of hospitalization were included in the study. Data about patients’ age, sex, site of infection, ward of hospitalization and type of NIs were collected. Bacterial strains were isolated from various clinical samples of patients and identified by conventional methods. Results: The incidence of NIs was low (i.e. < 2%). Among 16936 admitted patients in this hospital, 174 patients (79 males and 95 females) with a mean age of 51.7 ± 24.6 years (range, 5 to 90 years) were diagnosed with an NI. Incidence density of NIs were 3.18% in infectious diseases ward, 2.17% in intensive care unit (ICU), 2% in orthopedic ward, 0.68% in obstetrics and gynecology (OBGYN) ward and 0.278% in general surgery. Regarding the etiology of infection, coagulase-negative staphylococci in 23.69%, Bacillus in 21.05%, Escherichia coli was found in 18.42%, and coagulase-positive staphylococci in 13.16% of the cases. The results indicated that coagulase-negative staphylococci was the most frequent pathogen. Conclusions: The frequency of NIs in this hospital was lower in comparison with other worldwide studies. However, low incidence of health care-associated infections in our study may be due to under diagnosis and underreporting of such infections by health care staff.

Frequency of Nosocomial Infections in Pediatric Intensive Care Unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia

Background: Nosocomial infections in PICU vary from 6–26%. Causative pathogens isolated depend upon patient disease, exposure to invasive and non-invasive procedures, and body-system affected. Objectives: To determine frequency of nosocomial infections, organisms involved, sites affected and clinical outcome in pediatric patients. Methods: It is a retrospective cross-sectional study on pediatric patients who acquired infections after 48 hours of admission in PICU at King Abdulaziz Medical City during 2012. Data was collected from medical, laboratory records. Results: 22 (3%) patients acquired nosocomial infections in 684 admissions during year 2012, out of which 12 were female and 10 were male patients. The common incidence was found in first year of age (10 patients). There were a total of 57 events in these patients; respiratory infections were the commonest (24) followed by urinary infections (19). Most common organism involved was Klebsiella (16) followed by Candida (13). Most common pathogens isolated from respiratory infections were Klebsiella pneumoniae (6) and Pseudomonas aeruginosa (5), while Klebsiella (6) and Candida (5) were found in urinary tract infections. The common organisms causing septicemia included Candida (4) and Klebsiella pneumoniae (4). In initial 10 days of admission at PICU, 10 patients acquired the infection (median 14 days). Acquisition of nosocomial infections prolonged hospitalization (median 49.5 days). Conclusion: Nosocomial infections were caused by Klebsiella and Candida. These pathogens mainly caused respiratory, urinary and hematogenous infections, respectively. They have prolonged hospitalization. There is an extensive need for further studies to identify risk factors and review empiric management.