Risk Factors For Nosocomial Infection Research Articles

Clinical Characteristics and Risk Factors of Nosocomial Infection in 472 Patients with Non-Hodgkin Lymphoma

To investigate the clinical characteristics and risk factors of nosocomial infection in patients with non-Hodgkin lymphoma (NHL), in order to guide better clinical prevention and treatment of nosocomial infection. The incidence of nosocomial infection, infection site, characteristics of pathogenic bacteria, drug sensitivity test results and infection risk factors of 472 non-Hodgkin lymphoma patients admitted to the Second Affiliated Hospital of Fujian Medical University from January 2015 to September 2020 were retrospectively analyzed. Among the 472 patients, 97 (20.6%) had nosocomial infection, mainly in the lower respiratory tract (41.2%), followed by oral cavity, upper respiratory tract, urogenital tract, and blood. A total of 71 strains of pathogenic bacteria were isolated, including Gram-negative (G-) bacteria (52.1%), Gram-positive (G+) bacteria (28.2%), and fungi (19.7%). The detection rate of extended-spectrum β-lactamase (ESBLs) in Klebsiella pneumoniae and Escherichia coli was 36.4% and 22.2%, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenems (imipenem) in G- bacteria was 33.3%, while the sensitivity rate of other G- bacteria was 100%. Among the 7 strains of Staphylococcus aureus, 1 strain was found to be methicillin-resistant Staphylococcus aureus (MRSA), and the sensitivity of G+ bacteria to linezolid, tigecyclinetegacycline and vancomycin was 100%. Candida albicans was the main source of fungal infection. Univariate analysis showed that nosocomial infection was associated with hospital day, bone marrow involvement, clinical stage, chemotherapy, neutrophil count in peripheral blood, and lymphoma type. Multivariable Logistic regression model showed that hospital days ≤7 was the protective factor of nosocomial infection, while clinical stage (Ⅲ, Ⅳ period), tumor involving bone marrow, and peripheral blood neutrophil count <0.5×109/L were major risk factors. NHL patients show high nosocomial infection rate and lower respiratory tract infection is common. Hospital day, clinical stage, presence of bone marrow invasion, and neutrophil count in peripheral blood are independent risk factors.

Analysis of Nosocomial Infection and Risk Factors in Patients with ECMO Treatment.

ObjectiveTo investigate the drug resistance of nosocomial infection-related pathogens in patients who underwent extracorporeal membrane oxygenation (ECMO), analyzing the nosocomial infection-related risk factors.MethodsThe medical records of 56 patients who received ECMO support treatment in the First Affiliated Hospital with Nanjing Medical University from January 2013 to December 2019 were selected. The nosocomial infection, pathogen distribution and drug resistance, and the influencing factors of nosocomial infection were analyzed. The predictive value of independent risk factors for nosocomial infection after ECMO was analyzed using the receiver operating characteristic (ROC) curve.ResultsA total of 56 patients receiving ECMO treatment were included. The nosocomial infection rate was 28.57%, and the prevalence infection rate was 44.64%. Lower respiratory tract infection was the main infection site. Among these infectious patients, 53 strains of pathogens were detected. The results showed that the gram-negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumonia. Moreover, the drug resistance rate of Acinetobacter baumannii to most of the antibiotics was more than 65%, among which the drug resistance rate to carbapenems was 80%. The results of risk factors of nosocomial infection after ECMO were analyzed by univariate analysis, showing that ECMO treatment time, hospitalization time, antibacterial drug use time, ventilator use time, catheter intubation time and central venous intubation time were statistically significant (all p < 0.001). Multivariate analysis identified that ECMO treatment time was an independent risk factor. As showed by ROC curve, ECMO treatment time had a high predictive value for postoperative nosocomial infection. ECMO treatment times of more than 4.5 days were associated with an increased risk of nosocomial infection.ConclusionThe nosocomial infection rate after ECMO was relatively high, and the main pathogens are Gram-negative bacteria. The selection of antibiotics should be based on the results of pathogen drug sensitivity.

The pathogenic characteristics and influencing factors of health care-associated infection in elderly care center under the mode of integration of medical care and elderly care service: A cross-sectional study.

The aim of this study was to analyze the distribution of pathogenic bacteria in hospitalized patients in elderly care centers under the mode of integration of medical care and elderly care service, and explore the influencing factors to reduce the health care-associated infection rate of hospitalized patients.A total of 2597 inpatients admitted to elderly care centers from April 2018 to December 2019 were included in the study. The etiology characteristics of health care-associated infections (HCAI) was statistically analyzed, univariate analysis, and multivariate logistic regression analysis method were used to analyze the influencing factors of HCAI.A total of 98 of 2597 inpatients in the elderly care centers had HCAI, and the infection rate was 3.77%. The infection sites were mainly in the lower respiratory tract and urinary tract, accounting for 53.92% and 18.63%, respectively. A total of 53 pathogenic bacteria were isolated, 43 of which (81.13%) were Gram-negative, mainly Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae, which respectively accounted for 24.53, 16.98, and 13.21%. 9 (16.98%) strains were Gram-positive, mainly Staphylococcus aureus and Enterococcus faecium, respectively accounting for 7.55 and 5.66%. Only 1 patient (1.89%) had a fungal infection. Multivariate logistic regression analysis indicated that total hospitalization days, antibiotic agents used, days of central line catheter, use of urinary catheter and diabetes were independent risk factors of nosocomial infection in elderly care centers (P < .05).Many factors can lead to nosocomial infections in elderly care centers. Medical staff should take effective intervention measures according to the influencing factors to reduce the risk of infection in elderly care facilities.

Clinical investigation of nosocomial infections in adult patients after cardiac surgery.

Nosocomial infections (NI) are common complications after cardiac surgery. To date, there have been few manuscripts investigating NI in the intensive care unit after cardiac surgery. Our study was designed to investigate the characteristics of the distribution of pathogenic bacteria, antibiotic resistance and risk factors for NI.A total of 1360 patients received standard postoperative care, including antibiotic prophylaxis. Microbiological examinations of sputum, blood, catheter tips and excrement were performed as clinically indicated to isolate pathogens. Thirty potential associated variables were collected and compared between the 2 different groups according to the development of NI using univariate and multivariate analyses.Eighty-nine patients (6.54%) acquired a microbiologically documented NI. There was a significant difference in mortality between the 2 groups with or without postoperative NI (23.60% vs 2.28%, P < .00). A total of 98 pathogens (73.13%) were isolated from sputum, 32 pathogens (23.88%) from blood and only 1 (0.75%) from urine. Three (2.24%) surgical site infections were detected, including 2 superficial surgical site infections and 1 mediastinitis. The most common pathogens were Gram-negative bacteria (78.36%), followed by Gram-positive bacteria (14.93%) and fungi (6.71%). The major pathogenic species had different levels of drug resistance, and most of them exhibited multidrug resistance. Six out of thirty variables were identified as independent risk factors for the development of NI, namely, duration of surgery, low cardiac output syndrome, continuous veno-venous hemofiltration, mechanical ventilation time, reintubation and tracheostomy.We analyzed the characteristics of the distribution of pathogens, antibiotic resistance and risk factors for NI in our center and provided some suggestions for clinical practice. In addition to antibiotic treatment, avoidance of risk factors and aggressive infection control measures may be crucial to stop or prevent outbreaks.

Distribution of pathogenic bacteria and risk factors of nosocomial infection after laparoscopic radical gastrectomy

Distribution of pathogenic bacteria and risk factors of nosocomial infection after laparoscopic radical gastrectomy

A study of the incidence of nosocomial infections and the associated risk factors in the city of Mbujimayi, Democratic Republic of Congo

Introductioncette étude vise à déterminer l´incidence des infections nosocomiales et les facteurs de risque chez les accouchées et les nouveau-nés dans les maternités de la ville de Mbujimayi en République Démocratique du Congo.Méthodesil s´agit d´une étude descriptive longitudinale d´incidence et facteurs de risque des infections nosocomiales dans les 231 maternités, qui a été réalisée chez les sujets indemnes de la pathologie au départ qu´on devrait suivre en utilisant la collecte hebdomadaire des données pendant 6 mois. Les critères utilisés pour la collecte des données étaient ceux de l´Organisation Mondiale de la Santé (OMS) basés sur les définitions simplifiées pouvant être utiles pour certains établissements n´ayant pas accès à des techniques diagnostiques poussées.Résultatsl´incidence globale des infections nosocomiales chez les accouchées est de 24,8% et de 22,3% chez les nouveau-nés. Les facteurs de risque significatif d´infection nosocomiale au couple étaient les manœuvres instrumentales (p=0,005; OR=2,7; IC95% [1,3-5,4]), la césarienne faite en urgence (p=0,000; OR=2,3; IC95% [1,7-3,9]), l´utilisation d´un même flacon de collyre chez tous les bébés (p=0,004; OR=2,7; IC95% [1,4-5,5]) et l´élevage du prématuré hors couveuse (p=0,000; OR=2,61; IC95% [1,73-3,92]).Conclusionla réalisation d'enquêtes d'incidence (ou à défaut de prévalence) régulières est indispensable pour évaluer les effets des actions d'information, de sensibilisation et de formation qui pourront être mises en place pour lutter contre les infections acquises à l'hôpital.

Epidemiology and risk factors of nosocomial infection among trauma patients hospitalized in Kashan Shahid Beheshti Hospital

Aim: Nosocomial infection is one the most important health problem in the world. In trauma patients, nosocomial infection is one the most important factor of morbidity and mortality, increased hospitalization days, economic costs, and patient dissatisfaction. This study aimed at assessing the frequency of nosocomial infection and its related factors in hospitalized trauma patients in Beheshti Hospital in Kashan, Iran. Materials and Methods: This descriptive study was conducted on 338 trauma patients who had been admitted to Kashan Beheshti Hospital during 2015. Data were collected using the questionnaire containing demographic and paraclinical results in trauma patients. The patients were examined for fever and nosocomial infection daily. The data were analyzed using t-test and Chi-square by the SPSS software version 16. Results: Twenty-one (6.2%) out of 338 trauma patients had nosocomial infection. There were 7 (33.3%) surgical site infections, 5 (23.8%) pneumonia, 5 (23.8%) soft-tissue infection, and 3 (14.2%) urinary tract infection and 4 (19.04%) fever with of unknown origin. There was a significant statistical association between underlying disease, duration of hospitalization, multiple trauma, surgical intervention, using the device, and history of admission to ICU with the rate of the infections. However, there was no significant association between sex, age, body mass index, and smoking with the rate of the infection. Conclusions: The rate of nosocomial infection was 6.2% and it was lower than other studies. The nosocomial infection is more frequent in patients with underlying diseases, with surgical intervention, admission in ICU, using device, multiple trauma, and more duration of hospitalization.

Assessment of Mupirocin Resistance among Clinical Isolates of Methicillin Resistant Staphylococcus aureus

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is considered a major risk factor for nosocomial infections and its decolonization has reduced these infections. Mupirocin (MUP) is the topical antibiotic of choice for decolonization. MUP decolonization failure is attributed to MUP resistance. Objective: The aim of the current study is to assess MUP resistance among MRSA isolates phenotypically and genotypically. Methodology: Fifty MRSA isolates were identified in Microbiology Department in the Medical Research Institute hospital, Alexandria University. Antibiotic susceptibility to different classes of antibiotics by disk diffusion method was done. MUP minimum inhibitory concentration (MIC) was determined phenotypically by MUP Ezy MIC™ Strips. MUP resistance was determined genetically by multiplex PCR detection of mupA and mupB. Results: Of all MRSA isolates, 6% exhibited high level and none showed low level MUP resistance. Only mupA was detected in all resistant isolates. Conclusion: Despite low prevalence of MUP resistance, it is appropriate to test MUP resistance prior nasal decolonization

807. Effect of Inter-Hospital Transfer on Nosocomial Infection Rates in Patients Receiving Extracorporeal Membrane Oxygenation

BackgroundExtracorporeal Oxygenation (ECMO) has been increasingly used as a life support modality for cardiac and pulmonary failure. Due to improved survival in patients treated in high volume ECMO centers, inter-hospital transport of these critically ill patients is on the rise. These patients may be transported via ambulance locally, or by aircraft over long distances. However, potential risks of nosocomial infectious complications associated with transfers has not been reported. We evaluated the impact of transfers on nosocomial infections for patients who received ECMO at Brooke Army Medical Center (BAMC).MethodsAll patients who received ECMO for ≥48 hours at BAMC between May 2012 and October 2019 were included. Chart review was performed to determine transport status, infectious complications while on ECMO, and antimicrobial susceptibility of isolated organisms. Statistical analyses were performed using Chi-squared, Fisher’s exact, or Mann-Whitney U tests as appropriate. Factors associated with nosocomial infections were evaluated by multivariate logistic regression.ResultsCompared to patients who were cannulated locally (n=33), patients who underwent cannulation at referral facility and inter-hospital transfer (n=76) had no difference in infections per 1000 ECMO days (33.1 vs. 30.5, p=0.74) or in infections with multidrug resistant organisms (MDRO) (50% vs. 55%, p=1). Of transferred patients, those transferred by aircraft (n=11) had no difference in infection rate (22.4 vs. 31.8 per 1000 ECMO days, p= 0.39) or MDRO incidence (52% vs 75%, p=0.61) compared to those only transferred by ambulance (n=65). Multivariate analysis showed the greatest risk factor for nosocomial infection was time on ECMO (OR 12.2 for longest tertile time on ECMO vs. shortest tertile, p=0.0001); transport was not significantly associated with infection (OR 2.1, p=0.06).Nosocomial infection rate by site of ECMO cannulation ConclusionThis study did not find a significant difference in nosocomial infection rate or recovery of MDROs between transported and non-transported patients on ECMO, regardless of transport modality. This study suggests that transportation is not the primary driver of nosocomial infections in this cohort.Disclosures All Authors: No reported disclosures

ENVIRONMENTAL RISK FACTORS OF NOSOCOMIAL INFECTIONS IN NEUROLOGICAL INTENSIVE CARE UNIT

Background: The Centers of Disease Control and Prevention (CDC) estimate that 2 million patients develop hospital-acquired infection annually and as many as 88,000 die as a result, adding an estimated $5 billion to the annual national health care costs. Object: To evaluate risk factors and methods of infection control in surgical site infections in postoperative neurosurgical patients. Methods: This study was prospective, uncontrolled and observational study conducted on patients with postoperative neurosurgical operation and admitted to Intensive Care Unit postoperatively. The study was done in Al-Azhar university hospitals from March 2017 to March 2018. The study aim was. Analysis of data was done by IBM computer using SPSS (statistical program for social science version 25). Results: In the study sample, the mean age and standard deviation (SD) were 42.5 years ±19.1. Female patients were about 40%. Most male patient were above median age of the sample (37.8 years). The overall admission period includes pre-ICU admission, ICU admission and post-ICU admission. The mean and standard deviation of overall admission was 43.7 day±5.5. From the whole study sample, nosocomial infection was estimated to be 88.4% of cases (69 patients). Postoperative mortality among cases was 36%. The rest of cases were either referred or discharged to ward. Comorbid conditions may present as single factor or multiple factors in the same patient. Patients with nosocomial infections were found to have two or more comorbid conditions while infection-free cases were found to have no or at least one factor in a statistically significant association. It has been found that most cases with traumatic brain injury and hemorrhagic stroke had nosocomial infection (74%). Both types mentioned previously had longer ICU stay. It has been found that nosocomial infection is commonly predominant in traumatic brain injury and intracranial hemorrhage cases (ICH). Nosocomial infections were found to be either single or multiple infections in the same person. Most of infections were; respiratory tract infection, urinary tract infection or septicemia. When the entire study sample was subjected to logistic regression analysis, age, diagnosis and hospital stay, necessity for ventilation, low Glasgow Coma Scale (GCS), high temperature, high humidity and low karnofsky were found to be significantly independently predictive of postoperative nosocomial infection. Among these patients, type and timing of operative intervention and environmental factors did not significantly affect outcome. Conclusion: There are many risk factors of nosocomial infection in hospitalized neurosurgical treated, which requires strict monitor, including the development of various effective prevention measures and check of their implementation as well as effectiveness, to reduce the incidence of hospital infection.

The Prevalence and Risk Factors of Nosocomial Infections in the Intensive Care Unit of a Hospital in Iran

Background: Nosocomial infections account for about one third of deaths in hospitals. Objective: In this study, we aim to determine the factors affecting the incidence of nosocomial infections in the Intensive Care Units (ICUs) to provide more information for helping improve the prevention and treatment of these infections in the hospitals located in Iran. Methods: This is a comparative cross-sectional study conducted in 2017 on 86 patients admitted to the general ICU of Boo Ali Sina Hospital in Qazvin, Iran. We extracted the patients’ demographic and clinical information (e.g. blood and urine culture results) from their medical records. Findings: The prevalence of nosocomial infections were reported 24.3; 38.4% of infections was related to Acinetobacter and 18.6% to Pseudomonas aeruginosa and other microorganisms. The highest antibiotic resistance in patients was to Cefepime (64%) and Ciprofloxacin (60%). Conclusion: The prevalence of nosocomial infections in the general ICU of the study hospital is relatively high with different strains and varied patterns of antibiotic resistance indicating the need for more comprehensive studies and preventive measures in the country.

Nosocomial infection with SARS-CoV-2 and main outcomes after surgery within an orthopaedic surgery department in a tertiary trauma centre in Spain.

AimsThe purpose of the present study is to analyse clinical data of a series of cases who developed nosocomial infection with SARS-CoV-2 in an orthopaedic and traumatology department.Patients and methodsIn this non-interventional retrospective study, carried out at a tertiary hospital within the Spanish National Health System, all adult patients who were admitted in the Orthopaedic Surgery and Traumatology Department between March 9th and May 4th, 2020, were included. Clinical, biological and radiological data, as well as mortality rates, were collected from hospital medical records.ResultsA total of 293 periods of hospitalization were analysed in 288 patients. Mean age was 66.1 years old and 57.3% were females. Nineteen patients (6.48%) met the inclusion criteria to be categorized as a nosocomial infection with SARS-CoV-2. In a comparison between patients with and without nosocomial infection, age, mortality and hospital length of stay were statistically significant (p < 0.05). The median time from admission to diagnosis of SARS-CoV-2 infection in our cohort was 16 days (6–86 days). No statistically significant differences were found in sex, living situation, reason of admission or period of admission (even if we observed that most of the nosocomial infections (78.9%) occurred in March).ConclusionWe have found a 6.48% of nosocomial infection with SARS-CoV-2, but with an important reduction of it after undergoing preventing protocols that included screening RT-PCR test for COVID-19. Age and hospital length stay were statistically significant risk factors for nosocomial infection with SARS-CoV-2. For the progressive restoration of the surgical activity, we recommend to correctly select the patients in elective surgery and to encourage fast-track programs and early discharge of patients with fractures.

Some Risk Factors for Hospital Infections at the ICU in the Vietnam National Children’s Hospital

Purpose: To identify some risk factors for hospital infections in the ICU, Vietnam National Children’s Hospital in 2018-2019.&#x0D; Method: A prospective cohort study was conducted.&#x0D; Results: Malnutrition grade II or higher, PRISM &gt; 10, ≥ 3 invasive intervention, use of H2-receptor antagonists and intravenous feeding were risk factors for nosocomial infections. Endotracheal intubation, intubation for &gt; 5 days, re-intubation, and aspiration of vomit were risk factors for nosocomial pneumonia. Intravenous exposure, 3 or more IV lines, and central venous catheterization were risk factors for sepsis. Gastrointestinal surgery, surgery time &gt; 2 hours, postoperative drainage, drainage time &gt; 5 days and no prophylactic antibiotics were risk factors for wound infection. Urinary retention and urinary flow &gt; 3 days were risk factors for urinary tract infections.&#x0D; Conclusion: Nosocomial infections with grade II or higher malnutrition and 3 invasive interventions, the use of H2-receptor resistance and intravenous nutrition associated with nosocomial infections. Pneumonia, urinary tract infections, and sepsis are high risk factors for nosocomial infections.

COVID-19 Impact on Neurosurgical Practice: Lockdown Attitude and Experience of a European Academic Center

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Different models of reorganization have been described aiming to preserve resources and ensure optimal medical care. Limited clinical neurosurgical experience with patients with COVID-19 has been reported. We share organizational experience, attitudes, and preliminary data of patients treated at our institution.MethodsInstitutional guidelines and patient workflow are described and visualized. A cohort of all neurosurgical patients managed during the lockdown period is presented and analyzed, assessing suspected nosocomial infection risk factors. A comparative surgical subcohort from the previous year was used to investigate the impact on surgical activity.ResultsA total of 176 patients were admitted in 66 days, 20 of whom tested positive for COVID-19. Patients initially admitted to the neurosurgical ward were less likely to be suspected for a COVID-19 infection compared with patients admitted for critical emergencies, particularly with neurovascular and stroke-related diseases. The mortality of patients with COVID-19 was remarkably high (45%), and even higher in patients who underwent surgical intervention (77%). In addition to the expected decrease in surgical activity (–53%), a decrease in traumatic emergencies was noted.ConclusionsBy applying infection prevention and resource-sparing logistics measures shared by the international medical community, we were able to maintain essential neurosurgical care in a pandemic with controlled nosocomial infection risk. Special consideration should be given to medical management and surgical indications in patients infected with severe acute respiratory syndrome coronavirus 2, because they seem to show a problematic hemostatic profile that might result in an unfavorable clinical and surgical outcome.

Prevalence of Nosocomial Infections in Intensive Care Units in Shahid Sayyad-E-Shirazi Hospital of Gorgan During 2016-2018

Introduction: Understanding the pattern of infections in the intensive care unit and the correct pattern of antibiotic use is vital in reducing mortality. Identification of risk factors for nosocomial infection and preventive approaches can be effective in reducing the incidence. This study aimed to evaluate the intensive care unit (ICU) acquired infection.&#x0D; Material and Methods: This cross-sectional study was performed on patients admitted to the ICU of Sayyad Shirazi Hospital during 2016-18. All patients' information recorded and analyzed by SPSS version 16.&#x0D; Results: In this study, the nosocomial infection rate was 3.5%, mostly in individuals over 60 years old. Most of the positive cultures were from two sources of urine and then blood. The organisms observed in nosocomial infections were Escherichia coli (16.9%), Staphylococcus epidermis (11.5%), Enterococci, and Enterobacter. The most commonly used antibiotics were vancomycin and then meropenem. Antibiogram results indicated the highest antibiotic resistance (100%) to cefazolin, piperacillin and clindamycin, and 96.8% to ceftriaxone. Vancomycin and amikacin had the lowest resistance.&#x0D; Conclusion: According to the results of this study, the incidence of nosocomial infection is unavoidable, and its control is the most important health goals of medical centers. Proper treatment interventions are needed to reduce the impact of nosocomial infection.

Risk factors associated with nosocomial infections among end stage renal disease patients undergoing hemodialysis: A systematic review

Profound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections. The aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis. A systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099). Initially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients. The results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures.

Relationship between Nutritional Status and Nosocomial Infection in Children with Acute Lymphoblastic Leukemia

To study the risk factors and infection characteristics of nosocomial infection in children with acute lymphoblastic leukemia (ALL) and analyze the relationship between different nutritional status and nosocomial infection, early treatment response. The clinical data of 133 children with ALL treated with CCCG-ALL-2015 from June 2016 to June 2019 (chemotherapy stage, risk level, MRD), infection during hospitalization (course of infection, laboratory indicators, sites of infection, outcome) and nutritional status (sex, age, height/ length, weight) were enrolled. The Chi 2 test and Logistic regression analysis were used for statistical analysis. The rate of nosocomial infection was 19.9% in 133 children with ALL, in which 3 were infection-related death. Sex, immunophenotype and risk showed no significantly affect on the occurrence of nosocomial infection (P＞0.05), but neutrophil count, hemoglobin level, platelet count, chemotherapy stage, length of stay in hospital and nutritional status showed affect on the occurrence of nosocomial infection (P＜0.05). Logistic multivariate regression analysis showed that chemotherapy stage, length of hospital stay, neutrophils and nutritional status were the independent risk factors, in which the respiratory tract infection was the most common. Gram-positive bacteria, Gram-negative bacteria and fungi accounted for 44.1%, 52.9% and 2.9% respectively. The negative rate of MRD in day 19 and day 46 between different nutritional status groups showed statistically significant (P＜0.05). Neutrophil count, chemotherapy stage, length of stay in hospital and nutritional status are independent risk factors for nosocomial infection. Among of them, nutritional status negatively correlated with nosocomial infection, and the poorer nutritional status, the higher risk of nosocomial infection. Malnutrition, overweight and obesity can affect the early treatment response of ALL children. The level of nutrition at first diagnosis can be used as a bad factor to evaluate the early treatment response of ALL children.

Analysis of Characteristics and Risk Factors of Nosocomial Infection in Patients with Respiratory Medicine

Analysis of Characteristics and Risk Factors of Nosocomial Infection in Patients with Respiratory Medicine

Nosocomial Infection Following Severe Traumatic Injury in Children.

Nosocomial infection is a common source of morbidity in critically injured children including those with traumatic brain injury. Risk factors for nosocomial infection in this population, however, are poorly understood. We hypothesized that critically ill pediatric trauma patients with traumatic brain injury would demonstrate higher rates of nosocomial infection than those without traumatic brain injury. Retrospective case-control study. PICU, single institution. Patients under 18 years old who were admitted to the PICU for at least 48 hours following a traumatic injury were included. Patients were admitted between September 2008 and December 2015. Patients with the following injury types were excluded: thermal injury, drowning, hanging/strangulation, acute hypoxic ischemic encephalopathy, or nonaccidental trauma. Data collected included demographics, injury information, hospital and PICU length of stay, vital signs, laboratory data, insertion and removal dates for invasive devices, surgeries performed, transfusions of blood products, and microbiology culture results. Initial Pediatric Risk of Mortality III and Pediatric Logistic Organ Dysfunction-2 scores were determined. Patients were classified as having: 1) an isolated traumatic brain injury, 2) a traumatic injury without traumatic brain injury, or 3) polytrauma with traumatic brain injury. None. Two hundred three patients were included in the analyses, and 27 patients developed a nosocomial infection. Patients with polytrauma with traumatic brain injury demonstrated a significantly higher infection rate (30%) than patients with isolated traumatic brain injury (6%) or traumatic injury without traumatic brain injury (9%) (p < 0.001). This increased rate of nosocomial infection was noted on univariate analysis, on multivariable analysis, and after adjusting for other risk factors. In this single-center, retrospective analysis of critically ill pediatric trauma patients, nosocomial infections were more frequently observed in patients admitted following polytrauma with traumatic brain injury than in patients with isolated traumatic brain injury or trauma without traumatic brain injury.

Clinical Features of Nosocomial Infections in Agranulocytosis Patients with Hematological Malignancies and Analysis of Risk Factors

To explore the clinical features and risk factors for nosocomial infections in agranulocytosis patients with hematological malignancies so as to provide basis for clinical prevention and treatment of nosocomial infections. The clinical data of 725 patients with agranulocytosis in the First Hospital of Lanzhou University from May 2015 to May 2018 were retrospectively analyzed, including sex, age, primary disease, treatment stage, agranulocytosis degree, agranulocytosis duration, nosocomial infection, infectous site, average length of stay and average days of infection. Univariate analysis (Chi-square test) and multivariate analysis (non-conditional Logistic regression models) were used to analyze the risk factors of nosocomial infection. The most common sites of nosocomial infection in agranulocytosis patients with hematological maliguancies were upper respiratory tract, accounting for 24.0%, followed by lung (16.2%) and blood stream (13.8%). In disease composition, acute leukemia holded the first place, accounting for 82.1%, among which the acute myeloid leukemia had the highest infection rate, accounting for 73.3%, followed by acute lymphoblastic leukemia. The infection rates were 68.0% and 66.7% for multiple myeloma, 79.3% and 84.5% for acute leukemia at the initial induction and relapse stages, respectively. 184 pathogenic bacteria were isolated clinically, of which 126 were a Gram-negative bacteria, 23 were Gram-positive bacteria and 35 were fungi, accounting for 68.48%, 12.50% and 19.02%, respectively. It was found that age, primary disease, degree and duration of granulocyte deficiency, chemotherapy, glucocorticoid use and disease status all associated with nosocomial infection (P＜0.05). Multivariate unconditional logistic regression analysis showed that acute leukemia, absolute count of neutrophils＜0.2×109/L, chemotherapy and disease unremitting were the main risk factors of nosocomial infection. The patients with malignant hematological agranulocytosis are a high-risk population of nosocomial infection. Nosocomial infection rate is still high, especially in patients with acute leukemia who have received chemotherapy or without complete remission or neutrophil absolute count less than 0.2×109/L. Thus early intervention measures should be taken to reduce the incidence of nosocomial infection and mortality.