Infections In ICU Patients Research Articles

Risk Factors and Outcome of Nosocomial Infections in ICU Patients

Risk Factors and Outcome of Nosocomial Infections in ICU Patients

Control of nosocomial infections in ICU patients in the Pomeranian School of Medicine in Poland

Control of nosocomial infections in ICU patients in the Pomeranian School of Medicine in Poland

EPIDEMIC NOSOCOMIAL PNEUMONIA IN THE INTENSIVE CARE UNIT

The changing and expanding spectrum of pathogens associated with nosocomial pneumonia (NP) will require modification in our approach to both endemic and epidemic NP in the ICU. Knowledge of specific pathogens, modes of transmission, and sources or reservoirs of epidemic NP is crucial to the recognition, control, and prevention of these infections in ICU patients. This article reviews the epidemiology of nosocomial NP outbreaks and outlines guidelines for investigating suspected epidemics of NP within the ICU. Preventive strategies including appropriate surveillance for recognizing epidemic clusters, adherence to barrier isolation precautions, proper disinfection and sterilization of respiratory care equipment, and judicious use of antimicrobial agents are also discussed.

The Stomach Is Not a Source for Infection in ICU Patients?-To the Editor

We thank Dr. Inglis for his critical evaluation of our study, which is directed basically to three methodologic topics: the bacteriologic analysis, the deletion to perform determination of co-identity of paired isolates with molecular methods, and the frequency of collection of specimens.

The Stomach Is Not a Source for Infection in ICU Patients?

The interesting study reported by Bonten et al 1 Bonten M.J.M. Gaillard C.A. Van Tiel F.H. et al. The Stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients. Chest. 1994; 105: 878-884 Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar may at first seem an important contribution to the debate over the pathogenesis of ventilator-associated pneumonia. Unfortunately, Bonten et al have not investigated the bacteriology of the oropharynx, stomach, and trachea with the same rigor as they established a diagnosis of pneumonia.

EPIDEMIOLOGY OF NOSOCOMIAL PNEUMONIA IN INTENSIVE CARE UNIT PATIENTS

Pneumonia is the most commonly reported nosocomial infection in ICU patients, occurring predominantly in patients whose lungs are ventilated, at a rate of 1% to 3% per day of mechanical ventilation. Substantially increased costs and mortality have been attributed to nosocomial pneumonia. Our understanding of the epidemiology of nosocomial pneumonia in ICU populations has been limited by the reliance of most published studies on clinical diagnostic criteria, which are nonspecific. In addition to mechanical ventilation and tracheal intubation, other suspected risk factors of importance include chronic lung disease, age, severity of illness, upper abdominal or thoracic surgery, head trauma or depressed level of consciousness, and gastric acid inhibition. Aspiration appears to be the primary mode of inoculation of microorganisms into the distal lung; however, the relative importance of different sites as reservoirs for aspiration is controversial. It is hoped that studies based on improved diagnostic techniques, such as quantitative cultures of protected brush or bronchoalveolar lavage specimens, will provide the basis for an improved understanding of the epidemiology and prevention of this important infection in critically ill patients.

Value of Bedside Plating of Semiquantitative Cultures for Diagnosis of Central Venous Catheter-related Infections in ICU Patients

We compared semiquantitative central venous catheter tip cultures plated at the bedside with those cultured in the laboratory, to determine if bedside plating provides a significantly better yield. Paired segments of 197 catheter tips from 92 surgical and medical ICU patients were evaluated prospectively. A total of 31 catheter tip cultures were positive for > or = 15 organisms per agar plate, with 10 of these being simultaneously positive at the bedside and in the laboratory. Cultures were exclusively positive in 18 cases plated immediately at the bedside, whereas laboratory plating resulted in only 3 exclusively positive cases. This discrepancy was statistically significant (p < 0.005). Compared with bedside plating, the sensitivity and specificity of sending catheters to the laboratory were 36 percent and 98 percent, respectively. These results indicate that the practice of sending central venous catheter tips to the laboratory for routine culture should be reconsidered in favor of bedside plating.

Pefloxacin versus imipenem in the therapy of nosocomial lung infections of intensive care unit patients

In a prospective open randomized trial pefloxacin (400 mg, iv, 8-hourly) and imipenem (1 g, iv, 8-hourly) were given for 5-30 days to 35 and 36 ICU patients, respectively, suffering from bronchopneumonia (54) or purulent bronchitis (17). All were spiking high fevers (greater than or equal to 39 degrees C) while 25 and 26 patients in the two groups were under mechanical ventilation. Underlying predisposing disorders, mainly chronic obstructive pulmonary disease, ischaemic heart disease, neurological diseases and traumatic lung injuries, were encountered in almost all. In appropriate bronchial secretion cultures, multiresistant Acinetobacter anitratus (40), Pseudomonas aeruginosa (25), various Enterobacteriaceae (17) and Staphylococcus aureus (6) were isolated. A successful clinical response, as proved by elimination of abnormal lung x-ray findings, temperature normalization and decreases in oxygen requirements, permitting weaning from mechanical ventilation and/or removal of nasotracheal intubation, was observed in 23 patients given pefloxacin (65.7%) and 19 patients given imipenem (52.8%). The differences in clinical outcome did not reach statistical significance. During therapy pathogens persisted in 9 (25.7%) patients given pefloxacin versus 18 (50%) given imipenem (P less than 0.05), while persisters developed resistance to pefloxacin and imipenem in seven and 12 patients, respectively (P less than 0.05). Tolerance was excellent for both antimicrobials. In the therapy of lung infections in ICU patients, pefloxacin when compared to imipenem was associated with more promising results, lower numbers of persisting pathogens and a lower incidence of resistance development.

Selective decontamination for prevention of infection in ICU patients

Selective decontamination for prevention of infection in ICU patients

Abnormalities of some phagocyte membrane receptors during nosocomial infections.

The frequent and severe nosocomial infections in ICU patients suggest that these patients are immunodeficient. We studied the phagocytic activity of granulocytes and monocytes isolated from the blood of 32 ICU patients with nosocomial pneumonia (19 male, 13 female; age 41 +/- 4 yr). Cells were tested in standard medium and in the presence of patients' serum. Blood granulocytes and monocytes were purified and separately exposed to opsonized zymosan (to test C3 receptor function), immunoglobulin-coated erythrocytes (to test Fc receptor function), and glutaraldehyde-treated erythrocytes (to test nonspecific binding structures). Phagocytosis and superoxide anion production were measured. Granulocytes of patients exhibited a substantial decrease of zymosan ingestion (p less than .05), whereas phagocytosis of other particles was normal. Monocytes from the patients displayed an unselective overall decrease of phagocytic ability for the three particle types (p less than .05). Patients' sera were at least as efficient as a pool of normal sera in opsonizing zymosan. Further, no phagocytic inhibitor was found in the tested patients. In conclusion, we point out a deficiency of membrane receptors of neutrophils and monocytes in ICU patients with nosocomial infection.

Acquired Urinary Tract Infection in ICU Patients

Acquired Urinary Tract Infection in ICU Patients