Predictors Of Nosocomial Infection Research Articles

Low incidence of multidrug-resistant bacteria and nosocomial infection due to a preventive multimodal nosocomial infection control: a 10-year single centre prospective cohort study in neurocritical care

BackgroundNosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients. The primary aim of this study was to determine incidence of nosocomial infections and multidrug-resistant bacteria and seek predictors of nosocomial infections in a preventive multimodal nosocomial infection protocol in the neurointensive care unit (NICU). The secondary aim focused on their impact on stay, mortality and cost in the NICU.MethodsA10-year, single-centre prospective observational cohort study was conducted on 3464 acute brain disease patients. There were 198 (5.7%) patients with nosocomial infection (wound 2.1%, respiratory 1.8%, urinary 1.0%, bloodstream 0.7% and other 0.1%); 67 (1.9%) with Extended spectrum beta-lactamase (ESBL); 52 (1.5%) with Methicillin-resistant Staphylococcus aureus (MRSA), nobody with Vancomycin-resistant enterococcus (VRE). The protocol included hygienic, epidemiological status and antibiotic policy. Univariate and multivarite logistic regression analysis was used for identifying predictors of nosocomial infection.ResultsFrom 198 NI patients, 153 had onset of NI during their NICU stay (4.4%; wound 1.0%, respiratory 1.7%, urinary 0.9%, bloodstream 0.6%, other 0.1%); ESBL in 31 (0.9%) patients, MRSA in 30 (0.9%) patients. Antibiotics in prophylaxis was given to 63.0% patients (59.2 % for operations), in therapy to 9.7% patients. Predictors of NI in multivariate logistic regression analysis were airways (OR 2.69, 95% CI 1.81-3.99, p<0.001), urine catheters (OR 2.77, 95% CI 1.00-7.70, p=0.050), NICU stay (OR 1.14, 95% CI 1.12-1.16, p<0.001), transfusions (OR 1.79, 95% CI 1.07-2.97, p=0.025) antibiotic prophylaxis (OR 0.50, 95% CI 0.34-0.74, p<0.001), wound complications (OR 2.30, 95% CI 1.33-3.97, p=0.003). NI patients had longer stay (p<0.001), higher mortality (p<0.001) and higher TISS sums (p<0.001) in the NICU.ConclusionsThe presented preventive multimodal nosocomial infection control management was efficient; it gave low rates of nosocomial infections (4.2%) and multidrug-resistant bacteria (ESBL 0.9%, MRSA 0.9% and no VRE). Strong predictors for onset of nosocomial infection were accesses such as airways and urine catheters, NICU stay, antibiotic prophylaxis, wound complications and transfusion. This study confirmed nosocomial infection is associated with worse outcome, higher cost and longer NICU stay.

Role of regulatory T cells in neutrophil function

BackgroundIn systemic inflammatory response syndromes such as sepsis, there is an apparently paradoxical finding of impaired immune cell function. We have previously identified dysfunctional neutrophils and elevated proportions of regulatory T cells (Tregs) as predictors of nosocomial infection. Whether synergistic effects exist between neutrophils and Tregs is unclear. This study aimed to examine whether Tregs could impair neutrophil function, and what mechanisms could underpin any effect. MethodsHealthy human donor leucocytes were extracted from whole blood, and Tregs and T effector cells (Teffs) were purified with antibody-based selection. Tregs or Teffs were co-incubated with neutrophils before exposure to zymosan as the phagocytic target. Mechanism was explored through the use of membranes to separate T cells from neutrophils, T cell conditioned media, inhibitors of key downstream signalling pathways (adenylate cyclase and phosphoinositide 3-kinase [PI3K]), and purified E-type prostaglandins (PGE1 and PGE2). FindingsTregs were able to suppress phagocytosis by neutrophils, an effect that was not seen with Teffs. This effect was mediated by a soluble mediator and could be prevented by incubation of Tregs with inhibitors of cyclo-oxygenase and blockade of EP4, but not EP2, receptors. The effects of Tregs were also prevented by inhibition of adenylate cyclase and PI3Kδ. These effects could be recapitulated with use of purified PGE1 and PGE2, which also acted via the EP4 receptor, adenylate cyclase, and PI3Kδ. Although Tregs impaired generation of neutrophil reactive oxygen species, this effect did not appear to be mediated via the same pathway. InterpretationThis study shows that, in vitro, Tregs can impair the key neutrophil function of phagocytosis. This process appears to be mediated through secretion of E-type prostaglandins, which act through adenylate cyclase and PI3Kδ. This finding sheds new light on the association between elevated Tregs and nosocomial infection, and suggests potential targets for therapeutic intervention. The findings are restricted to in-vitro models, and will require further confirmation in vivo. FundingNational Institute of Academic Anaesthesia.

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Introduction: Intensive care acquired nosocomial infections are one of the major causes of increased morbidity, mortality, and costs in intensive care units (ICU). Methods: After Institutional Review Board approval the charts of patients who were admitted to the surgical ICU at Baskent University between January 2009 and July 2012, were reviewed. Sixty patients who developed CR-BSI, VAP, or CA-UTI during their ICU stay were identified and they were compared to 53 appropriate matches who did not have any nosocomial infections. Results: Out of 103 patients who were included in the final analyses, 60 (58%) had a nosocomial infection. Twenty five (24%) out of 60 infected patients had CR-BSI, 46 (45%) had VAP, and 20 (19%) had CA-UTI. Higher APACHE II scores (OR: 1.142; 95% CI: 1.007-1.294; p=0.039), presence of a comorbidity (OR: 39.488; 95% CI: 2.075-750.950; p=0.014), prolonged hospitalization prior to ICU (OR: 1.155; 95% CI: 1.015-7.953; p=0.029), and use of sedatives (OR: 10.980; 95% CI: 1.167-103.337; p=0.036) during the ICU course were identified as the risk factors for nosocomial infections. Advanced age (OR: 1.037; 95% CI: 1.001-1.073; p=0.042) was found to be the risk factor for CR-BSI. Presence of diabetes mellitus (OR: 12.048; %95 CI: 1.157-125.000; p=0.037), immunosupression therapy (OR: 16.949, %95 CI: 2.463-111.111; p=0.004), and presence of a open wound (OR: 5.714; 95% CI: 1.017-37.258; p=0.048), higher APACHE II scores (OR: 1.132; 95% CI: 1.022-1.254; p=0.018), and prolonged duration of mechanical ventilation (OR: 1.084; 95% CI: 1.002-1.171; p=0.043) were determined as risk factors for VAP. Prolonged hospitalization prior to ICU (OR: 1.037; 95% CI: 1.004-1.072; p=0.027) was found to be the risk factor for CA-UTI. Conclusions: In conclusion, in a cohort of surgical ICU patients we found that a higher APACHE II score, longer length of hospital stay, use of sedatives, and the presence of comorbidities were the predictors of nosocomial infections. Additionally, the respective predictors of individual ICU infections including CR-BSI; VAP; and CR-UTI were advanced age; presence of immunosuppressive state, open wounds, and length of mechanical ventilation; and length of hospitalization.

Surveillance of nosocomial infections in a Mexican community hospital. How are we doing?

To compare the nosocomial infection (NI) rate obtained from a retrospective review of clinical charts with that from the routine nosocomial infection surveillance system in a community hospital. Retrospective review of a randomized sample of clinical charts.Results were compared to standard surveillance using crude and adjusted analyses. A total of 440 discharges were reviewed, there were 27 episodes of NIs among 22 patients. Cumulated incidence was 6.13 NI per 100 discharges. Diarrhea, pneumonia and peritonitis were the most common infections. Predictors of NI by Cox regression analysis included pleural catheter (HR 16.38), entry through the emergency ward, hospitalization in the intensive care unit (HR 7.19), and placement of orotracheal tube (HR 5.54). Frequency of NIs in this community hospital was high and underestimated. We identified urgent needs in the areas of training and monitoring.

Microbiologically documented nosocomial infections after cardiac surgery: an 18-month prospective tertiary care centre report☆☆☆★

The aim of this study was to prospectively evaluate frequency, characteristics, and predictors of nosocomial infections (NI) in a tertiary care centre. Study population included 925 patients (mean age 62.3+/-12.5, 32.3% females, 22.9% diabetics, 6.8% with previous cardiac procedures) operated on between June 2005 and December 2006 (CABG 48.72%, valvular procedures 30.05%, thoracic aortic 10.9%, heart transplantations 3.78% and miscellanea 6.55%, procedure status: elective 72.9%, urgent 15.9% and emergent 11.2%). The study population was divided in two groups according to development of NI. Primary endpoints were multiorgan failure (MOF) and hospital mortality in the two groups. Secondary endpoints were length of intubation, intensive care unit (ICU) stay and overall hospitalisation. Univariate and multivariate analysis of NI predictors was conducted between 115 perioperative variables. Eighty-three patients (9%) developed a NI. Infections affected respiratory tract in 51.8%, blood stream in 20.5 and wound infection in 27.7 (13.3% deep wound). Staphylococcal species (60.6%) predominated in blood stream and surgical wound infections while Gram-negative species predominated in respiratory infections. Patients affected by NI experienced significantly higher incidence of MOF (12% vs 0.8%) and hospital mortality (24.1 vs 6.9%). Development of NI significantly lengthened all the steps of postoperative process of care (length of intubation: 49.9+/-73 h vs 19.1+/-35.2; ICU stay: 10.4+/-12.8 days vs 3.4+/-4.6 and hospitalisation 20.7+/-15.3 vs 10.6+/-7). Independent predictors of NI were immunosuppressive therapy [OR 12.9 (CI 5.07-31.2)], reintubation [OR 10.3 (CI 4.6-2.3)], stroke [OR 9.5 (CI 1.8-49)], resternotomy for bleeding [OR 6.7 (CI 1.9-23.6)], emergent/urgent status [OR 3.6 (CI 1.5-8.4)], CVVH [OR 3.2 (CI 1.4-7.5)] and length of intubation [OR 1.03 (CI 1.01-1.1)]. NI still represents a serious complication. Presence of identified determinants of NI should prompt modification of management algorithms.

FP3.05 Trends and Predictors of Nosocomial Infections in a Large Norwegian Hospital

FP3.05 Trends and Predictors of Nosocomial Infections in a Large Norwegian Hospital

Trauma Severity Scoring Systems as Predictors of Nosocomial Infection

To describe the patterns of nosocomial infections in patients with traumatic injuries and to compare the associations between injury severity, derived from various severity scoring systems, and subsequent nosocomial infections. Prospective observational study. A 750-bed university hospital serving as a medical school and referral center for the southern part of Thailand. All trauma patients admitted to the hospital for more than 3 days during 1996 to 1999 were eligible for this study. The severity of injuries was measured in terms of injury severity score (ISS), revised trauma score (RTS), new injury severity score (NISS), and trauma injury severity score (TRISS). Infections acquired during hospitalization were categorized using Centers for Disease Control and Prevention criteria. The association between severity of injury and nosocomial infection was examined with Poisson regression models. There were 222 nosocomial infections identified among 146 patients, yielding an infection rate of 0.8 infections per 100 patient-days. Surgical-site infection was the most common site-specific infection, accounting for 31.1% of all infections. The incidence of intravenous catheter-related bloodstream infection was 1.6 infections per 100 catheter-days. The bladder catheter-related urinary tract infection rate was 2.8 infections per 100 catheter-days. The rate of ventilator-associated pneumonia was 3.2 infections per 100 ventilator-days. The incidence of infection correlated well with injury severity. The infection incidence rate ratios for one severity category increment of ISS, NISS, RTS, and TRISS were 1.65 (95% confidence interval [CI95], 1.42 to 1.92), 1.79 (CI95, 1.55 to 2.05), 1.64 (CI95 1.43 to 1.88), and 1.32 (CI95, 1.14 to 1.52), respectively. Surgical-site infection was the most common site-specific nosocomial infection. The NISS might be the most appropriate severity scoring system for adjustment of infection rates in trauma patients.

Severity of underlying disease as a predictor of nosocomial infection. Utility in the control of nosocomial infection

Severity of underlying disease as a predictor of nosocomial infection. Utility in the control of nosocomial infection

Severity of Underlying Disease as a Predictor of Nosocomial Infection

In a prospective study, we determined that severity of underlying disease at time of admission indicates medical patients at unusual risk of nosocomial infection. The nosocomial infection rate was 23.6% in patients with fatal underlying disease, 9.6% in those with ultimately fatal disease, and 2.1% in those with nonfatal disease. After an awareness program that promoted the use of established methods for prevention of nosocomial infections was established, there was a decline of overall incidence of endemic nosocomial infections from 9.2% to 4.8% (P less than .001) within an eight-month period. With subsequent discontinuation of the program, the infection rate rose to 8.1%. Reinstitution of the program resulted in a decline to 5.2% (P = .05).