Intensive Care Unit Ward Research Articles

Incidence, time to occurrence and predictors of peripheral intravenous cannula-related complications among neonates and infants in Northwest Ethiopia: an institutional-based prospective study

BackgroundPeripheral intravenous cannulas (PIVC) are venous access devices commonly used for the administration of intravenous fluids, drugs, blood products, and parenteral nutrition. Despite its frequent use, it has complications that can seriously threaten patient safety, prolong hospital stays, and increases medical care costs. PIVC complications are associated with increased morbidity and reinsertion attempts are painful and anxiety-provoking for children and their parents. Therefore, this study was aimed to assess the incidence, time to occurrence and identify predictors for PIVC complications among infants admitted to Debre Tabor Comprehensive Specialized Hospital (DTCSH), Northwest Ethiopia.Methods and settingAn institutional-based prospective cohort study was conducted on 358 infants admitted to a neonatal intensive care unit and pediatric ward, DTCSH from January 1 to April 30, 2022. A systematic sampling technique was employed.ResultsThe incidence rate of PIVC complication was 11.6 per 1000 person-hours observation. PIVC complication was observed in 56.4% (202) of PIVCs, of which infiltration (42.1%) was the most common complication followed by phlebitis (29.7%). The median time to complication was 46 h. Anatomical insertion site (AHR = 2.85, 95%CI: 1.63–6.27), admission unit (AHR = 1.88, 95%CI: 1.07–4.02), sickness (AHR = 0.24, 95% CI: 1.31–4.66), medication type (AHR = 2.04, 95%CI: 1.13–3.66), blood transfusion (AHR = 0.79, 95%CI: 0.02–0.99), clinical experience (AHR = 0.52, CI:0.26–0.84), and flushing (AHR = 0.71, 95%CI: 0.34–0.98) were potential predictors of PIVC complication.ConclusionKnowing the predictor factors helps clinicians to provide effective care and to detect complications early.

Association between Iron Deficiency Anemia and Febrile Convulsions in Paediatric Patients: A Prospective Case Control Study

Background: Febrile seizure is among the most common convulsion disorders in children, in the first five years of life.
 
 It affects about 2% to 5% of all children between 6 to 60 months of age; coinciding with the peak age of incidence of Iron deficiency anemia.
 Some of the recent studies have reported that iron deficiency could be a risk factor for febrile seizure because febrile seizure is more common in children under two years and iron deficiency anemia is also common in children of the same age.
 Due to the presence of iron in the hemoglobin structure, it plays a crucial role in the transport of oxygen to different tissues such as the brain.
 Iron deficiency reduces the metabolism of some neurotransmitters.
 
 Aims & Objectives: This study aims to determine the association between iron status and febrile seizures in children aged 6 months to 60 months of age.
 Material & Methods: In this prospective case-control study, we evaluated 50 children aged 6 to 60months in two 25 persons group.
 
 Cases consisted of 25 children with diagnosis of febrile seizures and controls group consisted of 25 children with febrile illness without convulsions, who were admitted at the Paediatric Intensive Care Unit and Paediatric wards at Shadan Institute of Medical Sciences, Hyderabad from November 2020 to April 2022.
 Both groups were reviewed to determine the iron status using Hemoglobin concentration, Mean corpuscular volume, Mean corpuscular hemoglobin, serum ferritin, serum iron, TIBC and serum transferrin to make the diagnosis of Iron deficiency anemia.
 
 Results: The 2 groups were compared and no significant difference was found with regards to age, gender and disease causing the febrile illness.
 
 Iron deficiency anemia was found in 48% (12 children) of the cases and 20% (5 children) of the controls group.
 This indicates a statistically significant association between iron deficiency anemia and febrile seizures.
 
 Conclusion: Iron deficiency anemia is more frequent among children with febrile seizures than with febrile illness alone.

Emergence and clonal spread of KPC-2-producing clinical Klebsiella aerogenes isolates in a hospital from northwest Argentina.

Introduction. Klebsiella aerogenes is a nosocomial pathogen associated with drug resistance and healthcare-associated infections.Gap Statement. K. aerogenes is associated with hospital-acquired infections with the ability to acquire mechanisms of resistance to reserve antimicrobials; its clinical behaviour has been poorly documented.Objective. We proposed to investigate an outbreak of carbapenem-resistant K. aerogenes in a hospital that persisted for 4 months.Methods. The primary aim was to evaluate the molecular characteristics and the clonal relationships among the isolates. We characterized isolates by polymerase chain reaction (PCR) and pulsed-field gel electrophoresis (PFGE). The information was integrated with clinical and epidemiological data.Results. Fourteen strains were disseminated in an intensive care unit and different wards at the hospital. The overall mortality was 42.8 %, and mortality attributed to infection was 21.4 %; strains showed high rates of resistance to most of the antimicrobials tested and carried bla KPC-2, bla SHV-2 and bla CTXM-15 genes. PFGE analysis indicated 2 PFGE groups; 12/14 isolates were associated with subgroup A and were likely to be primarily responsible for the first isolation and subsequent dissemination. The outbreak characteristics data showed prolonged hospitalization and previous use of antibiotics as potential risk factors.Conclusion. We consider that it is essential to perform phenotypic and genotypic identification of early genetic resistance mechanisms in K. aerogenes isolates, not only from infection sites but also from colonization, to prevent the spread of these multidrug-resistant (MDR) isolates.

Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Pattern in ICU and Non-ICU Wards: A Four-Year Retrospective Study in Isfahan, Iran.

Bloodstream infections (BSIs) are one of the causes of morbidity and mortality in hospitalised patients. This study evaluated BSI's incidence, trend, antimicrobial susceptibility patterns and mortality in AL Zahra Hospital in Isfahan, Iran. This retrospective study was conducted in AL Zahra Hospital from March 2017 to March 2021. The Iranian nosocomial infection surveillance system was used for data gathering. The data included demographic and hospital data, type of bacteria, and antibiotic susceptibility findings and were analysed in SPSS-18 software. The incidence of BSIs was 1.67% and 0.47%, and the mortality was 30% and 15.2% in the intensive care unit (ICU) and non-ICU wards, respectively. In the ICU, the mortality was correlated with the use of the catheter, type of organism and year of study, but in non-ICU, correlated with age, gender, use of the catheter, ward, year of study and duration between the incidence of BSIs and discharging/death. Staphylococcus epidermidis, Acinetobacter spp. and Klebsiella spp. were the most frequent germs isolated in all wards. Vancomycin (63.6%) and Gentamycin (37.7%) for ICU and Vancomycin (55.6%) and Meropenem (53.3) for other wards were the most sensitive antibiotics. Despite the few rate of BSI in the last four years in AL Zahra Hospital, our data showed that its incidence and mortality in the ICU ward are significantly more than in other hospital wards. We recommend prospective multicentre studies to know the total incidence of BSI, local risk factors and patterns of pathogens causing BSI.

High Frequency of blaOXA-48like Producing Klebsiella pneumoniae Isolated from Nosocomial Infection in Azerbaijan, Iran.

Klebsiella pneumoniae is one of the significant agents of hospital-acquired infections. In recent years, carbapenem-resistant K. pneumoniae (CRKP) isolates have been found in numerous epidemics of nosocomial infections. This study aimed to determine carbapenem resistance mechanisms and molecular epidemiological of CRKP infections in Azerbaijan, Iran. A total of 50 non-duplicated CRKP from January 2020 to December 2020 were isolated form Sina and Imam Reza Hospitals in Tabriz, Iran. Antimicrobial susceptibility testing was performed by the disk-diffusion method. The carbapenem resistance mechanisms were determined by the phenotypic and PCR procedures. CRKP isolates were typed by the Random Amplified Polymorphic DNA PCR (RAPD-PCR) technique. Amikacin was the most effective antibiotics against CRKP isolates. AmpC overproduction was observed in five CRKP isolates. Efflux pump activity was found in one isolate by the phenotypic method. Carba NP test could find carbapenemases genes in 96% of isolates. The most common carbapenemases gene in CRKP isolates were blaOXA-48-like (76%) followed by blaNDM (50%), blaIMP (22%), blaVIM (10%), and blaKPC (10%). The outer membrane protein genes (OmpK36 and OmpK35) were identified in 76% and 82% of CRKP isolates, respectively. RAPD-PCR analysis yielded 37 distinct RAPD-types. Most blaOXA-48-like positive CRKP isolates were obtained from patients hospitalized in intensive care unit (ICU) wards with urinary tract infections. The blaOXA-48-like is the main carbapenemase among CRKP isolates in this area. Most blaOXA-48-like producer CRKP strains were collected from the ICU ward and urine samples. To control infections due to CRKP, a strict control program in hospital settings is required.

Prevalence of Pathogenic Bacteria and Antibiotic Susceptibility Profiles Isolated from Medical Equipment and Inanimate Surface.

The hospital environment, especially the intensive care unit, is a leading reservoir of nosocomial bacteria. Equipment and inanimate surfaces are among the most transmission vehicles for nosocomial bacteria. This study is to assess the bacterial profile and antibiotic susceptibility pattern of the isolates from medical equipment and inanimate surfaces at intensive care unit wards in Bahir Dar City government hospital, North West Ethiopia. A hospital-based, cross-sectional study was conducted between March 01/2021 and May 30/2021 at Felege Hiwot and Tibebe Gihon Compressive Specialized Hospitals. A total of 158 surface swab samples from the patient bed, table, chair, sphygmomanometer, and stethoscopes were collected. Sterile cotton-tipped swabs moistened with normal saline were used. Using standard protocols, the collected samples were processed at Bahir Dar University, Microbiology Laboratory. All isolates were cultured and identified by using routine bacterial culture, Gram staining, and biochemical tests. Phenotypic antimicrobial susceptibility testing was done on each isolate following the Kirby Bauer disk diffusion method. Data were entered and analyzed using SPSS version 26 and the results were explained by using percentages and tables. In this study, coagulase-negative Staphylococcus, S. aureus, and K. pneumoniae were the most predominant isolated bacteria, which accounted for 52.8%, 47.2%, and 43.2% respectively. Chairs, sphygmomanometers, and patient beds were the most contaminated. Imipenem and clindamycin were the most effective antibiotics for all Gram-negative and Gram-positive isolates, respectively. Among the total isolates, 84 (57.5%) were multidrug resistant and of these, 78.4% were Gram-negative isolates. Inanimate objectives and key medical devices of the hospital are heavily contaminated with potentially pathogenic bacteria. Additionally, the recovered isolates are multidrug resistant, making the control and prevention strategy more challenging. Thus, the hospital infection prevention and surveillance system must be activated and perform periodic disinfection of objects. Furthermore, large-scale surveillance is desirable.

Assessment of 28-day survival of patients with sepsis based on vitamin D status: a hospital-based prospective cohort study in Indonesia.

sepsis is a potentially life-threatening condition caused by the body´s response to an infection. Recent studies have demonstrated a correlation between low vitamin D status and high mortality in septic patients. This study aims to evaluate the vitamin D status of septic patients at Dr. Sardjito Hospital and describe 28-day survival with very low vitamin D levels (< 8.1 ng/mL). this prospective cohort study was conducted in the intensive care unit and internal medicine ward at Dr. Sardjito Hospital in septic patients admitted between December 2018 and October 2019. Vitamin D [25(OH)D] was prospectively measured within 24 hours of admission. Data collection used SPSS software for statistical analysis. In addition, the sample size was calculated using the sample size formula used in a comparative survival study intended to find the incidence rate in septic patients. The minimum sample for each group is 23 samples. sepsis-related mortality was higher in patients with low vitamin D. The analysis included 88 septic patients during the study period. The mean age was 56.09 ± 16.82 years and the proportion of males was 46.6%. 26 of 28 patients with vitamin D levels < 8.1 ng/mL died (92.6%), whereas 39 of 60 patients with vitamin D levels ≥ 8.1 ng/mL (65%) died. Multivariate Cox regression analysis showed that vitamin D concentrations < 8.1 ng/mL at admission (p=0.01) and sepsis shock (p=0.02) were associated with increased sepsis mortality. The hazard ratio of 28-day mortality was 1.95 (95% CI 1.15-3.29, p=0.01) for vitamin D levels < 8.1 ng/mL. The average survival was 9 days for patients with vitamin D levels < 8.1 ng/mL (median: 6 days) compared with 14 days for those with vitamin D levels ≥ 8.1 ng/mL (median: 10 days). low serum vitamin D levels (< 8.1ng/mL) at admission were associated with increased 28-day mortality in septic patients.

Safety and Efficacy of Peripherally Inserted Central Catheter Placement by Surgical Intensivist–Led Vascular Access Team

This study aimed to evaluate the safety and efficacy of bedside peripherally inserted central catheter (PICC) placement under ultrasonography (USG) guidance in the general ward by a surgical intensivist-led vascular access team versus that of PICC placement in the intensive care unit (ICU) or fluoroscopy unit. We conducted this retrospective study of all patients who underwent PICC placement between March 2021 and May 2022. Clinical, periprocedural, and outcome data were compared for PICC placement in the ICU, general ward, and fluoroscopy unit groups, respectively. A total of 354 PICC placements were made in 301 patients. Among them, USG-guided PICC placement was performed in 103 and 147 cases in the ICU and general ward, respectively, while fluoroscopy-guided PICC placement was performed in 104 cases. USG-guided PICC placement more often required post-procedural catheter repositioning than fluoroscopy-guided PICC placement (P<0.001), but there was no significant difference in any adverse events (P=0.796). In addition, USG-guided PICC placement in the general ward was more efficient than fluoroscopy-guided PICC placement (0.73 days vs. 5.73 days, respectively; P<0.001). In the multivariate analysis, previous PICC placement within 6 months was an independent risk factor for a PICC-associated bloodstream infection (odds ratio, 2.835; 95% confidence interval, 1.143-7.034; P=0.025). USG-guided PICC placement in the general ward by a surgical intensivist-led vascular access team has comparable safety and efficiency to that of USG-guided PICC placement in the ICU or fluoroscopy-guided PICC placement.

Evaluation of the effectiveness of the modified nutrition risk in the critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU)

BackgroundCOVID-19 is a very harmful pandemic, and its recovery process is highly influenced by nutritional status; however, an appropriate nutritional scale has not yet been proposed for these patients. Therefore, the purpose of this study was to evaluate the effectiveness of the modified Nutrition Risk in the Critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU).Material and methodsThis was a cross-sectional study performed on 204 critically ill patients affected by COVID-19 admitted to the ICU wards. Evaluated indicators include the mNUTRIC Score as well as demographic, and biochemical indicators.ResultsA high percentage of COVID-19 patients (67.2%) had severe disease. Hospital and ICU stay (p > 0.001) and PH (p > 0.001) values were significantly lower in non-survivors than in survivors. mNUTRIC score (p > 0.001), PCO2 (p = 0.003), and CRP levels (p = 0.021) were significantly higher in non-survivors than survivors. mNUTRIC score had a direct correlation with age (p > 0.001), AST (p = 0.000), LDH (p = 0.026), and CRP (p = 0.014) and an inverse correlation with hospital duration (p = 0.031), albumin (p = 0.003) and PH (p < 0.001). Furthermore, there was a non-significant correlation between the mNUTRIC score and mortality chance (OR = 1.085, 95%CI [0.83, 1.42], p = 0.552). While, patients with more severe COVID-19 disease (OR = 8.057, 95%CI [1.33, 48.64], p = 0.023) and higher PCO2 (OR = 1.042, 95%CI [1.01, 1.08], p = 0.023) levels had higher odds of mortality.ConclusionsOur findings revealed that COVID-19 patients with higher CRP levels and lower PH had higher mortality and poor nutritional condition. Moreover, there was a non-significant association between the mNUTRIC score and mortality chance.

Secondary sclerosing cholangitis in a young COVID-19 patient resulting in death: A case report

With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 in Wuhan, China, liver injury in patients with coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 infection has been regularly reported in the literature. There are a growing number of publications describing the occurrence of secondary sclerosing cholangitis (SSC) after SARS-CoV-2 infection in various cases. We present a case of sudden onset SSC in a critically ill patient (SSC-CIP) following COVID-19 infection who was previously healthy. A 33-year old female patient was admitted to our University Hospital due to increasing shortness of breath. A prior rapid antigen test showed a positive result for SARS-CoV-2. The patient had no known preexisting conditions. With rapidly increasing severe hypoxemia she required endotracheal intubation and developed the need for veno-venous extracorporeal membrane oxygenation in a setting of acute respiratory distress syndrome. During the patient´s 154-d stay in the intensive care unit and other hospital wards she underwent hemodialysis and extended polypharmaceutical treatment. With increasing liver enzymes and the development of signs of cholangiopathy on magnetic resonance cholangiopancreatography (MRCP) as well as endoscopic retrograde cholangiopancreatography (ERCP), the clinical setting was suggestive of SSC. At an interdisciplinary meeting, the possibility of orthotopic liver transplantation and additional kidney transplantation was discussed due to the constant need for hemodialysis. Following a deterioration in her general health and impaired respiratory function with a reduced chance of successful surgery and rehabilitation, the plan for transplantation was discarded. The patient passed away due to multiorgan failure. SSC-CIP seems to be a rare but serious complication in patients with SARS-CoV-2 infection, of which treating physicians should be aware. Imaging with MRCP and/or ERCP seems to be indicated and a valid method for early diagnosis. Further studies on the effects of early and late SSC in (post-) COVID-19 patients needs to be performed.

E-Learning versus Face-to-Face Methodology for Learning Antimicrobial Resistance and Prescription Practice in a Tertiary Hospital of a Middle-Income Country.

Antimicrobial resistance is a growing health problem worldwide. One strategy to face this problem in a reasonable way is training health personnel for the rational use of antimicrobials. There are some difficulties associated with medical staff to receiving training with E-learning education, but there is a lack of studies and insufficient evidence of the effectiveness of this method compared to face-to-face learning. An educational intervention on antimicrobial resistance (AMR) and antimicrobial prescription practice (APP) was designed and implemented using two approaches: face-to-face and E-learning among physicians of the intensive care unit (ICU) and internal medicine ward (IMW) at Eugenio Espejo Hospital in Quito. Modalities of interventions were compared to propose a strategy of continuous professional development (CPD) for all hospital staff. An interventional study was proposed using a quasi-experimental approach that included 91 physicians, of which 49 belong to the IMW and 42 to the ICU. All of them received training on AMR-half in a face-to-face mode and the other half in an asynchronous E-learning mode. They then all participated on APP training but with switched groups; those who previously participated in the face-to-face experience participated in an E-learning module and vice-versa. We evaluated self-perception about basic knowledge, attitudes and referred practices towards AMR and APP before and after the intervention. A review of medical records was conducted before and after training by checking antimicrobial prescriptions for all patients in the ICU and IMW with bacteremia, urinary tract infection (UTI), pneumonia, and skin and soft tissue infection. The study received IRB clearance, and we used SPSS for statistical analysis. No statistically significant difference was observed between the E-learning and the face-to-face methodology for AMR and APP. Both methodologies improved knowledge, attitudes and referred practices. In the case of E-learning, there was a self-perception of improved attitudes (p &lt; 0.05) and practices (p &lt; 0.001) for both AMR and APP. In face-to-face, there was a perception of improvement only in attitudes (p &lt; 0.001) for APP. In clinical practice, the use of antimicrobials significantly improved in all domains after training, including empirical and targeted treatment of bacteremia and pneumonia (p &lt; 0.001) and targeted treatment of UTI (p &lt; 0.05). For the empirical treatment of pneumonia, the mean number of antibiotics was reduced from 1.87 before to 1.05 after the intervention (p = 0.003), whereas in the targeted management of bacteremia, the number of antibiotics was reduced from 2.19 to 1.53 (p = 0.010). There was no statistically significant difference between the effect of E-learning and face-to-face strategy in terms of teaching AMR and APP. Adequate self-reported attitudes and practices in E-learning exceed those of the face-to-face approach. The empiric and targeted use of antimicrobials improved in all reviewed cases, and we observed an overall decrease in antibiotic use. Satisfaction with training was high for both methods, and participants valued the flexibility and accessibility of E-learning.

Factors associated with daptomycin consumption in French hospitals between 2019 and 2020: A nationwide surveillance study

ObjectivesThis study aimed to investigate factors associated with daptomycin consumption in French healthcare facilities (HCF) between 2019 and 2020. MethodsAntibiotic consumption expressed as number of defined daily doses (DDD) per 1,000 patient-days (PD) and antimicrobial resistance (AMR) expressed as incidence densities per 1,000PD were extracted each year from the nationwide surveillance network run by the SPARES project (Surveillance and Prevention of Antimicrobial RESistance in hospitals), collecting data at ward level among voluntary HCFs using standardized methodology and webtool. All HCF participating both in 2019 and 2020 were included. A multivariable linear regression was fitted. ResultsAmong 622 HCFs, we analyzed daptomycin consumption and AMR data in 1,637 clinical wards. Incidence densities of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCNS) were the highest in intensive care unit wards (0.54 and 6.83 respectively in 2020). On the most adjusted model, the year 2020 was correlated with a higher daptomycin consumption (1.53; p = 0.01). A greater number of inpatient beds (0.01; p < 0.001), the presence of orthopedic surgery activity in the HCF (1.66; p < 0.02), MRSA (4.38; p < 0.001) and MRCNS (0.61; p < 0.001) incidence densities were associated with a higher daptomycin use. The final model explained 18% of the observed variance. ConclusionsThis study showed that daptomycin consumption was correlated to MRSA and MRCNS incidence densities, to the year 2020 and to non-modifiable HCF-related factors. Prevention of coagulase-negative staphylococci infections should be considered by antimicrobial stewardship teams when daptomycin use is going up in HCF.

Improving service efficiency and throughput of cardiac surgery patients using Monte Carlo simulation: a queueing setting.

Bed occupancy rate (BOR) is important for healthcare policymakers. Studies showed the necessity of using simulation approach when encountering complex real-world problems to plan the optimal use of resources and improve the quality of services. So, the aim of the present study is to estimate average length of stay (LOS), BOR, bed blocking probability (BBP), and throughput of patients in a cardiac surgery department (CSD) using simulation models. We studied the behavior of a CSD as a complex queueing system at the Farshchian Hospital. In the queueing model, customers were patients and servers were beds in intensive care unit (ICU) and post-operative ward (POW). A computer program based on the Monte Carlo simulation, using Python software, was developed to evaluate the behavior of the system under different number of beds in ICU and POW. The queueing simulation study showed that, for a fixed number of beds in ICU, BOR in POW decreases as the number of beds in POW increases and LOS in ICU increases as the number of beds in POW decreases. Also, based on the available data, the throughput of patients in the CSD during 800days was 1999 patients. Whereas, the simulation results showed that, 2839 patients can be operated in the same period. The results of the simulation study clearly demonstrated the behavior of the CSD; so, it must be mentioned, hospital administrators should design an efficient plan to increase BOR and throughput of patients in the future.

A Randomized Comparative Effectiveness Study of Reflexology, Sucrose, and Other Treatments for Needle Procedures in Newborns

BackgroundApproximately 10 to 14 painful procedures per day are performed in infants during the hospital stay. We aimed to determine the effect of reflexology applied to the sole during painful procedures on pain perception in newborns compared with other nonpharmacologic methods. MethodsOur study was planned as a randomized controlled trial in term infants being followed up in the neonatal intensive care unit and maternity ward. To reduce pain during collection of venous blood or heel lance reflexology on the soles of the foot, 24% sucrose solution, kangaroo care, and classical music listening were applied to the infants. The Neonatal Infant Pain Scale (NIPS) was used to assess newborns during acute pain. ResultsA total of 300 patients were enrolled in the study. Higher pain scores and crying times were observed during heel blood collection. All analgesic methods significantly reduced NIPS scores during heel blood collection. Sucrose was the most effective method, followed by reflexology. The best method that significantly shortened the crying time was again sucrose solution followed by reflexology, kangaroo care, and classical music, during heel blood collection. However, none of the nonpharmacologic methods was effective during venous blood collection. ConclusionsAlthough sucrose was the most effective method, reflexology has significant positive effects, especially on average heartbeat, reducing pain, and shortening crying times during heel blood sampling. Reflexology might be considered among the nonpharmacologic methods to be applied before routine interventions, but still, there is a need for further studies to investigate the efficiency.

Evidence of Sharing of Carbapenem-Resistant Klebsiella pneumoniae Strains Between Intensive Care Unit Patients and the Environment.

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) has emerged as an important public health threat. Intestinal colonization with CR-KP increases the risk of infection and death, especially in intensive care unit patients. To clarify the source of colonizing bacteria is very important to prevent the spread of CR-KP, so the purpose of this study was to explore the relationship between the ward environment and intestinal colonization of CR-KP. In this study, 353 environmental swabs from ICU (Intensive Care Unit) wards and 241 anal swab samples from ICU patients were collected and screened on MacConkey plates containing 2 μg/mL ertapenem, and the origin and genotype of CR-KP were analyzed by PCR and sequencing. The sequence type of the strains was also obtained by multi-locus sequence type (MLST) analysis, and plasmid conjugation test was used to clarify whether CR-KP can promote the transmission of drug resistance genes through plasmid integration and rearrangement. A total of 20 CR-KP environmental strains and 7 intestinal strains were obtained, most of which were bla OXA-48 resistant genotypes. Four different STs were identified by multi-locus sequence type (MLST) analysis, among which the large logarithm was ST485 type, and PFGE clustering showed that the similarity between them was >85%. In the plasmid transcoupling assay, we report that one of the Klebsiella pneumoniae drug-resistant plasmids was successfully transferred to E. coli, indicating that it may promote the spread of drug-resistant genes through plasmid integration and rearrangement. Our research suggests that the environment may be a potential source of CR-KP and that there is a need for us to adopt more effective disinfection measures.

A Cross Sectional Study of Discharge Against Medical Advice Cases at a Tertiary Care Hospital of Central Gujarat Region

Background: Discharge Against Medical Advice (DAMA) is an obnoxious reality and dissatisfying event to both ends - patient and healthcare provider. It’s pertinent that periodical survey at single or multicentre be done to identify the predictors and seek solutions and suggest recommendations. Aim and Objectives: Aim of this study was to analyze the predictors of DAMA cases. Objectives were to find out prevalence and predictors of DAMA cases. Methodology: A prospective cross sectional analytical study was done at a tertiary level multi super speciality hospital of central Gujarat. Participants were all those cases who seek DAMA for one other attribute and consented to participate in the study by non-randomised method. After consent, details from DAMA cases were collected in pre-validated questionnaire forms from patients and relatives. All data was analysed statistically for descriptive and analytical statistics. Observations: Maximum DAMA cases were of age group 20-59 years (55%). followed by 60-100 years (25%). Most common reason for obtaining DAMA (56%) was financial constraints. Most of DAMA patients who were having financial constraints (70 &amp; 46) were admitted to Medical Intensive Care Unit (33.11%) and Male Medicine ward (21.22%) respectively. Conclusion: DAMA cases are damaging not only patient morbidity and mortality wise, but also burdens healthcare staff and resources negatively. The reasons for DAMA cases should be discussed and analysed at every healthcare facilities regularly to prevent this futile dissatisfying event.

Different Infection Profiles and Antimicrobial Resistance Patterns between Burn Intensive Care Unit (ICU) and Common Wards

Background: Infection is the most common cause of deaths after burns. However, the difference in infection patterns between the burn intensive care unit and burn common wards has no longer been really investigated. The current study finds out about aimed to evaluate infection profile, antimicrobial resistance, and changing patterns in burn patients in burn intensive care unit (ICU) and common wards. Objectives: The aim of the study to compare the infection profile, antimicrobial resistance, and their changing patterns in burn patients. Methods: Clinical samples were analyzed between April 2021 to March 2022 in Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh. The patient information, pathogen distribution, sources, and antimicrobial resistance were retrospectively collected. A total of 250 and 275 strains were detected in burn intensive care unit (ICU) and Common Wards, respectively. This cross- sectional study was done among patients to diagnose as different infection profiles and antimicrobial resistance patterns between burn ICU and common wards. Result: Out of 525 patients, the study population of the Burn Intensive Care Unit was 250, and the Burn common wards were 275. Most of the patients in Burn Intensive Care Unit 142(56.8%) were 18 to 30 years and Burn Common Wards 153(55.63%) belongs to 18-30 years age group. The majority of the patients in the Burn Intensive Care Unit 52.4% were flame burn and in common wards 46.27% were electric burns. In burn Intensive Care Unit, the most common pathogen sources (47.6%) were wound tissue, and in Burn common wards (90.90%) were wound tissue. Conclusion: Our existing study indicates that the infection profile is specific between burn Intensive Care Unit (ICU) and common Wards, and multidrug resistance is extra serious in burn intensive care unit (ICU) than in common wards. Therefore, exceptional infection-control techniques ought to be emphasized in extraordinary burn populations.

Clinical, Biochemical, and Radiological Presentation of RT-PCR-Positive vs RT-PCR-Negative SARS-CoV-2 Pneumonia Requiring ICU Care: An Observational, Cross-Sectional, Single-Center Study in Kalaburagi, Kalyana Karnataka.

Introduction Studies have reported similar clinical, biochemical, and radiological features between real-time polymerase chain reaction (RT-PCR)-positive and RT-PCR-negative patients. Therefore, the present study aims to assess differences in RT-PCR-positive versus RT-PCR-negative patients' characteristics. Methods We prospectively included 70 consecutive patients with typical coronavirus disease 2019 (COVID-19)-like clinical features who were either RT-PCR-positive or negative, requiring admission to the intensive care unit. The patients were classified into positive and negative RT-PCR groups and evaluated for clinical features, comorbidities, laboratory findings, and radiologic features. Results Fifty-seven point one percent (57.1%; 40/70) were RT-PCR positive, and 42.9% (30/70) were RT-PCR negative patients. The respiratory rate was higher among negative patients (P = 0.02), whereas the mean duration of fever was longer (3.34 vs 2.5; P = 0.022) among positive patients. At presentation, RT-PCR-negative patients had lower saturation of peripheral oxygen (SpO2) (near significant P = 0.058). Evaluation of co-morbidities revealed no differences. The neutrophil/lymphocyte ratio (NLR) (4.57 vs 6.52; P = 0.048), C-reactive protein (CRP) (9.97 vs 22.7; P = 0.007), and serum ferritin (158 vs 248.52; P = 0.010) were higher in patients who tested negative for RT-PCR. Thrombocytopenia (2.42 vs 1.76; P = 0.009), D-dimer levels (408.91 vs 123.06; P = 0.03), and interleukin (IL-6) levels (219.3 vs 80.81; P = 0.04) were significantly elevated among RT-PCR positive patients. The percentage of lung involvement in negative cases was 42.29+/-22.78 vs 36.21+/-21.8 in positive cases (P=0.23). The CT severity score was similar in both cohorts. Conclusion Both RT-PCR-positive and negative patients have similar clinical, biochemical, and radiological features. Considering that we are amidst a pandemic, it is advisable to have a similar approach irrespective of the RT-PCR report and triage and isolate accordingly. We recommend an RT-PCR-negative intensive care unit (ICU) ward and that the treating physician take a call on the management with a holistic approach driven clinically by the laboratory findings and helped by radiological findings. Stressing only on the RT-PCR report for management can be counterproductive.

Investigation on the effectiveness of ventilation dilution on mitigating COVID-19 patients’ secondary airway damage due to exposure to disinfectants

Chlorine-containing disinfectants are widely used in hospitals to prevent hospital-acquired severe acute respiratory syndrome coronavirus 2 infection. Meanwhile, ventilation is a simple but effective means to maintain clean air. It is essential to explore the exposure level and health effects of coronavirus disease 2019 patients’ inhalation exposure to by-products of chloride-containing disinfectants under frequent surface disinfection and understand the role of ventilation in mitigating subsequent airway damage.We determined ventilation dilution performance and indoor air quality of two intensive care unit wards of the largest temporary hospital constructed in China, Leishenshan Hospital. The chloride inhalation exposure levels, and health risks indicated by interleukin-6 and D-dimer test results of 32 patients were analysed.The mean ± standard deviation values of the outdoor air change rate in the two intensive care unit wards were 8.8 ± 1.5 h−1 (Intensive care unit 1) and 4.1 ± 1.4 h−1 (Intensive care unit 2). The median carbon dioxide and fine particulate matter concentrations were 480 ppm and 19 μg/m3 for intensive care unit 1, and 567 ppm and 21 μg/m3 for intensive care unit 2, all of which were around the average levels of those in permanent hospitals (579 ppm and 21 μg/m3). Of these patients, the median (lower quartile, upper quartile) chloride exposure time and calculated dose were 26.66 (2.89, 57.21) h and 0.357 (0.008, 1.317) mg, respectively.A statistically significant positive correlation was observed between interleukin-6 and D-dimer concentrations. To conclude, ventilation helped maintain ward air cleanliness and health risks were not observed.

Microbiological characteristics and risk factors on prognosis associated with Acinetobacter baumannii bacteremia in general hospital: A single-center retrospective study.

Acinetobacter baumannii is one of the most important pathogenic bacteria causing nosocomial infections and has a high mortality rate. Assessment of the microbiological characteristics and risk factors on prognosis associated with A.baumannii is essential. In this study, we aimed to investigate the clinical characteristics and prognostic risk factors of patients with A.baumannii bacteremia. This study retrospectively analyzed the antibiotic resistance of pathogens based on the clinical data of A.baumannii bacteremia patients presented in a tertiary teaching hospital from 2017 to 2022. Logistic regression and decision tree identified the prognostic risk factors for patients with baumannemia. Kaplan-Meier method was used for survival analysis between MDR and Non-MDR groups. The area under receiver-operating characteristic curve (ROC curve) was used to compare the predictive value of the APACHE II score and Sequential Organ Failure Assessment (SOFA) score. A total of 110 patients with positive A. Baumannii blood cultures were included. Most of the patients were from intensive care unit (ICU) wards. The drug sensitivity results showed that the resistance rate of A. baumannii to colistin was the lowest (1.1%), followed by tigecycline (3.6%).The survival time of MDR group was significantly shorter than that of Non-MDR group. Multivariate analysis showed that, APACHE II score and SOFA score were independent risk factors affecting the prognosis of 28 days of A.baumannii bacteremia. And both scores displayed excellent AUROCs (SOFA: 0.909, APACHE II: 0.895 in predicting 28-day mortality). The two scoring systems were highly correlated and predicted no significant difference (r 2 = 0.4410, P < 0.001). We found that SOFA > 7 and APACHE II > 21 are associated with significantly higher mortality rates. A.baumannii bacteremia have the highest incidence in the ICU, with high drug resistance and mortality rates. The survival time of patients with MDR A. Baumannii bacteremia was significantly shortened. The SOFA score and APACHE II score can reflect the severity of A.baumannii bacteremia patients and evaluate the 28-day prognosis. In addition, for the convenience of calculation, the SOFA score may be more clinically useful than the APACHE II score in predicting the mortality rate of A.baumannii bacteremia.