Microorganisms In Intensive Care Units Research Articles

ПЕРСПЕКТИВЫ ЭФФЕКТИВНОЙ ЭРАДИКАЦИИ МУЛЬТИРЕЗИСТЕНТНЫХ МИКРООРГАНИЗМОВ: РЕЗУЛЬТАТЫ МИКРОБИОЛОГИЧЕСКОГО МОНИТОРИНГА В ГРОДНЕНСКОЙ УНИВЕРСИТЕТСКОЙ КЛИНИКЕ

Background. Monitoring sensitivity to antibacterial drugs of various groups of microorganisms allows us to provide an optimal approach to the prevention and treatment of bacterial infection. In this regard, it is important to analyze the composition and resistance of the bacterial flora in order to select the most effective drugs for its eradication. Purpose of the study. Our aim is to identify the most common microorganisms in intensive care unit (ICU) and analyze their sensitivity to antibacterial drugs, and determine the general patterns and main directions in the development of antibiotic resistance. Materials and methods. The data of microbiological studies in 107 patients of the ICU of a therapeutic profile with various diseases were analyzed. Results. The most frequently detected microorganisms were Staphylococcus epidermidis (30 patients, 28.03% of cases), Staphylococcus hominis (15 patients, 14.01% of cases) and Klebsiella pneumoniae ssp. pneumoniae (17 patients, 15.8% of cases). The most common carriers were patients with community-acquired bilateral interstitial pneumonia (62.9% of cases). Low sensitivity of bacteria to carbapenems and colistin, complete resistance of most microorganisms to penicillins, cephalosporins and fluoroquinolones, as well as unexpectedly high sensitivity to tetracycline were revealed. Conclusions. In clinical practice, the range of effective drugs against isolated multi-resistant microorganisms is narrowing, it is necessary to avoid the unreasonable use of antibiotics and, as soon as possible, move from the empirical prescription of broad-spectrum drugs to targeted antimicrobial therapy according to microbiological control data. It is recommended to consider the possibility of a wider use of tetracycline in ICU.

ESBL production and carbapenem resistance increased the secondary bloodstream infection rates in intensive care units in Turkey, 2014–2019

Aim: Secondary bloodstream infections (SBSIs) are caused by another infection and differ from primary bloodstream infections (PBSIs) in terms of prevention and treatment strategies. The aim of this study was to determine the risk factors for bloodstream infections which were secondary to the most common healthcare-associated infections caused by the most common microorganisms in intensive care units (ICUs) and to examine whether extended-spectrum beta lactamase (ESBL) production and carbapenem resistance is related to the higher risk or not.Methods: The study population consisted of patients in ICUs with ventilator-associated pneumonia (VAP), ventilator-associated event (VAE) or catheter-associated urinary tract infection (CAUTI) caused by E. coli, K. pneumoniae, P. aeruginosa or A. baumannii between 2014 and 2019. The data were obtained through the National Healthcare-associated Infections Surveillance Network. Multivariate logistic regression analysis was performed separately for VAP/VAE and CAUTI to determine the risk factors for the development of SBSI.Results: Microorganism, ICU type, bed capasity and carbapenem resistance were found to be risk factors for SBSI for both types of infection. For VAPs/VAEs, female gender and hospital type were also identified as risk factors. The highest risk was in K.pneumoniae and in emergency ICUs. Among the hospitals, the highest risk in VAPs/VAEs was found in government education and research hospitals. ESBL production for K. pneumoniae and E. coli increased the risk in patients with VAP/VAE; however, it did not increase in patients with CAUTI.Discussion: By using the risk factors, it may be possible to recognize SBSIs earlier, especially in patients with CAUTIs or VAPs/VAEs caused by carbapenem-resistant or ESBL-producing K. pneumoniae.

Infections and antimicrobial resistance in an adult intensive care unit in a Brazilian hospital and the influence of drug resistance on the thirty-day mortality among patients with bloodstream infections.

INTRODUCTION: The present study aimed to determine the incidence of health care-associated infections (HCAIs) and identify the main resistant microorganisms in intensive care unit (ICU) patients in a Brazilian university hospital. METHODS: A retrospective cohort study was conducted in a Brazilian teaching hospital between 2012 and 2014. RESULTS: Overall, 81.2% of the infections were acquired in the ICU. The most common resistant pathogenic phenotypes in all-site and bloodstream infections were oxacillin-resistant coagulase-negative staphylococci and carbapenem-resistant Acinetobacter spp. (89.9% and 87.4%; 80.6% and 70.0%), respectively. CONCLUSIONS: There is an urgent need to focus on HCAIs in ICUs in Brazil.

Increased colistin resistance of Acinetobacter species in intensive care unit-acquired infections in a tertiary care hospital

Background: The aim of our study was to evaluate the antimicrobial resistance rates among pathogen microorganisms especially colistin resistant rates of Acinetobacter baumannii in intensive care unit (ICU)-acquired infections and to determine infection-specific correct treatment strategies.
 Methods: The data of adult and newborn infant patients diagnosed with ICU-acquired infection in a tertiary education and research hospital in Bursa in 2014 and 2016 were analyzed, retrospectively.
 Results: Acinetobacter baumannii was the most frequent pathogen of ICU-acquired infections in 2014 and 2016. There was a significant increase in colistin (CO) resistance rates in A. baumanii (0.0%-6.8%). A significant increase in CO, cefepime (FEP), ciprofloxacin (CIP) resistance rates was established in all gram negative bacteria (0.0%-7.9%, 50.0%-91.9%, 54.7%-74.6%), respectively. A significant increase in the rate of detection of A. baumanii as the pathogen microorganism in respiratory tract infection (RTI) was established (53.9% -79.5%). In addition, the average ventilator-associated pneumonia (VIP) infection rate also increased in 2016 compared to 2014 (VIP rate 2014: 7.12, 2016: 7.45, per 1000 ventilator days). A significant decrease in the rate of detection of all gram negative microorganisms in the surgical site infection (SSI), and a significant increase in the rate of detection of all gram positive microorganisms in the SSI was determined.
 Conclusion: Increased antimicrobial resistance, especially increased colistin resistance rates in ICU-acquired infections, necessitates the creation of new strategies in empirical therapy. Detection of antimicrobial resistance profiles of local and infectious pathogen microorganisms in ICUs is a good guide for correct antimicrobial management.

Profile of Micro-organisms in Intensive Care Unit of a Neurotrauma Centre: A Retrospective Study

Profile of Micro-organisms in Intensive Care Unit of a Neurotrauma Centre: A Retrospective Study

Acinetobacter baumannii microbiological and phenotypic characteristics of isolates from Intensive Care Unit of the Department of Internal Medicine at the University Hospital Centre in Zagreb over a four-year period

Acinetobacter baumannii is an opportun-istic nosocomial pathogen and one of the six most important multidrug-resistant microorganisms in intensive care units (ICU). The aim of this study was to determine the prevalence of antimicrobial resistant A. baumannii strains in ICU. We analysed antibiotic susceptibility of A. baumannii isolates collected in University Hospital Centre Zagreb over a four-year period (2011-2014) based on the hospital computer system data (BIS). The data were interpreted according to Clinical and Lab-oratory Standards Institute criteria.All strains from 2014 were found to be resistant to meropenem, which is a sig-nificant increase when compared to 1.4% in 2011 and 81.8% in 2012. The resistance rate to imipenem increased to 95.8% in 2014 from 91.4% in 2011 and 81.8% in 2012. Colistin resistance, confirmed by E test, was found only in one strain in 2013. The resistance rates of other antimicrobial agents were as follows: ampicillin/sulbac-tam 8.6% and 73.9%, netilmicin 70.6% and 83.3%, gentamicin 48.6% and 91.7%, ami-kacin 82.4% and 80.0% and ciprofloxacin 100% and 100% in 2011 and 2014 respec-tively.Our data confirmed a multidrug-resist-ance phenotype in Acinetobacter bauman-nii strains isolated in ICU at the Clinical Hospital Centre, with a significant increase in resistance rates between 2011 and 2014 against certain antimicrobial agents in-cluding ampicilin/sulbactam and carbap-enems.

Profile of micro-organisms in intensive care unit of a level-1 trauma centre: A retrospective study

Background:Patients with trauma usually require highly specialized care in ICU and many times their recovery is complicated by infections. Aim of this study was to determine the profile of pathogens and their impact on outcome among these patients.Materials and Methods:The clinical records of 101 consecutive patients who were admitted for more than 48-hrs in ICU during Jun-Dec 2007 were analyzed.Results:Total of 953 samples from blood, urine, BAL or pus/collection were subjected to cultures. From 276 samples, 299 organisms were isolated. Among pathogens Candida Spp. [89 (29%)] were the most common, followed by Acinetobacter Spp. [69 (23%)], Pseudomonas Spp. [63 (21%)], Klebsiella Spp. [31 (10%)], coagulase negative Staphylococcus aureus [16 (5%)], E coli [12 (4%)], Enterobacter Spp. [7 (2%)], S aureus [6 (2%)], Enterococcus Spp. [5 (2%)], Citrobacter Spp. [2 (0.6%)], S maltophila [1 (0.3%)] and Providentia Spp. [1 (0.3%)]. For gram negative pathogens drug-resistance rates were as follows: Fluoroquinolones, 76%; 3rd generation cephalosporins, 74%; aminoglycosides, 66%; β-lactams/β-lactamase inhibitors combinations, 64%; and carbapenems, 50%. Among these 27% of pathogens were resistant to all 5 classes of drugs. 58% of Staphylococcus aureus were methicillin-resistant whereas 85% of coagulase negative Staphylococcus were methicillin resistant. The mortality was higher among patients in whom pathogens were isolated [Odd's Ratio (OR) 0.185; 95% confidence interval (CI) 0.049-0.640; P = 0.002].Conclusions:Isolation of multi-drug resistant pathogens is common among trauma patients admitted in ICU and is associated with increased mortality and could impact on the consumption of hospital resources. The importance of high rate of fungal isolation needs to be studied among these patients.

Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece

The purpose of this study was to investigate the influence of an antibiotic policy programme based on restriction of the empirical use of fluoroquinolones and ceftazidime on the susceptibilities of Gram-negative microorganisms in a general Intensive Care Unit (ICU). The epidemiology of infections caused by the predominant ICU pathogens, i.e. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, and their resistance patterns as well as antibiotic consumption were recorded for a 6-month period. An antibiotic restriction policy including ceftazidime and quinolones was applied. After an 18-month period of protocol application, the same parameters were recorded for another 6-month period. Consumption of restricted and overall antibiotics was reduced by 92.5% and 55.4%, respectively. Susceptibilities to ciprofloxacin of the three predominant infection-causing Gram-negative bacilli were significantly increased. Ceftazidime showed an increase in susceptibility only for P. aeruginosa. Similar rates of infectious episodes were recorded in the two periods and no differences were observed either in overall mortality or in ICU ecology as expressed by the type of microorganisms implicated in colonisation and/or infection. The reported data suggest that an antibiotic restriction policy can significantly reduce antimicrobial consumption and antimicrobial resistance rates, although the latter effect can be also influenced by the prevalent resistance mechanisms and the prevalence of imported resistance.

Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients.

To investigate salivary flow and frequency of oral mucositis in intensive care unit patients compared with patients admitted because of elective coronary artery bypass graft (CABG) surgery. In addition, the pattern of oropharyngeal colonization was investigated in these patients. Prospective study. Mixed intensive care unit and cardiosurgical ward. In this study, 24 ventilated intensive care unit patients and 20 CABG patients were included. Two dental hygienists examined intensive care unit patients for the presence of periodontal disease and mucositis at admission and subsequently every week during their stay in the intensive care unit. At the same time, stimulated salivary flow and salivary total immunoglobulin A output were measured. Oropharyngeal cultures were obtained as well. CABG patients were examined the day before the operation, 1 day, 1 wk, and 2 wks after the operation. The following results were obtained: a) temporarily reduced postoperative stimulated salivary flow and total salivary immunoglobulin A output in CABG patients and nearly absent stimulated salivary flow in intensive care unit patients; b) oropharyngeal colonization with potentially pathogenic microorganisms in intensive care unit and not in CABG patients; and c) the increase in mucositis index in intensive care unit patients paralleled the increase in potentially pathogenic microorganism oropharyngeal colonization, especially and. Absence of adequate salivary flow in intubated intensive care unit patients causes severe xerostomia, which may contribute to the development of mucositis and oropharyngeal colonization with Gram-negative bacteria.