Healthcare-associated Infection Rates Research Articles

Letter in reply to: Nail polish used by healthcare personnel does not increase the rate of healthcare-associated infections.

Letter in reply to: Nail polish used by healthcare personnel does not increase the rate of healthcare-associated infections.

Prevention of Vascular Access Device-Associated Hospital Onset Bacteremia and Fungemia: A Review of Emerging Perspectives and Synthesis of Technical Aspects.

Significant events impacting healthcare over the last several years have been associated with escalating rates of healthcare-associated infections. This has resulted in increased efforts to reinstitute well-established and evidence-based infection prevention practices, particularly for central line associated bloodstream infections. However, implementation of prevention initiatives beyond central lines has not received the same level of acknowledgement and response as being a considerable risk to patients. This article, authored by infection prevention, infectious disease, and vascular access professionals, provides emerging perspectives and technical aspects associated with the complete lifecycle of a vascular access device. The intent is to provide insight and perspective into enhancing current IP practices in the acute care hospital setting. This will also help prepare hospitals for upcoming broader surveillance and intervention activities aimed at reducing Hospital Onset Bacteremia and Fungemia (HOB) associated with all types of vascular access devices.

Workflows and locations matter – insights from electronic hand hygiene monitoring into the use of hand rub dispensers across diverse hospital wards

While healthcare-associated infections (HAIs) affect approximately 3.2-6.5% of hospitalised patients in the US and Europe, improving hand hygiene (HH) could reduce HAI rates. Investigating HH is time-consuming and not always objective, and comprehensive, unbiased data is needed to develop effective strategies. Using electronic tools can provide new and detailed insights on the determinants of HH. To evaluate location-dependent usage of wall-mounted dispensers (WMDs) and point-of-care dispensers (POCs) using an electronic HH recording system. In this retrospective study, hand rub volumes were anonymously recorded for 931,446 disinfections from 17 wards in nine German hospitals using the electronic monitoring system NosoEx®. Number of disinfections and rub volumes of WMDs/POCs by ward and room type were analysed. Generally, WMDs were most prevalent. With >3 dispensers per bed and >20 disinfections per patient day, availability and use were highest in intensive care (ICU) and intermediate care (IMC), but here rub volumes from WMDs were lowest (∼2.0 mL). Although most dispensers are located in patient rooms (∼42%), they are more frequently used in hallways. In surgical ICUs, dispensers are often used in patient rooms, where contact with open wounds is common. About 3.6 mL of hand rub is used per disinfection in treatment rooms, the highest volume of all room types. Dispenser use was dependent on location, room type, ward specialisation and workflow. Optimising the location of hand rub dispensers (HRDs)s is not the only solution to improve HH, but can help reduce inconvenience, achieve more ergonomic workflows and better meet user needs.

Validation of the prevalence to incidence conversion method for healthcare associated infections in long-term care facilities.

Residents of long-term care facilities (LTCFs) are a population at high risk of developing severe healthcare associated infections (HAIs). In the assessment of HAIs in acute-care hospitals, selection bias can occur due to cases being over-represented: patients developing HAIs usually have longer lengths of stays compared to controls, and therefore have an increased probability of being sampled in PPS, leading to an overestimation of HAI prevalence. Our hypothesis was that in LTCFs, the opposite may occur: residents developing HAIs either may have a greater chance of being transferred to acute-care facilities or of dying, and therefore could be under-represented in PPS, leading to an underestimation of HAI prevalence. Our aim was to test this hypothesis by comparing HAI rates obtained through longitudinal and cross-sectional studies. Results from two studies conducted simultaneously in four LTCFs in Italy were compared: a longitudinal study promoted by the European Centre for Disease Prevention and Control (ECDC, HALT4 longitudinal study, H4LS), and a PPS. Prevalence was estimated from the PPS and converted into incidence per year using an adapted version of the Rhame and Sudderth formula proposed by the ECDC. Differences between incidence rates calculated from the PPS results and obtained from H4LS were investigated using the Byar method for rate ratio (RR). On the day of the PPS, HAI prevalence was 1.47% (95% confidence interval, CI 0.38-3.97), whereas the H4LS incidence rate was 3.53 per 1000 patient-days (PDs, 95% CI 2.99-4.08). Conversion of prevalence rates obtained through the PPS into incidence using the ECDC formula resulted in a rate of 0.86 per 1000 PDs (95% CI 0-2.68). Comparing the two rates, a RR of 0.24 (95% CI 0.03-2.03, p 0.1649) was found. This study did not find significant differences between HAI incidence estimates obtained from a longitudinal study and through conversion from PPS data. Results of this study support the validity of the ECDC method.

Nail polish used by healthcare personnel does not increase the rate of healthcare-associated infections.

Nail polish used by healthcare personnel does not increase the rate of healthcare-associated infections.

Temporal patterns and clinical characteristics of healthcare-associated infections in surgery patients: A retrospective study in a major Chinese tertiary hospital

BackgroundGiven the preventable nature of most healthcare-associated infections (HAIs), it is crucial to understand their characteristics and temporal patterns to reduce their occurrence. MethodsA retrospective analysis of medical record cover pages from a Chinese hospital information system was conducted for surgery inpatients from 2010 to 2019. Association rules mining (ARM) was employed to explore the association between disease, procedure, and HAIs. Joinpoint models were used to estimate the annual HAI trend. The time series of each type of HAI was decomposed to analyze the temporal patterns of HAIs. ResultsThe study included data from 623,290 surgery inpatients over 10 years, and a significant decline in the HAI rate was observed. Compared with patients without HAIs, those with HAIs had a longer length of stay (29 days vs 9 days), higher medical costs (96226.57 vs 22351.98 CNY), and an increased risk of death (6.42% vs 0.18%). The most common diseases for each type of HAI differed, although bone marrow and spleen operations were the most frequent procedures for most HAI types. ARM detected that some uncommon diagnoses could strongly associate with HAIs. The time series pattern varied for each type of HAI, with the peak occurring in January for respiratory system infections, and in August and July for surgical site and bloodstream infections, respectively. ConclusionsOur findings demonstrate that HAIs impose a significant burden on surgery patients. The differing time series patterns for each type of HAI highlight the importance of tailored surveillance strategies for specific types of HAI.

Healthcare-associated infections: prospective rotational surveillance data of a training and research hospital

Aims: Monitoring and prevention of healthcare-associated infections (HAI) are considered to be one of the key measures to improve the effectiveness and quality of healthcare services. This study aimed to ascertain the prevalence of HAI in various hospital departments, identify the causative bacterial profile, risk factors, and the association with mortality. Methods: This prospective study included 3117 patients who were monitored in various departments of a Training and Research Hospital. The identified HAI cases were monitored using an active, prospective, rotational surveillance method. Patient data on HAI was daily recorded on pre-established tracking forms. Results: The mean hospital stay of patients was 9.9±7.5 days. The HAI prevalence was 4.5% and the HAI rate was 5.5%. The HAI rate showed no difference between internal medicine and surgical departments (5.7% vs 5.5%, p>0.05), but it was higher in intensive care units (ICU) (p<0.001). The majority of the isolated agents (65.2%) were gram-negative bacteria. Advanced age, intrinsic risk factors such as malignancy, and invasive procedures (use of central, peripheral, and urinary catheters) were associated to the development of HAI. The frequency of HAI was higher in deceased patients compared to survivors (25.4% vs 4.1%, p<0.001). Conclusion: HAI remains a major concern in hospital settings, particularly in ICU, and strongly correlates with intrinsic risk factors and invasive procedures. Optimized infection control measures with these risk factors can make a significant contribution to improving patient outcomes.

The benefits of a closed ICU: a systematic review

This study compared closed and open intensive care unit (ICU) models in terms of patient outcomes. Closed ICUs had reduced mortality rates, shorter lengths of stay, and lower healthcare-associated infection rates. Intensivists in closed ICUs contributed to better outcomes due to their expertise and competence. Enhanced interdisciplinary collaboration, improved communication, and coordination in closed ICUs led to higher patient and family satisfaction.  In addition, closed ICUs were more cost-effective, with better resource use and reduced healthcare costs. Overall, closed ICU models have advantages in patient outcomes, better resource use, cost-effectiveness, and patient satisfaction compared to open ICU models.
  
 Key words: Intensive care unit, ICU, patient outcomes, resource utilization, quality of care.

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic led to a global increase in healthcare-associated infections (HAI) among intensive care unit (ICU) patients. Whether this increase is directly attributable to COVID-19 or whether the pandemic indirectly (via staff shortages or breaches in infection prevention measures) led to this increase, remains unclear. The objectives of this study were to assess HAI incidence and to identify independent risk factors for HAI in COVID-19 and non-COVID-19 ICU patients.MethodsWe established a monocentric prospective HAI surveillance in the medical ICU of our tertiary care center from September 1st 2021 until August 31st 2022, during circulation of the SARS-CoV-2 delta and omicron variants. We consecutively included patients ≥ 18 years of age with an ICU length of stay of > 2 calendar days. HAI were defined according to the European Centre for Disease Prevention and Control definitions. HAI rate was calculated per 1,000 patient-days or device-days; risk ratios (RR) and corresponding 95% confidence intervals (CI) for COVID-19 versus non-COVID-19 patients were calculated. We used multivariable Cox regression to identify independent risk factors for HAI. As a proxy for institutional COVID-19 burden, weekly COVID-19 density (i.e. percentage of COVID-19 patients among all ICU patients) was included in the model as time-dependent co-variable.ResultsWe included 254 patients, 64 (25.1%) COVID-19 and 190 (74.9%) non-COVID-19 patients; 83 HAI in 72 patients were recorded, thereof 45 ventilator-associated lower respiratory tract infections (VA-LRTI) (54.2%) and 18 blood stream infections (BSI) (21.6%). HAI incidence rate was 49.1/1,000 patient-days in COVID-19 and 22.5/1,000 patient-days in non-COVID-19 patients (RR 2.2, 95%-CI 1.4–3.4). This result was mainly due to different VA-LRTI rates (40.3 vs. 11.7/1,000 ventilator days, p < 0.001), whereas BSI rates were not statistically different (9.4 vs. 5.6/1,000 patient days, p = 0.27). Multivariable analysis identified COVID-19 as main risk factor for HAI development, whereas age, mechanical ventilation and COVID-19 density were not significant.ConclusionsThese data from the fourth and fifth wave of the pandemic show a higher HAI incidence in COVID-19 than in non-COVID-19 ICU patients, mainly due to an increase in pulmonary infections. A diagnosis of COVID-19 was independently associated with HAI development, whereas institutional COVID-19 burden was not.

Promoting Patient Safety: Exploring Device-Associated Healthcare Infections and Antimicrobial Susceptibility Pattern in a Multidisciplinary Intensive Care Units.

Device-associated healthcare infections are among the prevailing threats to patient safety worldwide. They constitute the third most common adverse event during healthcare delivery, resulting in heightened morbidity, mortality, and healthcare costs. Patients in intensive care units (ICUs) are at increased risk for device-associated healthcare infections. Focused active surveillance is a crucial measure for assessing the prevalence of healthcare-associated infections and controlling the transmission of pathogens, ultimately contributing to the establishment of quality outcome indicators.This study aimed to investigate and establish the baseline rates of healthcare-associated infections associated with medical devices in adult multidisciplinary ICUs within a tertiary care institute. This hospital-based prospective observational study was conducted in two adult ICUs of atertiary care institute in Central India over nine months. Targeted active surveillance for three device-associated health care infections namely central line-associated bloodstream infection(CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated event (VAE)was conducted as per the Center for Disease Control (CDC)/National Healthcare Safety Network (NHSN) 2016 surveillance definitions and criteria. Pathogens associated with device-associated healthcare infections were identified and their antimicrobial susceptibility profile was studied. During the study period, a total of 5,773 patientdays were investigated. Of1,270patients, 28 episodes of device-associated healthcare infectionswere detected in 26 patients, this suggests a collective occurrence of five device-associated healthcare infections for every 1,000 patient days in the ICUs. The device utilization ratios of the central line, mechanical ventilator, and urinary catheters were 0.33, 0.27, and 0.68, respectively. VAE, CLABSI, and CAUTI rates were 8.92, 5.68, and 0.76 per 1,000 device days, respectively. The most common pathogenisolated from device-associated healthcare infections wasKlebsiella pneumoniae (39%) followed by Acinetobacter baumanii (22%). The majority (82.3%) of pathogens were multidrug resistant. The death rate among device-associated healthcare infections was 69.2% with a crude excess mortality rate of 37.7%. The study sheds light on the proportion, types of device-associated healthcare infections, and underlying etiological agents associated with these infections in our institute's ICUs, thereby facilitating a better understanding of the healthcare-associated infection landscape within our facility. Moreover, the susceptibility patternof pathogens associated with these infections offers crucial information for guiding the selection of appropriate antimicrobial therapies and infection control measures.

Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance.

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

Development of Hand Hygiene Monitoring System Based on Android Mobile Application and User Perspective

Hand hygiene plays a crucial role in promoting overall health and preventing the spread of diseases. The World Health Organization reported that the prevalence of healthcare-associated infections (HAIs) ranges from 3-12% in high-income countries and 5-19% in low-and middle-income countries. Improved hand hygiene compliance can substantially reduce HAI rates. In Indonesia, the Ministry of Health has designated handwashing compliance as a compulsory quality indicator for hospitals. Introducing a mobile app can improve hand hygiene practices. This study aims to develop and design an Android mobile application that serves as an easy-to-operate hand hygiene monitoring system and to understand user perspectives. The study used Agile Methods for app development and a qualitative approach to know users' perspectives. Respondents (n=10) from AMC Muhammadiyah Hospital, including the IPC team, department heads, and administrators, were interviewed. The result revealed that mobile application is easy to use and have an attractive user interface. Users expressed the application's user-friendliness and utility in conducting observations. Nonetheless, they identified some drawbacks, such as lagging issues and a complicated manual installation process due to the app's unavailability on Playstore. Users expect the app's future inclusion on Play Store for simplified installation and request its development for iOS to cater to hospital staff using iPhones.

Antibiotic prophylaxis after 48 h postoperatively are not associated with decreased surgical site infections and other healthcare associated infections in pancreatic surgery patients: a retrospective cohort study

BackgroundIt is controversial whether antibiotic should be used prophylactically 48 h after pancreatic surgery. Hence, the association of antibiotic prophylaxis (AP) after 48 h postoperatively with the incidence of surgical site infections (SSIs) and other healthcare-associated infections (HAIs) in patients receiving pancreatic surgery was evaluated.MethodsA retrospective cohort analysis was performed on 1073 patients who underwent pancreatic surgery. These patients were categorized into the non-AP after 48 h postoperatively group (n = 963) and the AP after 48 h postoperatively group (n = 110) based on whether or not they obtained AP from 48 h to 30 days after surgery. Outcomes included SSIs and other HAIs.ResultsThe incidence of SSIs in the non-AP after 48 h postoperatively group (98/963, 10.2%) was notably lower than that in the AP after 48 h postoperatively group (22/110, 20.0%) (P = 0.002). Other HAIs incidence was not significantly different between the non-AP after 48 h postoperatively group (77/963, 8.0%) and the AP after 48 h postoperatively group (11/110, 10.0%) (P = 0.468). Multiple regression analysis demonstrated that AP after 48 h postoperatively was a risk factor for SSIs (OR = 2.14, 95% CI 1.28–3.59) but not for other HAIs (OR = 1.24, 95% CI 0.63–2.42) after adjustment for age, gender, and diabetes. Subsequent to adjustment for all confounding factors, AP after 48 h postoperatively was not a influence factor for SSIs (OR = 2.13, 95% CI 0.76–5.99) and other HAIs (OR = 3.69, 95% CI 0.99–13.81).ConclusionsAP after 48 h postoperatively following pancreatic surgery was not associated with the lower morbidity rate of SSIs and other HAIs. Nonetheless, this study may facilitate further development of strategies towards standardization of the duration of AP management of pancreatic surgery.

1415. Effect of Self-Sanitizing Copper Impregnated Surfaces on Healthcare-Associated Infection Rates

Abstract Background Healthcare-associated infections (HAI) are a major cause of morbidity and mortality in the United States. Prevention of HAIs is a multipronged approach that involves hand hygiene, antibiotic stewardship, and environmental sanitation. The efficacy of polymer-based self-sanitizing copper oxide-impregnated solid surface on Clostridioides difficile (C. diff) spores in a laboratory setting showed 1-2 log reduction. Here we assessed the efficacy of the same surface for preventing HAIs over a 7-year period in a hospital setting. Methods The copper surfaces installation in the hospital began in late 2016 and peaked in January 2018. HAIs that met 2017 National Healthcare Surveillance Network definitions were recorded for all infections between 2014 and 2022. A Bayesian multivariate multilevel negative binomial model was fit to assess the mean HAI rate over time for blood, urine, site specific, pneumonia, and C. diff infections, and the effect of copper on those trends while adjusting for autocorrelation, seasonality, average length of stay, and the COVID-19 pandemic. We report the median incidence rate ratio (IRR) and 95% uncertainty interval (UI), as defined by the highest density posterior interval, for the intervention. Copper Surface Installation The figure demonstrates the various components of the copper surfaces that were installed in the hospital and the timelines for installation. Results During the copper intervention there was 0.36 (0.04 – 0.94) times the incidence for blood, 0.44 (0.06 – 1.26) for pneumonias, 0.61 (0.10 – 1.61) for urine, 0.70 (0.02 – 2.89) for site specific, and 0.85 (0.31 – 1.72) for C. diff infections, indicating reduced HAIs during the intervention. Although only the effect for blood infections had a 95% UI excluding an IRR=1, the posterior probability for the model estimates indicates that conditional on this model and data, the chance that the IRR&amp;lt; 1 (indicating reduced HAIs) was 96% for blood, 90% for pneumonia, 80% for urine, 66% for site specific, and 66% for C diff infections. HAI Rates by time Incident Rate Ratios for HAI and Effect of Copper Conclusion The overall effect of introducing copper bed rails appears to be beneficial with respect to lowering HAIs. The trends were stronger for certain infections such as blood infections and for pneumonias but weaker for C. diff infections. Due to this study being a real-world intervention that also overlapped with the COVID-19 pandemic certain beneficial factors may have been overshadowed by the unknowns that the pandemic bought. Disclosures All Authors: No reported disclosures

Impact of COVID-19 Pandemic on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis.

This study investigated how the Coronavirus Disease 2019 (COVID-19) pandemic has affected the rate of healthcare-associated infections (HAIs). PubMed, Scopus and Google Scholar were searched to identify potentially eligible studies published from December 2019 to September 2022. A random effect model was used to determine the changes in the rate of HAIs during the pandemic. Thirty-seven studies, mostly from the United States (n = 13), were included. Fifteen studies described how the pandemic affected the rate of CLABSIs and CAUTIs, and eight of them showed a significant increase in CLABSIs. The risk of CLABSIs and CDIs was 27% (pooled odds ratio [OR]: 0.73; confidence interval [CI]: 0.61-0.89; p < 0.001) and 20% (pooled OR: 1.20; CI: 1.10-1.31; p < 0.001) higher during the pandemic compared to before the COVID-19 pandemic period, respectively. However, the overall risk of HAIs was unaffected by the pandemic (pooled OR: 1.00; 95 CI: 0.80-1.24; p = 0.990). Furthermore, there were no significant changes in the risk of CAUTIs (pooled OR: 1.01; 95 CI: 0.88-1.16; p = 0.890), and SSIs (pooled OR: 1.27; CI: 0.91-1.76; p = 0.16) between the two periods. The COVID-19 pandemic had no effect on the overall risk of HAIs among hospitalized patients, but an increased risk of CLABSIs and CDI were observed during the pandemic. Therefore, more stringent infection control and prevention measures and prudent interventions to promote the rational use of antibiotics are warranted across all healthcare facilities to reduce the burden of HAIs.

Ripple effects of hospital team faultlines on patient outcomes

Medical errors are rampant across healthcare settings, imposing a significant burden on patient safety. Here, we examined the ripple effects of diversity splits, or faultlines, within hospital teams on patient safety and care. Hospitals consist of hierarchical, mixed-gender, and multiracial units that are prone to conflict. Within a diverse unit, faultlines can occur when multiple attributes (e.g., gender and race) of unit members align and divide a unit into two or more homogeneous subgroups. Yet, little is known about how such faultlines influence patients. Hierarchical path modeling of data collected from 1,102 hospital employees and 4,138 patients across 38 hospital units illustrated that when strong faultlines formed through homogenous subgroups within hospital units resulted in decreased civility among staff. This incivility was related to higher rates of medical error and patient deaths. A 10% increase in unit incivility was linked to a maximum 8.87% increase in healthcare-associated infection rates and a maximum 10.59% increase in mortality rates. However, we found patients within units high on collaborative cultures for managing conflicts—that fostered mutual respect, active listening, and openness to differing opinions—experienced fewer medical errors and lower mortality rates, regardless of strong faultlines. These findings offer an evidence-based, culture-focused approach to reducing medical errors and improving the quality of patient care.

Novel scores relevant to antimicrobial resistance and hospital-acquired infections developed with data from a multi-hospital consortium in the Parisian region of France

Indicators for comparing and understanding differences in antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) for benchmarking are essential to identify priorities for hospitals. This study measured the incidence of hospital-acquired or resistant Gram-negative bacilli bloodstream infections (GNB-BSIs) in a large public healthcare consortium in the Parisian region of France. Within each hospital, there was a strong positive correlation between the incidence of GNB-BSIs due to resistant GNB and the incidence of hospital-acquired GNB-BSIs. Two scores measuring AMR and HAI rates by combining different GNB-BSI incidence rates were developed as indicators. These scores were highly variable within the hospital consortium. On multi-variate analysis, AMR and HAI scores were significantly associated with the proportion of surgical beds, staff absenteeism and the consumption of alcohol-based hand rub, with the latter two characteristics being amenable to interventions. Carbapenem use was also linked to AMR, but this may be because carbapenems are the preferred drug for treating resistant infections. These results shed light on the incidence of HAIs and AMR in the study hospitals, and suggest possibilities for targeted interventions at healthcare facility level.

Monitoring health disparities in healthcare-associated infection surveillance: A Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) Survey.

We investigated whether and how infection prevention programs monitor for health disparities as part of healthcare-associated infection (HAI) surveillance through a survey of healthcare epidemiology leaders. Most facilities are not assessing for disparities in HAI rates. Professional society and national guidance should focus on addressing this gap.

Evaluation of Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus respiratory tract superinfections among patients with COVID-19 at a tertiary-care hospital in Tehran, Iran

BackgroundThe emergence of healthcare-associated infections (HAIs) or superinfections in COVID-19 patients has resulted in poor prognosis and increased mortality.MethodsIn a cross-sectional study, 101 respiratory samples were collected from ICU-admitted COVID-19 patients. The HAI rate, demographics, and antibiotic resistance were assessed.ResultsThe HAI rate was 83.16% (76.62% bacterial and 6.54% fungal). The prevalence of 3 major HAI-causing organisms included Klebsiella pneumoniae (41.5%), Acinetobacter baumannii (20.8%), and Staphylococcus aureus (4.9%). Mortality and intubation ventilation proportions of 90% (p = 0.027) and 92.2% (p = 0.02) were significant among patients with superinfection, respectively. Multiple logistic regression analysis showed SpO2 pressure (odds ratio 0.842; 95% CI 0.750–0.945; p = 0.004) as a predictive factor in the association between antibiotic usage and mortality. More than 50% of patients received carbapenems. The resistance rates to at least one antibiotic of third-generation cephalosporins, aminoglycosides, quinolones/fluoroquinolones, tetracyclines, and β-lactam inhibitors were 95.2%, 95.2%, 90%, 57.1%, and 100% among A. baumannii isolates and 71.4%, 55%, 69%, 61.9%, and 59.5% among K. pneumoniae isolates, respectively. A proportion of 60% was recorded for methicillin-resistant S. aureus isolates.ConclusionAs a result, antibiotic treatment should be administered following the microbial resistance profile. Contact isolation and infection control measures should be implemented as needed.

Probiotics for Infection Prevention in Critically Ill and Trauma Patients: A Concise Review.

Critically ill trauma patients are at an increased risk for infection, which can increase morbidity and mortality. The use of probiotic preparations for infection prevention is promising, yet the results of their effectiveness are mixed. To synthesize current research regarding the use of probiotics to prevent and possibly treat infection in the critically ill adult trauma population. Upon reviewing the current body of evidence, one cannot definitively conclude that probiotic supplementation in the critically-ill trauma population decreases health care-associated infection rates and improves outcomes, but most published evidence supports their use.