Point Prevalence Study Research Articles

Prevalence, risk factors and impact of delirium in adult inpatients in a tertiary care hospital: A point prevalence study.

To describe the point prevalence, risk factors and possible outcomes of delirium in inpatients. A cross-sectional point prevalence study. Delirium is an acute brain syndrome that negatively affects patients, healthcare professionals and institutions alike; it is common in inpatient settings and is preventable in about one third of cases. Although guidelines recommend systematic screening and assessment, delirium is often unrecognised, undiagnosed and uncoded. There is a lack of valid data on this patient safety indicator in German-speaking countries. The study was conducted in a tertiary care hospital in Switzerland on 5 July 2022. Specially trained registered nurses collected data from all patients meeting the inclusion criteria using CAM, ICDSC or mCAM-ED. Data were analysed descriptively with stratification by delirium status, setting and surgery. The point prevalence across all settings was 6.9% (27/390), with large variation between settings: ICU 28.6% (4/14), IMC 28.0% (7/25), wards 4.6% (15/326) and ED 4% (1/25). Surgical patients were almost twice as likely to be affected as medical patients (8.9% vs. 4.8%). Patients with delirium differed most clearly from those without by having a larger number of ICD-10 F-diagnoses, a larger number of medications and higher age, which are known risk factors. Moreover, those with delirium had more missed diagnoses, increased mortality, more adverse events and higher costs. A significant number of patients experienced delirium and adverse clinical outcomes. Missed delirium diagnoses may further jeopardise patient safety and result in lost revenue. It remains unclear to what extent the risk factors and effects of delirium are causal and what determinants underlie missed diagnoses. Consistent identification of high-risk patients and treatment settings with elevated risk, accompanied by the implementation of effective preventive and management strategies, is critical to addressing delirium.

Prevalence of frailty and pain in hospitalised cancer patients: implications for older adult care.

A hospital-wide point prevalence study investigated frailty and pain in patients with a cancer-related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty-eight patients (19%) with cancer-related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer-related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer.

Point prevalence of antibiotic usage in major referral hospital in Turkey.

The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center. A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated. Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001). Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.

Cross-border differences in the prevalence and risk factors for carriage of antimicrobial resistance in children attending daycare centers: a point prevalence study in the Netherlands and Belgium

BackgroundDay care centres (DCCs) are ideal settings for drug-resistant bacteria to emerge. Prevalence numbers of faecal carriage of antimicrobial resistant bacteria in these settings are rare. We aimed to determine the prevalence of faecal antimicrobial resistant bacteria carriage in children attending DCCs and to assess and identify infection risk factors within DCCs in The Netherlands and Belgium.MethodsA point-prevalence study was conducted in 28 Dutch (499 children) and 18 Belgian (448 children) DCCs. Stool samples were taken from the children’s diapers and a questionnaire was filled in by their parents. Hygiene related to stool and toilet use, hygiene related to food, environmental contamination, hand hygiene and hygiene guidelines were assessed conform a standardized questionnaire by the infection prevention and control expert visiting the DCC. Multilevel logistical regression analyses were used to define which characteristics predicted the presence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant enterococci (VRE), and ciprofloxacin-resistant Enterobacterales (CipR-E).ResultsThe ESBL-E prevalence was 16% (n = 71) in Belgium and 6% (n = 30) in the Netherlands. The CipR-E prevalence was 17% (n = 78) in Belgium and 8% (n = 38) in the Netherlands. Antimicrobial use (RR: 0.30; 95% CI: 0.33–0.48) and hospital admissions (RR: 0.37; 95% CI: 0.25–0.54) were lower in the Netherlands. Children travelling to Asia were at higher risk of being an ESBL-E carrier. Children using antimicrobials were at higher risk of being a CipR-E carrier. Cleaning the changing mat after each use was found as a protective factor for CipR-E carriage.ConclusionsWe established a significant difference in ESBL-E and CipR-E carriage and antimicrobial use and hospital admissions between the Netherlands and Belgium among children attending DCCs. The differences between both countries should be further studied to improve the policy on anti-microbial use and hospital admissions in children.

Lack of microbiological awareness on the ward as a key factor for inappropriate use of anti-infectives: results of a point prevalence study and user satisfaction survey in a large university hospital in Austria.

Although diagnostic stewardship issuesin clinical microbiology harbor an optimization potential for anti-infective consumption, they are only marginally addressed in antimicrobial stewardship (AMS) programs. As part of an AMS point prevalence (PPS) survey we therefore aimed to gain a more dynamic view on the microbiological awareness within therapeutic regimens. By examining whether initial microbiological sampling was performed and in which way microbiological results were incorporated into further treatment considerations we sought to find out to what extent these points determine the appropriateness of treatment regimens. PPS was performed at the University Hospital Salzburg (1524 beds) in May 2021. Relevant data was determined from the patient charts and the appropriateness of anti-infective use was assessed using predefined quality indicators. Six months after the PPS, a questionnaire was administered to clinicians to obtain information on the use of microbiological findings and their relevance in the clinic. Lack of microbiological awareness in the clinical setting proved to be the key reason for an overall inadequate use of anti-infectives (35.4% of cases rated as inadequate), ahead of the aspects of dose (24.1%), empirical therapy (20.3%) and treatment duration (20.2%). This was particularly the case for broad-acting agents and was most evident in urinary tract infections, skin and soft tissue infections, and pneumonia. The results of the questionnaire indicate a discrepancy between the physicians surveyed and the routine clinical setting. A high potential in improving the use of anti-infectives in hospitals seems to lie in a strong emphasis on microbiological diagnostic stewardship measures.

Investigation of the Prevalence of HBsAg, Anti-HCV, and Anti-HIV in a Prison in Turkey: A Point Prevalence Study

Investigation of the Prevalence of HBsAg, Anti-HCV, and Anti-HIV in a Prison in Turkey: A Point Prevalence Study

Intensive care utilisation after elective surgery in Australia and New Zealand: A point prevalence study

ObjectiveWe aimed to describe the characteristics, outcomes and resource utilisation of patients being cared for in an ICU after undergoing elective surgery in Australia and New Zealand (ANZ). MethodsThis was a point prevalence study involving 51 adult ICUs in ANZ in June 2021. Patients met inclusion criteria if they were being treated in a participating ICU on he study dates. Patients were categorised according to whether they had undergone elective surgery, admitted directly from theatre or unplanned from the ward. Descriptive and comparative analysis was performed according to the source of ICU admission. Resource utilisation was measured by Length of stay, organ support and occupied bed days. Results712 patients met inclusion criteria, with 172 (24%) have undergone elective surgery. Of these, 136 (19%) were admitted directly to the ICU and 36 (5.1%) were an unplanned admission from the ward. Elective surgical patients occupied 15.8% of the total ICU patient bed days, of which 44.3% were following unplanned admissions. Elective surgical patients who were an unplanned admission from the ward, compared to those admitted directly from theatre, had a higher severity of illness (AP2 17 vs 13, p<0.01), require respiratory or vasopressor support (75% vs 44%, p<0.01) and hospital mortality (16.7% vs 2.2%, p < 0.01). ConclusionsICU resource utilisation of patients who have undergone elective surgery is substantial. Those patients admitted directly from theatre have good outcomes and low resource utilisation. Patient admitted unplanned from the ward, although fewer, were sicker, more resource intensive and had significantly worse outcomes.

Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study

ObjectiveTo describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions. Design, setting and participantsProspective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021. Main outcome measuresTransfusion types, amounts, clinical reasons, and triggers; use of anti-platelet medications, anti-coagulation, and VHA. ResultsOf 712 adult patients in 51 ICUs, 71 (10%) patients received a transfusion during the 24hr period of observation. Compared to patients not transfused, these patients had higher Acute Physiology and Chronic Health Evaluation II scores (19 versus 17, p = 0.02), a greater proportion were mechanically ventilated (49.3% versus 37.3%, p < 0.05), and more had systemic inflammatory response syndrome (70.4% versus 51.3%, p < 0.01). Overall, 63 (8.8%) patients received red blood cell (RBC) transfusions, 10 (1.4%) patients received platelet transfusions, 6 (0.8%) patients received fresh frozen plasma (FFP), and 5 (0.7%) patients received cryoprecipitate. VHA was available in 42 (82.4%) sites but only used in 6.6% of transfusion episodes when available. Alignment with guidelines was found for 98.6% of RBC transfusions, but only 61.6% for platelet, 28.6% for FFP, and 20% for cryoprecipitate transfusions. ConclusionsNon-RBC transfusion decisions are often not aligned with guidelines and VHA is commonly available but rarely used to guide transfusions. Better evidence to guide transfusions in ICUs is needed.

2488. Healthcare-associated infections in acute care hospitals in Greece, results of the third Point Prevalence Survey, April – December 2022

Abstract Background The burden of healthcare-associated infections (HAIs) in European acute care hospitals is estimated through periodic Point Prevalence Studies (PPS) coordinated by European Centre for Disease Prevention and Control (ECDC). In 2016, Greece had the highest HAI prevalence among European countries (10%). The current PPS aimed to estimate the prevalence of HAIs among inpatients, especially in the context of COVID-19 pandemic. Methods A cross-sectional study was conducted between April and December 2022, according to ECDC PPS protocol v.6.1, in a representative sample of 50 Greek hospitals across all country regions. Patients admitted in wards before 8.00 am of the study day were screened for inclusion. Infection control teams collected hospital characteristics (e.g., total beds, infection control markers), wards (specialty, bed occupancy) and active HAIs (type, origin, microbiological results). Active HAIs included present HAIs or past HAIs that are still being treated. ECDC HelicsWin.Net software v.4.4.0, was used for data entry and analysis. Results Overall, 12.1% inpatients (1,175 of a total 9,707) had at least one active HAI. Among the 1,408 HAIs, the most commonly observed were lower respiratory tract infections (28.9%), bloodstream infections (20%), among which 4.6% were catheter-related, and urinary tract infections (13.1%), as shown in table 1. HAI prevalence was higher in patients of intensive care units (45.7%), compared to medical (13.5%) and surgical ones (8.2%). Laboratory data were available for 58.9% of HAIs and 1,259 microorganisms were identified. Klebsiella species (20.5%), Acinetobacter species (12.8%), P. aeruginosa (10.2%), Candida species (7.9%) and S. aureus (6.3%) were frequent isolates. Antimicrobial susceptibility patterns varied depending on the pathogen (table 2). Conclusion This study shows the increased burden of HAIs among inpatients and the emergence of difficult-to-treat pathogens in Greek hospitals. Subsequent prevalence studies will provide additional evidence regarding the trend in HAI prevalence among inpatients and support the identification of modifiable practices. The invigoration of infection control and antimicrobial stewardship programs in these settings is essential. Disclosures All Authors: No reported disclosures

The Impact of MRSA Colonization on Healthcare-Associated Infections in Long-Term Care Facility Residents: A Whole-Genome Sequencing-Based Study.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been considered a risk factor for the development of infection, however, there are no studies that have compared the colonizing and infecting strains using whole-genome sequencing (WGS). The aim of this study is to determine the prevalence of and risk factors for MRSA colonization among long-term care facilities (LTCF) residents of Tenerife (Spain), and to analyze the epidemiological relationship between the colonizing and infecting strains using WGS. A point-prevalence study was carried out at 14 LTCFs in Tenerife from October 2020 to May 2021. Nasal swabs were cultured for MRSA. Colonized residents were followed up for two years. A phylogenetic comparison between colonization and infection strains was performed using WGS. A total of 764 residents were included. The prevalence of colonization by MRSA was 28.1% (n = 215), of which 12 (5.6%) subsequently developed infection. A close genetic relationship between colonization and infection isolates was found in three of the four (75%) residents studied. Our study confirms that colonized residents can develop serious MRSA infections from the same nasal colonization strain. Given the high prevalence of MRSA colonization in these centers, it is necessary to implement strategies with preventive measures to avoid the development of infection and the transmission of MRSA.

Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Off-Label and Unlicenced Medicine Use among Hospitalised Children in South Africa: Practice and Policy Implications.

Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event of adverse events. This potentially exposes physicians to legal penalties. Consequently, we sought to determine the prevalence of off-label and unlicensed medicine use among paediatric patients in South Africa to provide future direction. This study retrospectively examined the use of medicine in a point-prevalence survey study (PPS) involving paediatric patients aged (0-2 years) admitted to selected public hospitals in Gauteng Province, South Africa. Data were collected per hospital over two days between February 2022 and July 2022. Demographics, duration of treatment, diagnosis, and medicines prescribed were collected from patient medical records using a mobile application. Prescribed medicines were reviewed against the medicine formularies and other databases to assess their appropriateness. From three academic hospitals, 184 patient records were reviewed. A total of 592 medicines were dispensed, of which 379 (64.0%) were licensed and 213 (36.0%) were used off-label/unlicensed for paediatric patients 0-2 years of age. The most prevalent off-label and unlicensed medicines were multivitamins (n = 32, 15.0%) and ampicillin injections (n = 15, 7.0%). The frequency of unlicensed and off-label medicine prescribing shown in this study is consistent with the literature and can be considered high. This practice can pose a risk because it adversely affects patients if not properly regulated. Attention is needed to ensure future high-quality, safe, and effective use of medicines.

Застосування антимікробних лікарських засобів у дитячих хірургічних відділеннях згідно з результатами дослідження точкового поширення

використання антимікробних лікарських засобів має велике значення у хірургічнійпрактиці, оскільки вони впливають на мікроорганізми, які є частими збудниками хірургічноїінфекції й використовуються як для периопераційної профілактики, так і для лікуванняхірургічної інфекції. Оскільки у всьому світі існує тенденція до нераціонального та надмірногоїх використання, сприяючи поширенню антимікробної резистентності, у діяльність закладівохорони здоров’я впроваджують програму адміністрування антимікробних препаратів. Метоюдослідження було оцінити особливості призначення антимікробних лікарських засобів у дитячиххірургічних відділеннях. Проведено дослідження точкового поширення у 4 хірургічних відділеннях2 клінічних лікарень (розглянуто застосування антимікробних лікарських засобів у 32 дітей вікомвід 5 місяців до 17 років). Більшість (60 %) дітей були віком 7-14 років. Діти знаходились у хірургічнихвідділеннях із різними діагнозами, найбільше було пацієнтів з хронічним остеомієлітом (16 %) тагострим апендицитом (9 %). Проаналізовано 42 призначення антимікробних лікарських засобів.Встановлено, що антимікробні лікарські засоби у 32 % випадків використовувались з метоюпериопераційної антибіотикопрофілактики, у 68 % – з метою лікування. Для периопераційноїпрофілактики частіше (70 %) використовували антибіотик з групи цефалоспоринів II покоління(цефуроксим), у решті випадків – ІІІ покоління (цефтріаксон). Для антимікробної терапії у 71,4 %пацієнтів застосовувалась монотерапія, зокрема у 46,7 % – з використанням антибіотикагрупи цефалоспоринів III покоління – цефтазидиму. При лікуванні 28 % дітей використовуваликомбіновану терапію, яка складалась з двох і більше антибактеріальних препаратів. Отже, заданими дослідження точкового поширення у дитячих хірургічних відділеннях периопераційнапрофілактика здійснюється препаратами цефалоспоринового ряду 2-го та 3-го поколінь, убільшості випадків з метою лікування використовують монотерапію, найбільш вживанийпрепарат – цефтазидим.

[Scoring tool to identify patients at increased risk for drug-related problems: results of a point prevalence study at hospital admission].

Drug therapy is a high-risk process and requires special attention, especially at sectoral borders. Pharmaceutical services such as medication review are appropriate measures to identify drug-related problems and thus improve the safety of drug therapy. Risk-scoring tools have been described in the literature as helpful for prioritizing medication reviews for patients at high risk for drug-related problems. In a multi-centre point prevalence study, we identified patients at increased risk for medication-related problems at hospital admission using the medication risk tool. In addition, the current level of implementation of pharmacy services was surveyed. A total of 11 (58%; 11/19) hospital pharmacies in Saxony participated in the point prevalence survey. The scoring tool identified 32% (279/875) of patients at increased risk for medication-related problems (Meris score >12 group) at admission. Thereby, the number of drugs in the Meris score >12 group was 10.6 (average; standard deviation 3.5; n=279), while in the Meris score ≤12 group it was only five drugs per patient (average 4.6; standard deviation 2.8; n=596). The age of patients in the Meris score >12 group averaged 75.9 ± 11 years, while the age of patients in the Meris score ≤12 group averaged 60.6 ± 17.9 years. Prioritization with the help of a risk-scoring tool is essential as pharmacy services in Saxon hospitals still need to be regularly established and in order to identify patients with an increased risk for drug-related problems at an early stage.

Prevalence of Pressure Ulcer in Orthopaedic Bedridden Patients With a Higher Braden Pressure Ulcer Score in a Tertiary Care Government Hospital in Jammu

In this research, our primary objective was to determine the prevalence of pressure ulcers (PU) in bedridden patients with risk of higher Braden Pressure Ulcer scores who were admitted to the orthopaedic wards at the tertiary care government hospital in Jammu. Methodology To achieve this, we conducted a cross-sectional point prevalence study utilising the Braden Pressure Ulcer Risk Assessment Scale and the European Pressure Ulcer Advisory Panel (EPUAP) grading scale and data form. Our research sample consisted of 180 bedridden patients with higher Braden scores admitted to the orthopaedic ward of the selected facility. We monitored these patients using an observational checklist based on the established EPUAP minimal dataset form and grading scale. We conveniently selected patients who had moderate to severe Braden Pressure Ulcer Risk scores. Result Our findings revealed that 22.8% of the bedridden patients with moderate to high-risk Braden pressure ulcer scores developed pressure ulcers. Among the respondents, the majority (67.78%) were categorised as high risk, followed by severe risk (18.89%) and moderate risk (13.33%). Of those who developed pressure ulcers, 28 had Grade 1 ulcers and 12 had Grade 2 ulcers. The most common locations for these ulcers were the sacrum (40%), followed by the iliac region (35%), and the buttocks (25%). We did not observe any significant association between clinical variables and the incidence of pressure ulcers, except for skin turgor.

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.

Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Multicenter prospective observational clinical study. This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Nutritional practices in medical intensive care units: Multicenter, one-day point prevalence study

Background/AimNutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines. MethodsThis multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status. ResultsA total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57–83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18–29], median SOFA score was 6 [4–9] and median BMI was 25.32 [21.22–29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24hours of admission. On the study day, the median energy intake of the patients during the last 24hours was 21.62 [15.9–27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7–1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU. ConclusionNutrition therapy in medical ICUs was initiated early after ICU admission, the enteral route was preferred and target calories were calculated using weight-based formulas. These results suggest that multi-dimensional planning of critical care management of patients by intensivists may provide better nutritional care for the critically ill.

Agreement between pharmacists and physicians on the assessment of appropriateness of antimicrobial prescribing

IntroductionAudits for monitoring the quality of antimicrobial prescribing are a main tool in antimicrobial stewardship programs; however, interobserver reliability has not been conclusively assessed. Our objective was to measure the level of agreement between pharmacists and physicians on the appropriateness of antimicrobials prescribing in hospitals. MethodsA national multicenter, cross-sectional study was conducted of patients who were receiving antimicrobials one day of April 2021. Hospital participation was voluntary, and the study population was randomly selected. Pharmacists and physicians performed a simultaneous, independent assessment of the quality of antimicrobial prescriptions. The observers used an assessment method by which all indicators of the quality of antimicrobial use were considered. Finally, an algorithm was used to rate overall antimicrobial prescribing as appropriate, suboptimal, inappropriate, or not assessable. Gwet's AC1 coefficient was used to assess interobserver agreement. ResultsIn total, 101 hospitals participated, and 411 hospital antimicrobial prescriptions were reviewed. The strength of agreement was moderate regarding the overall quality of prescribing (AC1=0.51; 95%CI=[0.44–0.58]). A very good level of agreement (AC1>0.80) was observed between pharmacists and physicians in all indicators of the quality, except for duration of treatment, rated as good (AC1=0.79; 95%CI=[0.75–0.83]), and registration on the medical record, rated as fair (AC1=0.34; 95%CI=[0.26–0.43]). The agreement was greater in critical care, onco-hematology, and pediatric units than in medical and surgery units. ConclusionsIn this point prevalence study, a moderate level of agreement was observed between pharmacists and physicians in the evaluation of the appropriateness of antimicrobials prescribing in hospitals.

Cessation of Rectal Screening for Vancomycin-Resistant Enterococci: Experience from a Tertiary Care Hospital from Türkiye.

Here, we compared the impact of different polices on the epidemiology of Vancomycin-resistant Enterococcus faecium bloodstream infections (VRE-BSIs) in a tertiary care hospital including two hospital buildings (oncology and adult hospitals) in the same campus. All patients who were hospitalized in high-risk units were screened weekly for VRE colonization via rectal swab between January 2006 and January 2013. After January 2013, VRE screening was only performed in cases of suspicion of VRE outbreak and during point prevalence studies to evaluate the epidemiology of VRE colonization. Contact precautions were in place for all VRE-positive patients. The incidence density rates of hospital-acquired (HA)-VRE-BSIs were compared between two periods. While the rate of VRE colonization was higher in the second period (5% vs. 9.5% (p < 0.01) for the adult hospital, and 6.4% vs. 12% (p = 0.02 for the oncology hospital), there was no increase in the incidence rate HA-VRE BSIs after the cessation of routine rectal screening in either of the hospitals. Screening policies should be dynamic and individualized according to the epidemiology of VRE as well as the workforce and cost. Periodical rectal screening of VRE can be discontinued if suspicion of an outbreak can be carefully monitored.

Speech-language pathologist involvement in the paediatric intensive care unit

Purpose To measure the prevalence of speech-language pathologist (SLP) involvement and associated trends for critically ill children in United States (US) paediatric intensive care units (PICU) through secondary analysis of the Prevalence of Acute Rehab for Kids in the PICU (PARK-PICU) study data. Method A secondary analysis of cross-sectional point prevalence study conducted over 1 day in 82 US PICUs. Data collected included SLP presence, patients’ age, length of stay, medical interventions, aetiology, admission data, Glasgow Coma Scale scores, staffing involvement, and family presence. Result Among 961 patients, 82 were visited by an SLP on the study day for a prevalence of 8.5%. Most visits were for children <3 years old. The odds of SLP involvement were lower for children who were 7–12 years old (vs. age 0–2; adjusted odds ratio [aOR] 0.28; 95% CI 0.1–0.8), were mechanically ventilated via endotracheal tube (vs. room air; aOR 0.02; 95% CI 0.005–0.11), or had mild or severe disability (mild vs. no disability; aOR 0.34; 95% CI 0.16–0.76 and severe vs. no disability; aOR 0.39; 95% CI 0.17–0.90). Concurrent physical and/or occupational therapy involvement was associated with higher odds of SLP involvement (aOR 3.6; 95% CI 2.1–6.4). Conclusion SLP involvement is infrequent in US PICUs. PICU teams should be educated about the scope of SLP practice, to support communication and oral feeding needs during early recovery from critical illness.