Infections In Hospitalized Patients Research Articles

Emergence of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae Strains in China.

We report the emergence of five carbapenem-resistant K1 hypervirulent Klebsiella pneumoniae (hvKP) strains which caused fatal infections in hospital patients in Zhejiang Province, China, upon entry through surgical wounds. Genotyping results revealed the existence of three genetically related strains which exhibited a new sequence type, ST1797, and revealed that all strains harbored the magA and wcaG virulence genes and a plasmid-borne bla(KPC-2) gene. These findings indicate that K1 hvKP is simultaneously hypervirulent, multidrug resistant, and transmissible.

Relationship between perioperative blood transfusion and post-operative hospital infection in patients with closed traumatic brain injury

To explore the relationship between allogeneic transfusion and hospital infections in patients with closed traumatic brain injury in the perioperative period. The clinical data of 181 patients with open brain surgery suffering closed brain injury in Changsha Central Hospital from February, 2012 to December, 2013 were retrospectively collected. The patients were divided into a mild and moderate brain injury group (n=83) and a severe brain injury group (n=98) according to evaluation system of Glasgow coma scale (GCS). They were also divided into a autologous transfusion plus mild and moderate brain injury group (n=14), a autologous transfusion plus severe brain injury group (n=10); an allogeneic transfusion plus mild and moderate brain injury group (n=31), an allogeneic transfustion plus severe brain injury group (n=70); a non-transfusion plus mild and moderate brain injury group (n=38) and a non-transfusion plus severe brain injury group (n=18) according to the transfusion styles. The hospital infection of all the patients was examined. The rate of hospital infection was significantly higher in the severe brain injury group than that in the mild and moderate brain injury group (P<0.05). The rate of post-operative hospital infection in the allogeneic transfusion plus severe brain injury group was also significantly higher than that in the autologous transfusion plus severe brain injury group (P<0.05). Similarly, the rate of post-operative hospital infection in the allogeneic transfusion plus mild and moderate brain injury group is higher than that in the non-transfusion plus mild and moderate brain injury group (P<0.05). The allogeneic transfusion at perioperative period may be one of the risk factors for post-operative hospital infection in the closed brain injury patients. The more severe the injury is, the higher risk the hospital infection will be.

Ants as vectors of pathogenic microorganisms in a hospital in São Paulo county, Brazil.

BackgroundThe present study aimed to identify and characterize the presence of bacteria carried by ants, and check the distribution of these ants in the physical confines of a medium-sized hospital in São Paulo county, Brazil.MethodsThe ants were collected from March 2012 to February 2013. Attractive non-toxic baits were used to catch the ants, and the sectors considered for the study were medical wards, outdoor areas, obstetric unit, reception area, kitchen, surgical centres, paediatric clinic and intensive care unit. Captured ants were classified using taxonomic keys and subsequently immersed in Brain Heart Infusion broth.ResultsParatrechina spp. and Monomorium floricola ants were found most frequently in the hospital. Ants had a high capacity for carrying bacteria, and the isolates comprised 68.8% Gram-positive, spore-producing bacilli (Bacillus spp. and Listeria spp.); 14.7% Gram-negative bacilli (Pseudomonas aeruginosa and Klebsiella spp.); and 16.4% Gram-positive cocci (Streptococcus spp. and Staphylococcus aureus). Among the areas being evaluated, the medical wards had the largest number of ants captured, and therefore the most bacteria.ConclusionsAnts in hospitals may carry both Gram-positive and Gram-negative bacteria, and methods of controlling urban ants should be adopted and strictly adhered to, to minimize the risk of infection in hospital patients.

Impact of sepsis on CD4 T cell immunity.

Sepsis remains the primary cause of death from infection in hospital patients, despite improvements in antibiotics and intensive-care practices. Patients who survive severe sepsis can display suppressed immune function, often manifested as an increased susceptibility to (and mortality from) nosocomial infections. Not only is there a significant reduction in the number of various immune cell populations during sepsis, but there is also decreased function in the remaining lymphocytes. Within the immune system, CD4 T cells are important players in the proper development of numerous cellular and humoral immune responses. Despite sufficient clinical evidence of CD4 T cell loss in septic patients of all ages, the impact of sepsis on CD4 T cell responses is not well understood. Recent findings suggest that CD4 T cell impairment is a multipronged problem that results from initial sepsis-induced cell loss. However, the subsequent lymphopenia-induced numerical recovery of the CD4 T cell compartment leads to intrinsic alterations in phenotype and effector function, reduced repertoire diversity, changes in the composition of naive antigen-specific CD4 T cell pools, and changes in the representation of different CD4 T cell subpopulations (e.g., increases in Treg frequency). This review focuses on sepsis-induced alterations within the CD4 T cell compartment that influence the ability of the immune system to control secondary heterologous infections. The understanding of how sepsis affects CD4 T cells through their numerical loss and recovery, as well as function, is important in the development of future treatments designed to restore CD4 T cells to their presepsis state.

Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study

The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.6% (19/731) in July 2013, 1.7% (19/1100) in August 2013, and 1.69% (21/1238) in September 2013. Male patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.

Antibiotic Prescribing in Primary Care and Antimicrobial Resistance in Patients Admitted to Hospital with Urinary Tract Infection: A Controlled Observational Pilot Study.

There is growing evidence that primary care prescribed antibiotics lead to antibiotic resistance in bacteria causing minor infections or being carried by asymptomatic adults, but little research to date has investigated links between primary care prescribed antibiotics and resistance among more serious infections requiring hospital care. Knowledge of these effects is likely to have a major influence on public expectations for, and primary care use of, antibiotics. This study aimed to assess the feasibility of recruiting symptomatic adult patients admitted to hospital with urinary infections and to link primary and secondary data information to investigate the relationship between primary care prescribed antibiotics and antimicrobial resistance in these patients. A microbiology database search of in patients who had submitted a urine sample identified 740 patients who were potentially eligible to take part in the study. Of these, 262 patients did not meet the eligibility criteria, mainly due to use of a urinary catheter (40%). Two-hundred and forty three patients could not be recruited as the nurse was unable to visit the patients prior to discharge, as they were too unwell. Eighty patients provided complete information. Results indicate that there is evidence that prior antibiotic use is associated with resistant infections in hospital patients. A fully powered study, conducted using routinely collected data is proposed to fully clarify the precision of the association.

Device for filamentous fungi growth monitoring using the multimodal frequency response of cantilevers

Filamentous fungi cause opportunistic infections in hospital patients. A fast assay to detect viable spores is of great interest. We present a device that is capable of monitoring fungi growth in real time via the dynamic operation of cantilevers in an array. The ability to detect minute frequency shifts for higher order flexural resonance modes is demonstrated using hydrogel functionalised cantilevers. The use of higher order resonance modes sees the sensor dependent mass responsivity enhanced by a factor of 13 in comparison to measurements utilizing the fundamental resonance mode only. As a proof of principle measurement, Aspergillus niger growth is monitored using the first two flexural resonance modes. The detection of single spore growth within 10 h is reported for the first time. The ability to detect and monitor the growth of single spores, within a small time frame, is advantageous in both clinical and industrial settings.

Practice patterns for lower respiratory tract infections in hospital patients with particular focus on bacteriological examinations and injection antibiotics use.

BackgroundVarious types of medical institutions perform treatments for lower respiratory tract infections. However, few studies have assessed and compared practice patterns across different medical institutions in Japan. To assess practice patterns for community-acquired lower respiratory tract infections among patients who needed hospitalization, we examined the use of injection antibiotics and the implementation of bacteriological examinations, and compared these across medical institutions. We then evaluated whether bacteriological examinations were being adequately implemented.MethodsA cross-sectional study was conducted using a database of health insurance claims. Subjects were patients (≥16 years old) who received injection antibiotics to treat lower respiratory tract infections, and who were listed among 2004–2007 insurance claims data. For each type of antibiotic, we obtained the dose prescribed, the number of patients treated, and the frequency of bacteriological examinations.ResultsA total of 1649 patients were evaluated. The implementation rate of Gram stain and sputum culture was 14% at clinics (<20 beds), approximately 30% at small hospitals (20–99 beds), and 40%–45% at medium-sized (100–499 beds) and large hospitals (≥500 beds). As a whole, beta-lactams were most frequently used, accounting for 80% of all antibiotics used. Among beta-lactams, penicillins comprised 25% of the total amount of drugs used at hospitals with ≥300 beds, but approximately 13% at clinics and small hospitals.ConclusionPractice patterns varied depending on the size of the medical institution. The implementation rate of bacteriological examinations was not high enough, especially at clinics and small hospitals.

Structural insights into the broadened substrate profile of the extended-spectrum β-lactamase OXY-1-1 fromKlebsiella oxytoca

Klebsiella oxytoca is a pathogen that causes serious infections in hospital patients. It shows resistance to many clinically used β-lactam antibiotics by producing chromosomally encoded OXY-family β-lactamases. Here, the crystal structure of an OXY-family β-lactamase, OXY-1-1, determined at 1.93 Å resolution is reported. The structure shows that the OXY-1-1 β-lactamase has a typical class A β-lactamase fold and exhibits greater similarity to CTX-M-type β-lactamases than to TEM-family or SHV-family β-lactamases. It is also shown that the enzyme provides more space around the active cavity for the R(1) and R(2) substituents of β-lactam antibiotics. The half-positive/half-negative distribution of surface electrostatic potential in the substrate-binding pocket indicates the preferred properties of substrates or inhibitors of the enzyme. The results reported here provide a structural basis for the broadened substrate profile of the OXY-family β-lactamases.

Investigation and analysis of hospital infections in patients with cleft lip and palate after repair operation

Objective To investigate the risk factors of hospital infection in patients with cleft lip and palate after repair operation and provide evidence for controlling it.Methods The data of 235 patients with deft lip and palate after repair operation from May 2007to May 2010 were collected to analyze retrospectively.Results The occurrence of hospital infection was 19.57%.The main infection sites were respiratory,incision and gastrointestinal tract.The major pathogens were staphylococcus aureus,pseudomonas aeruginosa and escherichia coli.The hospital infection rate had an increasing trend as hospitalization duration extending.Conclusions The hospital infection in patients with cleft lip and palate after repair operation is related to age,hospitalization duration and postoperative time.Some measures,for example,intra-operative aseptic operation,postoperative drainage tube unblocked and rational use of antibiotics are important to control hospital infection. Key words: Cleft lip and palate repair operation; Hospital infections; Investigation and analysis

Four Children with Multidrug-resistantAcinetobactor baumaniiInfections in the Intensive Care Units of a University Hospital

The Multidrug-resistant Acinetobactor baumanii (MDRAB) is an opportunistic pathogen. Patients with long periods of hospital stay and/or under intensive care unit (ICU) receiving invasive management are more susceptible to this pathogen. In this report, four children with MDRAB infection are reviewed and described their clinical characteristics. There had been concurrent outbreaks of MDRAB infection in adult patients in the ICU at this period of time. The first child had received a craniotomy and epidural hematoma evacuation. The second child was admitted for status epilepticus with hydrocephalus. The third child had pneumonia with status epilepticus with hydrocephalus. The fourth child had poor activity due to hypoxic ischemic encephalopathy and convulsive disorder. Except the fourth child, all had not been exposed to carbapenem prior to infection of MDRAB. That imply the cause of MDRAB infections may be associated with invasive management and prolonged hospitalization together with the previous exposure to carbapenem in our cases. We would like to emphasize the importance and minimizing the spread of hospital infection in patients under prolonged intensive care management regardless of the use of carbapenem.

CD64 Index Provides Simple and Predictive Testing for Detection and Monitoring of Sepsis and Bacterial Infection in Hospital Patients

CD64 Index Provides Simple and Predictive Testing for Detection and Monitoring of Sepsis and Bacterial Infection in Hospital Patients

CD64 Index Provides Simple and Predictive Testing for Detection and Monitoring of Sepsis and Bacterial Infection in Hospital Patients

The rapid diagnosis and management of bacterial infection are heavily dependent upon clinical assessment. Blood culture may take up to 2 days for results and may be suspect. Surface neutrophil CD64 expression has been shown to be upregulated in cases of bacterial infection. Recently, a standardized kit for the CD64 index was used in neonatal intensive care units, showing high sensitivity and specificity for bacterial infections. Our study was designed to confirm and extend these results to adult hospital patients and to determine the impact of this testing on a clinical laboratory's finances and staffing. CD64 indices were performed with peripheral blood drawn in tandem with blood cultures from 109 patients over a 2-month period. We found that a CD64 index of <or=1.19 was predictive of "no growth" blood culture results. An index of >1.19 was predictive of an ultimate clinical and/or culture diagnosis of infection with a sensitivity and specificity of 94.6% and 88.7%, respectively. Positive and negative predictive values were 89.8% and 94%, respectively. The CD64 index was easily performed using our flow cytometer and staff, producing minimal alteration in clinical workflow. A 7-day-a-week testing schedule will result in some additional expense but will be more than offset by the expected cost savings. The CD64 index is a useful and inexpensive test for improving the diagnosis and management of hospital patients with bacterial infection. It can be readily performed by clinical laboratories and could result in considerable savings for the institution.

Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units

Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (ICU) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. The objective of this study was to identify predisposing factors for pneumonia. A prospective cohort study was carried out between June 1996 and June 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult ICU of the Londrina State University's Teaching Hospital. Of these, 83 (15.4%) developed pneumonia. All patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. Univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the ICU. Multivariate analysis identified four risk factors for pneumonia in the ICU: tracheotomy (RR = 1.09; 95%CI = 1.04-1.17), nasogastric tube feeding (RR = 1.11; 95%CI = 1.05-1.18), H2-blocker use (RR = 1.09; 95%CI = 1.05-1.14) and decreased level of consciousness (RR = 2.67; 95%CI = 1.43-5.04). In 56.6% of patients, pneumonia occurred within the first four days following ICU admission. The risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.

Genotypic analysis of Acinetobacter bloodstream infection isolates in a Turkish university hospital

Acinetobacter baumannii is a significant pathogen of bloodstream infections in hospital patients that frequently causes single clone outbreaks. We aimed to evaluate the genetic relatedness and antimicrobial susceptibility of Acinetobacter spp. bloodstream isolates, in order to obtain insight into their cross-transmission. This prospective study was conducted at the Erciyes University Hospital. During a 1-y period, all patients with nosocomial BSI caused by Acinetobacter spp. were included in the study. All data with regard to the patients, underlying diseases and risk factors for BSI and the severity of disease were collected. Blood culture isolates of Acinetobacter spp. were identified according to their morphology and biochemical reactions. The antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion test according to the NCCLS; the genetic relatedness of isolates was determined by RAPD-PCR analysis and pulsed-field gel electrophoresis (PFGE). 41 patients acquired a nosocomial bloodstream infection caused by A. baumanii during this period. 88% of these infections (36 of 41) occurred while the patients were treated in the intensive care unit. Nearly 80% of the isolates belonged to 3 genotypes, suggesting cross-transmission in ICU settings where infection control practices are poor. All Acinetobacter isolates were multidrug-resistant and the crude mortality of patients infected with A. baumanii was 80.5%. We concluded that the genetic relatedness of Acinetobacter spp. causing BSI was very high, indicating cross-transmission within the ICU setting. Essential components of an infection control programme to prevent nosocomial transmission of A. baumannii are early detection of colonized patients, followed by strict attention to standard precautions and contact isolation.

A model of antibiotic-resistant bacterial epidemics in hospitals

The emergence of drug-resistant strains of bacteria is an increasing threat to society, especially in hospital settings. Many antibiotics that were formerly effective in combating bacterial infections in hospital patients are no longer effective because of the evolution of resistant strains, which compromises medical care worldwide. In this article, we formulate a two-level population model to quantify key elements in nosocomial (hospital-acquired) infections. At the bacteria level, patients infected with these strains generate both nonresistant and resistant bacteria. At the patient level, susceptible patients are infected by infected patients at rates proportional to the total bacteria load of each strain present in the hospital. The objectives of this paper are to analyze the dynamic elements of nonresistant and resistant bacteria strains in epidemic populations in hospital environments and to provide understanding of measures to avoid the endemicity of resistant antibiotic strains.

Factors influencing hospital infection in patients in the intensive care unit

OBJECTIVE The accumulation of risk factors in hospitalized patients is one of the elements contributing to the increase in the frequency of nosocomial infection in the intensive care unit (ICU). Our aim was to identify nosocomial infection risk factors in the ICU of our hospital. METHODS We performed a prospective cohort study of 1,134 patients admitted to the ICU for at least 24 hours in 2001. The patients were followed-up for 48 hours after leaving the ICU. Multivariate Cox regression analysis was used to identify risk factors. RESULTS The intrinsic risk factors identified were the principal diagnosis motivating admission to the ICU, traumatic brain injury and renal insufficiency. Invasive techniques that were independently associated with nosocomial infection (from high to low risk) were urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheter, and total parenteral nutrition. CONCLUSIONS Although endogenous risk factors, which cannot be modified, represented the most important associated factors, steps to reduce nosocomial infections should concentrate on the following exogenous risk factors: urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheters, and total parenteral nutrition.

Gram-Negative Bacteria and Broad-Spectrum Antibiotics: Good News Except for Fluoroquinolones

For nearly 2 decades, the use of broad-spectrum antibiotics for treatment of infections in hospitalized patients has been widespread and often empiric.

UTI in patients with urethral catheters: an audit tool.

This article presents an audit tool for the evaluation of practice relating to urinary tract infection in hospital patients with indwelling urethral catheters. It has been formulated primarily because urinary tract infection is a known complication of catheterization, and because studies have shown practitioners' knowledge in this area to be poor. Although health professionals have an obligation to ensure their practice is evidence based, this requires substantial time and skills in critical appraisal. The standard presented here is based on evidence from an extensive literature review on how best to minimize urinary tract infection during catheter insertion, meatal hygiene and management of the drainage system. The audit tool offers the potential for improved practice and demonstration of clinical effectiveness through measurable reduction in rates of urinary tract infection. Moreover, it provides an ideal opportunity for nurses to take the lead in clinical audit activity, which is so often medically led. The supplementary information will also provide a useful guide for nurses to undertake and initiate clinical audit activity in the future.

An evaluation of surveillance methods for detecting infections in hospital inpatients

Eight selective surveillance methods were compared with a reference method for their ability to detect hospital infections in patients occupying 122 beds of a district general hospital. The time for data collection was also assessed. In the reference method, case records were reviewed three times a week, and during the 11-month period of study, 668 infections were identified amongst 3326 patients. Three hundred and thirty-eight were community acquired infections (CAI) and 330 were hospital acquired infections (HAI). The time for data collection was 18·1 h per 100 beds per week. Of the selective surveillance methods, those based on the review of treatment and temperature charts detected the highest proportion (70%) of CAI; and the review of microbiology reports with regular ward liaison identified the highest proportion (71%) of HAI. The time for data collection in the eight methods ranged from 1·2 h per 100 beds per week to 6·5 h per 100 beds per week. After considering the sensitivity for identifying patients with HAI and time for data collection, the review of microbiology reports with regular ward liaison was judged to be an effective and efficient method of surveillance.