Nosocomial Respiratory Infections Research Articles

Impact of universal masking in reducing the risk of nosocomial respiratory viruses among people with cancer.

Universal masking within healthcare settings was adopted to combat the spread of coronavirus disease 2019 (COVID-19). In addition to mitigating the risk for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, it also had an added benefit of preventing the nosocomial transmission of other respiratory viral diseases. This study examines the impact of the masking intervention on nosocomial respiratory viral infections (RVI) in vulnerable sub-populations of people with cancer at a tertiary care hospital. Interrupted time series analysis. We reviewed non-SARS-CoV-2 nosocomial RVI between January 1, 2017 and December 31, 2023 and compared its quarterly trends before (January 2017 to March 2020) and after (April 2020 to December 2023) the universal masking intervention was implemented. Prior to the masking policy, there was no significant change in the quarterly rate of non-SARS-CoV-2 nosocomial RVI (baseline trend: P = 0.662). Crude infection rates decreased from 5.6% preintervention to 4.3% after the masking policy was implemented (P < 0.001). Quarterly trends continued to steadily decline post-intervention (β = -0.10, SE = 0.04, P < 0.007). Our results suggest that universal face masking is associated with reduced non-SARS-CoV-2 nosocomial RVI, providing further evidence to support the continued use of face masks in healthcare settings to protect the health of immunocompromised patients.

Colistin Resistance Mechanisms and Molecular Epidemiology of Enterobacter cloacae Complex Isolated from a Tertiary Hospital in Shandong, China.

Enterobacter cloacae complex (ECC), which includes major nosocomial pathogens, causes urinary, respiratory, and bloodstream infections in humans, for which colistin is one of the last-line drugs. This study aimed to analyse the epidemiology and resistance mechanisms of colistin-resistant Enterobacter cloacae complex (ECC) strains isolated from Shandong, China. Two hundred non-repetitive ECC strains were collected from a tertiary hospital in Shandong Province, China, from June 2020 to June 2022. Whole-genome sequencing and bioinformatics analyses were performed to understand the molecular epidemiology of the colistin-resistant ECC strains. The nucleotide sequences of heat shock protein (hsp60) were analyzed by using BLAST search to classify ECC. The gene expression levels of ramA, soxS, acrA, acrB, phoP, and phoQ were assessed using RT-qPCR. MALDI-TOF MS was used to analyse the modification of lipid A. Twenty-three colistin-resistant strains were detected among the 200 ECC clinical strains (11.5%). The hsp60 cluster analysis revealed that 20 of the 23 ECC strains belonged to heterogeneous resistance clusters. Variants of mgrB, phoPQ, and pmrAB, particularly phoQ and pmrB, were detected in the 23 ECC strains. The soxS and acrA genes were significantly overexpressed in all 23 colistin-resistant ECC strains (P < 0.05). Additionally, all 23 ECC strains contained modified lipid A related to colistin resistance, which showed five ion peaks at m/z 1876, 1920, 1955, 2114, and 2158. Among the 23 ECC strains, 6 strains possessed a phosphoethanolamine (pETN) moiety, 16 strains possessed a 4-amino-4-deoxy-L-arabinose (-L-Ara4N) moiety, and one strain had both pETN and -L-Ara4N moieties. This study suggests that diverse colistin resistance existed in ECC, including unknown resistance mechanisms, exist in ECC. Mechanistic investigations of colistin resistance are warranted to optimise colistin use in clinical settings and minimise the emergence of resistance.

Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic.

The COVID-19 pandemic has had an unprecedented impact on population health and hospital operations. Over 7 million patients have been hospitalized for COVID-19 thus far in the United States alone. Mortality rates for hospitalized patients during the first wave of the pandemic were > 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.

Hospital Acquired Diarrhoea in Children: A Study in a Tertiary Care Hospital in Sylhet

Background: Children hospitalized for diseases other than diarrhoea can be infected with an enteric pathogen during their stay at hospital, which may complicate and prolongs the course of illness and hospital stay. Hospital acquired diarrhoea are defined as those occurring more than 72 hours after admission to hospital. Nosocomial diarrhoea second to nosocomial respiratory tract infections in causing morbidity among hospitalized children. Objectives: The study was designed to find the rate of hospital acquired diarrhoea, their risk factors and to observe the clinical features. Method: This cross-sectional observational study was conducted in the inpatient department of Pediatrics in Jalalabad Ragib-Rabeya Medical College, Sylhet over a period of 3 months between July to September 2018. A total number of 274 children aged from 1 month to 5 years were admitted in inpatient department other than diarrhoea were included in the study. During their hospital stay, all patients were followed up daily for development of diarrhoea. Results: Out of 274 children 80 patients developeddiarrhoea 72 hours after admission, the rate of occurrence of hospital acquired diarrhoea was 29.2%. Patients who developed hospital acquired diarrhoea, were initially admitted due to pneumonia accounted for about 65% followed by 12.5% due to malnutrition. Patients aged below two years and staying in hospital for longer duration developed diarrhoea more. Presence of any diarrhoeal patient in a bed close the patient’s bed (p=0.00001), hand washing by mother’s during handling baby (p=0.00001), hand washing by doctors (p=0.00001), and sharing the bathroom with diarrhoeal patient (p=0.000061), were statistically associated with the development of nosocomial diarrhoea. Diarrhoea was mostly watery in nature (80%) having pus (80%) and RBC (100%) on stool microscopy and patients suffered from milder dehydration (80%). Conclusions: Hospital acquired diarrhoea is common in admitted patients, which may complicate the disease course, prolonged the hospital stay. J Rang Med Col. March 2024; Vol. 9, No. 1: 65-70

Clinical features of drug reaction with eosinophilia and systemic symptoms: A retrospective study in a reference centre of dermatology in Madagascar

AbstractBackgroundDrug reaction with eosinophilia and systemic symptoms (DRESS) is drug‐induced hypersensitivity reaction that can have fatal complications. Three sets of diagnostic criteria have been proposed, however, consensus is lacking.ObjectivesThis study aimed to describe the causative agents, severity, and the clinical course of patients with DRESS in Antananarivo, Madagascar.MethodsA cross‐sectional study was conducted in patients seen for DRESS, in the department of dermatology at the University Hospital Antananarivo, Madagascar from 2014 to 2022. European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) criteria was used for the diagnosis. Demographic data, latency periods, clinical and laboratory findings, culprit drugs, and outcomes were assessed.ResultsA total of 24 patients were included. Fifteen patients were female. The three most common culprit drugs were carbamazepine (17 patients), phenobarbital (2 patients), and ampicilline (2 patients). Median onset time (interquartile range) was 20 days (range: 7–62 days). Skin rash was present in all patients, and fever in 18 patients. A total of 12 patients showed two or more internal organs involved. Liver and kidney injuries were the most common visceral manifestation. All patients had eosinophilia. Fifteen patients received systemic corticosteroids. Two mortality cases were reported due to DRESS‐related fulminant liver failure and to nosocomial respiratory infection. Mortality was associated with higher eosinophilia (p = 0.03), higher creatininemia (p = 0.04), and shorter time of latency (p = 0.04).ConclusionsOur study show that DRESS is associated with severe morbidity. Early detection and withdrawal of the culprit dru gis crucial to save life and reduce morbidity.

Respiratory infection transmission risk and indoor air quality at outpatient departments and emergency treatment units of Sri Lankan teaching hospitals.

Indoor carbon dioxide (CO2) concentration has been used as a proxy of the degree of ventilation and, by extension, as an indicator of the risk of contracting respiratory infections. No publications exist regarding indoor air quality (IAQ) parameters of Sri Lankan hospitals.We measured the levels of CO2 and seven other IAQ parameters during morning rush hours for three days, in outpatient departments (OPDs) and emergency treatment units (ETUs) of all 21 teaching hospitals of Sri Lanka. We measured the same parameters of outdoor air also. We calculated the mean values of those parameters. We looked for correlations between outdoors and OPD and ETU levels of selected air quality parameters.The average CO2 levels of outdoors, OPDs and ETUs respectively were 514ppm (ppm = parts per million), 749ppm and 795ppm. The average levels of PM2.5 (particulate matter with diameters <2.5μm) outdoors, OPDs and ETUs respectively, were 28.7μg/m3,32μg/m3 and 25.6 μg/m3. The average levels of PM10 (particulate matter with diameters <10μm) outdoors, OPDs and ETUs respectively, were 49.4μg/m3, 55.5μg/m3 and 47.9 μg/m3. The median levels of formaldehyde outdoors, OPDs and ETUs respectively, were 0.03mg/m3, 0.04mg/m3 and 0.08mg/m3. The median levels of total volatile organic compounds (VOC) outdoors, OPDs and ETUs respectively were 0.12mg/m3, 0.19mg/m3 and 0.38mg/m3.CO2 levels of air in OPDs and ETUs generally were below the national ceilings but above the ceilings used by some developed countries. Outdoors, OPDs and ETUs air contain PM10, PM2.5 levels higher than WHO ceilings, although below the national ceilings. VOC and formaldehyde levels are generally below the national ceilings. Air in OPDs and ETUs is hotter and humid than national ceilings. Outdoor PM10, PM2.5 levels influence OPDs and ETUs levels. We propose methods to reduce the risk of nosocomial respiratory infections and to improve IAQ of Sri Lankan OPDs and ETUs.

Multi-epitopes Vaccine Design against Klebsiella pneumoniae based on Outer Membrane Protein using Immunoinformatics Approaches

Klebsiella pneumoniae is a gram-negative of bacteria that are known to cause a variety of nosocomial respiratory tract infections including pneumonia. K. pneumoniae is also included in the ESKAPE bacteria group which has high resistance to antibiotics. Therefore, alternative treatment for K. pneumoniae infection is needed, one of which is by developing a vaccine. The aim of this study was to design a vaccine against K. pneumoniae by targeting the outer membrane protein using immunoinformatics approaches. 1,708 protein of K. pneumoniae was then screened using signalP, pred-TMBB2, and Blastp to select outer membrane proteins. The selected protein, PA1_KLEPN and BAMA_KLEP7 were then predicted using T-and B-cell Epitope Prediction on IEDB to obtain epitope regions. Vaccine design of K. pneumoniae consists of 1 BCL epitope, 2 CTL epitopes, 1 HTL epitope, an adjuvant and PADRE sequences constructed with linkers using Benchling. This vaccine construction is predicted to be non-toxic/allergenic and have a strong binding affinity with human TLR-4 with the HADDOCK score of -93.2kcal/mol, RMSD 0.5 and Z-score -2.5. According to the computer-aided studies conducted for this study, the chosen epitopes may provide excellent vaccine candidates to stop K. pneumoniae infections in people. However, in order to further confirm the efficacy of this suggested vaccine candidate, in vitro and in vivo validation is required.

Impact of antimicrobial stewardship in organisms causing nosocomial infection among COVID-19 critically ill adults

ObjectiveTo evaluate the implementation of an antibiotic stewardship program in critically ill COVID-19 patients and to establish risk factors for coinfection. Secondary objective was to analyze the evolution of the etiology of respiratory nosocomial infections. MethodsSingle-center observational cohort study of consecutive patients admitted to ICU due to COVID-19 pneumonia from March 2020 to October 2022. An antibiotic stewardship program was implemented at the end of the second wave. ResultsA total of 878 patients were included during 6 pandemic waves. Empirical antibiotic consumption decreased from the 96% of the patients during the first pandemic wave, mainly in combination (90%) to the 30% of the patients in the 6th pandemic wave most in monotherapy (90%). There were not differences in ICU and Hospital mortality between the different pandemic periods. In multivariate analysis, SOFA at admission was the only independent risk factor for coinfection in critically ill COVID-19 patients (OR 1,23 95%CI 1,14 to 1,35). Differences in bacterial etiology of first nosocomial respiratory infection were observed. There was a progressive reduction in Enterobacteriaceae and non- fermentative Gram Negative Bacilli as responsible pathogens, while methicillin-sensitive Staphylococcus aureus increased during pandemic waves. In the last wave, however, a trend to increase of potentially resistant pathogens was observed. ConclusionsImplementation of an antibiotic stewardship program was safe and not associated with worse clinical outcomes, being severity at admission the main risk factor for bacterial coinfection in covid-19 patients. A decline in potentially resistant pathogens was documented throughout the pandemic.

Carbapenem resistant Acinetobacter baumannii in ICU patients in a tertiary care hospital: A retrospective study highlighting their demographic and clinical profile, impact on ICU stay and mortality

: was considered as a leading cause of nosocomial respiratory infection and bacteremia in many hospitals all over the world. However, there was a still a debates whether colonization and/or infection with , increases morbidity and mortality independently of the effect of other risk factors.Aim of the study was to isolate among ICU patients, to detect carbapenem resistant among ICU patients with infections and to determine specific risk factors and outcome of the infections due to CRAB isolates. : A retrospective study was carried out at Vydehi Institute of Medical Sciences and RC in Bangalore, in the ICU department from June 2021 to May 2022.Among all the patients carbapenem resistance was detected more in patients above 60 years of age, males were predominant than females, most of the patients were on ventilation and in sepsis and mortality rate was high with the increased duration of ICU stays. is a highly prevalent microorganism among ICU patients, while its potential to acquire resistance toward commonly used antibiotics represents it as a grave threat to the health care industry. Therefore, signifying the need for its regular monitoring in the health care setups. VAP due to CRAB and excess use of intravascular devices are the most important risk factors for CRAB bacteremia in our ICU. Early implementation of appropriate antimicrobial therapy, particularly in critically ill ICU patients with Carbapenem resistant infections, with two or more co morbidities, can be crucial for survival.

Enterococcus Species: A Systemic Review

Enterococci are gram-positive facultative anaerobes, these are commensals in the intestinal system of numerous animals, including humans. They affect hospitalized patients and cause nosocomial infections, respiratory infections, endocarditis, wound infections, UTIs, and other enterococcal infections. This discovery can be explained by hemolysin, gelatinase, aggregation substances, hyaluronidase, capsular polysaccharides, and cell wall carbohydrate. Various enterococcal spp. include Enterococcus avium Vancomycin resistance was acquired by enterococci throughout the antibacterial spectrum, primary antibiotic used regimen based on dual β lactams and aminoglycosides.

High-speed drill craniostomy as a minimally invasive method of chronic subdural hematoma management. Preliminary results of a pilot study

Objectives: The objective of this study was to assess the safety and efficiency of minimally invasive high-speed drill craniostomy in the treatment of chronic subduralhematomas.Study design: The study was designed as a retrospective case series study.Patients and Methods: The patients with compressive chronic subdural hematomas were treated by minimally invasive high-speed craniostomy performed underlocal anesthesia or conscious sedation. A minimal skin incision was followed by a single high-speed drill hole placement in the frontal or parietal region, over the area of maximal hematoma thickness. After hematoma aspiration, a 1.9 mm silicone catheter was placed in subdural space and connected to gravity-assisteddrainage. Patients were ambulatory immediately after surgery. Data on clinical course and outcome were recorded and analyzed.Results: There were 23 patients (5 female, 21.7%) included in the study. The median patient age was 77.5 years (interquartile range 67 - 83). Six (26.1%) of the patients had bilateral subdural hematomas. Septated/multiloculated hematomas were observed in 6 (26.1%) patients. Heterodense hematomas denoting more recent bleeding were recorded in 16 (69.5%) patients. The median duration of subdural drainage was 4 days (interquartile range 3 to 5). The median length of hospital stay was 9.5 days (interquartile range 6 - 16). One patient died of sepsis following a nosocomial respiratory infection. One patient developed a wound infection with subdural empyema, requiring subsequent craniotomy. One patient had deep venous thrombosis and pulmonary embolism. In all patients, postoperative CT scans showed a significant reduction of hematoma volume and midline shifting. No postoperative seizures were observed.Conclusion: High-speed drill craniostomy is a safe, simple, straightforward, and effective treatment for the management of chronic subdural hematomas, including multiloculated and heterodense lesions. Elderly patients could most benefit from such a procedure, avoiding general anesthesia, prolonged intracranial procedures, and lengthy hospital stays.

Implication de la carence en phosphates inorganiques dans la virulence bactérienne de Pseudomonas aeruginosa

Pseudomonas aeruginosa is a bacterium causing a wide spectrum of nosocomial and opportunistic respiratory infections. As an element essential for bacterial metabolism , phosphorus is incorporated as an inorganic phosphate and regulated by a two-component PhoB-PhoR system. Recently, it has been shown that as a result of overexpression of virulence factors, including the PhoB transcription factor, P.aeruginosa exhibited increased virulence in phosphate-deficient conditions. Exploration of the relationship between phosphate homeostasis and P.aeruginosa virulence could effectively contribute to the development of new, simple and innovative therapeutic strategies.

1209. The Impact of the COVID-19 Pandemic on Hospital-Acquired Infections at a Comprehensive Cancer Center

Abstract Background Robust infection control (IC) measures were deployed across healthcare institutions at the start of the COVID-19 pandemic, resulting in increased use of personal protective equipment (PPE), enhanced contact precautions, and emphasis on hand hygiene. The impact of these IC measures on the rates of hospital-acquired infections (HAIs), such as multidrug-resistant organisms (MDROs), device-related infections (DRIs), Clostridium difficile infection (CDI), and respiratory viral infections (RVIs) is not known. Here, we aim to evaluate the effect of the enhanced IC practices on the occurrence of various HAIs in a comprehensive cancer center. Methods We analyzed the monthly HAIs rates from September 2017 through March 2022, including data 42 months pre-pandemic (September 2016-February 2020) and 24 months during the pandemic (March 2020-August 2021). Reported HAIs were calculated using denominators of patient days for CDI and MDROs, per 1,000 admissions for RVIs, and catheter days for DRIs. The incidence rate ratios (IRR) were calculated for all HAIs. Results When comparing pre-pandemic to the pandemic period, a significant increase in the overall incidence rate (IR) of MDROs from 0.56 to 0.67 per 1,000 patient days with an IRR of 1.19 (95% CI 1.02-1.39), a decrease in the IR of CLABSIs and a stable IR of CAUTIs and VAEs were observed (Table 1). A significant decrease was observed in the IR of CDI (IRR 0.65 (95% CI 0.55-0.78)). The total IR of hospital-acquired RVIs per 1,000 admissions (5.24 to 1.82; IRR 0.36; 95% CI 0.30-0.44) decreased, as did each respiratory virus (Respiratory Syncytial Virus (0.51 to 0.15; IRR 0.30), Influenza (0.50 to 0.24; IRR 0.50), Parainfluenza (1.21- to 0.34; IRR 0.28), Rhinovirus (1.91 to 0.5; IRR 0.26), and Human Metapneumovirus (0.19 to 0.05; IRR 0.24) during their respective respiratory viral seasons (Figure 1). Table 1.Comparison of hospital-acquired infection incidence rates during pre-pandemic and pandemic periods.Abbreviations. IR, incidence rate; IRR, incidence rate ratio; MDRO, multidrug-resistant organisms; ESBL, extended-spectrum beta-lactamase; PsA, Pseudomonas aeruginosa; CRE, carbapenem-resistant Enterobacterales; LabID, laboratory identified; MRSA, methicillin-resistant Staphylococcus aureus; CDI, Clostridium difficile infection; CAUTI, catheter-associated urinary tract infection; VAE, ventilator-associated events; CLABSI, catheter-associated bloodstream infection; RVI, respiratory viral infections; RSV, respiratory syncytial virus.Figure 1.Nosocomial respiratory viral infections diagnosed at MD Anderson Cancer Center prior to and during the COVID-19 pandemic Conclusion Implementing strict IC measures during the COVID-19 pandemic in a cancer hospital led to a significant decrease in many HAIs and a reduction in nosocomial RVIs. However, whether these enhanced measures, such as masking at all times as part of patient care, are needed during the upcoming respiratory viral seasons is not known. Disclosures Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support.

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis.

Pseudomonas aeruginosa is a pathogen often encountered in a healthcare setting. It has consistently ranked among the most frequent pathogens seen in nosocomial infections, particularly bloodstream and respiratory tract infections. Aside from having intrinsic resistance to many antibiotics, it rapidly acquires resistance to novel agents. Given the high mortality of pseudomonal infections generally, and pseudomonal sepsis particularly, and with the rise of resistant strains, treatment can be very challenging for the clinician. In this paper, we will review the latest evidence for the optimal treatment of P. aeruginosa sepsis caused by susceptible as well as multidrug-resistant strains including the difficult to treat pathogens. We will also discuss the mode of drug infusion, indications for combination therapy, along with the proper dosing and duration of treatment for various conditions with a brief discussion of the use of non-antimicrobial agents.

Designing mRNA- and Peptide-Based Vaccine Construct against Emerging Multidrug-Resistant Citrobacter freundii: A Computational-Based Subtractive Proteomics Approach.

Background and Objectives: Citrobacter freundii (C. freundii) is an emerging and opportunistic Gram-negative bacteria of the human gastrointestinal tract associated with nosocomial and severe respiratory tract infections. It has also been associated with pneumonia, bloodstream, and urinary tract infections. Intrinsic and adaptive virulence characteristics of C. freundii have become a significant source of diarrheal infections and food poisoning among immune-compromised patients and newborns. Impulsive usage of antibiotics and these adaptive virulence characteristics has modulated the C. freundii into multidrug-resistant (MDR) bacteria. Conventional approaches are futile against MDR C. freundii. Materials and Methods: The current study exploits the modern computational-based vaccine design approach to treat infections related to MDR C. freundii. A whole proteome of C. freundii (strain: CWH001) was retrieved to screen pathogenic and nonhomologous proteins. Six proteins were shortlisted for the selection of putative epitopes for vaccine construct. Highly antigenic, nonallergen, and nontoxic eleven B-cell, HTL, and TCL epitopes were selected for mRNA- and peptide-based multi-epitope vaccine construct. Secondary and tertiary structures of the multi-epitope vaccine (MEVC) were designed, refined, and validated. Results: Evaluation of population coverage of MHC-I and MHC-II alleles were 72% and 90%, respectively. Docking MEVC with TLR-3 receptor with the binding affinity of 21.46 (kcal/mol) occurred through the mmGBSA process. Further validations include codon optimization with an enhanced CAI value of 0.95 and GC content of about 51%. Immune stimulation and molecular dynamic simulation ensure the antibody production upon antigen interaction with the host and stability of the MEVC construct, respectively. Conclusions: These interpretations propose a new strategy to combat MDR C. freundii. Further, in vivo and in vitro trials of this vaccine will be valuable in combating MDR pathogens.

Detection of Nosocomial Respiratory Infections among Hospitalized Patients in Intensive Care Unit: a Survey in Northern Iran

Detection of Nosocomial Respiratory Infections among Hospitalized Patients in Intensive Care Unit: a Survey in Northern Iran

Nosocomial COVID-19 at a comprehensive cancer center during the first year of the pandemic: Lessons learned

BackgroundThe spread of coronavirus disease 2019 (COVID-19) in health care settings endangers patients with cancer. As knowledge of the transmission of COVID-19 emerged, strategies for preventing nosocomial COVID-19 were updated. We describe our early experience with nosocomial respiratory viral infections (RVIs) at a cancer center in the first year of the pandemic (March 2020-March 2021). MethodsNosocomial RVIs were identified through our infection control prospective surveillance program, which conducted epidemiologic investigations of all microbiologically documented RVIs. Data was presented as frequencies and percentages or medians and ranges. ResultsA total of 35 of 3944 (0.9%) documented RVIs were determined to have been nosocomial acquired. Majority of RVIs were due to SARS CoV-2 (13/35; 37%) or by rhinovirus/enterovirus (12/35; 34%). A cluster investigation of the first 3 patients with nosocomial COVID-19 determined that transmission most likely occurred from employees to patients. Five patients (38%) required mechanical ventilation and 4 (31%) died during the same hospital encounter. ConclusionsOur investigation of the cluster led to enhancement of our infection control measures. The implications of COVID-19 vaccination on infection control policies is still unclear and further studies are needed to delineate its impact on the transmission of COVID-19 in a hospital setting.

Effects of endotracheal suctioning on respiratory parameters in Pediatric Intensive Care Unit: a prospective observational study

Introduction The endotracheal suctioning is an invasive practice performed in critical care units that allows removal of the pulmonary secretions in intubated patients. During this procedure, patients are exposed to potential risks that health professionals, should prevent or minimize. At date is a shortage of published studies on the frequency of endotracheal suction in pediatric critically ill patients. It is supposed that the endotracheal suction does not affect significantly the assessment of short-term respiratory parameters and therefore may be deferred by the clinical condition of the patient. Methods The study carried out from 1 January to 30 September 2016 in mechanically ventilated pediatric patients at pediatric intensive care unit of Salesi children’s Hospital of Ancona. The study involved the collection of two venous blood samples taken from a central venous catheter: the first blood gas analysis was performed on each patient 1 minute before endotracheal aspiration and after a time interval of about 30 minutes from the endotracheal suctioning a second sample from the same vascular access device. Mean and percentages were calculated for qualitative variables, mean and standard deviation were calculated for quantitative parameters. For inferential purposes, to evaluate the effects of endotracheal aspiration on respiratory parameters detected by blood gas analysis, the student T test was performed for paired data with a 95% confidence interval. Results A total of 40 patients were recruited, of which 14 were females (35%) and 26 were males (65%). The results were as follows: For pH, the mean of the difference in values is .0065 [95% CI -0.0067 - 0.0197]. According to T test for paired data, a p=.3256 was obtained. From the inferential point of view, this difference is not considered statistically significant. For the pO2 the mean of the difference in values is .03 [95% CI-1.62 -1.67]. According to T tests for paired data, a p =.9756 was obtained. For the pCO2, the mean of the difference in values is -1.88 [95% CI -3.81 - 0.06] with a p value = .0577.&#x0D; Discussion Our findings highlighted no statistically significant differences between pre and post endotracheal aspiration values of pH, pO2 and pCO2. This suggests that the aspiration has beneficial effects on the pulmonary mechanics. Therefore, it is declared that the reduction of the frequency of endotracheal aspiration pediatric cause a reduction of the related infectious risks, reducing costs and respiratory nosocomial infections leading to reduced length of hospital stay.&#x0D;

Characterization of bacteria isolates colonizing the throat of hospitalized patients at Sobi Specialist Hospital, Ilorin, Nigeria and in vitro antimicrobial effects of Citrus aurantifolia and Alum on the isolates

Background: Antibiotic resistance in microorganisms implicated in nosocomial respiratory infections is a major reason for prolonged hospital stay and increased cost of therapeutic treatment of hospital acquired pneumonia (HAP). This study was designed to isolate bacterial pathogens colonizing the throat of hospitalized patients at the Sobi Specialist Hospital, Ilorin, and to evaluate antibacterial effects of extracts of Citrus aurantifolia peel and Alum against these bacterial isolates.&#x0D; Methodology: This was a cross sectional study of 100 randomly recruited hospitalized patients at the Sobi Specialist Hospital, Ilorin, Nigeria. Throat samples collected from consenting participants were cultured on selective agar media (MacConkey, Eosin-Methylene blue and Mannitol salt) for isolation of bacteria. Identification of isolates from culture plates was done by Gram reaction and conventional biochemical tests while confirmation of the isolates was done by the polymerase chain reaction (PCR) assay. Antibiotic susceptibility test for each isolate to selected antibiotics (ampicillin, amoxicillin-clavulanate, cefuroxime, ceftazidime, gentamicin, nitrofuran, ofloxacin and ciprofloxacin) was done by the Kirby Buer disc diffusion method. Aqueous extract of Alum ([KAl(SO4).12H2O]) was done to produce concentrations of 10, 20, 30, 40 and 50% (w/v) at pH 3.6 and tested on the bacterial isolates using agar diffusion method. Citrus aurantifolia peel was extracted using methanol and hexane solvents to produce extract concentrations of 500mg/ml, 250mg/ml and 150mg/ml, and tested on the isolates by agar diffusion, and by the broth dilution method to obtain minimum inhibitory (MIC) and minimum bactericidal concentrations (MBC) of C. aurantifolia. &#x0D; Results: A total of 14 bacterial isolates were recovered from throat samples of 100 hospitalized patients with Staphylococcus aureus (43%, n=6) being the most frequent while Escherichia coli (14.5%, n=2) was the least frequent. The isolates were generally resistant to penicillin, aminoglycoside and fluoroquinolone groups of antibiotics tested. The zone of inhibition for hexane and methanol extracts of C. aurantifolia and aqueous extract of alum on the bacterial isolates ranged from 11.5-19.2mm, 9.8-15.8mm, and 9.3-21.2mm respectively while those of selected antibiotics ranged from 7.0-25.0mm. The MICs of hexane and methanol extracts of C. aurantifolia against S. aureus were 10mg/ml and 25mg/ml, while the MBCs were 50 and 100mg/ml respectively.&#x0D; Conclusion: Findings from this study showed the presence of resistant pathogenic bacteria colonizing the throat of hospitalized patients receiving care at the Sobi Specialist Hospital, Ilorin, Nigeria. The crude extracts of C. aurantifolia and Alum in this study showed inhibitory effects (albeit at higher concentrations) on the bacterial isolates comparable to the standard antibiotics. We posit that based on the inhibition capacity, further studies to characterize, purify and isolate the active anti-bacterial components in the extracts should be considered for novelty.

Vydovyi spektr bakteriinykh chynnykiv shpytalnykh infektsii dykhalnykh shliakhiv u likarnianykh ustanovakh m. Lvova ta poshyrenist sered nykh antybiotykorezystentnosty

Introduction. Healthcare-associated infections (HAIs) are a pressing problem in the health care system. Respiratory tract infections (RTI) are the second most common group of HAIs. One of the determining factors in the development of nosocomial pneumonia, which is predominantly bacterial in origin, is the properties and level of virulence of microbial factors. Early nosocomial pneumonia occurs when the upper respiratory tract microbiota infects the respiratory tract. Late nosocomial pneumonia is caused by nosocomial strains of microorganisms, characterized by multidrug resistance to antibiotics and disinfectants high levels of virulence, which include P. aeruginosa, Acinetobacter spp., Enterobacteriaceae family, MRSA. Unfortunately, in Ukraine, the structure and prevalence of HAIs and the antimicrobial resistance of pathogens are extremely poorly studied. The aim of the study. Therefore, the study investigates the species spectrum and antimicrobial resistance of the main causative agents of respiratory tract infections. Materials and methods. A study of microbial factors of nosocomial respiratory tract infections in 4 hospitals in Lviv. 205 patients of intensive care units diagnosed with RTI (36.6 %) were examined. Statistical analysis of the results was performed using the standard package of the program “Microsoft Excel 2010”. Microbiological diagnostics were performed following current regulations in the specialty “Bacteriology and Virology” and “Guidelines for Clinical Microbiology” of the 12th revision of the American Association for Microbiology. Microbiological diagnostics is performed in the research laboratory of the Department of Microbiology of Danylo Halytsky Lviv National Medical University. Results. The species profile of the detected pathogens of RTI indicates that among 14 representatives of different taxa, the gram-positive microbiota predominates, but the quantitative level of seeding per gram-negative microbiota accounts for 70.17 %. Among the isolates – factors of HAIs, multidrug-resistant (MDR) share accounted for 62.8 %. 3 strains are classified as pan drug resistant (PDR): 2 – P. putida and 1 – P. aeruginosa. Of the gram-positive microbiota, Enterococcus spp., represented mainly by E. faecalis and E. faecium, was most often detected in clinical material. E. faecalis was most often detected in the clinical material of the gram-positive microbiota. E. faecalis isolates were characterized by pronounced resistance to penicillins (including oxacillin), cephalosporins, fluoroquinolones, erythromycin and azithromycin, clindamycin with preserved sensitivity to vancomycin and linezolid. Pseudomonas aeruginosa isolates showed absolute sensitivity to colistin. Among other antibiotics, the most effective in terms of the number of sensitive strains were carbapenems – imipenem (57.5 %) and meronem (55.0 %). Only 37.5 % of the cultures were sensitive to tobramycin and tegicillin, an inhibitor of the protected cephalosporin antibiotic, sulfperazone. The genus Staphylococcus was among the causative agents of pneumonia other than Staph. aureus subsp. aureus, will Staph. haemolyticus, Staph. lugdunensis. Moreover, only one strain of methicillin-resistant Staphylococcus was detected. Most cases of RTI (57.4%) of patients in intensive care units occurred within 48 hours after the installation of a tracheostomy or intubation tube. Conclusions. According to the results of microbiological diagnostics, it has been established that the main etiological factors of nosocomial pneumonia associated with medical care are opportunistic microorganisms – Pseudomonas aeruginosa and enterococci. 62.8 % of strains were MDR. Furthermore, the results of monitoring the antibiotic resistance of hospital strains of microorganisms show their differences in different institutions of Lviv and the connection exclusively with the hospital environment. Therefore, optimization of antimicrobial treatment of nosocomial pneumonia is possible only based on the broader use of microbiological research results, constant monitoring of the microbiological status of patients in intensive care units, hospitality (distribution and properties of pathogens in hospitals).