Nosocomial Infections In Intensive Care Units Research Articles

Burden of nosocomial infections in intensive care units: Cost of antibiotics, the extra length of stay and mortality rate.

Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients' condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs. The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients' information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded. During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin. This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden.

Clinical Impact and Risk Factors of Intensive Care Unit-Acquired Nosocomial Infection: A Propensity Score-Matching Study from 2018 to 2020 in a Teaching Hospital in China.

Nosocomial infection (NI) is associated with poor prognosis. The present study assessed the clinical and microbiological characteristics of NI patients in the intensive care unit (ICU) and investigated the clinical impact and risk factors for NI in ICU patients. An observational study was conducted in an adult general ICU. The electronic medical records of all patients admitted to the ICU for >2 days from 2018-2020 were analyzed retrospectively. Multivariate regression models were used to analyze the risk factors for NI in ICU patients. Propensity score-matching (PSM) was used to control the confounding factors between the case and control groups, thus analyzing the clinical impact of NIs. The present study included 2425 patient admissions, of which 231 (9.53%) had NI. Acinetobacter baumannii (33.0%) was the most common bacteria. Long-term immunosuppressive therapy, disturbance of consciousness, blood transfusion, multiple organ dysfunction syndromes (MODS), treatment with three or more antibiotics, mechanical ventilation (MV), tracheotomy, the urinary catheter (UC), nasogastric catheter, and central venous catheter (CVC) were risk factors for NI in the ICU patients. After PSM, patients with NI had a prolonged length of stay (LOS) in the ICU and hospital, significant hospitalization expenses (all p<0.001), increased mortality (p=0.027), and predicted mortality (p=0.007). The differences in the ICU and hospital LOSs among three pathogens were statistically significant (p<0.001); the results of the Escherichia coli infection group were lower than the other two pathogenic groups. NI was associated with poor outcomes. The risk factors for NI identified in this study provided further insight into preventing NI.

Monitoring Multidrug-Resistant Acinetobacter baumannii Infections in the Neurosurgery ICU Using a Real-Time Surveillance System.

Multidrug-resistant Acinetobacter baumannii (MDR-AB) infections are becoming increasingly common. The Real-Time Nosocomial Infection (NI) Surveillance System (RT-NISS) was used to monitor MDR-AB NI in intensive care units (ICUs) to prevent NI outbreaks. Therefore, the RT-NISS was used in the current study to monitor MDR-AB infections in a neurosurgery ICU. Clinical interventions, including recommended antibiotics, bacterial distribution in the patient analysis, and bed adjustments, were carried out based on the monitoring results. The RT-NISS was also used to monitor clinical data, implement, and provide training on NI control. The RT-NISS detected a potential cluster of XDR-AB when five patients admitted to the neurosurgery ICU were tested positive for AB between 11 and 17 June 2019. Only two infected cases originated in the hospital, and there was no NI outbreak. The hospital Infection Control Department took appropriate measures to prevent cross-infection; specifically, an epidemiologic investigation and environmental assessment were conducted, and NI prevention and outbreak management training was provided. In summary, the RT-NISS enhanced the timeliness and efficacy of NI control and surveillance in a neurosurgery ICU. In order to prevent NI outbreaks, the Real-Time Nosocomial Infection (NI) Surveillance System (RT-NISS) was employed to monitor MDR-AB NI in critical care units (ICU). Based on the monitoring data, clinical actions such as required antibiotics, bacterial distribution in the patient analysis, and bed changes were carried out. In a neurosurgery ICU, the RT-NISS improved the timeliness and efficacy of NI control and surveillance.

Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors.

BACKGROUNDIntensive care unit (ICU) patients are critically ill and have low immunity. They will undergo various trauma medical procedures during diagnosis and treatment. The use of high-dose hormones and broad-spectrum antibiotics will increase the incidence of nosocomial infection in ICU patients. Therefore, it is necessary to explore the causes of nosocomial infection in ICU and provide basis for the prevention and control of nosocomial infection in ICU.AIMTo explore major pathogens of nosocomial infection in ICUs, methods of detection and drug resistance trends. METHODSRisk factors of multidrug-resistant infection were analyzed to provide a basis for clinical rational use of antimicrobial drugs in the ICU. These findings were used to standardize rational use of antimicrobial agents. BD PhoenixTM100 automatic bacterial identification analyzer was used to for cell identification in specimens collected from the ICU between January 2016 and December 2019. Drug sensitivity tests were carried out and drug resistance trends were analyzed using the optical disc diffusion method. Odds ratios and corresponding 95%CI of independent variables were calculated using a logistic regression model. Backward elimination (trend = 0.1) was used as an inclusion criterion for multivariate analysis. All data were analyzed using SPSS version 22.0, and P < 0.05 was considered statistically significant. RESULTSWe collected 2070 samples from ICU patients between January 2016 and December 2019. Sample types comprised sputum (1139 strains, 55.02%), blood (521 strains, 25.17%), and drainage fluid (117 strains, 5.65%). A total of 1051 strains of major pathogens, including Acinetobacter baumannii, Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae) and Staphylococcus aureus, were detected, with a detection rate of 35.97% (378/1051). Most of these strains were resistant to antibiotics. Detection rate of E. coli was 21.79% (229/1051), and it was generally sensitive to many antimicrobial drugs. Detection rate of P. aeruginosa was 24.74% (260/1051), and showed low sensitivity to most antibiotics. Detection rate of K. pneumoniae was 9.42% (99/1051), which was generally resistant to multiple antimicrobial drugs and resistant forms. K. pneumoniae was resistant to imipenem for approximate 4 years, and showed a 19.9% (19/99) and 20.20% (20/99) rate of meropenem resistance. Logistic analysis showed that mechanical ventilation and ureteral intubation were risk factors for multidrug-resistant bacterial infections. CONCLUSIONThis study showed a high incidence of ICU infections. Mechanical ventilation and urine tube intubation were risk factors for infection with multidrug-resistant bacteria.

Nosocomial infections-related antimicrobial resistance in a multidisciplinary intensive care unit

Background: Intensive care units (ICUs) have become hubs of nosocomial infections worldwide. There has been a continuous rise in the development of antimicrobial resistance among ICU-acquired infections. Particularly, the Gram-negative bacteria implicated in ICU-acquired infections have become resistant to the majority of the antibiotics leading to a critical therapeutic problem. The present study was conducted to determine the antimicrobial resistance pattern of microorganisms causing nosocomial infections (ventilator-associated pneumonia [VAP], central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) in a multidisciplinary ICU. Materials and Methods: This prospective observational cohort study included the patients with ICU stay ≥ 48 h and any of the ICU-acquired infections: VAP, CLABSI, or CAUTI. The appropriate specimen was collected as per the standard procedure and cultured. The antimicrobial susceptibility of all the bacterial isolates recovered from the samples was performed according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. The antimicrobial resistance data were analyzed using WHONET Microbiology Laboratory Database software 5.6 (WHONET 5.6). Results: Gram-negative microorganisms were the principal pathogens causing various infections in the ICU, out of which Pseudomonas aeruginosa and Klebsiella pneumonia were the commonest. Most of the Gram-negative bacteria showed a high degree of resistance to the majority of the antibiotics. Colistin was observed to be the most effective antimicrobial for Gram-negative pathogens followed by doripenem, meropenem, and tigecycline. The majority of Staphylococcus aureus isolates (71.4%) were methicillin-resistant S. aureus; however, all were sensitive to vancomycin and linezolid. Vancomycin-resistant Enterococci constituted 43% of Enterococcus isolates and were sensitive to linezolid and tigecycline. Conclusion: Antimicrobial resistance was very high among the pathogens causing nosocomial infections in the ICU, especially Gram-negative bacteria demonstrated a substantially high degree of resistance to the majority of the antibiotics. Antibiotic stewardship will help control the emergence of multidrug-resistant microbes.

Effectiveness of air purifiers in intensive care units: an intervention study

Effective design and operation of intensive care unit (ICU) ventilation systems is important to prevent hospital-acquired infections. Air purifiers may contribute. To detect the number and types of micro-organisms present in the air and on high-touch surfaces in ICUs, and to evaluate the effectiveness of air purifiers in reducing the microbial load and thus the rate of nosocomial infections in ICUs. This intervention study was conducted in two similar ICUs between May to November 2020. Novaerus air purifiers were located in the intervention ICU for 2 months. Routine cleaning procedures and high-efficiency particulate air filtration continued in the control ICU as well as in the intervention ICU. After 2 months, the air purifiers were moved to the other ICU for the next 2 months to reduce any possible bias in the results. Air and surface samples were evaluated. Evaluation of changes in the intervention ICU over time revealed a significantly lower colony concentration in the air and on surfaces on Day 60 compared with Day 1 (Pair<0.001 and Psurface<0.001). There was a significant positive correlation between the number of colonies detected and the rate of hospital-acquired infections in the intervention ICU (r=0.406, P=0.049) and in the control ICU (r=0.698, P=0.001). Using air purifiers in addition to heating, ventilation and air conditioning systems in hospitals may be an effective way to reduce the microbial load in the air and on surfaces, and thus hospital-acquired infections.

Synbiotic Therapy Prevents Nosocomial Infection in Critically Ill Adult Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Based on a Bayesian Framework

Background: The efficacy of synbiotics, probiotics, prebiotics, enteral nutrition or adjuvant peripheral parenteral nutrition (EPN) and total parenteral nutrition (TPN) in preventing nosocomial infection (NI) in critically ill adults has been questioned. We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) to evaluate and rank the effectiveness of these therapies on NI amongst critically ill adults.Methods: Four electronic databases were systematically searched up to June 30, 2019 for RCTs comparing the administration of probiotics, prebiotics, synbiotics, EPN and TPN in critically ill adults. The primary outcome was NI. The relative efficacy of all outcomes was determined by a Bayesian framework with random effects NMA. We estimated the odds ratio (OR) and mean difference (MD) and ranked the comparative effects of all regimens with the surface under the cumulative ranking probabilities. The study has been registered on PROSPERO (CRD42019147032).Results: Fifty-five RCTs (7,119 patients) were identified. Primary outcome showed that synbiotics had the best effect in preventing NI than EPN (OR 0.37; 95% CrI 0.22–0.61), probiotics followed (OR 0.52; 95% CrI 0.34–0.77), whereas TPN significantly increased NI (OR 2.29; 95% CrI 1.48–3.67). Subgroup analysis showed that TPN significantly increased NI in intensive care unit (ICU) patients (OR 1.57; 95% CrI 1.01–2.56) and severe acute pancreatitis (SAP) patients (OR 3.93; 95% CrI 1.74–9.15). Secondary outcomes showed that synbiotics were more effective in preventing hospital-acquired pneumonia (HAP) (OR 0.34; 95% CrI 0.11–0.85), catheter-related bloodstream infection (OR 0.08; 95% CrI 0.01–0.80), urinary tract infection (OR 0.27; 95% CrI 0.08–0.71) and sepsis (OR 0.34; 95% CrI 0.16–0.70) than EPN. Amongst the treatments, probiotics were most effective for shortening the mechanical ventilation duration (MD −3.93; 95% CrI −7.98 to −0.02), prebiotics were most effective for preventing diarrhea (OR 0.24; 95% CrI 0.05–0.94) and TPN was the least effective in shortening hospital length of stay (MD 4.23; 95% CrI 0.97–7.33).Conclusions: Amongst the five therapies, synbiotics not only prevented NI in critically ill adults but also demonstrated the best treatment results. By contrast, TPN did not prevent NI and ranked last, especially in ICU and SAP patients.Take-Home Message: Nosocomial infection is a leading cause of mortality in critically ill patients in the ICU. However, the efficacy of synbiotics, probiotics, prebiotics, enteral nutrition or adjuvant peripheral parenteral nutrition and total parenteral nutrition in preventing nosocomial infection in critically ill adults has been questioned. The network meta-analysis provides evidence that amongst the five therapies, synbiotics not only prevented NI in critically ill adults but also demonstrated the best treatment results. By contrast, TPN did not prevent NI and ranked last, especially in ICU and SAP patients. The results of this study will provide a new scientific basis and a new idea for the debate on the efficacy of synbiotics and other treatments in the improvement of prognosis in critically ill adult patients.Tweet: Synbiotic prevents nosocomial infection in critically ill adults, while total parenteral nutrition has the adverse curative.

Evaluation of Nosocomial Infections in Reanimation Intensive Care Unit: Analysis of Six Years Surveillance

Objective: Nosocomial infections (NI) raise costs due to the increased in mortality and long-term hospitalization. There are more NIs in intensive care units (ICU) probably due to invasive procedures. In order to reduce NIs, the most important step in terms of prevention is the identification of the common pathogens with their infection rates among these units. For this purpose, the centers should conduct surveillance studies and often evaluate their data.&#x0D; Methods: We evaluated the infection rates and ratios, between January 1st, 2014 and August 31st, 2019 in Reanimation Intensive Care Unit (ICU) in our hospital. Method of the surveillance was, prospective, active, laboratory and patient based.&#x0D; Results: In our reanimation ICU, 1591 patients were followed up during the study period. 192 NIs were observed in 179 patients on 21,840 intensive care days. NI rate was found to be 11.25 and Infection density rate was found to be 8.20 and their change over the years was examined. Analysis regarding the source of infections revealed that ventilator-related pneumonia (27.08%) and central venous catheter-related blood-stream infection (25.52%) was most commonly observed during the study period. The ventilator usage rate was 0.54 (11.859 ventilator days) and the central venous catheter usage rate was 0.94 (20.566 catheter days) in the study period. Acinetobacter baumannii (n = 96, 50%), Pseudomonas aeruginosa (n = 24, 12.5%) and Klebsiella pneumonia (n = 18, 9.38%) were most commonly isolated.

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.

Use of chlorhexidine for the prophylaxis of nosocomial infections in ICU

This review summarizes published data on the use of chlorhexidine for the prevention of nosocomial infections in the intensive care units (ICU). The use of a 0.5–2.0% alcohol solution of chlorhexidine is strongly recommended for the surgical site decontamination before surgical intervention or vascular puncture for the prevention of surgical site infections and catheter-associated bloodstream infections. The following measures could be considered: daily skin decontamination with water solution of chlorhexidine (chlorhexidine bathing) in ICU for the prevention of catheter-associated bloodstream infection; the use of impregnated with chlorhexidine dressing for the prevention of catheter-associated bloodstream infections and catheter colonization; cleaning of the urinary meatus with water solution of chlorhexidine for the prevention of catheter-associated urinary tract infections. A routine use of chlorhexidine solution for oral care to prevent ventilator-associated pneumonia is not reasonable. The risks of contact dermatitis, anaphylaxis and emergence of chlorhexidine-resistant microorganisms should be considered when using chlorhexidine.

ВИДОВИЙ ПРОФІЛЬ МІКРОБНИХ ЧИННИКІВ НОЗОКОМІАЛЬНИХ ІНФЕКЦІЙ

Nosocomial infections, also known as health care-associated infections (HAIs) are infections that appear in patients under medical care in hospitals or other health care facilities and were absent at the time of admission. From 5 to 7 thousand cases of HAIs are registered in Ukraine every year, but according to experts, the actual number is 900 thousand cases per year. Intensive care unit (ICU) represents a prominent tool in HAIs control and quality assurance in many developed countries. In this respect, the US Center for Disease Control and Prevention (CDC) recommends monitoring HAI as a leading tool for the reduction of HAIs. Therefore, the aim of this research was to investigate microbiological profile of nosocomial infections in ICU of public hospitals in Lviv, Ukraine. Material and methods. 105 clinical materials from 50 patients in two public hospitals in Lviv (Lviv Regional clinical hospital and Military Medical Clinical Center of the Western Region) were analyzed during July-December 2018. 114 strains of pathogens were isolated. HAIs was defined as an infection that appeared in patients later than 48 hours after admission to the hospital. Urinary tract infections (UTI), blood stream infection (BI), respiratory tract infection (RTI) and surgical site infections (SSI) were diagnosed using the criteria defined by the CDC and clinical protocols. Causative bacterial strains were isolated and identified using standard methods and chromogenic media CHROMID*S.aureusElite, CHROMID*VRE, CHROMID*MRSASMART, CHROMID*CARBASMART, CHROMID* ESBL, CHROMID*OXA-48, CHROMID*Candida (Biomerieux) and biochemical identification kitsMIKRO-LA-TESTNEFERMtest24, ENTEROtest24, CANDIDAtest21, STAPHYtest24, STREPTOtest24 (ErbaLacema, Czech Republic). Antibiotic sensitivity test was done using Kirby-Bauer disc diffusion technique. (Ethical Committee or Institutional Animal Care and Use Committee Approval Danylo Halytsky Lviv National Medical University: 25/06/2018 № 6). HAIs structure was as follows: Staphylococcus lentus (22%), Eschrichia coli (22%), Klebsiella pneumoniae subsp.ozaenae (9.8%), Pseudomonas aeruginosa (43.9%), Klebsiella pneumoniae subsp.pneumonia (8.8%), Srreptococcus spp. (7.0%), Burkholderia pseudomallei (5.3%), Staphylococcus haemolyticus (3.5), Staphylococcus aureus (3.5%). There were several types of HAIs which are rarely found, such as Staphylococcus lentus, Staphylococcus simulans, Staphylococcus lugdunensis, Aerococcus viridans, Pragia fontium, Aeromonasichthiosmia, Raoultella terrigena, Macrococcus caseolyticus. Conclusions. In the era of antibiotics, HAIs are still uncontrollable. It is assessed that over 90.0% of HAIs are not recognized as epidemics. It is important to remember this fact when attempting to design prevention or control strategy to reduce HAIs either at WHO level, or at the level of local health care unit.

Effect of early supplemental parenteral nutrition on outcomes of critically ill patients

Objective To explore the effect of early supplemental parenteral nutrition on the outcomes of critically ill patients. Methods Totally 302 patients admitted in the intensive care unit (ICU) of Taizhou Hospital of Zhejiang Province from 2015 to March 2017 were enrolled and divided into two groups: the enteral nutrition group and the supplemental parenteral nutrition group. The clinical data of the two groups were retrospectively analyzed and the outcomes was compared between the two groups. Results The time of ICU stay, mechanical ventilation days, nosocomial infections in ICU and the rate of feeding intolerance were significantly lower in the supplemental parenteral nutrition group than in the enteral nutrition group (P<0.05). There was no statistically significant difference in the mortality rate in 28 days between the two groups. Conclusion Supplemental parenteral nutrition has many advantages like reduce the duration of ventilation, ICU stay and the rate of feeding intolerance, and it does not affect the 28-day mortality rate of critically ill patients with NRS2002 score>5, or increase the complication of infection. Key words: Nutritional therapy; Early enteral nutrition; Supplemental parenteral nutrition; Intensive care unit

Influence of bacterial resistance on mortality in intensive care units: a registry study from 2000 to 2013 (IICU Study)

Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance. To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles. The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included. The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission. Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.

Multidrug-resistant bacteria isolated from cell phones in five intensive care units: Exploratory dispersion analysis.

Cell phones are susceptible to bacterial contamination. The aim of this study was to characterize the bacterial isolates and to explore their dispersion in five Intensive Care Units (ICUs) over the time. We performed a secondary analysis of non-fermenting Gram-negative bacteria and Gram-positive cocci isolated from a 5-month observational cohort study developed among health care workers' cell phones in five ICUs. Cell phones were sampled using a swab every 15 days. Antimicrobial resistance was determined by the minimum inhibitory concentration method. We constructed resistance phenotypes to group the isolates according to species and antimicrobial resistance pattern to explore dispersion through time. A total of 35 P. aeruginosa, 16 Acinetobacter spp., 30 S. aureus and 26 Enterococcus spp. were isolated from 491 phone samples. Multidrug resistance was 2.9% for P. aeruginosa, 31.3% for Acinetobacter spp., 46.7% for S. aureus and 80.8% for Enterococcus spp. The resistance to methicillin in S. aureus and to vancomycin in Enterococcus spp. was 26.7% and 42.3%, respectively. We did not observe distribution patterns or clusters over the time for P. aeruginosa, Acinetobacter spp. and Enterococcus spp. isolates. All the S. aureus isolates grouped into eight phenotypes. Interestingly, we observed S. aureus isolates with the same phenotype in consecutive and separate sampling dates in the same cell phone. Cell phones are contaminated with highly harmful bacteria and potentially can maintain them for prolonged periods of time. These devices could be considered as a potential source of nosocomial infections in ICUs.

Targeted surveillance of nosocomial infection in intensive care units of 176 hospitals in Jiangsu province, China

Nosocomial infections (NIs) impact care and costs in hospitals across the globe. There are few data on targeted surveillance of NI in intensive care units (ICUs), and data specific to the risk factors for NI are especially limited. One hundred and seventy-six secondary and tertiary hospitals performed NI targeted surveillance in their ICUs. The data were collected and summarized by Minke software, then fed back once per quarter. The incidence of NI appeared to decrease, and the incidence of NI per 1000 patient-days and adjusted incidence were 25.63‰ and 7.41‰ in 2010, and 9.73‰ and 2.76‰ in 2015, respectively. The NI incidence in general hospitals was higher than in specialized hospitals. The incidence of central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) appeared to decrease, and the incidence of ventilator-associated pneumonia (VAP) decreased markedly from 20.33‰ to 2.76‰. There was no statistically significant difference among ICUs. The six most frequently found pathogen-caused NIs were Acinetobacter baumannii (AB), Klebsiella pneumoniae (KP), Pseudomonas aeruginosa (PA), Staphylococcus aureus, Candida albicans, and Escherichia coli (E.coli). The isolation rate of carbapenem-resistant Gram-negative bacilli were carbapenem-resistant AB 80.53%, carbapenem-resistant PA 39.94%, carbapenem-resistant KP (CRKP) 24.86%, and carbapenem-resistant E.coli 9.23%. The isolation rate of meticillin-resistant S.aureus (MRSA) was 66.30%. The increasing trend of CRKP was statistically significant as analysed by the regression model. The incidences of VAP, CAUTI, and CLABSI were high in ICUs, and multidrug-resistant organisms were the primary pathogens of NI. The implementation of targeted surveillance may determine the risk factors of NI so that effective intervention measures can be taken to reduce the incidence of NI in ICU patients.

Outcome and Management of Refractory Respiratory Failure With Timely Extracorporeal Membrane Oxygenation: Single-Center Experience With Legionella Pneumonia.

To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016. A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia. Patients with Legionella pneumonia were slightly older than patients with acute respiratory failure of other etiologies (51 [48-56] vs 45 [35-54]), but with no significant differences in acute respiratory failure severity between groups: Pao2/Fio2 ratio 67 (60-75) versus 69 (55-85) and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score 4 (1-5) versus 2 (-1-4), respectively. Legionella pneumonia was associated with earlier ECMO initiation (days of invasive mechanical ventilation [IMV] before ECMO: 2.0 [1.0-4.0] vs 5.0 [2.0-9.5]). After IMV adjustment to "lung rest" settings, this group presented higher respiratory system (RS) static compliance (28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmH2O) but required higher ECMO support (blood flow 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]). Patients with Legionella pneumonia had shorter IMV (16 [14-23] vs 27 [20-42] days) and lower incidence of intensive care unit nosocomial infections (35.7% vs 64.3%), with a trend to higher hospital survival (85.7% vs 62.2%; P = .13). In Legionella pneumonia complicated by refractory respiratory failure, ECMO support allowed patient stabilization under lung protective ventilation and high survival rates. Timely ECMO referral should be considered for Legionella pneumonia failing conventional treatment.

Nosocomial Infections in Intensive Care Unit: Pattern of Antibiotic-resistance in Iranian Community.

Background:Bacterial infections are responsible for great number of mortality in Intensive Care Unit (ICU). Knowledge about prevalence of bacterial infections and their antibiotic-resistance pattern would be a great step for their treatment and management.Materials and Methods:Data about nosocomial infections in ICUs of Alzahra Hospital (referral hospital in Isfahan, center of Iran) were gathered during the years 2007–2010. A questionnaire was fulfilled for any specific patient with nosocomial infection containing demographic data of patient and also characteristics of the infection.Results:Out of all patients, 707 individuals (65.6%) were male and 370 (34.4%) were female. Our data revealed that Pseudomonas aeruginosa (13.9%), Klebsiella (11%), and Escherichia coli (6.4%) were the most prevalent bacterial infections. The most common sites of nosocomial infections in the ICU were respiratory system (399 cases, 37%), urinary system (230 cases, 21.4%), and blood (102 cases, 9.5%). The antibiotic-resistance of each bacteria in ICU ward was assessed and data were categorized in a table. There were less documentary about bacterial cultures in the year 2007 when compared with the next years.Conclusion:We found some differences (such as bacterial prevalence in ICU wards which caused nosocomial infections) in our local prevalence of nosocomial infections and also in their resistance pattern compared to other centers. Knowing about our data will help physicians to administer the most suitable antibiotics for treatment of nosocomial infections in our area.

Is there a relationship between rectal colonization and nosocomial infection of patients in intensive care unit?

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a major problem in intensive care units (ICUs) with high mortality and morbidity rates and the prior colonization is an important risk factor for these infections. The aim of this study was to investigate the prevalence of rectal colonization of MDR microorganisms and the association between the microorganisms that caused colonization and infection in the patients with nosocomial infections in ICUs. Rectal swabs were obtained on the day of 0, 3, 7, 14, 21 and weekly thereafter from 80 patients over 18 years of age hospitalized in ICU for more than 48 hours, and cultured for vancomycin-resistant enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)- producing gram-negative bacilli (GNB) and carbapenem-resistant enteric and nonenteric bacilli. Patients whose rectal swabs were not obtained on admission (on the day of 0), were excluded even they were hospitalized more than 48 hours. Bile esculin agar containing 64 μg/mL ceftazidime and 6 μg/mL vancomycin, chromogenic MRSA agar and blood agar media, MacConkey agar containing 1 mg/L ceftazidime and ceftriaxone, and 5 mL tryptic soy broth media containing 10 µg imipenem and meropenem discs were used for identification. Identification of GNB was determined by conventional methods and ESBL production was determined by double-disc synergy test. Patients have been followed up for nosocomial infections. Bacterial identification and antibiotic susceptibility tests were performed with standard microbiological methods. In 37 (46%) of the 80 patients, at least one MDR microorganism was isolated in rectal swab cultures on the day of 0. The most common microorganisms were ESBL-positive E.coli (19%), followed by ESBL-positive K.pneumoniae (13%), carbapenem-resistant P.aeruginosa (10%), ESBL-positive K.oxytoca (3%), MRSA (1%), VRE (1%), carbapenem-resistant Acinetobacter sp. (1%) and carbapenem-resistant K.pneumoniae (1%), respectively. The number of microorganisms isolated from rectal swab cultures on the following days have increased, and on the 7th day, the rate of the patients with rectal colonization ascended to 72%. Out of 80 patients, 52 (65%) had nosocomial infections in the follow-up and the mean duration of infection development was 11.8±9.9 days in these patients. Patients with and without rectal colonization were compared in terms of subsequent nosocomial infection rates. While no statistically significant difference has been detected between two groups on the day of 0, patients with rectal colonization detected on the day of 3 and 7, had a significantly higher incidence of nosocomial infections (p=0.02, p=0.01). Among the patients with ESBL-positive GNB, carbapenem-resistant K.pneumoniae, carbapenem-resistant P.aeruginosa and VRE infections, the same microorganisms have been isolated in the rectal swab cultures taken before the development of infection. This result was statistically significant for each of these microorganisms (p=0.00-0.03). However, such a correlation was not observed for Acinetobacter infections. Since MRSA infections developed in only two patients, no istatistical analysis has been done for this microorganism. In conclusion, our data suggest that MDR microorganisms that cause nosocomial infections, initially colonize the gastrointestinal tract, and early detection of colonized patients in ICUs may help an effective infection control by preventing the spread of these resistant microorganisms.

The Current Definitions of Health-Care Associated Infections in Intensive Care Units

The incidence of nosocomial infections is higher than other sites of the hospitals at intensive care units (ICUs) because of high frequency of invasive interventions and multidrug resistant microorganism’s prevalence. The most frequent nosocomial infections in ICUs’ are ventilator-related pneumoniae, urinary tract infections, catheter-related bacteremia and surgical site infections. The definitions of health care associated infections and the diagnosis criteria were updated at 2008 by CDC/NHSN (Centers for Disease Control and Prevention/National Healthcare Safety Network). After this period, Public Health Agency of Turkey translated this guideline to Turkish and publicated it. The aim of this study to discuss the definitions of health care associated infections in the lightening of current guidelines.

Monitoring and analysis of the relevant factors and strategies of nosocomial infection in intensive care unit

Objective To investigate the characteristics of nosocomial infections and factors in patients in intensive care unit （ ICU） ,in order to provide a basis for the measures .Methods Using the method of target monitoring , to the patients who were in the ICU from January 2013 to December had a prospective surveillance , statistics and analysis the monitoring data .Results There were 163 cases happened nosocomial infection in 677 cases of patients, hospital infection rate was 24.1%;212 cases of secondary infection , infection cases rate was 31.3%. The main site of infection followed by respiratory tract （ 143 cases, 67.5%）, blood （28 cases,13.2%）, urinary tract （15 cases, 7.1%）.The main pathogen of infection followed by Acinetobacter baumannii （64 strains, 30.2%）, Pseudomonas aeruginosa （35 strains, 16.5%） and Klebsiella pneumoniae （24 strains, 11.3%）.Different age, hospitalization, the number of disease diagnosis at ICU hospitalized , mechanical ventilation time and presence of detaining urethral catheter for endotracheal intubation , deep venous catheterization , indwelling catheters in patients with the incidence of comparative differences were statistically significant （P〈0.05）Conclusions Should take appropriate prevention and control measures for related factors of nosocomial infection in ICU , strict aseptic procedures and disinfection and isolation system , strengthen the hand hygiene , good management of invasive procedures , try to shorten the hospital stay of patients , rational use of antibiotics and so on are the key measures to reduce the nosocomial infections in ICU . Key words: ICU Nosocomial infection Monitoring Relevant factors