High Rate Of Nosocomial Infection Research Articles

A Review: Hospital Acquired Infection in Some Gram Negative Pathogenic Bacterial Strains

Objective: This review aims to update healthcare workers on the current scientific understanding of hospital-acquired infections, witha focus on describing the pathophysiology and patterns of antimicrobial resistance, particularly concerning Pseudomonas aeruginosa,Acinetobacter baumannii, and Klebsiella pneumoniae. Methods: Data on hospital-acquired infections were collected globally, with a specific emphasis on the Eastern Mediterranean, South-East Asia, Europe, and the Western Pacific regions. Infection rates, predominant pathogens, and antimicrobial resistance patterns were analyzed to provide insights into the current landscape of nosocomial infections. Results: Hospitals in the Eastern Mediterranean and South-East Asia regions reported the highest rates of nosocomial infections (11.8%and 10.0%, respectively), while rates in Europe and the Western Pacific were 7.7% and 9.0%, respectively. Infections typically arise frominvasive medical equipment and surgical operations, with lower respiratory tract and bloodstream infections being particularly hazardous. Gram-negative bacterial infections, notably, exhibit worrisome antibiotic resistance patterns, potentially developing multiple mechanisms against various antibiotics. Conclusion: The emergence of antimicrobial resistance presents a significant threat to patient safety, compounded by challenges indiscovering new antibiotics. Factors such as high costs and lengthy drug development processes contribute to this concern. Healthcareworkers must remain abreast of evolving antimicrobial resistance patterns, especially concerning pathogens like Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, to implement effective infection control measures and preserve the efficacy of existing antimicrobial agents.

Impact of invasive fungal infections in men from a state in southern Brazil: A geospatial analysis.

To analyse the records of male hospitalisation for fungal infections, including their spatial distribution and the main invasive epidemiological and sociodemographic characteristics in the State of Paraná, Brazil. Spatial analysis based on data from male admission records for invasive fungal infections (IFIs) in the State of Paraná, from 2015 to 2019. Data were taken from the hospital records obtained in the Hospital Information System of the Unified Health System, being collected, georeferenced and analysed to infer the existence of autocorrelation with the hospitalisation rates in the state. From 2015 to 2019, there were 385 cases of IFIs in men, being more prevalent in white individuals aged 61-70 years. We observed that the metropolitan, southeast, central-eastern, north-central, northwestern and western regions formed high-high clusters, with regions with a high number of registered cases. In the regression, there was an association with socioeconomic and demographic factors that showed a correlation with the rates of hospitalisation for IFIs. The study draws attention to Paraná as an endemic region for paracoccidioidomycosis, in addition to presenting high rates of nosocomial fungal infections. We also emphasise the importance of compulsory notification in the state and in the country to gain greater control over the incidence and prevalence of cases and to incentivise the creation of public policies for the prevention of IFIs.

Effective Handwashing Practice in Dilla University Referral Hospital; Duration of Hand Rubbing and the Amount of Water as Key Enablers.

Background:Ineffective hand hygiene in healthcare settings is a global challenge that is associated with a high rate of nosocomial infections. The study aimed to measure the effectiveness of handwashing at Dilla University referral hospital.Method:This study consisted of 2 parts; the survey work and laboratory analysis. A total of 63 participants were selected to take surveys using an interviewer-administered questionnaire to collect the data regarding the socio-demographic and hand hygiene-related practices. A laboratory tests (swab test) was used to assess handwashing effectiveness from 63 participants by taking 126 swab test (63 before and after hand washing sessions). A swab test was collected from the palms of each participant before and after hand washing using a sterile technique. The cultures were then incubated aerobically overnight at 37°C, and examined for microbial growth. The bacterial load was reported as the number of colony-forming units (CFU).Result:The proportion of effective hand washing in Dilla University Referral Hospital was 82.5%. The mean colony-forming unit before and after handwashing were 55 and 2 CFU/ml, respectively with an average reduction of 94.6% in terms of CFU/ml. The mean amount of water used for effective handwashing was 336.03 (±219.46) ml. There was a significant mean difference in the amount of water used and duration of hand rubbing between effective and non-effective handwashing among the participants (P < 0.01). The bacterial load before and after handwashing indicated that there was a significant (53.3 mean CFU) reduction in bacterial load after handwashing practice which indicated that the handwashing intervention in the Referral hospital was effective (P < 0.01).Conclusion:The proportion of effective Hand washing in Dilla University referral Hospital was 82.5% with a 94.6% reduction in terms of (CFU/ml). The amount of water use and the duration of hand rubbing showed a significant difference in the reduction of the microbial load.

220. The Treatment of Enterococcus Blood Stream Infections in Patients Receiving Extracorporeal Membrane Oxygenation

Background Background: Extracorporeal membrane oxygenation (ECMO) is a growing modality of life support that is subject to a high rate of nosocomial infections. There is a paucity of data to guide treatment for infections on ECMO, which can lead to vastly different practice patterns at different centers. This case series describes the outcomes of patients with Enterococcus bacteremia at a single center. MethodsA retrospective chart review was performed on all patients who received ECMO support at a tertiary academic medical center with ECMO capabilities between October 2012 and May 2020 with positive blood cultures for Enterococcus species. ResultsA total of 10 patients had Enterococcus bacteremia during the study period with E. faecalis (n=7, 70%) more commonly than E. faecium (n=3, 30%). Infections occurred more often in men (n=6, 60%) than women (n=4, 40%) with median age 36 (IQR: 31-42). Infections occured late in the hospitalization (median: 33 days (IQR: 26-59)) and after several weeks on the ECMO circuit (median: 24 days (22-52)). Infections were often polymicrobial (n=5, 50%). There were no cases of infective endocarditis. Infections were treated with 7-14 days of therapy with ampicillin being the most common antibiotic prescribed (n=5, 50%). Four (40%) patients were decannulated before completion of therapy. No patients had cannulas removed due to bacteremia. There were no cases of recurrence. Mortality was 20% in this cohort. Clinical Characteristics of Patients with Enterococcus Bacteremia ConclusionEnterococcus is a common cause of blood stream infections in patients with prolonged courses on ECMO circuit. In this cohort of patients, Enterococcus did not cause any metastatic infections and was generally treated with 7-14 days of antibiotics without recurrence, despite many patients remaining on ECMO for extended periods after clearance. As ECMO use continues to expand, there will need to be more data on treatment outcomes of infections to establish best practices. Disclosures All Authors: No reported disclosures

Relationship of Knowledge And Attitude of Nurses With Hand Hygiene Application Behavior

The high rate of nosocomial infections is a very important problem in the hospital. Nurses' awareness to do hand hygiene is a fundamental behavior in an effort to prevent nosocomial infections that occur in hospitals. The research objective was to determine the relationship between knowledge and attitudes of nurses and the behavior of applying hand hygiene in the inpatient room at Lanto Dg Pasewang Jeneponto Hospital in 2020. This type of research design was creational with a cross-sectional research approach. The research population was 180 people. The sample was taken using purposive sampling with a total sample of 36 respondents. Data collection tools in the form of questionnaires and observation sheets. Based on the results of statistical tests using the fisher's exact test, the results of the p-value = 0.631&gt; α = 0.05, so it can be concluded that there is no relationship between knowledge and the behavior of applying hand hygiene in the inpatient room of Lanto Hospital Dg Pasewang Jeneponto and for the relationship between attitude and behavior. The result obtained a p-value of 0.715&gt; ɑ = 0.05, so it can be concluded that there is no relationship between attitude and behavior of applying hand hygiene in the inpatient room of Lanto Dg Pasewang hospital Jeneponto. Suggestions are expected that further researchers will expand the reach of the room/location.

A Serious Game Designed to Promote Safe Behaviors Among Health Care Workers During the COVID-19 Pandemic: Development of "Escape COVID-19".

BackgroundAs many countries fear and even experience the emergence of a second wave of COVID-19, reminding health care workers (HCWs) and other hospital employees of the critical role they play in preventing SARS-CoV-2 transmission is more important than ever. Building and strengthening the intrinsic motivation of HCWs to apply infection prevention and control (IPC) guidelines to avoid contaminating their colleagues, patients, friends, and relatives is a goal that must be energetically pursued. A high rate of nosocomial infections during the first COVID-19 wave was detected by IPC specialists and further cemented their belief in the need for an engaging intervention that could improve compliance with COVID-19 safe behaviors.ObjectiveOur aim was to develop a serious game that would promote IPC practices with a specific focus on COVID-19 among HCWs and other hospital employees.MethodsThe first 3 stages of the SERES framework were used to develop this serious game. A brainswarming session between developers and IPC specialists was used to identify the target audience and acquisition objectives. Nicholson’s RECIPE mnemonic (reflection, engagement, choice, information, play, exposition) for meaningful gamification was used to guide the general design. A common and simple terminology was used to suit the broad target audience. The game was tested on various platforms (smartphones, tablets, laptops, desktop computers) by different users during each development loop and before its final release.ResultsThe game was designed to target all hospital staff who could be in direct contact with patients within the Geneva University Hospitals. In total, 10 acquisition objectives were defined by IPC specialists and implemented into the game according to the principles of meaningful gamification. A simple storyboard was first created using Microsoft PowerPoint and was progressively refined through multiple iteration loops. Articulate Storyline was then used to create two successive versions of the actual game. In the final version, a unique graphic atmosphere was created with help from a professional graphic designer. Feedback mechanisms were used extensively throughout the game to strengthen key IPC messages.ConclusionsThe SERES framework was successfully used to create “Escape COVID-19,” a serious game designed to promote safe IPC practices among HCWs and other hospital employees during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. A SCORM (shareable content object reference model) package is available to facilitate results and completion tracking on most current learning management systems.

Dynamics of nosocomial parainfluenza virus type 3 and influenza virus infections at a large German University Hospital between 2012 and 2019

Nosocomial virus infections cause significant morbidity and mortality. Besides influenza viruses, the disease burden of parainfluenza virus type 3 (PIV-3) is comparatively high among hospitalized patients and severe disease courses can occur. PIV-3 showed the highest rates of nosocomial infections of a panel of respiratory viruses. Therefore, a retrospective observational study was conducted among patients with either PIV-3 or influenza viruses, which served as reference pathogen. The aim was to compare the seasonal dynamics and clinical characteristics of nosocomial infections with these highly transmittable viruses. Nosocomial infection occurred in 15.8% (n = 177) of all influenza cases, mainly in the first half of a season. About 24.3% (n = 104) of the PIV-3 cases were nosocomial and occurred mainly in the second half of a season. Both nosocomial rates of influenza and nosocomial rates of PIV-3 varied between the seasons. Community acquired and nosocomial cases differed in underlying medical conditions and immunosuppression. Knowledge of the baseline rates of nosocomial infections could contribute to the implementation of appropriate infection control measures.

Six Gynecological Cancer Patients Infected With SARS-CoV-2 After Surgery or Radio-/Chemo-Therapy Treatment: Case Series

ObjectiveRecently, the number of gynecological cancer patients infected with SARS-CoV-2 has been increasing. This article was committed to studying the influence of gynecological tumor treatment history compared to the Coronavirus Disease 2019 (COVID-19), which was of great significance for the treatment of gynecological cancer patients during the outbreak of COVID-19.MethodsWe retrospectively analyzed the diagnosis and treatment of six gynecological cancer patients infected with SARS-CoV-2 in Tongji Hospital in Wuhan from January 30 to March 25, 2020. To better explain the treatment of gynecological cancer patients during the epidemic of COVID-19, we summarized the case characteristics, auxiliary examination, treatment plan, and outcome of these six patients.ResultsWe observed a high rate of nosocomial SARS-CoV-2 infection among these six gynecological cancer patients, who were in a low immune state. Also, due to the influence of cancer treatment history, COVID-19-related atypical symptoms became the first symptom of COVID-19 in some cases, which increased the difficulty of diagnosis. Furthermore, in terms of treatment for these cases, immune boosters and reagents that raised white blood cells were applied, except for in symptomatic antiviral treatment. At present, all patients in this study were discharged from the hospital with a good prognosis.ConclusionAfter cancer-related treatment, the gynecological cancer patients became more susceptible to COVID-19. Besides, the history of cancer treatment made the diagnosis of COVID-19 difficult, which also affected the treatment of COVID-19. Therefore, we put forward the corresponding therapy suggestions for gynecological cancer patients during the outbreak of COVID-19.

Nosocomial Infection Following Severe Traumatic Injury in Children.

Nosocomial infection is a common source of morbidity in critically injured children including those with traumatic brain injury. Risk factors for nosocomial infection in this population, however, are poorly understood. We hypothesized that critically ill pediatric trauma patients with traumatic brain injury would demonstrate higher rates of nosocomial infection than those without traumatic brain injury. Retrospective case-control study. PICU, single institution. Patients under 18 years old who were admitted to the PICU for at least 48 hours following a traumatic injury were included. Patients were admitted between September 2008 and December 2015. Patients with the following injury types were excluded: thermal injury, drowning, hanging/strangulation, acute hypoxic ischemic encephalopathy, or nonaccidental trauma. Data collected included demographics, injury information, hospital and PICU length of stay, vital signs, laboratory data, insertion and removal dates for invasive devices, surgeries performed, transfusions of blood products, and microbiology culture results. Initial Pediatric Risk of Mortality III and Pediatric Logistic Organ Dysfunction-2 scores were determined. Patients were classified as having: 1) an isolated traumatic brain injury, 2) a traumatic injury without traumatic brain injury, or 3) polytrauma with traumatic brain injury. None. Two hundred three patients were included in the analyses, and 27 patients developed a nosocomial infection. Patients with polytrauma with traumatic brain injury demonstrated a significantly higher infection rate (30%) than patients with isolated traumatic brain injury (6%) or traumatic injury without traumatic brain injury (9%) (p < 0.001). This increased rate of nosocomial infection was noted on univariate analysis, on multivariable analysis, and after adjusting for other risk factors. In this single-center, retrospective analysis of critically ill pediatric trauma patients, nosocomial infections were more frequently observed in patients admitted following polytrauma with traumatic brain injury than in patients with isolated traumatic brain injury or trauma without traumatic brain injury.

Efforts to Reduce the Impact of Coronavirus Disease 2019 Outbreak on Radiation Oncology in Taiwan

Efforts to Reduce the Impact of Coronavirus Disease 2019 Outbreak on Radiation Oncology in Taiwan

Nosocomial Infections: Multicenter Surveillance of Antimicrobial Resistance in Tehran During 2015 - 2017

Background: Rapid increase in nosocomial infections (NIs) due to antibiotic resistant organisms is a global issue, which causes significant morbidity in both patients and healthcare professionals ultimately leading to an extra cost on health care systems. Thus, studying NIs is a public health priority. Methods: The study was designed as a cross-sectional investigation between 2015 - 2017. Inpatient cases of selected hospitals with nosocomial infections were included. Demographics, source of infections, causative agents, and their antibiotic susceptibility through E-test method were collected. All data were analyzed using SPSS statistical software (version 19). Results: A total of 168 patients with NIs were identified. Of the patients, 100 (59.5%) cases were male. The intensive care unit had the highest infection rate (N = 100 (59.5%)) and bronchoalveolar lavage (BAL) (N = 58 (34.5%)) and Acinetobacter (N = 76 (47.5%)) were the most common source and organism of NI. Conclusions: Results of this study showed the dangerously high nosocomial infection rates, which necessitates considering surveillance of antibiotic usage and restriction of using broad spectrum antibiotics in infections.

Phytochemical screening, free radical scavenging and antimicrobial potential of Chromolaena odorata leaf extracts against pathogenic bacterium in wound infections– a multispectrum perspective

Abstract The chronic bed ridden patients acquire infections are the main source of alarming morbidity and mortality as their correlation with fomites. Fomites are reservoirs of drug-resistant pathogens found in the unhygienic clinical environment, which can infect patients and leading to high nosocomial infection rates and use of antimicrobial drugs. The use of and search for drugs and dietary supplements derived from plants have accelerated various therapeutic applications and obtaining new antimicrobial agents from natural resources is necessary to develop alternative drugs for safe and cost-effective health care. Hence, the objective of this research was to perform a phytochemical analysis on Chromolaena odorata and to study the antioxidant and antimicrobial activities of the ethanolic and aqueous extracts of its leaves. In this regard, phytochemicals obtained from C.odorata was investigated for their radical scavenging activity using 2, 2-diphenyl-1-picryl-hydrazyl (DPPH) assay. The phytochemical analysis revealed the presence of active ingredients such as glycosides, steroids, saponins, phenols, flavonoids, terpenoids, and tannins were categorized either as primary metabolites, such as chlorophyll, proteins, and amino acids, or as secondary metabolites, which include terpenoids and alkaloids. The ethanolic leaf extract showed a higher antioxidant activity and antibacterial properties than the aqueous extract exhibited. C. odorata leaf extracts of both ethanoloic and aqueous were subjected to an antibacterial study using the agar diffusion method. Our antibacterial results showed that the ethanolic extract could inhibit to a certain extent the growth of various human pathogens like Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilis, Bacillus cereus, and Escherichia coli. In summary, the present study highlights the significance of C. odorata leaf extracts for their antioxidant and antibacterial potentials, which explain the traditional use of the plant in animal and human medicine and cost-effective health care.

Epidemiological Aspects and Evolution of Nosocomial Infection in the Neonatology Unit of Angondje Teaching Hospital

Introduction: Hospital-acquired infections in neonatology are a major security problem. We aimed to analyze the evolution of nosocomial infections and their epidemiological aspects in neonatal medicine unit of Angondje Teaching Hospital. Patients and methods: Retrospective and descriptive study, we included newborns hospitalized for more than 48 h from December 2012 to December 2016. Results: We admitted 727 newborns in hospital during the study period, 521 have been included, and 134 developed a nosocomial infection, a prevalence of 25.7% of cases. In the end, 103 newborns have constituted our study population. The average age was 33.6 weeks, the sex ratio 1.96. The preterm rate was 79.6 percent. The average weight was 2088.4 g. The reason for hospitalization was prematurity in 46.3%, followed by neonatal infection in 21.1%. Tachycardia associated with hypotonia and apnea, was the main sign of discovery in respectively 56.3% and 39.8%. The average delay between appearance of the signs and hospitalization was 07 days. The average of C-reactive protein was 86.64 mg/dl. Thrombocytopenia was most observed disorder on cell blood count. Escherichia coli was the significant bacteria found the blood culture, urines analysis and culture, lumbar puncture, and umbilical venous catheter culture. Imipenem was the most used antibiotics in the management of nosocomial infection in 44.7% of cases. The mortality rate was 23.3%. Conclusion: The high rate of nosocomial infection and neonatal mortality urge the implementation of effective methods against this scourge in our neonatology unit.

Epidemiological Aspects and Evolution of Nosocomial Infection in the Neonatology Unit of Angondje Teaching Hospital

Introduction: Hospital-acquired infections in neonatology are a major security problem. We aimed to analyze the evolution of nosocomial infections and their epidemiological aspects in neonatal medicine unit of Angondje Teaching Hospital. Patients and methods: Retrospective and descriptive study, we included newborns hospitalized for more than 48 h from December 2012 to December 2016. Results: We admitted 727 newborns in hospital during the study period, 521 have been included, and 134 developed a nosocomial infection, a prevalence of 25.7% of cases. In the end, 103 newborns have constituted our study population. The average age was 33.6 weeks, the sex ratio 1.96. The preterm rate was 79.6 percent. The average weight was 2088.4 g. The reason for hospitalization was prematurity in 46.3%, followed by neonatal infection in 21.1%. Tachycardia associated with hypotonia and apnea, was the main sign of discovery in respectively 56.3% and 39.8%. The average delay between appearance of the signs and hospitalization was 07 days. The average of C-reactive protein was 86.64 mg/dl. Thrombocytopenia was most observed disorder on cell blood count. Escherichia coli was the significant bacteria found the blood culture, urines analysis and culture, lumbar puncture, and umbilical venous catheter culture. Imipenem was the most used antibiotics in the management of nosocomial infection in 44.7% of cases. The mortality rate was 23.3%. Conclusion: The high rate of nosocomial infection and neonatal mortality urge the implementation of effective methods against this scourge in our neonatology unit.

Factors related to the implementation of universal precautions by nurses in the inpatient unit (IRINA F) Prof. Dr. R. D. Kandou Central General Hospital Manado

Nosocomial infection is an infection acquired when someone had ever been in a hospital or other health care facility. The high incidence rates of nosocomial infections indicate low quality of health services in the hospital. In this regard so that the implementation of universal precautions is an action to control against infections by health workers to reduce the infection transmission risk. The aim of this study is to determine factors related to the implementation of universal precautions by nurses in the inpatient unit (IRINA F) Prof. Dr. R. D. Kandou Central General Hospital Manado.Quantitative research design was employed with analytical survey method and by using cross sectional study approach. The study was conducted in the inpatient unit (IRINA F) Prof. Dr. R. D. Kandou Central General Hospital Manado since September – December 2016. Total sampling technique employed to obtain 65 people. Data was collected through validated questionnaires.The result shows a significant relationship between knowledge and the implementation of universal precautions (p &lt; 0,005), but there is no significant relationship between the availability of facilities and motivation with the implementation of universal precautions (p=0,271 and 0.338, respectively). Multiple logistic regression showing that knowledge is the most predominant factor regarding the implementation of universal precautions by nurses.Overall, it can be concluded that there is a significant relationship between knowledge with the implementation of universal precautions by nurses. Thus, various efforts to improve the knowledge of nurses regarding with the implementation of universal precautions are necessary in preventing nosocomial infection.Â

Prevalence and Antibiogram of Microbial Agents Causing Nosocomial Urinary Tract Infection in Surgical Ward of Dhaka Medical College Hospital

Background: Nosocomial infections pose substantial risk to patients receiving care in hospitals. In Bangladesh, this problem is aggravated by inadequate infection control due to poor hygiene, resource and structural constraints and lack of awareness regarding nosocomial infections.Objective: We carried out this study to determine the prevalence of different microorganisms from urine in surgery ward and antimicrobial susceptibility pattern against various antibiotics.Materials and Methods: This cross sectional study was carried out in Department of Microbiology, Dhaka Medical College, Dhaka over a period of 12 months from July 2011 to June 2012. A total of 52 urine specimens were collected from catheterized patients admitted in general surgery ward of Dhaka Medical College Hospital (DMCH) and incubated in blood agar, MacConkey agar media and the isolates were identified by different biochemical tests – oxidase test and reaction in MIU (motility indole urease) and Simmon’s citrate and TSI (triple sugar iron) media. ESBL producers were detected by double-disk synergy test (DDST).Results: Bacteria were isolated from 35 specimens and Escherichia coli was the commonest isolate (23, 65.71%) followed by Pseudomonas aeruginosa 6 (17.14%), Klebsiella pneumoniae 3 (8.57%), Acinetobacter baumannii 2 (5.72%) and Proteus vulgaris 1 (2.86%) respectively. Among the isolates, 10 (28.57%) ESBL producers were detected and the highest ESBL production was observed in Escherichia coli (8, 22.85%) followed by Klebsiella pneumoniae 1 (2.86%) and Pseudomonas aeruginosa 1 (2.86%). The isolates were resistant to most of the commonly used antimicrobial agents.Conclusion: The emergence of multi-drug resistant (MDR) bacteria poses a difficult task for physicians who have limited therapeutic options. However, the high rate of nosocomial infections and multi-resistant pathogens necessitate urgent comprehensive interventions of infection control.J Enam Med Col 2016; 6(2): 75-79

Acinetobacter Infections among Adult Patients in Qatar: A 2-Year Hospital-Based Study.

This retrospective study was conducted at Hamad General Hospital, Qatar, to describe the demographic data, clinical features underlying diseases, antimicrobial susceptibility, and outcome of A. baumannii infection. It involved all adult patients 15 years of age or older who were managed at Hamad General Hospital for A. baumannii infection from January 1, 2012, to December 31, 2013. We identified a total of 239 patients with A. baumannii infection, of which 182 (76.2%) were males. The mean age was 49.10 ± 19.57 years. The majority of the episodes (25.1%) occurred in elderly patients (≥65 years) and the most commonly identified site of A. baumannii infection was the respiratory tract, 117 (48.9%). Most episodes of infection, 231 (96.7%), were hospital-acquired and high rate of nosocomial infections occurred in the medical intensive care unit, 66 (28.6%). All patients had underlying medical conditions. Maximum resistance was seen to cefotaxime, 147 (58.3%), and minimum resistance was seen to colistin, 2 (1.4%). Of the 239 isolates, 102 (42.7%) were susceptible and 137 (57.3%) were multidrug-resistant. The in-hospital mortality in our study was 31%. Male gender, multidrug resistance, and septic shock were found to be independent mortality predictors.

Influence of supplemental parenteral nutrition approach on nosocomial infection in pediatric intensive care unit of Emergency Department: a retrospective study.

Background & aimsNutritional support for patients in the intensive-care unit (ICU) is a part of standard care which promotes medical quality and decreases nosocomial infection. Supplemental parenteral nutrition (SPN) approach (enteral nutrition (EN) combined with parenteral nutrition (PN) when EN alone is insufficient) has become one major concern in nutrition research field. This research aims to explore the following relationships: (i) the relationship between SPN and nosocomial infection, (ii) the relationship between early and late SPN initiation and the development of nosocomial infection.MethodsA retrospective study was conducted in patients who met the inclusion criteria from February 2012 to February 2015 in Pediatric ICU (PICU). Patients were classified into two groups according to nutrition delivery approach-SPN group and EN alone group. Then SPN group were further divided into two subgroups by initiation timing, which were defined as early-initiation SPN and late-initiation SPN group respectively. Age, gender, serum albumin at admission, severity of disease, length of stay in PICU, nutrition delivery approach, amounts of delivered caloric intake and occurence of nosocomial infection were recorded. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors and assess the independent effect of SPN approach on nosocomial infection in PICU of Emergency Department.Results204 patients were included in our study. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate (34.0 vs.10.9 %, p < 0.001). The late-initiation subgroup of SPN approach was found to be an independent predictor of nosocomial infection in the logistic regression analysis model (OR = 3.40; 95 % CI, 1.13 ~ 10.19; p = 0.029). Serum albumin at admission (OR = 0.91; 95 % CI, 0.84 ~ 0.97; p = 0.008), mechanical ventilation (OR = 3.85; 95 % CI, 1.43 ~ 10.39; p = 0.008), severity of disease (OR = 3.79; 95 % CI, 1.03 ~ 13.99; p = 0.045) and PICU length of stay (OR = 1.23; 95 % CI, 1.11 ~ 1.35; p < 0.001) were also identified as significant risk factors for nosocomial infection.ConclusionsOur study shows late-initiation SPN approach increases the incidence of nosocomial infection compared with early-initiation approach in critically ill children in PICU of Emergency Department. Compared with EN alone group, patients delivered by SPN approach had a higher nosocomial infection rate.

Evolving beyond the vicious triad: Differential mediation of traumatic coagulopathy by injury, shock, and resuscitation.

A subset of trauma patients with critical injury present with coagulopathy, portending markedly worse outcomes. Clinical practice is evolving to treat the classical risk factors of hypothermia, hemodilution, and acidosis; however, coagulopathy persists even in the absence of these factors. We sought to determine the relative importance of injury- and shock-specific factors compared with resuscitation-associated factors in coagulopathy after trauma. Comprehensive demographic data, laboratory data, and outcomes data were prospectively collected from seven trauma centers over 8 years (November 2003 to August 2011) as part of the Inflammation and the Host Response to Injury Large-Scale Collaborative Program. A total of 1,537 critically injured patients with blunt trauma and hemorrhagic shock were analyzed to evaluate predictors of admission coagulopathy (international normalized ratio [INR] ≥ 1.3), multiorgan failure, and mortality. Of 1,537 patients, 578 (37.6%) had admission INR of 1.3 or greater. Coagulopathic patients had more severe injury, more severe base deficit and lactate levels, as well as lower admission temperature, lower pH, and higher prehospital crystalloid volume (all p < 0.001). Coagulopathic patients required more blood products and mechanical ventilation and had higher rates of nosocomial infection, multiorgan failure, and mortality (all p < 0.02). Injury severity, temperature, and acidosis (all p < 0.02) independently predicted coagulopathy in multivariate analysis, with a significant interaction between lactate and prehospital crystalloid. In Cox regression models, however, coagulopathy itself remained an independent predictor of both multiorgan failure and mortality (p < 0.02) even when adjusted for injury severity, shock, and elements of the vicious triad. Most patients with coagulopathy after trauma have mixed risk factors; however, coagulopathy has deleterious effects independent of injury severity, shock, and the vicious triad. Better understanding of the biochemical mechanisms of acute traumatic coagulopathy may facilitate biochemically targeted resuscitation strategies and improve outcomes. Prognostic and epidemiologic study, level II.

Prevalence of nosocomial infections and anti-infective therapy in Benin: results of the first nationwide survey in 2012.

BackgroundData on nosocomial infections in hospitals in low-income countries are scarce and often inconsistent. The objectives of this study were to estimate the prevalence of nosocomial infections and antimicrobial drug use in Benin hospitals.MethodsAll hospitals were invited to participate in the first national point prevalence study conducted between 10–26 October 2012 using the protocol developed by the “Hospitals in Europe Link for Infection Control through Surveillance” (HELICS) project. Infection prevalence rates and the proportion of infected patients and exposure to antimicrobials were assessed.ResultsOverall, 87% (39/45) of hospitals participated. Of 3130 inpatients surveyed, 972 nosocomial infections were identified among 597 patients, representing an overall prevalence of infected patients of 19.1%. The most frequent infections were related to the urinary tract (48.2%), vascular catheter use (34.7%), and surgical site (24.7%). 64.6% of patients surveyed were treated with antibiotics, including a significant proportion (30%) of non-infected patients and a high proportion of self-medication (40.8%). Resistance of leading nosocomial pathogens to antimicrobials included methicillin-resistance (52.5%) among Staphylococcus aureus, vancomycin resistance among enterococci (67.5%), cefotaxime resistance among Escherichia coli (67.6%), and ceftazidime resistance among Acinetobacter baumannii (100%) and Pseudomonas aeruginosa (68.2%).ConclusionsBenin has high nosocomial infection rates and calls for the implementation of new national infection control policies. Patient safety education and training of all individuals involved in healthcare delivery will be critical to highlight awareness of the burden of disease. The high use of antimicrobials needs to be addressed, particularly their indiscriminate use in non-infected patients.