Infections In Intensive Care Unit Research Articles

Učestalost i karakteristike multirezistentnih bakterija u jedinici intezivnog lečenja

Introduction: Patients in intensive care units (ICUs) are at higher risk of infections due to invasive procedures and antibiotic therapy. Infections caused by multidrug-resistant (MDR) bacteria represent a global problem, limiting the choice of antimicrobial therapy. Objective: To determine the rate of infections in ICUs, as well as the type of MDR bacteria associated with such infections. Material and methods: The study included strains of MDR bacteria isolated from laboratory samples of hospitalized patients in surgical ICUs in a one-year period. All strains of MDR bacteria were isolated and identified by standard microbiological methods for aerobic bacteria according to the recommendations and guidelines are given by the Clinical and Laboratory Standards Institute (CLSI). Results: Infections caused by MDR bacterial isolates were confirmed in 199 (19.17%) patients in ICUs. The frequency of Gram-negative isolates was significantly higher than Gram-positive (88.35% and 11.65%, p <0.001). The most common infections in ICUs caused by MDR bacteria were respiratory tract infections (49%), followed by soft tissue and skin infections. The CDI incidence density 1.13 cases/10,000 patient-days. Conclusion: A high frequency of infections caused by MDR bacteria was found with patients in ICUs, and respiratory tract infections dominated. Information on the types of infections and pathogens can help develop policies for prevention, diagnosis, treatment, and resource allocation.

Klebsiella pneumoniae Infections in Intensive Care Unit and Risk Factors for Carbapenem Resistance

Objective: Klebsiella pneumoniae infections have been a problem in intensive care units (ICU) in recent years due to multi-drug resistance. In this study, it was aimed to analyze K. pneumoniae infections in ICU, determine distribution of carbapenem resistance rates and risk factors. Methods: Nosocomial infections (NI) with K. pneumoniae between January 2017-January 2020 were evaluated retrospectively. In cases with recurrent K. pneumoniae infection, only the first episode was included. Results: K. pneumoniae infections were developed in a total of 78 patients. Bloodstream infections (BSI) were the most common (51.3%), followed by pneumonia (41%) and urinary tract infections (7.7%). Among BSI cases, 52.5% were associated with central venous catheter (CVC) and 81.2% of pneumonia cases were ventilator-associated pneumonia (VIP). It was observed that while the proportion of BSI was gradually decreasing in years, pneumonia rates have increased. Among BSI, it was observed that the rate of CVC-related BSI was increased from 33.3% in 2017 to 62.5% in 2019. Carbapenem resistance was 52.6% and colistin resistance was 17.9% in K. pneumoniae isolates and both increased over 3 years. When carbapenem-resistant K. pneumoniae infections were compared with carbapenem-sensitive K. pneumoniae infections, the independent risk factors associated with carbapenem resistance were found to be carbapenem use (p=0.008, OR: 8.45, 95% CI: 1.76-40.64), prior NI developing with different microorganism (p=0.005, OR: 8.70, 95% CI: 1.91-39.65) and total parenteral nutrition (TPN) use (p=0.04, OR: 4.2, 95% CI: 1.06-16.67). Conclusions: Carbapenem-resistant K. pneumoniae infections are gradually increasing in ICUs, and colistin resistance has started to be observed recently. Our study showed that carbapenems are independent risk factors in carbapenem resistance and suggested that carbapenem use should be restricted in our unit. It is important for each center to reveal its own data of frequency and resistance, in order to decrease infection rates with the infection control measures and determine the antibiotic using policies.

Risk factors, antimicrobial susceptibility pattern and patient outcomes of Pseudomonas aeruginosa infection: A matched case-control study

BackgroundPseudomonas aeruginosa is a leading nosocomial Gram-negative bacteria associated with prolonged hospitalization, and increased morbidity and mortality. Limited data exist regarding P. aeruginosa infection and outcome in patients managed in intensive care units (ICUs) in the Gulf countries. We aimed to determine the risk factors, antimicrobial susceptibility pattern and patient outcomes of P. aeruginosa infection in ICU. MethodsIn this matched case-control study, all P. aeruginosa infections that occurred >48 h after hospital admission between January 31st 2016 and December 31st 2018 at ICUs affiliated with King Abdulaziz Medical City, Riyadh were included. P. aeruginosa was identified using MALDI-TOF (Vitek-MS) by biomérieux, and the antimicrobial susceptibility testing was performed using an automated biomérieux VITEK®️ 2 Antimicrobial Susceptibility card. ResultsThe study included 90 cases and 90 controls. Compared with controls, cases had significantly higher mean ICU stay and higher proportions with previous history of antimicrobial therapy, coronary artery disease, malignancy, hemodialysis, previous surgery, use of central line, urethral catheterization, nasogastric tube, and tracheostomy. In a multivariate conditional logistic regression analysis, factors independently associated with P. aeruginosa infection were ICU duration [Odds Ratio (OR) 9.05, 95%CI 2.53−32.27, p = .001], previous surgery (OR = 7.33, 95%CI 1.66−32.36, p = .009), tracheostomy (OR = 11.13, 95%CI 1.05−118.59, p = .046), urethral catheterization (OR = 7.38, 95%CI 1.21−45.11, p = .030) and use of aminoglycosides (OR = 10.59, 95%CI 1.14−98.13, p = .038). Approximately 41% of P. aeruginosa isolates were resistant to imipenem, while 36.7% were multidrug-resistant. Mortality was similar in both groups: 54(60%) cases and 51(56.7%) controls; p = .650. ConclusionsThe study identifies several potentially modifiable factors associated with P. aeruginosa infection in ICUs. Identification of these factors could facilitate case identification and enhance control measures.

Evaluation of effectiveness of central venous catheter related bloodstream infections in the antesty and reanimation intensive care units of the bundle

Aim: The aim of this study is to evaluate the efficacy of prevention bundle study on central venous catheter-associated bloodstream infection (CLABSI) in the Anesthesia and Reanimation Intensive Care Unit (ICU) patients who have central venous catheter. Invasive vehicle related infections, especially CLABSIs, are one of the most difficult infections in ICUs. It has been reported that the use of proven interventions as a bundle to prevent infections associated with invasive tools is effective in reducing infection rates. Materials and Methods:The study was conducted interventionally between July and December 2017. Data, physician and nurse information form, CLABSI package tracking form, CLABSI package information test form, CVC insertion process observation form, bedside CLABSI package tracking form, and CLABSI package tracking form. Ethics committee permission was obtained for the study. Approval was obtained from nurses and doctors. The study was carried out in three stages. Number, Percentage, Chi-square, Fisher Exact Chi-square Test and Wilcoxon Test were used in the research.Results: The overall compatibility of ICUs for the CLABSI bundle was 61%, 65% and 70%, respectively. As a result of the Bundle study, CLABSI rates per 1000 catheter days were decreased, from 11.3 to 9.5 in ICU1, from 9.4 to 6.8 in ICU2, and from 17.1 to 10.6 in ICU3.Conclusion: As a result, it was seen that CLABSI precaution bundle study prepared with evidence based guidelines decreased infection rates. The bundle is recommended for use in intensive care units.

Bacterial Multidrug Resistant Patterns Associated with Intensive Care Unit Infections in Akum, Cameroon

Background: Patients admitted into the intensive care unit (ICU) usually have impaired immunity and are therefore at high risk of acquiring hospital associated infections. Infections caused by multidrug resistant bacteria now constitute a major problem, limiting the choice of antimicrobial therapy.
 Objectives: This study was aimed at determining the antimicrobial resistance pattern of pathogens causing ICU infections at the Catholic Holy Family Hospital Akum-Bamenda. The etiological agents, prevalence and types ICU infections were also determined.
 Methods: Thirteen months hospital associated infections surveillance was conducted in the hospital for patients admitted into ICU. Blood, urine, tracheal aspirate and wound biopsies specimens were collected under strict asepsis and sent to the Medical Microbiology laboratory of the same institution for immediate processing. All pathogens were isolated and identified by standard microbiological methods. Disk diffusion antibiotic susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines.
 Results: The overall prevalence of ICU infections was 30.9% out of which 12.9% were bloodstream infections, 31.5% urinary tract infections, 38.9% pneumonia, and 16.7% skin and soft tissue infections. Klebsiella species and Escherichia coli were the predominant pathogens. Multidrug resistant organisms constituted 59.3% of the pathogens, MDR Klebsiella spp and MDR E. coli were 70.8% and 71.4% respectively. Resistance to Cefuroxime was the highest (92.9%) while Meropenem had the least resistance (21.4%).
 Conclusion: There is a high prevalence of multidrug resistant bacteria causing ICU infections. With the advent of covid-19, infection control procedures and institution of functional antimicrobial stewardship are needed to be put in place in order to cover come this herculean task.

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

BackgroundIt is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients.MethodsRetrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between January 01, 2012, and September 30, 2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria.ResultsSuspected infection was detected in 1306 (18.3%) of IMCU, 1365 (35.5%) of ICU, and 1734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU 45 [0.6%]; ICU 250 [6.5%]; IMCU/ICU 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS 0.72 [0.71–0.72]; SOFA 0.52 [0.51–0.53]; qSOFA 0.82 [0.79–0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53–0.54]; SOFA 0.73 [0.70–0.77]; qSOFA 0.59 [0.58–0.59]).ConclusionsNone of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

Optimal timing of initiating CRRT in patients with acute kidney injury after liver transplantation.

BackgroundAcute kidney injury (AKI) is a frequent complication after liver transplantation (LT), and is associated with high mortality. Continuous renal replacement therapy (CRRT) is an important treatment for AKI, but the optimal time for initiation is still controversial. The purpose of this study was to investigate the prognostic effect of initial CRRT treatment time.MethodsWe retrospectively reviewed the clinical data of 173 recipients undergoing LT from January 2018 to March 2019. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. All patients receiving CRRT were divided into early and late group according to urine output. Prognosis was compared between the two groups.ResultsA total of 48 (27.8%) patients were identified with AKI, 23 (13.3%) of whom received CRRT. According to urine output, 13 (56.5%) patients were in early group and 10 (43.5%) patients in late group. AKI was associated with longer intensive care unit (ICU) and hospital stay, increased post-operative 90-day mortality and the incidence of early allograft dysfunction (EAD). Patients in late CRRT group had a longer ICU stay {median, IQR, 183.5 [92.25–336.75] vs. 139 [94–240] hours, P=0.043} and hospital stay {median, IQR, 38.5 [17.5–62.75] vs. 35 [17–38] days, P=0.019} than patients in early CRRT group, respectively. The rate of severe infection was significantly higher in the late CRRT group than in the early CRRT group (80.0% vs. 30.8%, P=0.026).ConclusionsAKI was associated with longer length of ICU and hospital stay, poor short-term mortality and functional recovery of transplanted organ. Early initiation of CRRT could reduce the severe infection and length of ICU and hospital stay.

Pseudomonas aeruginosa infection in intensive care: Epidemiology, outcomes, and antimicrobial susceptibilities.

Pseudomonas aeruginosa (PA) infection in the intensive care unit (ICU) contributes to substantial mortality. In this study, we describe the epidemiology, antimicrobial susceptibilities, and outcomes of ICU patients with pseudomonal infection. ICU patients with PA were identified and classified as colonized or infected. Infected patients were reviewed for source, patient characteristics, antimicrobial susceptibilities, appropriateness of empiric antimicrobial therapy, and 30-day mortality. Independent predictors of mortality were identified using multivariable logistic regression. One hundred forty (71%) patients with PA were infected. Mean patient age was 55 (SD 18) years; 62% were male. Admission categories included medical (71%), surgical (20%), and trauma or neurological (9%). Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 (SD 10). One hundred twenty-six (90%) patients were mechanically ventilated, 102 (73%) required vasopressors, and 27 (19%) received renal replacement; 32 (23%) died within 30 days. Infection was nosocomial in 101 (72%) cases. Sources were respiratory (66%), skin-soft tissue (11%), urinary (10%), blood (5%), surgical (5%), gastrointestinal (2%), or unknown (1%). Twenty (14%) isolates were multi-drug resistant; 6 (4%) were extensively drug resistant. Empiric antimicrobial therapy was effective in 97 (69%) cases. Liver disease (adjusted OR [aOR] 6.2, 95% CI 1.5 to 25.7; p = 0.01), malignancy (aOR 5.0, 95% CI 1.5 to 17.3; p = 0.01), and higher APACHE II score (aOR 1.1, 95% CI 1.0 to 1.1; p = 0.02) were independently associated with 30-day mortality. PA infection in ICU is most commonly respiratory and associated with substantial mortality. Existing malignancy, liver disease, and higher APACHE II score were independently associated with mortality.

Risk Factors for Carbapenemase-Producing Enterobacterales Infection or Colonization in a Korean Intensive Care Unit: A Case-Control Study.

The purpose of this study is to identify the factors related to the infection and/or colonization of carbapenemase-producing Enterobacterales (CPE) based on clinical and microbiological data for patients in the intensive care unit (ICU). All patients admitted to medical ICU were screened for CPE on admission and weekly, and this 1:2 case–control study included patients with CPE identified by screening or clinical cultures from 2017 to 2018. The clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). A total of 45 CPE patients were identified with a prevalence of 3.8%. The most frequent organism was Klebsiella pneumoniae (69%) and the carbapenemases belonged to the class A Klebsiella pneumoniae Carbapenemase (KPC-2) (87%), class B New Delhi Metallo-β-lactamase (NDM) (11%), and Imipenemase (IMP-1) (2%) strains. The PFGE profiles showed two large clustered groups of KPC-2-producing K. pneumoniae. In the multivariate analysis, pneumonia/chronic pulmonary disease, previous fluoroquinolone use, and previous use of nasogastric tube were the significant risk factors for CPE infection or colonization in ICU-admitted patients. Critical illness and underlying medical conditions such as pneumonia/chronic pulmonary disease, antimicrobial selective pressure, and the use of a medical device are identified as risk factors for CPE infection or colonization in ICU. Person to person transmission also contributed.

Antimicrobial Resistance Pattern of Bacterial Pathogens in Intensive Care Unit (ICU) of Tertiary Care Hospital

Introduction: In ICU the spread of drug resistance has been realized that is related to widespread of antibioticsuses. In ICU the rate of antimicrobial resistance is higher than in general hospital setting. The emergence ofMDR bacteria is an increasing problematic cause of health care associated infections in ICUs, not only dueto increased morbidity and mortality, but also due to increased treatment costs as result of frequent empiricalfailure and lengthy hospital stay. Aim: The main purpose of this study was to know prevalence of the drugresistance pattern for the patients admitted in ICUs. Material and Method: The study was conducted in theDepartment of Microbiology of a tertiary care hospital in Maharashtra during December 2019 to May 2020.In this study patients admitted in ICUs of the hospital who were clinically suspected of having any infectionwere included. Depending on the clinical suspicion from the patients samples were collected. Sampleswere subjected to testing for identification and antibiotic susceptibility testing. Result: E.coli was the mostcommon organism isolated and shows highly resistance to Amoxcillin+Clavulanic acid, Ciprofloxacin.ESBL producer were 20.17% out of all isolate and 29.07% out of total Gram negative organism. Amongall Gram positive organism 13(61.90%) were Staphylococcus aureus in which 8(61.54%) were MRSA.Enterococcus showed 100% resistance to Erythromycin and Penicillin whereas Staphylococcus aureusshowed 84.62% and 69.23% resistance to Penicillin and Erythromycin respectively. Conclusion: This studyconcludes general overview of the incidence and antimicrobial resistance of bacteria isolated from ICU.Gram Negative Organisms are causing more infection than Gram Positive Organisms in ICU patients.Hence gram negative organisms are more resistance to higher antibiotics. So antibiotics are used carefully.Therefore antibiotics policies should be formed for ICU and other critical care facilities.

Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System

Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None

Differences in Device-Associated Infections Rates in Argentina

Background: Infection control programs (ICPs) are essential to reducing, in a progressive and sustained manner, healthcare-associated infections (HAIs). To achieve this goal these programs need not only resources (ie, trained human resources and financial resources) but also institutional leadership support. In our country, epidemiological surveillance is voluntary and is registered in the Argentina National Hospital Infection Surveillance System (VIHDA) where 114 hospitals and 78 adult intensive care unit (ICU) report their HAI rates. Many of these institutions do not have IPC or specific resources for this purpose. On the other hand, there are institutions with IPC, recognized by an international accreditation like Joint Commission International, that carry out an advanced and continuous program, with specific improvement goals for prevention and infection control. There is an imperative need in low- and middle-income countries to highlight the impact of ICPs in this setting and to promote regulations for mandatory surveillance and ICPs in all acute-care hospitals. Objective: To compare the rates for device-associated infections in ICUs of institutions with advanced ICPs versus national rates. Design: We conducted an observational, retrospective study, which includes device associated infection rates in adult critical care units from 2014 to 2018. We included all ICUs reporting to VIHDA and 3 surgical-medical teaching hospitals with an advanced ICP and Joint Commission International accreditation (Hospital Italiano de Buenos Aires, Hospital Universitario Austral, Hospital Aleman). The VIHDA definition was used to define central line-associated bloodstream infection (CLABSI), catheter-related urinary infection (CAUTI), and ventilator-associated pneumonia (VAP). The rates were compared as adjusted reasons for exposure time using openepi.com software provided by the CDC. Results: Device associated infection rates in hospitals with advanced ICPs and in hospitals in the national surveillance system in Argentina are shown in Table 1. Compliance with infection control measures and bundles for device-associated infections in the 3 hospitals with advanced ICPs was >80%. No data were available for the rest of hospitals included the national surveillance system. Conclusions: Lower infection-control rates, catheter-related bloodstream infection and VAP, are possible in a middle-income country like Argentina when resources are allocated for this purpose and hospital leadership reinforces the efforts. Notably, all 3 hospitals improved their rates over time. The differences in catheter-related bloodstream infection and VAP rates between these hospitals and the rest of the hospitals in our surveillance system was significant and highlights the need for support when it comes to implementing ICPs.Funding: NoneDisclosures: Wanda Cornistein reports fees for conferences not related to this topic from the following speaker’s bureaus: Pfizer, Merck, and Becton Dickinson.

The Prevalence and Risk Factors of Nosocomial Infections in the Intensive Care Unit of a Hospital in Iran

Background: Nosocomial infections account for about one third of deaths in hospitals. Objective: In this study, we aim to determine the factors affecting the incidence of nosocomial infections in the Intensive Care Units (ICUs) to provide more information for helping improve the prevention and treatment of these infections in the hospitals located in Iran. Methods: This is a comparative cross-sectional study conducted in 2017 on 86 patients admitted to the general ICU of Boo Ali Sina Hospital in Qazvin, Iran. We extracted the patients’ demographic and clinical information (e.g. blood and urine culture results) from their medical records. Findings: The prevalence of nosocomial infections were reported 24.3; 38.4% of infections was related to Acinetobacter and 18.6% to Pseudomonas aeruginosa and other microorganisms. The highest antibiotic resistance in patients was to Cefepime (64%) and Ciprofloxacin (60%). Conclusion: The prevalence of nosocomial infections in the general ICU of the study hospital is relatively high with different strains and varied patterns of antibiotic resistance indicating the need for more comprehensive studies and preventive measures in the country.

Quantity of Antibiotic Use and Resistance Pattern of Gut Normal Flora Escherichia coli at Intensive Care Unit and Tropic Infection Ward, Dr Soetomo Hospital, Surabaya, Indonesia

This study aimed to analyze the relationship of the quantity of antibiotic use with the pattern of resistance of gut normal flora Escherichia coli among patients in Intensive Care Unit (ICU) and Tropic Infection Ward, Dr. Soetomo Hospital, Surabaya. This study was cross-sectional design with 64 samples (32 the ICU and 32 in Tropic Infection Ward). The total sample were collected for three Months. Identification of intestinal microflora was done with McConkey differential selective medium, followed by IMViC biochemical test, and sensitivity test by antibiotic disc diffusion method. Data were analyzed with Chi square test and Fisher's Exact test. There was no significant difference (p=0.441) in the quantity of antibiotic use between ICU and Tropic Infection Ward. There was no significant difference (p>0.05) in normal intestinal flora Escherichia coli resistance pattern between Tropic Infection Ward and ICU against 12 types of antibiotics. The highest percentage of intestinal flora Escherichia coli resistance at the ICU was ceftriaxone as many as 18 (56.3%) and at Tropic Infection Ward on ciprofloxacin and levofloxacin 20 (62.5%). The other study in Primary Health center, showed that the resistance rates of both wards were significantly different as compared to intestinal flora of patients in primary health center (p <0.001), in which the use of antibiotics in primary health center was also lower (1.6 DDD). There was no significant difference (p>0.05) The pattern of bacterial resistance between patient with and without antibiotic use at Tropic Infection Ward and ICU. The quantity of antibiotic use was not significantly different against resistnt gut flora between patients in ICU and Tropic Infection ward. The pattern of bacterial resistance between patient with and without antibiotic use was also not significantly different.

Rising Klebsiella pneumoniae Infections and Its Expanding Drug Resistance in the Intensive Care Unit of a Tertiary Healthcare Hospital, Saudi Arabia.

Nosocomial infections caused by Klebsiella pneumoniae and other Gram-negative organisms have emerged as a significant health problem especially in intensive care units (ICU). This study aims to examine K. pneumoniae infections in the ICU of Aseer Central Hospital and to determine their antimicrobial susceptibility and their relationship to patients' clinical outcomes. This is a retrospective observational study done in a tertiary care center in the Aseer region in Saudi Arabia. The study spanned from January 2018 to December 2019. Demographic, microbiologic, and patient outcomes were collected from 276 patients with various infections. Identification of isolates and in vitro susceptibility to 32 antimicrobial agents were done by the Vitek 2 automated system (bioMérieux, Marcy-l'Étoile, France). Prevalence of K. pneumoniae bacteria, their susceptibility to antimicrobials, and effect on clinical outcome were studied. Two hundred seventy-six K. pneumoniae were recovered from ICU patients with various infections. K. pneumoniae isolates (n=276) were collected mainly from the respiratory tract (61%) and K. pneumoniae represented 39% of the major causal agents of ICU infections, followed by Acinetobacter spp. (30%), Pseudomonas aeruginosa (10.0%), Escherichia coli (7%), and others (14%). The mortality among the 276 ICU patients was 33.3%; K. pneumoniae was connected to 42% of the cases and 67% of the total deaths were between 50 and 90 years of age. K. pneumoniae demonstrated high sensitivity and hence can be recommended for in vivo treatment for tigecycline (81%), cefazolin (77.2%), colistin (64.9%), and to a lesser extent norfloxacin (60%) and imipenem (55.5%). High resistance was detected for ampicillin (100%), extended-spectrum β-lactamases-sulbactam (ESBL-SCM) (100%), piperacillin (100%), and ceftazidime (92.5%). Resistance to carbapenems was elevated in ertapenem (65.2%) and meropenem (61.7%). The increase of K. pneumoniae represents a threat to ICU patients, although K. pneumoniae infections were results rather than the causes, as it was connected to almost half of the ICU mortalities. Tigecycline alone or in combination with colistin on high-dose regimens could be a more effective therapy for treating carbapenem-resistant K. pneumoniae infections.

Handwash versus hand-rub practices for preventing nosocomial infection in hospital intensive care units: A systematic review and meta-analysis

Background: Compliance with handwashing in busy healthcare facilities, such as intensive care units (ICUs), is suboptimal and alcohol hand-rub preparations have been suggested to improve compliance. There is no evidence on the comparative effectiveness between handwash and hand-rub strategies. This systematic review was to assess the effectiveness of handwash versus hand-rub strategies for preventing nosocomial infection in ICUs. Methods Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and hand-rub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of healthcare-associated infections (HCAIs), length of ICU/hospital stays, and adverse events. Studies were independently screened and data extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software. Results: Seven studies published between 1992-2009 and involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%). On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of hand rub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%). The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies;1504 patients; I2 = 0%) in favour of hand rub. Overall quality of evidence was low. Conclusion: Hand rub appeared more effective when compared to handwash in ICUs.

Clinical, epidemiological and microbiological characterization of bacteremia produced by carbapenem-resistant enterobacteria in a university hospital in Córdoba, Argentina

Enterobacteriaceae are a major cause of bloodstream infections and their antimicrobial resistance continues to increase. This leads to higher morbidity-mortality rates and public health costs. Carbapenem-resistant Enterobacteriaceae represent a serious challenge globally, since there are few therapeutic options available. Clinical/microbiological characterization of the carbapenem-resistant bacteremia observed over a period of 4 years. Retrospective, observational and descriptive study about bacteremia caused by carbapenem-resistant and susceptible Enterobacteriaceae. A total of 84 patients with bacteremia including carbapenem-resistant and susceptible Enterobacteriaceae were analyzed. We found that patients infected with carbapenem-resistant strains presented a higher proportion of: previous antibiotic treatment, hospitalization in intensive care unit (ICU), onset of the bacteremia during hospitalization in ICU and previous infection with extended-spectrum-beta-lactamase producing Enterobacteriaceae. Additionally, we observed a predominance of KPC-producing Klebsiella pneumoniae and an attributable mortality rate of 52.4%. This study allowed for a better understanding of an emerging problem with high mortality, which in turn is useful for the design and adoption of infection control strategies and effective treatment regimens adapted to our local epidemiology.

Decreased duration of intravenous cephalosporins in intensive care unit patients with selective digestive decontamination: a retrospective before-and-after study.

Selective digestive decontamination (SDD) reduces the rate of infection and improves the outcomes of patients admitted to an intensive care unit (ICU). A risk associated with its use is the development of multi-drug-resistant organisms. We hypothesized that a 1-day reduction in systemic antimicrobial exposure in the SDD regimen would not affect the outcomes of our patients. In this before-and-after study design, 199 patients and 248 patients were included in a 3-day SDD group and a 2-day SDD group, respectively. The rates of hospital-acquired pneumonia and ICU infections were similar in both groups. The rates of bloodstream infection and bacteriuria were significantly lower in the 2-day SDD group than in the 3-day SDD group. Compared with the patients in the 3-day group, the patients in the 2-day SDD group received fewer antibiotics and less exposure to mechanical ventilation, and they used fewer ICU resources. The rates of ICU mortality and 28-day mortality were similar in both groups. The incidence of multi-drug-resistant organisms was similar in both groups. Within the limitations inherent to our study design, reducing the exposure of prophylactic systemic antibiotics in the SDD setting from 3 days to 2 days was not associated with impaired outcomes. Future randomized controlled trials should be conducted to test this hypothesis and investigate the effects on the development of multi-drug resistant organisms.Electronic supplementary materialThe online version of this article (10.1007/s10096-020-03966-w) contains supplementary material, which is available to authorized users.

Clinical characteristics and epidemiological analysis of pathogenic bacteria of severe abdominal infection in surgical intensive care unit

To study the clinical characteristics of patients with severe abdominal infection and the epidemiological characteristics of pathogenic bacteria in a hospital, to provide a basis for rational use of antibiotics and reduce the drug resistance rate of pathogens. A retrospective analysis was performed on 237 patients with abdominal disease as the primary disease admitted to the surgical intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from January 1st, 2017 to December 31st, 2019. They were divided into two groups according to whether abdominal infection occurred or not. The clinical features of patients in both groups were analyzed, including gender, age, acute physiology and chronic health evaluation II (APACHE II) score, chronic underlying diseases, primary abdominal site, abdominal trauma or bleeding, multiple organ dysfunction syndrome (MODS) involving organs and surgical treatment. At the same time, the bacterial origin, bacterial distribution and antibiotics sensitivity test results of patients with abdominal infection were recorded. Abdominal infection occurred in 141 of the 237 patients and did not occur in the remaining 96 patients. There were no statistically significant differences between the abdominal infection group and the non-abdominal infection group in terms of gender, age, chronic underlying diseases, etiology and trauma. The APACHE II score in the abdominal infection group was obviously higher than that of the non-abdominal infection group (24.0±8.1 vs. 17.1±5.8, P < 0.01). Incidences of abdominal bleeding, MODS involving four or more organs, surgery and the times of surgery ≥ 3 in the abdominal infection group were significantly higher than those in the non-abdominal infection group (36.2% vs. 17.7%, 20.6% vs. 1.0%, 84.4% vs. 21.9%, 9.3% vs. 0%, all P < 0.05). Among the 141 patients with abdominal infection, 107 obtained positive microbial culture results, and a total of 133 pathogenic strains were detected, including 115 strains of bacteria (86.5%) and 18 strains of fungi (13.5%). The main source of bacteria was abdominal drainage (46.1% of non-bloody specimens and 13.9% of bloody specimens). Among the 115 bacteria, Gram-negative (G-) bacteria were the most common (72.2%) and Gram-positive (G+) bacteria accounted for 27.8%. Escherichia coli and Acinetobacter baumannii were the top two G- bacteria (40.9% and 13.9%, respectively), and enterococcus faecalis accounted for the largest proportion of G+ bacteria (7.8%). The pathogenic bacteria of abdominal infection were sensitive to tigacycline. The patients with abdominal infection in our hospital had high APACHE II score, more organs failure and were easily complicated with intraperitoneal hemorrhage and required surgical intervention and even repeated surgery. The pathogenic bacteria in patients with abdominal infection in ICU were mainly G- bacteria, and the rate of multi-drug resistance of Acinetobacter baumannii was high. Empirical anti-infective treatment should be started as soon as possible according to the microbial spectrum of the region until the pathogenic bacteria results are obtained. Broad-spectrum antimicrobial therapy and combined antimicrobial therapy are recommended for the healthcare acquired abdominal infection in hospital.

Resistance, Persistence and Tolerance Significance of MDR Nosocomial Bacterial Infections in ICUs in Relation to MBC/MIC

NOSOCOMIAL infections are a major challenge, as one third of yearly admissions estimated as deaths. In intensive care units (ICUs), Gram-negative pathogens are responsible for the majority of these deadly infections. Multidrug resistance (MDR) in the seorganisms has been attributed to production of modified enzymes responsible of elevated MICs and MBC/MICs putting them in the transient stages for persistence and tolerance. Bacterial cells those can survive high doses of antibiotics comprise a subpopulation of persistent but not resistant cells. Bacterial isolates (326) were collected from nosocomial infections via microbiology laboratories of police hospitals in Cairo. Frequency-wise, it was found that Escherichia is the most frequent (155), Pseudomonas (96), Staphylococcus (34), Klebsiella (24), Proteus (16) while Citrobacter is the least frequent (1). Pseudomonas, Klebsiella, Proteus and Citrobacter showed the highest MDRs, with the highest MICs in a descending order. Results clearly indicated the high risk of the two Pseudomonas aeruginosa from sputum and urine persisting (inhibited but not killed) against MICs 3 tested antibiotics; CRO, AMC and FEB. It is highly recommended here to run tests for MBC/MICs to choose the antibiotic with least MBC/MIC ratio; less than four, in order to reduce the transient persistent and/ or tolerant stages.