Risk Factors For Nosocomial Infection Research Articles

Magnitude of Nosocomial Infection in Neonatal Intensive Care Unit at Benha Children Hospital

A nosocomial infection is an infection in which the clinical, laboratorial and microbiological diagnostic evidence is found after the first 48 hours of admission in a hospital unit. The objectives of this study were to determine the incidence of nosocomial infection in NICU Benha children hospital and to study the risk factors of nosocomial infection. Subjects and Methods: The present study is cross sectional was carried out at Neonatal Intensive Care Unit of Benha Hospital during the period from the start of Jan. 2018 to the end of June 2018 .Data were collected through the following tools: a) Sociographic Data include: Gender, Date of birth, Gestational age in weeks b) Medical Data include (1) Interventions done to the neonates at the unit: invasive procedure, device exposure and treatments received. (2) Presence of risk factors for infection: weight in grams, Mode of delivery, Presence of congenital anomalies, length of stay.3) Laboratory investigations as count blood cells and blood culture. Results: The percentage of HAI was (23 %). BSI (68.42%) and VAP (31.58%) There was no statistically significant difference between HAI and Non HAI regarding age on admission, Sex and Mode of delivery. There was statistically significant decrease in G. Age and weight among HAI than Non HAI. There was statistically significant difference between HAI and Non HAI regarding Fate. There was statistically significant increase in Period of stay among HAI than Non HAI. Conclusion: Nosocomial infection in the studied NICU was a relatively high and causes high mortality rates. Low birth weight as well as gestational age and length of stay in hospital were important risk factors in such, infections. However, multi-center studies are needed to confirm these findings.

Methodological challenges in using point-prevalence versus cohort data in risk factor analyses of nosocomial infections

PurposeTo explore the impact of length-biased sampling on the evaluation of risk factors of nosocomial infections (NIs) in point-prevalence studies. MethodsWe used cohort data with full information including the exact date of the NI and mimicked an artificial 1-day prevalence study by picking a sample from this cohort study. Based on the cohort data, we studied the underlying multistate model which accounts for NI as an intermediate and discharge/death as competing events. Simple formulas are derived to display relationships between risk, hazard, and prevalence odds ratios. ResultsDue to length-biased sampling, long stay and thus sicker patients are more likely to be sampled. In addition, patients with NIs usually stay longer in hospital. We explored mechanisms that are—due to the design—hidden in prevalence data. In our example, we showed that prevalence odds ratios were usually less pronounced than risk odds ratios but more pronounced than hazard ratios. ConclusionsThus, to avoid misinterpretation, knowledge of the mechanisms from the underlying multistate model is essential for the interpretation of risk factors derived from point-prevalence data.

Nosocomial Infections in Six Major Hospitals in Sana’a Capital City and in Some Governorates in Yemen

Nosocomial infections (NIs) and antimicrobial resistances are spread worldwide. This study was carried out in six major hospitals in some governorates in Yemen to determine the risk factors, incidence rates, nosocomial infections causative agents and antimicrobial resistance. A total of 384 patients, whose ages range between <1 to 90 years old, were taken in consideration for this study. Moreover, patients case definition and phenotypic identification methods for microbial isolates and antimicrobial sensitivity tests were based on standards methods. Findings are that the overall incidence rate for nosocomial infection was 65.4 cases in every 100 patients; however, the highest rate was in the intensive care units with a rate of 68.2 cases in every 100 patients and the overall mortality rate was 9.2 in every 100 nosocomial patients. Risk factors for nosocomial infection were; staying in hospitals for long time, surgical operation, antibiotics and devices used. The highest incidence rates were as 33.1% for Nosocomial Urinary Tract Infections (NUTIs). The common isolated pathogens were C. albicans (86.1%) and E. coli (66.7%) of NUTIs while, Acinetobacter spp. (69.7%) and S. aureus (16.8%) were from Nosocomial Surgical Site Infections (NSSIs). The highest resistant percentages of isolated bacteria were 79.8% to ampicillin, and 78.9% to ceftazidime of broad spectrum antibiotics and the highest resistant percentage to narrow spectrum antibiotics for Gram-positive (G +ve) bacteria was 85.7% to methicillin. In conclusion, incidence and mortality rates for nosocomial infections and antibiotics resistant percentages were very high in Yemen.

Related factors of nosocomial infection in severe thoracic trauma patients after operation

Objective To investigate the related factors of nosocomial infection after severe thoracic trauma so as to provide basis and interventions for lowering nosocomial infection rate. Methods A retrospective case series study was conducted in 148 cases of severe thoracic trauma surgically treated from January 2014 to January 2016. There were 98 males and 50 females with an average age of 34.7 years. The abbreviated injury scale (AIS) was ≥ 3 points. The incidence of nosocomial infection was statistically analyzed. The possible factors related to nosocomial infection were analyzed, including age, gender, previous basic diseases, coma, blood transplantation, surgical procedure, operation time, tracheal intubation time, postoperative tracheotomy, and postoperative ICU hospitalization. Results Nosocomial infection occurred in 18 cases, with infection rate of 12.2%. There were 11 cases of pulmonary infection, four urinary tract infection, two incision infection, and one thoracic cavity infection. There were four cases (22%) of Gram-positive bacteria as pathogen, both of which were Staphylococcus aureus. A total of 12 cases (67%) were Gram-negative bacteria, among which four were infected with Klebsiella pneumonia, three with Acinetobacter baumannii, three with Pseudomonas aeruginosa, and two with Escherichia coli. Two cases were infected by fungi. The incidence of infection was correlated with the patients' age (≥60 years), previous basic disease, coma, operation methods, operation time (≥3 hours), endotracheal intubation time (≥24 hours), tracheotomy after surgery, and postoperative hospitalization duration in the ICU (P<0.05), rather than gender and blood transplantation. Conclusions The most common pathogen of nosocomial infection in severe thoracic trauma patients is Gram-negative bacteria. The older age, previous basic diseases, coma, thoracotomy, long operation time, long tracheal intubation time, tracheotomy and long ICU hospital stay are the risk factors for nosocomial infection. More attention should be paid to these risk factors in order to minimize the occurrence of postoperative hospital infection, and to reduce the harm to patients. Key words: Thoracic injuries; Surgical procedures, operative; Cross infection; Risk factors

Risk factors for nosocomial infection among hospitalised severe influenza A(H1N1)pdm09 patients.

Nosocomial infections following influenza are important causes of death, requiring early implementation of preventive measures, but predictors for nosocomial infection in the early stage remained undetermined. We aimed to determine risk factors that can help clinicians identify patients with high risk of nosocomial infection following influenza on admission. Using a database prospectively collected through a Chinese national network for hospitalised severe influenza A(H1N1)pdm09 patients, we compared the characteristics on admission between patients with and without nosocomial infection. A total of 2146 patients were enrolled in the final analysis with a median age of 36.0 years, male patients comprising 50.2% of the sample and 232 (10.8%) patients complicated with nosocomial infection. Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Staphylococcus aureus were the leading pathogens, and invasive fungal infection was found in 30 cases (12.9%). The in-hospital mortality was much higher in patients with nosocomial infection than those without (45.7% vs 11.8%, P<0.001). Need for mechanical ventilation (OR: 3.336; 95% CI 2.362-4.712), sepsis (OR: 2.125; 95% CI 1.236-3.651), ICU admission on first day (OR: 2.074; 95% CI 1.425-3.019), lymphocytopenia (OR: 1.906; 95% CI 1.361-2.671), age>65 years (OR: 1.83; 95% CI 1.04-3.21) and anaemia (OR: 1.39; 95% CI 1.39-2.79) were independently associated with nosocomial infection. Need for mechanical ventilation, sepsis, ICU admission on first day, lymphocytopenia, older age and anaemia were independent risk factors that can help clinicians identify severe influenza A(H1N1)pdm09 patients at high risk of nosocomial infection.

Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease

Congenital heart diseases are among the most common congenital malformations. Approximately 50% of the patients with congenital heart disease undergo cardiac surgery. Nosocomial infections (NIs) are the main complications and an important cause of increased morbidity and mortality associated with congenital heart diseases. This study's objective was to identify the risk factors associated with the development of NIs after cardiac surgery in newborns with congenital heart disease. This was a nested case-control study that included 112 newborns, including 56 cases (with NI) and 56 controls (without NI). Variables analyzed included perinatal history, associated congenital malformations, Risk-Adjusted Congenital Heart Surgery (RACHS-1) score, perioperative and postoperative factors, transfusions, length of central venous catheter, nutritional support, and mechanical ventilation. Differences were calculated with the Mann-Whitney-U test, Pearson X2, or Fisher's exact test. A multivariate logistic regression was used to determine the independent risk factors. Sepsis was the most common NI (37.5%), and the main causative microorganisms were gram-positive cocci. The independent risk factors associated with NI were non-cardiac congenital malformations (OR 6.1, CI 95% 1.3-29.4), central venous catheter indwelling time>14 days(OR 3.7, CI 95% 1.3-11.0), duration of mechanical ventilation>7 days (OR 6.6, CI 95% 2.1-20.1), and ≥5 transfusions of blood products (OR 3.1, CI 95% 1.3-8.5). Mortality attributed to NI was 17.8%. Newborns with non-cardiac congenital malformations and with >7 days of mechanical ventilation were at higher risk for a postoperative NI. Efforts must focus on preventable infections, especially in bloodstream catheter-related infections, which account for 20.5% of all NIs.

Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy

Background and objectiveThe aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. Patients and methodsClinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. ResultsAmong 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<0.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. ConclusionsECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible.

Invited commentary

Infections after placement of a prosthetic graft, for either aortic or peripheral arterial reconstruction, are feared and potentially devastating complications. These infections can have significant morbidity and can also lead to subsequent infections. In this issue of the Journal of Vascular Surgery, Fariñas et al report their experience with postoperative infectious complications after placement of prosthetic grafts for both lower extremity and aortic reconstruction. Their all-cause infection rate was 27.2%. The majority of infections were surgical site infections, and only two graft infections were noted. The authors identified preoperative active lower extremity soft tissue infection as an independent risk factor for infectious complications after both aortic and lower extremity operations. Although active lower extremity infection may not be able to be resolved for patients with advanced critical limb ischemia or those who undergo emergent aortic surgery, efforts should be undertaken to treat soft tissue infection before elective aortic aneurysm repair. Prolonged mechanical ventilation was noted to be a predictor for infectious complications after aortic surgery, once again emphasizing the importance of expeditious extubation in the immediate postoperative period, although it is unclear whether this is a marker of overall illness. There are several lessons to be learned from this analysis. Studies of postoperative infectious complications should not combine very different procedures together as “vascular surgery procedures.” To correctly identify high-risk patients and to set in place systems for improvement, each specific type of intervention and indication needs to be closely examined. Leg bypass and aortic surgery are very different from one another with regard to a number of issues. For example, postoperative nasogastric tubes are often used after aortic procedures and seldom after leg bypass. Prolonged intubation with postoperative tracheostomy placement is less of an issue for lower extremity bypass as it is for major open abdominal surgery. Finally, for aortic surgery, an operation performed for aneurysmal disease is very different from one executed to treat occlusive disease, and a ruptured aneurysm is much different from an elective aneurysm repair. To decrease these rates of postoperative infections, risks identification and interventions should be tailored for specific scenarios. Studies need to be optimally designed to answer the questions that they set up to ask. Future prospective work is needed as granular details are needed, including surgical and preparation technique. Risks factors identified in this study, such as poor glucose control, anemia, and prolonged ventilation, can also be analyzed and teased out to see if they are really factors that predict a poor outcome or merely markers for ill and sick patients with more advanced disease. As such, risk reduction methods should focus specifically on each procedure and indication. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Risk factors and outcomes for nosocomial infection after prosthetic vascular graftsJournal of Vascular SurgeryVol. 66Issue 5PreviewThe objective of this study was to determine risk factors for nosocomial infections (NIs) and predictors of mortality in patients with prosthetic vascular grafts (PVGs). Full-Text PDF Open Archive

Characteristics of nosocomial infection and its effects on the survival of chemotherapy patients with advanced non-small cell lung cancer.

The present study was planned to investigate the characteristics of nosocomial infection and its effects on the survival in advanced non-small cell lung cancer (NSCLC) patients. Retrospective analysis was performed for the 169 chemotherapy patients with NSCLC and nosocomial infection during hospitalization in Binzhou City Central Hospital from March, 2013 to January, 2015. In addition, 170 patients without nosocomial infection were also involved as a control group. The distribution of major drug resistance of Gram-negative (G−) and Gram-positive (G+) were analyzed. The survival conditions of the patients were analyzed according to the nosocomial infection occurrence. The risk factors of nosocomial infection in patients with NSCLC were analyzed by univariate and multivariate logistic analysis. The percentage of G+ infection was 45.6% while G− infection was 54.4%. Nosocomial infections were most common in respiratory system. The median survival time of the observation group was shorter than that of the control group (P<0.05). G− infection was the most common type of infection in nosocomial infection of the patients with NSCLC. The occurrence of infection seriously affected the survival time of patients. Attention is required to the patients older than 60 years undergoing treatment with glucocorticoids as well as immunosuppressive agents.

Risk factors and outcomes for nosocomial infection after prosthetic vascular grafts

ObjectiveThe objective of this study was to determine risk factors for nosocomial infections (NIs) and predictors of mortality in patients with prosthetic vascular grafts (PVGs). MethodsThis was a prospective cohort study of all consecutive patients who underwent PVG of the abdominal aorta with or without iliac-femoral involvement and peripheral PVG from April 2008 to August 2009 at a university hospital. Patients younger than 15 years and those with severe immunodeficiency were excluded. The follow-up period was until 3 years after surgery or until death. ResultsThere were 261 patients included; 230 (88.12%) were male, and the mean age was 67.57 (standard deviation, 10.82) years. The reason for operation was aortic aneurysm in 49 (18.77%) patients or lower limb arteriopathy in 212 (81.23%) patients. NIs occurred in 71 (27.20%) patients. Of these, 42 were surgical site infections (SSIs), of which 61.9% occurred in the lower extremities (14 superficial, 10 deep, and 2 PVG infections) and 38.1% in the abdomen (7 superficial, 7 deep, and 2 PVG infections); 15 were respiratory tract infections; and 15 were urinary tract infections. Active lower extremity skin and soft tissue infection (SSTI) at the time of surgery was a significant predictor of NI for both types of PVG (abdominal aortic PVG: adjusted odds ratio [OR], 12.6; 95% confidence interval [CI], 1.15-138.19; peripheral PVG: adjusted OR, 2.43; 95% CI, 1.08-5.47). Other independent predictors of NI were mechanical ventilation (adjusted OR, 55.96; 95% CI, 3.9-802.39) for abdominal aortic PVG and low hemoglobin levels on admission (adjusted OR, 0.84; 95% CI, 0.71-0.99) and emergent surgery (adjusted OR, 4.39; 95% CI, 1.51-12.74) for peripheral PVG. The in-hospital mortality rate was 1.92%. The probability of surviving the first month was 0.96, and significant predictors of mortality were active lower extremity SSTI (adjusted risk ratio [RR], 12.07; 95% CI, 1.04-154.75), high postsurgical glucose levels (adjusted RR, 1.02; 95% CI, 1.00-1.04), and noninfectious surgical complications (adjusted RR, 19.38; 95% CI, 2.25-167.29). The long-term mortality rate was 11.88%. The probability of surviving at 12, 24, and 36 months was 0.94, 0.92, and 0.87, respectively. Variables significantly associated with long-term death were older age (adjusted RR, 1.08; 95% CI, 1.01-1.15), high values of creatinine on discharge (adjusted RR, 1.91; 95% CI, 1.08-3.38), and an SSI with the highest adjusted RR (6.35; 95% CI, 1.87-21.53). ConclusionsSSI was the primary NI. The risk of NI depended primarily on the presence of a lower extremity SSTI at the time of surgery, whereas mortality was determined by age, surgical complications during the operation, and SSI. These findings suggest that in those cases in which surgery is reasonably delayed, surgery should be deferred until the lower extremity SSTIs are resolved.

Risk factors of bacterial nosocomial infection after pediatric liver transplantation

Objective: To analyze the risk factors of nosocomial infection after liver transplantation in children, so as to provide scientific evidence for the prevention and control of nosocomial infection. Method: Clinical data of 223 pediatric patients undergoing liver transplantation between January 2014 and December 2015 were analyzed retrospectively. Univariate and multivariate analyses were carried out to investigate the risk factors of infection after transplantation. Result: Totally 51 children were infected among the 223 patients, the infection rate was 22.86%(51/223). Among the 74 cases with infection, 38 were infected with the blood (included peripherally inserted central catheters) accounting for 51.35 %; and surgical site infection accounted for 21.62%, the respiratory tract infections accounted for 18.92% and the other infections accounted for 8.11%. Totally 74 strains of infectious pathogens were found in 51 cases of infected patients, including Gram-negative bacteria accounting for 48.65%, Gram-positive bacteria accounting for 44.59% and the fungus accounting for 6.76%. According to a variety of survey factors, univariate analysis showed factors of hospitalization time, hospitalization time before surgery, surgical duration, and reoperation had statistically significant association with nosocomial infection(P<0.05). Logistic regression analysis showed that hospitalization time before surgery, surgical duration, reoperation and blood loss per unit weight were independent risk factors for nosocomial infection after pediatric liver transplantation. Conclusion: There are a variety of risk factors for the postoperative infections after liver transplantation in children. It is necessary to take into account the surgery factor, medical staff factor and hospital management factor. Management strengthening of these factors is necessary to reduce the infection rate.

Pathogen distribution, risk factors, and outcomes of nosocomial infection in very premature infants

To study the pathogen distribution and risk factors of nosocomial infection in very preterm infants, as well as the risk of adverse outcomes. A retrospective analysis was performed for the clinical data of 111 very preterm infants who were born between January and December, 2016 and had a gestational age of <32 weeks and a birth weight of <1 500 g. According to the presence or absence of nosocomial infection after 72 hours of hospitalization, the infants were divided into infection group and non-infection group. The infection group was analyzed in terms of pathogenic bacteria which caused infection and their drug sensitivity. A multivariate logistic regression analysis was used to investigate the potential risk factors and risk of adverse outcomes of nosocomial infection in very preterm infants. Gram-negative bacteria were the main pathogens for nosocomial infection in very preterm infants and accounted for 54%, among which Pseudomonas aeruginosa was the most common one; the following pathogens were fungi (41%), among which Candida albicans was the most common one. The drug sensitivity test showed that Gram-negative bacteria were highly resistant to β-lactam and carbapenems and highly sensitive to quinolones, while fungi had low sensitivity to itraconazole and high sensitivity to 5-fluorocytosine and amphotericin B. Early-onset sepsis, duration of peripherally inserted central catheter, steroid exposure, and duration of parenteral nutrition were risk factors for nosocomial infection in very preterm infants (P<0.05). Compared with the non-infection group, the infection group had significantly higher risks of pulmonary complications (P<0.05), as well as a significantly longer length of hospital stay and a significantly higher hospital cost (P<0.001). Nosocomial infection in very preterm infants is affected by various factors and may increase the risk of adverse outcomes. In clinical practice, reasonable preventive and treatment measures should be taken with reference to drug sensitivity, in order to improve the prognosis of very premature infants.

Incidence and Risk Factors of Nosocomial Infections in Neonatal Unit Sanglah General Hospital, Denpasar

The rate of morbidity due to infection including nosocomial infection during neonatal period is higher than that due to other causes. The purpose of this study was to know the incidence and risk factors of nosocomial infection. This study was conducted on all babies treated at the neonatal unit, Sanglah General Hospital, Denpasar during the period of April-June 1995. Chi square test was used to compare nosocomial infection between birth weight groups and mode of deliveries. The incidence of nosocomial infections in this study was 6%, with male to female ratio of 1.6:1. Skin infections were found most frequently. This occurrence of nosocomial infection was significantly related to the birth weight and mode of delivery, in which the risk of nosocomial infection was greater in babies with low birth weight and delivered by cesarean section or other obstetric procedures.

Factores de riesgo de las infecciones nosocomiales en pacientes que reciben oxigenación por membrana extracorpórea

Background and objectiveThe aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. Patients and methodsClinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. ResultsAmong 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. ConclusionsECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible.

A Retrospective Study Investigating Risks of Acute Respiratory Distress Syndrome and Mortality Following Human Metapneumovirus Infection in Hospitalized Adults

Background Human metapneumovirus (hMPV) is a relatively recently identified respiratory virus that induces respiratory symptoms similar to those of respiratory syncytial virus infection in children. The characteristics of hMPV-infected adults are unclear because few cases have been reported.Methods We conducted a retrospective review of hospitalized adult patients with a positive multiplex real-time polymerase chain reaction assay result from 2012 to 2016 at a single tertiary referral hospital in South Korea. We analyzed clinical characteristics of the enrolled patients and divided patients into an acute respiratory distress syndrome (ARDS) group and a non-ARDS group.Results In total, 110 adults were reviewed in this study. Their mean age was 61.4 years, and the majority (n = 105, 95.5%) had comorbidities or were immunocompromised. Most of the patients had pneumonia on chest X-ray (n = 88, 93.6%), 22 (20.0%) had ARDS, and 12 (10.9%) expired during hospitalization. The mortality rate for patients with ARDS was higher than that of the other patients (36.4% vs. 5.7%, P = 0.001). The risk factor for hMPV-associated ARDS was heart failure (odds ratio, 5.24; P = 0.044) and laboratory values were increased blood urea nitrogen and increased C-reactive protein. The acquisition site of infection was divided into community vs. nosocomial; 43 patients (39.1%) had a nosocomial infection. The risk factors for nosocomial infection were an immunocompromised state, malignancy and immunosuppressive treatment.Conclusions These data suggest that hMPV is one of the important respiratory pathogens important respiratory pathogen that causes pneumonia/ARDS in elderly, immunocompromised individuals and that it may be transmitted via the nosocomial route.

Risk factors of nosocomial infection in patients in department of neurosurgery

Objective To analyze the risk factors of nosocomial infection in Department of Neurosurgery and to provide evidence for the prevention and treatment of infection. Methods A total of 931 patients with neurosurgery operation in our hospital from January 2012-January 2016 were collected medical history data immediately after admission, including age, gender, underlying diseases, and primary diseases. Surgical records include preoperative white blood cell count, blood glucose level before operation, duration of operation, and reoperation. Hospitalization records include hospitalization time, without the use of corticosteroids, with or without the use of proton there is no pump inhibitor, and tracheal intubation / incision. Patients were divided into infection group and non infection group according to whether the hospital infection occurred during hospitalization. The difference of two groups of clinical data with statistically significant variables was Logistic multivariate regression analysis. Results There were 112 patients with nosocomial infection, the infection rate was 12.03%, and the infection occurred in the postoperative 3-25 d. The main infection site was postoperative wound, accounting for 35.7%; respiratory tract, accounting for 34.8%. There were 64 strains of pathogenic bacteria, 81 strains of Gram-negative bacteria, accounting for 64.1%, 21 strains of gram positive bacteria, accounting for 32.8%, 2 strains of fungi, accounting for 3.1%. There were significant difference between infection group and non infection group in ≥60 years, with basic diseases, reoperation, combined with other injuries, white blood cells, abnormal preoperative hyperglycemia, glucocorticoid use, proton pump inhibitors use, tracheotomy, hospitalization time, operation time (P<0.05). Further Logisitc regression analysis showed that age, reoperation, hospitalization time, preoperative high blood sugar and tracheotomy were the risk factors of nosocomial infection in Department of neurosurgery. Conclusions For the older, reoperation, longer hospitalization time, preoperative hyperglycemia and tracheotomy patients can take specific measures to improve the immunity of the patients, the ra-tional use of antimicrobial drugs to avoid the occurrence of postoperative infection. Key words: Neurosurgical procedures; Cross infection; Risk factors

Nosocomial Infections in Very Low Birth Weight Infants: Etiology and Risk Factors

Objective: We aimed to find out the incidence and risk factors of nosocomial infections in VLBW neonates and to explore the microbiologic flora, sensitivity pattern and outcome. Methods: A prospective, observational study was performed in a neonatal intensive care unit of a teaching hospital. VLBW infants excluding those diagnosed with early onset sepsis, admitted to the unit between August 2012 and March 2013 were followed up for evidence of nosocomial sepsis. Results: Of 92 VLBW infants, 23 developed nosocomial sepsis, incidence rate being 25%. Decreasing birth weight (1251-1500 g, 10.9%; 1001-1250 g, 28%; 751-1000 g, 50%; P<.001) and gestational age (>33wks, 0%; 29-32wks, 21.3%; 26-28 wks, 66.7%; p<.001) were found to be associated with statistically significant increase in nosocomial sepsis rate. On multivariate logistic regression, only peripherally inserted central catheter (PICC) line was independently associated with increased risk of nosocomial sepsis (aOR 13.33, 95% CI 3.58-49.5) in VLBW. A predominance of Gram negative over Gram positive nosocomial sepsis (75% vs. 25%) with higher mortality in the Gram negative group (55% vs. 0%) was observed. Klebsiella pneumoniae was the predominant microbe (33.4%). All microbes were sensitive to first line antibiotics except Elizabeth kingia meningoseptica and one episode of K. pneumoniae. Seven (30.4%) VLBW neonates with nosocomial sepsis died. Conclusions: Among VLBW infants, the incidence of nosocomial sepsis was 25%. Lower birth weight, lesser gestational age and PICC line were important risk factors. Gram negative nosocomial sepsis was associated with higher mortality compared to Gram positive sepsis. J Microbiol Infect Dis 2017; 7(1): 7-12

Knowledge and attitude towards infection control among supporting staffs of Chitwan Medical College, Bharatpur, Chitwan

Nosocomial infections (NIs) are one of the most important health issues, particularly in developing countries, because these infections cause high mortality and morbidity, and economic and human resource loss as a consequence Nosocomial infections can be defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. Many studies have examined risk factors of nosocomial infections. However, knowledge of frontline workers (attendants) in infection prevention have been reported rarely in developing countries. The aim of this study was to investigate the knowledge of attendants working in different wards and OPDs about infection prevention. S: Data were collected from 100 attendants in Chitwan Medical College Teaching Hospital. Regarding the knowledge on hand washing, gloving and personal accessories for Infection Prevention, majority of the respondents had good knowledge ranging from 94-100%. Though hospital has established Infection Prevention Committee and regular training on infection prevention is provided to all the staffs, the data indicated that only 68% respondents were benefitted by the infection prevention training and proper use of virex solution to disinfect the equipment’s was found unsatisfactory. Infection control is the responsibility of all Health Care Facility (HCF) personnel. The goal of the infection control policies are to identify and reduce risks of acquiring and transmitting infections among patients, staff, students, volunteers, contract service workers, and visitors Although significant effort has been made to reduce the Nosocomial infections, regular training as well as monitoring supervision will enhance the capacity of the health care providers and front line workers for cleaning services they are our valued respondents.DOI: http://dx.doi.org/10.3126/jcmc.v6i1.55069

Repeated prevalence studies of nosocomial infections in one university hospital in Serbia.

Nosocomial infections occur worldwide and affect both developed and resource-poor countries. The aim of this paper was to determine the prevalence and risk factors for nosocomial infections in one Serbian hospital. Three-point prevalence surveys were conducted in the Clinical Center of Kragujevac (1240 beds). The standard definitions for nosocomial infections of the Centers for Diseases Control and Prevention were used. The authors conducted surveys according to the same protocol. The prevalence of infected patients and the overall prevalence of nosocomial infections was 6.2% and 7.1% in 2003, 4.6% and 4.6% in 2005, and 7.6% and 8.7% in 2009, respectively. In all three studies, the risk factors for nosocomial infections were older age, intravascular catheters, urinary catheters, longer hospital stays, hospitalization in an intensive care unit, and surgeries. According to the multivariate regression analysis, a prolonged hospitalization and use of a urinary catheter were independent risk factors for nosocomial infections in the first and second study. The overall healthcare-associated infection prevalence in our hospital increased from 2003 to 2009, and this was an incentive for a better definition of infection control priorities in high-risk departments.

Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.

Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065–4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081–1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.