Types Of Hospital-acquired Infections Research Articles

Reduction of Hospital-Acquired Infections Through a Nursing Education Program: A Quality Improvement Project on the Sensitization of Nursing Staff Toward Infection Control in Neonates.

Background This study aimed to reduce hospital-acquired infections (HAIs) by at least 50% in our unit through a nursing education program to sensitize the nursingstafftoward infection control in neonates. Methodology This pre- and post-intervention observational study was conducted in Liaquat National Hospital's Neonatal Intensive Care Unit (NICU) from October 2021 until March 2023. This observational study was conducted in three phases. In phase I (pre-implementation), all neonates with suspected HAIs were included. In phase II (implementation), the nursing staff dedicated to the NICU were trained. In phase III (post-implementation), all neonates with suspected HAIs were included. Culture-proven bloodstreaminfections (BSIs), urinary tract infections (UTIs), and ventilator-associated pneumonia (VAP) were the three types of HAIs. The nursing scoring was done by the principal investigator based on a questionnaire. The Shapiro-Wilk test was used to evaluate the normality of all quantitative data across all phases. Results In the pre-implementation phase, there were 24 (10.8%) HAIs, among which 19 (8.6%) were BSIs, one (0.5%) was a catheter-associated urinary tract infection (CAUTI), and seven (3.2%) were VAP. Whereas in the post-implementation phase, there were 12 (5%) HAIs, among which 10 (4.1%) were BSIs, none were CAUTIs, and five (2.1%) were VAP. Therewas a significant reduction of HAIs in the post-implementation phase (p < 0.01). The difference in the knowledge, assessment, and practice was statistically significant in the post-implementation phase (p < 0.01). Conclusions We established a successful cost-effective intervention to improve theawareness and compliance of NICU nurses with infection control practices. This helped us in reducing HAIs in our NICU.

Prevalence of extended-spectrum beta-lactamase and molecular detection of blaTEM, blaSHV, and blaCTX-M genotypes among gram-negative Bacilli isolates from hospital acquired infections in pediatrics, one institutional study

BackgroundGram-negative bacilli represents an important pathogen in hospital-acquired infections (HAIs) worldwide. The emergence of antibiotic resistance in these pathogens warrants attention for the proper management of infections. Extended-spectrum beta-lactamase (ESBL) resistance represents a major therapeutic problem in infections due to Gram-negative bacilli.The present study aimed to study the extended-spectrum beta-lactamase genes blaTEM, blaSHV, and blaCTX-M by multiplex polymerase reaction in isolated Gram-negative bacilli from HAIs in pediatric patients.MethodsThe study included one hundred-five isolates of Gram-negative bacilli from pediatric patients with different types of HAIs. The isolates were subjected to full microbiological identification, antibiotics susceptibility by disc diffusion method, the phenotypic study of ESBL, and the genetic study of ESBL genes by multiplex PCR.ResultsFifty isolates of Gram-Negative bacilli showed ESBL activity by a phenotypic study by double disc diffusion method (50/105). All ESBL producers’ isolates were positive by PCR for ESBL genes. The most frequent gene was blaTEM (64%), followed by blaSHV (30%) and CTX-M (22%). Mixed genes were found in 4 isolates (8%) for blaTEM and blaSHV, blaTEM and CTX-M. There was a significant association between PCR for ESBL genes and phenotypic ESBL detection (P = 0.001). There was significant detection of ESBL genes in E. coli (28%), followed by Enterobacter spp. (26%), Klebsiella spp. (24%), Serratia (14%), Pseudomonas spp. (6%) and Proteus (2%), P = 0.01. There Seventy percent of isolates positive for ESBL production had an insignificant association between MDR and PCR for ESBL genes (P = 0.23).ConclusionThe present study highlights the prevalence of ESBL activity among clinical isolates of Gram-negative bacilli isolated from hospital-acquired infections in pediatric patients. The most common gene responsible for this activity was blaTEM gee followed by blaSHV and blaCTX-M. There was a high prevalence of multiple antibiotic resistance among isolates with ESBL activity. The finding of the present study denotes the importance of screening extended beta-lactamase among Gram-negative bacilli associated with HAIs in pediatric patients.

Impact of the 4th of August Beirut explosion mass casualty incident on a university hospital microbial Flora

BackgroundFollowing the Beirut explosion, our university hospital received at least 350 casualties. Subsequently, infection control standard practices were compromised. Concerns for Multi-Drug Resistant Organisms (MDROs) infections in injured patients and a resulting hospital outbreak were raised. The objectives of the study were to compare the rate of hospital growing MDROs 6 months before and 6 months after the Beirut explosion, to identify emerging microorganisms and to evaluate the change in surgical infection prevention practices.MethodsThis is a retrospective chart review of patients with hospital acquired infections (HAI) admitted to the hospital before and after the Beirut explosion. The study was conducted between February 4, 2020 and January 4, 2021. Excluded patients were those transferred from other hospitals and those with community acquired infections. The primary outcome was to identify the rate of growing MDROs post explosion. The secondary outcomes were identifying antibiotics used for surgical prophylaxis in patients requiring surgeries and patients diagnosed with a HAI. Therefore, patients were divided in three groups. Control group included patients admitted with explosion-related injuries on that same day. Patients admitted and between February 4 and August 4 and diagnosed with HAI were compared to those admitted post August 4 with explosion-related HAI and to patients diagnosed with non-explosion-related HAI between August 4 and January 4, 2021. An estimated rate of 18-22% MDRO was needed to achieve a statistical significance with 80% power and 0.05 α. Pearson Chi square test was used to analyze the primary outcome.ResultsA total of 82 patients with 150 cultures were included in this study. Data showed an increase in the rate of MDRO after the explosion with 37.1% of the cultures taken before the explosion and 53.1% after the explosion (p = 0.05). When comparing the types of HAI in both groups, culture sites were significantly different between pre- and post-explosion patients (p = 0.013). However, both groups had similar types of microbes (p = 0.996) with an increase in candida related infections.ConclusionThese findings confirmed that the Beirut explosion impact on antimicrobial resistance was similar to combat zone incidence, where an increase in MDROs rate such as Escherichia coli (E.Coli) and Stenotrophomonas maltophilia, in addition to the increase in candida related infections.

Evaluation of the impact of COVID-19 pandemic on hospital-acquired infections in a tertiary hospital in Malaysia

BackgroundInfection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital.MethodThis is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients’ electronic medical records.ResultsThere were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19.ConclusionOur research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices.

The COVID-19 pandemic and reduced surgical site infection following cardiac surgery: time to take up the baton

Abstract Background Various hygienic measures have been reinforced or newly-adopted since the start of the COVID-19 pandemic. At the same time, studies have indicated a reduction in various types of hospital-acquired infections, including surgical site infections (SSI). Purpose This study investigated the association of the pandemic with SSI following cardiac surgeries. Method From 2014 to 2022, 26143 patients undergoing cardiac surgery were included and categorized into "pre-pandemic" (n= 22015) and "during-pandemic" (n=4128) groups. SSIs were classified into harvest-site, superficial sternal, and complex sternal infection. Logistic regression (univariate and multivariable) and inverse probability weighting (IPW) assessed the association of the pandemic with SSIs. For both analyses, various known SSI-related risk factors were taken into account as covariates. Results Among the study population, 793 SSIs occurred. The "during-pandemic" patients were significantly younger (61.87±10.58 vs. 65.64 ±11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of comorbidities/risk factors (expect for cigarette smoking). Total SSI rate significantly plummeted from 3.3% before COVID-19 to 1.8% afterward (P&amp;lt;0.001) (Figure 1 and 2). IPW analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted-OR: 0.59, 95% confidence interval (CI):0.45-0.78), harvest-site (adjusted-OR: 0.36, 95%CI: 0.19-0.70), and superficial sternal infection (adjusted-OR: 0.60, 95%CI: 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted-OR: 1.05, 95% CI: 0.55-2.01). Multivariable regression recapitulated these findings (Figure 2). Conclusions The COVID-19 pandemic pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. To some extent, the drop in SSIs following the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending reinforcement of and adherence to these measurements into the post-COVID-19 era to maintain the status quo.

Improving infection prevention briefing through predictive predesign: a computational approach to architectural programming by evaluating socioecological risk factors

ABSTRACT This research aimed to use a computational approach to aid infection prevention strategies during the predesign phase of healthcare environment planning. The objective of this study was to decompose and analyze health system catchment area ‘outside design basis factors’ such as demographic, public health, and environmental characteristics that may contribute to infection causing pathogen spread in healthcare environments using state of Florida data as a context for analysis. Supervised Machine Learning methodologies were used to determine relationships between Socioecological System (SES) factors and observed incidence rates of specific Hospital Acquired Infections (HAI). Results of the analysis suggest that relevant regional population SES factors, when included as independent variables, can forecast the potential co-occurrence of specific types of HAI in regional health system service areas. Outcomes of the analysis suggest that demographic and regional characteristics are significantly related to the predictive incidence of Antimicrobial-resistant infections in healthcare settings in Florida Agency for Healthcare Administration (ACHA) regions. The outcomes of this research suggest the benefit of using SES computational modeling for decision-making in health system Architectural Programming and predesign. This process allows for manifesting meaningful patterns by applying quantitative methods to analyze patient population characteristics that may influence the prevalence of pathogen spread within the interior environments of healthcare inpatient settings. This information contributes to a deeper understanding of context-specific priorities for operationalizing human-centered Infection Prevention through Design (PtD) infrastructure and planning.

Characteristics of Quinolone Resistance in Multidrug-Resistant Acinetobacter baumannii Strains Isolated from General Hospitals

Background: Acinetobacter baumannii is the causative agent in various types of hospital-acquired infections, including respiratory, urinary tract, and wound infections. Objectives: This study investigated the primary mechanisms underlying quinolone resistance in A. baumannii strains, isolated from samples collected from general hospitals. Methods: Ninety-eight strains of A. baumannii were isolated from clinical specimens from general hospitals from 2017 – 2019. Antimicrobial susceptibility, efflux pump inhibition tests, multilocus sequence typing (MLST), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analyses were conducted on 64 strains, and the blaoxa-51-like gene sequence was detected. Results: In the antimicrobial susceptibility test, 78.1% (n = 50) of the strains exhibited resistance to ciprofloxacin, a quinolone antibiotic, and 57.8% (n = 37) strains were multidrug resistant (MDR). For 18 strains, the minimum inhibitory concentration of ciprofloxacin reduced in presence of an efflux pump inhibitor. Sequence analysis revealed that in 50 strains of A. baumannii, the codon for serine (TCA) in gyrA was replaced by that for leucine (TTA), whereas in 43 strains, the codon for serine (TCG) in parC was replaced by that for leucine (TTG). Multilocus sequence typing analysis confirmed 18 sequence types, and allelic number analysis showed the presence of nine gyrB alleles, with gyrB3 showing the highest frequency (62.5%). Conclusions: The findings of this study will be useful in improving treatment efficiency and preventing the spread of A. baumannii (both MDR and non-MDR strains).

Microbiological Profile of Nosocomial Infections Due to Gram Negative Lactose Non-fermentative Bacteria in A Teaching Hospital of Gujarat

Hospital acquired infections caused by Non-fermentative gram-negative bacteria (NFGNB) have features that are of specific concern, detection of which is helpful for prevention and for better quality of healthcare in hospital premises. Present study was conducted to find out the nosocomial infections caused by NFGNB and its sensitivity pattern. Present microbiological study was carried out at C. U. Shah Medical College. Clinical samples which were included in this study were in accordance with inclusion criteria laid down in the research protocol, which were obtained during January 2018 to June 2020.Samples were collected and processed with the help of automated identification and antimicrobial susceptibility testing instrument i.e. Vitek – 2 as per standard guidelines. Statistical analysis was done by Microsoft Excel. Total 385 were classified as NFGNB from 1000 confirmed isolates causing Hospital acquired infection (HAI). Respiratory site infection was most common type of HAI i.e. 48%. While most common isolate was Pseudomonas sp.i.e. 42% followed by Acinetobacter baumannii i.e. 31%. Medicine ward showed maximum isolates i.e. 33%, followed by Surgery ward i.e. 23%. Maximum NFGNB isolates encountered from sputum sample i.e. 25% while blood shows only 6%. Trimethoprim/sulfamethoxazole and ciprofloxacinwere disclosedmaximum resistant. This study reports 385NFGNB isolates causing HAI. Such alarming resistance among NFGNB spreading the threat in medical care and epidemiology as they act as nosocomial pathogen. These isolated pathogens being the major cause of illness particularly in hospitalized patients.

Association of Electronic Health Record Use Above Meaningful Use Thresholds With Hospital Quality and Safety Outcomes

By 2018, Medicare spent more than $30 billion to incentivize the adoption of electronic health records (EHRs), based partially on the belief that EHRs would improve health care quality and safety. In a time when most hospitals are well past minimum meaningful use (MU) requirements, examining whether EHR implementation beyond the minimum threshold is associated with increased quality and safety may guide the future focus of EHR development and incentive structures. To determine whether EHR implementation above MU performance thresholds is associated with changes in hospital patient satisfaction, efficiency, and safety. This quantile regression analysis of cross-sectional data used publicly available data sets from 2362 acute care hospitals in the United States participating in both the MU and Hospital Value-Based Purchasing (HVBP) programs from January 1 to December 31, 2016. Data were analyzed from August 1, 2019, to May 22, 2020. Seven MU program performance measures, including medication and laboratory orders placed through the EHR, online health information availability and access rates, medication reconciliation through the EHR, patient-specific educational resources, and electronic health information exchange. The HVBP outcomes included patient satisfaction survey dimensions, Medicare spending per beneficiary, and 5 types of hospital-acquired infections. Among the 2362 participating hospitals, mixed associations were found between MU measures and HVBP outcomes, all varying by outcome quantile and in some cases by interaction with EHR vendor. Computerized provider order entry (CPOE) for laboratory orders was associated with decreased ratings of every patient satisfaction outcome at middle quantiles (communication with nurses: β = -0.33 [P = .04]; communication with physicians: β = -0.50 [P < .001]; responsiveness of hospital staff: β = -0.57 [P = .03]; care transition performance: β = -0.66 [P < .001]; communication about medicines: β = -0.52 [P = .002]; cleanliness and quietness: β = -0.58 [P = .007]; discharge information: β = -0.48 [P < .001]; and overall rating: β = -0.95 [P < .001]). However, at middle quantiles, CPOE for medication orders was associated with increased ratings for communication with physicians (τ = 0.5; β = 0.54; P = .009), care transition (τ = 0.5; β = 1.24; P < .001), discharge information (τ = 0.5; β = 0.41; P = .01), and overall hospital ratings (τ = 0.5; β = 0.97; P = .02). At high quantiles, electronic health information exchange was associated with improved ratings of communication with nurses (τ = 0.9; β = 0.23; P = .03). Medication reconciliation had positive associations with increased communication with nursing at low quantiles (τ = 0.1; β = 0.60; P < .001), increased discharge information at middle quantiles (τ = 0.5; β = 0.28; P = .03), and responsiveness of hospital staff at middle (τ = 0.5; β = 0.77; P = .001) and high (τ = 0.9; β = 0.84; P = .001) quantiles. Patients accessing their health information online was not associated with any outcomes. Increased use of patient-specific educational resources identified through the EHR was associated with increased ratings of communication with physicians at high quantiles (τ = 0.9; β = 0.20; P = .02) and with decreased spending at low-spending hospitals (τ = 0.1; β = -0.40; P = .008). Increasing EHR implementation, as measured by MU criteria, was not straightforwardly associated with increased HVBP measures of patient satisfaction, spending, and safety in this study. These results call for a critical evaluation of the criteria by which EHR implementation is measured and increased attention to how different EHR products may lead to differential outcomes.

Management of hospital-acquired infections among patients hospitalized at Zewditu memorial hospital, Addis Ababa, Ethiopia: A prospective cross-sectional study.

BackgroundHospital-Acquired Infections (HAIs) are acquired when the patient is hospitalized for more than 48 hours. In Ethiopia data are scarce in management appropriateness of HAIs. Hence, this study was aimed to assess the prevalence and management of HAIs among patients admitted at Zewditu Memorial Hospital.MethodA facility based prospective cross sectional study was conducted from March 1, 2017 to August 30, 2017. The sample was proportionally allocated among (medical, pediatrics, gynecology and obstetrics and surgical) wards, based on patient flow. Data were collected using data abstraction format and supplemented by key informant interview. Interview was made on eight physicians and four microbiologists who have been working in the wards during study period. Management appropriateness was assessed using Infectious Disease Society of America guideline and experts opinion (Infectious disease specialist). A multivariate logistic regression was used to identify factors associated with HAIs.ResultThe prevalence of HAIs was 19.8%. Surgical Site Infection (SSI) and pneumonia accounted for 20 (24.7%) of the infections. Culture and sensitivity was done for 24 (29.6%) patients. Of the 81 patients who developed HAIs, 54 (66.67%) of them were treated inappropriately. Physicians’ response for this variation was information gap, forgetfulness, affordability and availability issue of first line medications. Younger age (AOR (Adjusted odds ratio) = 8.53, 95% CI: 2.67–27.30); male gender (AOR = 2.06, 95% CI: 1.01–4.22); longer hospital stay (AOR = 0.17, 95% CI: 0.06–0.51); and previous hospital admission (AOR = 3.22, 95% CI: 1.76–5.89); were independent predictors of HAIs.ConclusionPrevalence of HAIs and inappropriate management were substantially high in this study. Pneumonia and SSI were the common types of HAIs. Locally conformable guidelines could help to correct such problems.

Outcomes Related to Intravenous Fluid Administration in Sickle Cell Patients during Vaso-Occlusive Crisis

Introduction Fluid replacement therapy is often used as a primary treatment modality in vaso-occlusive crises for sickle cell disease. However, aggressive intravenous fluid administration can lead to complications, including pulmonary vascular congestion and acute chest syndrome. Data is limited on the safety, efficacy, and variability of fluid replacement therapy in this context. This study describes the extent of and outcomes associated with receiving fluid replacement therapy for vaso-occlusive episodes at a single institution. Methods We performed a retrospective analysis on 157 unique patient encounters from 49 sickle cell patients hospitalized with a vaso-occlusive episode at the University of California Los Angeles between 2013 and 2017. Fluid administration measurements were derived from documented intakes (both oral and intravenous fluids) in the medical record. The association between fluid administration and outcomes were analyzed using chi-squared and Fisher's exact tests followed by univariate and multivariate logistic regression. Results The mean age of the patient cohort at the time of hospital admission was 36.0 years (Std 7.9). Most encounters were from patients with hemoglobin SS disease (147 encounters, 93.6%). Twenty-two of the encounters (14.0%) were from patients on hemodialysis prior to admission. The majority of admissions were to an observation unit (99 encounters, 63.1%), whereas 53 admissions (33.8%) were to an inpatient service and 5 encounters (3.2%) were solely in the emergency room. The median length of hospital stay was 4 days (IQR 2-7). The mean total amount of intravenous fluid administered during the hospitalization was 7.4 L (Std 9.6). The mean total amount of fluid intake including intravenous fluids, blood transfusions, and oral fluids was 6.5 L (Std 10.0) (Table 1). The most common clinical outcome that occurred during the hospitalizations was a new oxygen requirement in 28 encounters (17.8%). Other clinical outcomes noted were acute chest syndrome (12 encounters, 7.6%), an aspiration event (2 encounters, 1.3%), other type of hospital-acquired infection (2 encounters, 1.3%, which included Clostridium difficile colitis and Staphylococcus epidermidis bacteremia), acute kidney injury (3 encounters, 1.9%), and intensive care unit transfer (3 encounters, 1.9%). There was a significant association between receiving more than 3 L of intravenous fluid and the development of any of the adverse events listed (p = 0.029) but no association between fluid administration and each individual adverse event (Table 2). Logistic regression analysis confirmed that patients with higher fluid intake were more likely to develop any adverse event (Table 3, Table 4). In multivariable analysis, each component including oral intake during hospitalization (p = 0.041, OR 1.065, 95% CI 1.003-1.132), intravenous fluid administered in the first 24 hours (p = 0.001, OR 1.899, 95% CI 1.319-2.733), total amount of intravenous fluid administered (p = 0.005, OR 1.081, 95% CI 1.023-1.141), and total amount of fluid intake (p = 0.040, OR 1.065, 95% CI 1.003-1.132) all revealed a statistically significant association between higher fluid administration and the development of any adverse event. Other factors found to be significantly associated with any adverse event were dialysis dependence prior to admission (p = 0.000, OR 8.686, 95% CI 2.881-26.190) and admission to inpatient service versus emergency room or observation unit (p = 0.018, OR 2.758, 95% CI 1.186-6.416). Conclusions There was a statistically significant association between higher fluid intake (both oral and intravenous) and the development of any adverse event during hospitalization for sickle cell vaso-occlusive crisis including a new oxygen requirement, acute chest syndrome, aspiration event, other hospital-acquired infection, acute kidney injury, and intensive care unit transfer. While fluid administration may theoretically slow the sickling process, our data suggests that excessive fluid administration during a vaso-occlusive episode may be harmful. Further study is necessary to further elucidate the relationships between exogenous fluids, vaso-occlusion, and adverse events in sickle cell patients. *Equal contribution from Daria Gaut and Jennifer Jones for this work. Disclosures No relevant conflicts of interest to declare.

Molecular characterization, serotypes and phenotypic and genotypic evaluation of antibiotic resistance of the Klebsiella pneumoniae strains isolated from different types of hospital-acquired infections.

Purpose: Virulent and resistant Klebsiella pneumoniae strains are considered as one of the most significant causes of hospital-acquired infections. The present investigation was done to study the distribution of virulence factors, capsule serotypes and phenotypic and genotypic evaluation of antibiotic resistance of the K. pneumoniae strains isolated from hospital-acquired infections.Patients Materials and methods: Two hundred and sixty different types of hospital-acquired infections were collected and cultured. Antibiotic resistance pattern of K. pneumoniae isolates and their molecular characterization were studied using disk diffusion and PCR, respectively.Results: One hundred and fifty out of 260 (44.22%) hospital-acquired infections harbored K. pneumoniae. Urine samples (63.75%) had the highest prevalence of K. pneumoniae, while wound (33.33%) had the lowest. K. pneumoniae strains harbored the highest prevalence of resistance against ampicillin (100%), cefuroxime (100%), amoxicillin/clavulanic acid (95.65%) and ceftazidime (95.52%). FimH-1 (93.04%), traT (92.17%), mrkD (84.34%), and entB (80.86%) were the most commonly detected virulence genes. AcrAB (96.52%) and tolC (85.21%) were the most commonly detected antibiotic resistance genes. Prevalence of ompK35 and ompK36 virulence genes were 75.65% and 79.13%, respectively. Prevalence of K1 and K2-positive serotypes were 27.82% and 6.96%, respectively.Conclusions: High prevalence of resistance against several types of antibiotics and simultaneous presence of some virulence factors and multi-drug resistance genes pose an important public health issue.

SURVEILLANCE OF HOSPITAL ACQUIRED INFECTIONS IN A MEDICAL INTENSIVE CARE UNIT

Introduction: Hospitalized patients are at risk to develop sepsis from infections due to colonized intravenous lines, surgical wounds, and/or bedsores. Multidrug resistant Acinetobacter commonly colonizes patients in the intensive care unit (ICU) and can cause serious infections. The APACHE II severity score has shown a good calibration and discriminatory value across a wide range of disease processes, and remains the most commonly used international severity scoring system worldwide. Aim of work: to evaluate the patients having different types of hospital-acquired infections in the medical ICU, especially infections caused by multidrug resistant organisms (as Acinetobacter spp.), in a specific period of time, applying the APACHE II scoring system of severity. Materials and methods: The study included 148 patients from the medical ICU in Cairo University Hospital. Routine laboratory investigations were done together with chest X-rays, ECG, abdominal ultrasound and bacterial cultures,and APACHE II scores were calculated for all patients. Results: We found that the mostcommon cause of death in ICU patients in our study was sepsis (48% of all deaths). Most frequently reported isolated organisms were Klebsiella spp. (24.4%), E-coli (21.8%), and Acinetobacter spp. (17.1%). There was a meaningful association between observed mortality rates in patients in ICU and their APACHE II score evaluation, so APACHEII score had a strong positive correlation with actual mortality rate. Conclusion: Sepsis was the cause of high mortality rates in medical ICU, and the most important step in the prevention and control of infection in the ICU is continuous application of effective infection control measures.

A Serendipitous Mutation Reveals the Severe Virulence Defect of a Klebsiella pneumoniae fepB Mutant.

Klebsiella pneumoniae is considered a significant public health threat because of the emergence of multidrug-resistant strains and the challenge associated with treating life-threatening infections. Capsule, siderophores, and adhesins have been implicated as virulence determinants of K.pneumoniae, yet we lack a clear understanding of how this pathogen causes disease. In a previous screen for virulence genes, we identified a potential new virulence locus and constructed a mutant (smr) with this locus deleted. In this study, we characterize the smr mutant and show that this mutation renders K.pneumoniae avirulent in a pneumonia model of infection. The smr mutant was expected to have a deletion of three genes, but subsequent genome sequencing indicated that a much larger deletion had occurred. Further analysis of the deleted region indicated that the virulence defect of the smr mutant could be attributed to the loss of FepB, a periplasmic protein required for import of the siderophore enterobactin. Interestingly, a ΔfepB mutant was more attenuated than a mutant unable to synthesize enterobactin, suggesting that additional processes are affected. As FepB is highly conserved among the members of the family Enterobacteriaceae, therapeutic targeting of FepB may be useful for the treatment of Klebsiella and other bacterial infections. IMPORTANCE In addition to having a reputation as the causative agent of several types of hospital-acquired infections, Klebsiella pneumoniae has gained widespread attention as a pathogen with a propensity for acquiring antibiotic resistance. It is capable of causing a range of infections, including urinary tract infections, pneumonia, and sepsis. Because of the rapid emergence of carbapenem resistance among Klebsiella strains, there is a dire need for a better understanding of virulence mechanisms and identification of new drug targets. Here, we identify the periplasmic transporter FepB as one such potential target.

Antimicrobial Resistance Surveillance among Intensive Care Units of a Tertiary Care Hospital in Southern India.

Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them. The record based retrospective data of culture reports of the patients admitted to all the ICUs of JIPMER during the period from April 2015 to March 2016 were collected. A total of 3,090 isolates were obtained from the clinical specimens of 1,244 patients. Data on various factors like demographic characters, type of ICU, infecting organism, site of infection, type of HAI's and AMR including co-resistance were collected and analysed using Microsoft Excel. Most common culture positive clinical specimen received was tracheal aspirate (29.9%) followed by exudate (22.7%). Acinetobacter spp from tracheal aspirate and Pseudomonas spp from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 22.2% infections were HAIs, out of which pneumonia (6.24%) was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli (GNB) was Multi Drug Resistant (MDR) i.e., resistant to three or more class of antibiotics such as cephalosporins, carbapenems, aminoglycosides, tetracyclines and fluoroquinolones. The prevalence of Methicillin- resistant Staphylococcus aureus (MRSA) and Vancomycin- resistant Enterococci (VRE) were found to be 40.6% and 11.9% respectively. The increasing trend AMR among the hospital acquired pathogens such as MDR-GNBs, MRSA and VRE pose a great threat to HCWs as well as to the other critically ill patients of the ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. It also guides the clinicians to choose appropriate empirical therapy and assist escalation and de-escalation wherever possible. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial use.

Utilizing a Central Line and Foley Catheter Daily Indicator to Decrease Central-line Associated Blood Stream and Catheter-associated Urinary Tract Infections

Central line–associated blood stream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are two types of hospital-acquired infections (HAI) that greatly impact the health and lives of patients. These types of HAI increase both the length of hospital stay and the cost of hospitalization. 65% to 70% of CLABSIs may be prevented by implementing evidence-based strategies. A multi-pronged effort has been successful to reduce the incidence of CLABSI and CAUTI.

Assessing the Relative Burden of Hospital-Acquired Infections in a Network of Community Hospitals

Hospital-acquired infections (HAIs) occur commonly, cause significant harm to patients, and result in excess healthcare expenditures. The urinary tract is frequently cited as the most common site of HAI, but these estimates were extrapolated from National Nosocomial Infection Surveillance (NNIS) data from the 1990s. Updated information regarding the relative burden of specific types of HAIs would help governmental agencies and other stakeholders within the field of infection prevention to prioritize areas for research and innovation. The objective of our study was to assess the relative proportion of HAIs attributed to each of the following 5 types of infection in a network of community hospitals: catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI), ventilator-associated pneumonia (VAP), central line–associated bloodstream infection (CLABSI), and Clostridium difficile infection (CDI).We performed a retrospective cohort study using prospectively collected HAI surveillance data from hospitals participating in the Duke Infection Control Outreach Network (DICON). DICON hospital epidemiologists and liaison infection preventionists work directly with local hospital infection preventionists to provide surveillance data validation, benchmarking, and infection prevention consultation services to participating hospitals.

Prevalence of hospital-associated infections can be decreased effectively in developing countries

Hospital-acquired infections (HAI) are an important public health problem worldwide. Little information is available from African countries, but published data show that the burden of HAI is greater in Africa than in developed countries. In 2002, the World Health Organization (WHO) published guidelines for preventing HAI. To evaluate the impact of a hospital infection control programme on the prevalence of HAI among patients in a large Ugandan hospital. A one-day cross-sectional prevalence survey and a ward procedure survey were performed in Lacor Hospital in March 2010 using standardized questionnaires. All patients admitted to hospital not less than two days before the survey were eligible to participate in the prevalence survey. Modified WHO criteria for HAI were used. The ward procedure survey examined the procedures to prevent HAI. Several hospital infection control measures were subsequently implemented, in accordance with WHO infection control guidelines, starting in October 2010. The prevalence survey and ward procedure survey were repeated in October 2011. The prevalence of HAI was 34% in 2010 and 17% in 2011. The prevalence of infected patients reduced from 28% to 14%. The prevalence of HAI was lower in all age groups and for all types of HAI except urinary tract infections following the implementation of infection control activities. This study showed that HAI is an important problem in this large African hospital, and that the prevalence of HAI can be reduced effectively following the adoption of basic infection control procedures.

Assessment of Costs Associated with Hospital-Acquired Infections in a Private Tertiary Care Hospital in India

ObjectiveThis study aims to assess the costs associated with hospital-acquired infections (HAIs) in a private tertiary care hospital in northern India. MethodsThis retrospective case-control study covered four types of HAIs: urinary tract infections, ventilator-associated pneumonia, bloodstream infections, and surgical site infections. The “case” group comprised patients who had developed HAIs, whereas the “control” group had patients who had not acquired HAIs. The control group was matched with the case group on the criteria of age, diagnosis, and severity of illness. Drugs’ acquisition costs, hospital rental, consultation fees, investigation costs, and antimicrobial costs were computed for patients over a period of 1 year, and comparisons were made between both the arms of the study. The costs were also compared within the different HAIs. ResultsOf the four types of HAIs studied, the most commonly encountered infection was bloodstream infection (38%). The pathogen most frequently responsible for causing HAIs was Acinetobacter baumanii. Patients aged between 60 and 69 years were found to be more susceptible to HAIs than the patients in other age groups. Furthermore, the most common diagnosis of patients who developed HAI was head injury followed by renal failure. Drugs’ acquisition costs, rent, consultation fees, investigation costs, and antimicrobial costs were significantly higher for cases than for controls (P<0.001). Drugs’ acquisition cost was the major contributor of the extra cost, and antimicrobial drugs constituted almost half of it. ConclusionsThis study has provided evidence that the cost of drugs is a major contributor to costs of HAIs in an Indian setting. Continuous surveillance and prophylaxis is recommended for reducing HAIs.

Economic Implications of the Dynamic Relationship between Antibiotic Use and Hospital-Acquired Infections

ObjectivesThe emergence and spread of antimicrobial resistance is still an unresolved problem worldwide. Recent evidence shows correlations between the volume of broad-spectrum antibiotics used in the hospital setting and the incidence of multidrug-resistant bacteria. According to this dynamic relationship, loss of antibiotic activity can be modeled as a negative externality of antibiotic consumption. MethodsThe present study proposes to present an economic model describing the probability of antibiotic treatment failure as a function of antimicrobial use and alcohol-based hand-rub use. Furthermore, the results of recently conducted time-series analyses and cost-of-illness studies are applied to the model to determine the externalities of antibiotic consumption and alcohol-based hand-rub use with respect to the costs of hospital-acquired infections. ResultsAccording to our calculations, the consumption of third-generation cephalosporins and fluoroquinolones is associated with the highest negative externalities (€143 and €101, respectively) because their use has been shown to be associated with most types of hospital-acquired infections. In contrast, the use of alcohol-based hand-rub solution for hand disinfection is associated with a positive externality of 41 cents per single disinfection of the hands. ConclusionsThe externalities presented in this work represent a possible application of cost-of-illness data to quantify the impact of antibiotic use on antimicrobial resistance. In addition, the results indicate that most economic research on the topic is biased in assuming the overall use of antibiotics to be responsible for the spread of antimicrobial resistance.