Use Of Invasive Devices Research Articles

Bacteremias in Hemato-Oncological Pediatric Patients: Clinical and Microbiological Characteristics

Abstract Background In haemato-oncologic patients bacteremia is frequent increasing mortality rates, therefore surveillance and close follow up is essential to optimize treatment. The use of invasive devices used frequently in this population increases the incidence of infections by gram-positive microorganisms (currently gram-negative bacilli have been added). Therefore, we propose the characterization the microorganisms to identify the epidemiologic conditions, and the areas of improvement to establish improvement care strategies for this population. Methods We conducted a retrospective study at the haemato-oncologic diseases service at the National Medical Center “20 de Noviembre”. Prevalence of bacteremia in pediatric patients with cancer and neutropenia in Mexican population, which ranges from 8% to 36%, assuming that our results could be similar to higher percentage, employing a proportion formula with a study population of 65 patients. Results It was demonstrated in our population studied that in all cases of bacteremia, patients were in depth neutropenia at diagnosis. The most prevalence phase of chemotherapy was Induction phase (69.2%), with Total XV ST Jude protocol. The clinical data revealed the following frequencies in 100% of the patients: Fever (92%), Tachycardia (72%), Shivering and piloerection (65%), Elevated acute-phase reactants PCT (51%), CPR (32%), and Tachypnea (28%). Cases of Central Line-associated Bloodstream Infection (CLABSI) was reported in 86.2%, affecting individuals with vascular devices. The predominant microbiological isolate in our patients was Escherichia coli ESBL (31%), followed by Klebsiella pneumoniae (18%), and Pseudomonas aeruginosa (13.8%), Staphylococcus epidermidis (11%). Other bacteria were identified at even lower frequencies, such as Stenotrophomonas maltophilia (5%), Klebsiella oxytoca (5%), Staphylococcus aureus (3%), Serratia marcescens (3%), Enterococcus faecalis (3%), and Enterobacter cloacae (3%). The least observed in our population was the identification of Acinetobacter baumannii (2%). The different outcomes recorded in our sample were highly consistent, with a resolution rate of infection in 97% of cases and 3% of cases resulting in death attributable to bacteremia (Table 1). Conclusion The low mortality found in this study may be due to the early initiation of empirical antibiotic treatment in “golden hour”, a protocol carried out in our Center, as well as the identification of severity scales.

Emergency surgery for traumatic brain injury in geriatric patients

Objectives: Verify the sociodemographic profile of an elderly victim of trauma due to a fall who is admitted to the ICU of a public reference hospital to determine whether there are relationships between his age, comorbidities, length of stay, complications and clinical results. A retrospective analytical study with a quantitative approach was carried out between April and October 2014 in the Intensive Care Unit (ICU) of the Hospital de Base do Distrito Federal, administered by the State Department of Health of the Federal District, DF. Using the TrakCare® computerized medical record, sociodemographic data were found on elderly people hospitalized between the fall of July 2012 and July 2014, including mechanisms of trauma, comorbidities, length of stay, use of invasive devices, vasoactive and sedative drugs, complications and clinical internships. Results: The sample was made up of 52 elderly people, the majority of whom were men and the injury was a fall in height. Lung infection, septic shock, use of blood products and acute renal failure were the main complications. Despite the high mortality observed in the study, the majority of elderly people survived the traumatic event. Male sex, traumatic brain injury (TBI), pulmonary septic shock and dialysis were the main causes of mortality. Conclusion: Falling in height, fractures and severe TBI were extremely common, and most patients had more than one complication during hospitalization. No significant difference was found between age and mortality.

Multimodal surveillance of Care-related infections by Alert microorganisms in Ospedali Riuniti di Vittoria e Comiso ASP Ragusa

Background: monitoring the incidence and surveillance of alert microorganism infections detected in inpatients of the Ospedali Riuniti di Vittoria and Comiso in 2023. Objectives: early identification and implementation of shared pathways aimed at prevention and control of care-related infections. the spread of colonization and infections; promotion and implementation of effective risk assessment programs. Methods: a multicenter study was conducted on 79 patients with infections with Alert microorganisms, in ordinary hospitalization, day service, and day hospital, of the "R. Guzzardi" hospitals of Vittoria and "R. Margherita" of Comiso. Sample stratification was performed according to gender, females 51.9% and males 48%, and the four age groups: 18-40 (4.8%), 41-60 (9.5%), 61-80 (45.2%), >80 (40.5%), x̄ 51.90. The calculated mortality rate was n.16 (20.25%). The types, number and frequency of use of invasive devices were described (n.68, 86%, including 64.5% urinary bladder catheter). Results: the operating unit in which there is significant positivity to Alert infections is the UOC of Internal Medicine (40.5%), followed by RSA (16.46%) and ICU (8.86%), table1. The most representative Alert is Acinetobacter baumannii (24.05%), other microorganisms isolated are Klebsiella P. (22.78%), Escherichia c. (21.52%), and Staphylococcus A. (18.99%). In addition, a significant correlation between microorganisms and sample type is confirmed (p=0.019). Inpatient days are proportional to the care complexity index (p=0.0021). In addition, there is no correlation between inpatient days and microorganism type. Conclusions: the reduction of inpatient time and the move toward territorial continuity of care will promote the community spread of selected antibiotic-resistant bacteria in the hospital. Surveillance measures include early identification of patients positive to Alerts, active follow-up of colonized patients, isolation of colonized/infected patients, and adoption of contact precautions in the management of such patients.

High rates of nosocomial infections and antimicrobial resistance in a Moroccan pediatric intensive care unit: A cause for alarm

ObjectivesThis study aimed to determine the epidemiology of nosocomial infections (NIs) in a pediatric intensive care unit and define the risk factors associated with NIs. MethodsWe performed a prospective descriptive and analytical monocentric study on the incidence of NIs in the pediatric intensive care unit between July 2021 and May 2022. Children with NIs (cases) were compared with matched controls without NIs. ResultsWe analyzed 396 patients; 102 had NIs. The global incidence of NIs is 44.7% (incidence density of 10.6 per 1000 days of hospitalization). The incidence densities of blood stream infection, pneumonia associated with mechanical ventilation, and urinary tract infection were 10 per 1000 days of central venous catheter use, 7.2 per 1000 of mechanical ventilation use, and 11.1 per 1000 days urinary catheter use. The overall microbiological profile of NIs is dominated by gram-negative bacilli in 78%, followed by gram-positive cocci in 13%. The most common agents in sepsis were Klebsiella pneumoniae. In pneumonias, Acinetobacter Baumanii was the most common cause, and, in urinary tract infection, the most frequent agents were gram-negative bacteria, especially Escherichia coli (33.3%). The presence of NIs was associated with a long period of hospitalization, use of invasive devices (central venous catheter, mechanical ventilation, and bladder catheters), and use of antibiotics. ConclusionsThe incidence of NIs acquired in this unit was high and was associated with extrinsic and intrinsic factors.

BACTERIOLOGICAL PROFILE AND ANTIBIOGRAM OF GRAM-NEGATIVE BACILLI ISOLATED FROM ENDOTRACHEAL TUBE SECRETIONS AND TRACHEAL ASPIRATES FROM PATIENTS ON MECHANICAL VENTILATION: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

Objective: Nosocomial infections have become a serious threat to mortality and morbidity among hospitalized patients. Major risk factor among critically ill patients is excessive use of invasive devices like Endotracheal tube (ET) and tracheal intubation. The development of biofilm and their subsequent dislodgement aids in lung colonization and may cause Ventilator-associated pneumonia (VAP) [1]. Methods: Present study was conducted on ET tube tips and Tracheal aspirates received in microbiological laboratory from various ICU’s (Medical, surgical and pediatric) in Andhra Medical College, Visakhapatnam over a period of one year from September 2022 to August 2023. A total of 116 samples were processed according to standard protocols and Antibiotic Susceptible Testing (AST) was performed by Kirby-Bauer disc diffusion method on Mueller-Hinton agar as per CLSI guidelines. Results: In total, 116 samples were processed. ET tube tips were 76/116 and tracheal aspirates were 40/116, with males (69/116) outnumbered females (47/116). Out of a total of 116 samples, 72 (62%) were culture-positive and 44 (38%) were sterile. Acinetobacter spp. was the most common pathogen among 72 culture positives (31/72, 43%), followed by Klebsiella spp. (20/72, 28%), Pseudomonas spp. (13/72, 18%) and Escherichia coli (8/72, 11%). A total of 11 (11/72, 15%) GNB were found as multi-drug resistant. The multi-drug resistant GNB isolated were Acinetobacter (6/72), Klebsiella (3/72) and Pseudomonas (2/72). Meropenem is the most susceptible antibiotic, followed by Piperacillin-Tazobactam. Conclusion: It was concluded from this study that most commonly isolated pathogen was Acinetobacter spp. Most of these isolates were sensitive to Carbapenem and BLBLI combination drugs. Microbial persistence and impaired response to the treatment were more frequent, when multi-drug resistant organisms were present. Hence a local combined antibiotic approach, based on bacteriological profile and AST is essential to initiate empirical therapy which will minimize the bacterial colonization and prevent the incidences of VAP.

Immunosuppression at ICU admission is not associated with a higher incidence of ICU-acquired bacterial bloodstream infections: the COCONUT study

BackgroundImmunosuppression at intensive care unit (ICU) admission has been associated with a higher incidence of ICU-acquired infections, some of them related to opportunistic pathogens. However, the association of immunosuppression with the incidence, microbiology and outcomes of ICU-acquired bacterial bloodstream infections (BSI) has not been thoroughly investigated.MethodsRetrospective single-centered cohort study in France. All adult patients hospitalized in the ICU of Lille University-affiliated hospital for > 48 h between January 1st and December 31st, 2020, were included, regardless of their immune status. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, hematopoietic stem cell and solid organ transplants, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic immune deficiency. The primary objective was to compare the 28-day cumulative incidence of ICU-acquired bacterial BSI between immunocompromised and non-immunocompromised patients. Secondary objectives were to assess the microbiology and outcomes of ICU-acquired bacterial BSI in the two groups.ResultsA total of 1313 patients (66.9% males, median age 62 years) were included. Among them, 271 (20.6%) were immunocompromised at ICU admission. Severity scores at admission, the use of invasive devices and antibiotic exposure during ICU stay were comparable between groups. Both prior to and after adjustment for pre‐specified baseline confounders, the 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between immunocompromised and non-immunocompromised patients. The distribution of bacteria was comparable between groups, with a majority of Gram-negative bacilli (~ 64.1%). The proportion of multidrug-resistant bacteria was also similar between groups. Occurrence of ICU-acquired bacterial BSI was associated with a longer ICU length-of-stay and a longer duration of invasive mechanical ventilation, with no significant association with mortality. Immune status did not modify the association between occurrence of ICU-acquired bacterial BSI and these outcomes.ConclusionThe 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between patients with and without immunosuppression at ICU admission.

Antibiofilm Strategies in Neonatal and Pediatric Infections.

Biofilm-related infections pose significant challenges in neonatal and pediatric care, contributing to increased morbidity and mortality rates. These complex microbial communities, comprising bacteria and fungi, exhibit resilience against antibiotics and host immune responses. Bacterial species such as Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis commonly form biofilms on medical devices, exacerbating infection risks. Neonates and children, particularly those in intensive care units, are highly susceptible to biofilm-associated infections due to the prolonged use of invasive devices, such as central lines and endotracheal tubes. Enteral feeding tubes, crucial for neonatal nutritional support, also serve as potential sites for biofilm formation, contributing to recurrent microbial contamination. Moreover, Candida species, including Candida pelliculosa, present emerging challenges in neonatal care, with multi-drug resistant strains posing treatment complexities. Current antimicrobial therapies, while important in managing infections, often fall short in eradicating biofilms, necessitating alternative strategies. The aim of this review is to summarize current knowledge regarding antibiofilm strategies in neonates and in children. Novel approaches focusing on biofilm inhibition and dispersal show promise, including surface modifications, matrix-degrading enzymes, and quorum-sensing inhibitors. Prudent use of medical devices and exploration of innovative antibiofilm therapies are imperative in mitigating neonatal and pediatric biofilm infections.

Neonatal Osteomyelitis.

Osteomyelitis is a serious and potentially life-threatening condition affecting the skeletal system of newborns. The condition is relatively rare in neonates but occurs at higher rates in high-risk pregnancies, in preterm infants, and with the use of invasive devices. As a result of the anatomy and immature immune system of newborns, neonates differ in presentation, diagnosis, and management of osteomyelitis compared to patients of other age groups. An understanding of these differences will assist clinicians in the prompt diagnosis and management of this neonatal infection and lead to improved long-term outcomes.

Overview of Healthcare-Related Infections in Intensive Care Units of a public hospital

Introduction: Healthcare-Associated Infections are illnesses acquired after the patient's admission to the hospital unit and which manifest themselves during hospitalization or after discharge. Aim: To analyze the panorama of health-related infections in patients admitted to intensive care units. Outlining: Cross-sectional, retrospective study, collected from the Hospital Infection Control Commission database in a public hospital from July to December 2022. Crude and adjusted odds ratios were calculated using logistic regressions. The study followed the ethical and legal precepts of resolution 466/2012. Results: There was a predominance of males and those aged over 60 years. The main clinical problems were co infection with COVID-19 and co-infection with HIV. Regarding previous conditions, Systemic Arterial Hypertension stood out. When analyzing the etiological agents, the presence of Klebsiella pneumoniae showed a marginally significant association with an increase in the chances of death. Implications: The use of invasive devices, prolonged hospital stay and other factors such as age, associated comorbidities, were predictors of mortality among patients, as well as risk factors for the development of Klebsiella Pneumoniae Carbapenemase infection.

Comparison of The Effect of Candida Score and Candida Colonization Index on Decrease in Candidemia Incidence in Our Intensive Care Unit

Aim: Since candidemia is an important cause of mortality and morbidity in hospitals, especially in intensive care units (ICU), those hospitalized in the ICU; In patients with risk factors such as invasive device use and undergoing abdominal surgery, early empirical antifungal therapy is recommended to reduce mortality according to the results of candida score (CS) and candida colonization index (CCI). In this study, the data of the patients who were followed up in the ICU, who were started on empirical treatment according to KS and CCI, were evaluated and their effects on the incidence of candidemia were analyzed. Method: Cultures taken from 100 patients hospitalized in the intensive care unit where adult patients were followed between 01.06.2018 and 01.08.2021 were examined. While investigating the colonization index of each patient, swab samples were taken once during the hospitalization from five main sites: mouth, nose, skin, perineum, and catheter. Samples taken with sterile swabs were inoculated on Sabouraud dextrose agar (SDA) plates and the plates were incubated at 35°C for 48 hours. The yeast colonies formed were defined according to their microscopic appearance and biochemical properties. CCI and CS of the patients were evaluated and fluconazole prophylaxis was started in patients with KS ≥3 or CCI ≥0.5. Results: A total of 500 culture samples from 100 non-neutropenic adult patients were analyzed (Mean of 5 cultures/patient). No growth was detected in any of the samples in 32 (32 %) of 100 patients, and growth was detected in at least one of the samples taken from 68 patients (68 %). Reproduction was detected from a total of 118 samples. Of the yeasts, 104 were identified as Candida albicans, 10 as Candida glabrata and 4 as Candida inconspicua. CS≥ 3 and CCI ≥0.5 in 11 (11%) patients, and CS≥3, CCI

Factors associated with delirium in a real-world acute-care setting: analysis considering the interdependence of clinical variables with the frailty syndrome

Key summary pointsAimThis study investigated factors associated with delirium in an acute-care setting, considering the interdependency of several clinical parameters with the frailty syndrome.FindingsIn acute care, delirium was mainly present in participants with at least one among age > 85 years old, Clinical Frailty Scale > 4, and use of invasive devices. At the individual level, dementia, other psychiatric illnesses and use of antipsychotics were the greatest risk factors for delirium.MessageThe evaluation of a limited number of clinical parameters, including frailty, can help clinicians identify older patients at high risk of delirium in acute-care wards with a high level of accuracy.

Skin lesions associated with invasive devices in highly complex neonatal and pediatric patients

The skin is the largest organ of the human body. It has three layers: epidermis, dermis and hypodermis. The epidermis performs multiple functions in the body, standing out as a defensive barrier and internal integrity in addition to containing the evasion of moisture, and exogenous substances. Injury is by definition any interruption in the continuity of the skin regardless of its extent and may be chronic or acute. A newborn's skin is delicate and vulnerable, and the use of invasive devices in highly complex care can negatively affect its integrity. This review study addressed data from Brazilian research on newborn skin in intensive hospital treatment units. The studies evaluated were obtained from the SciELO, Medline and Lilacs, Google Scholar and Elsevier databases. The inclusion criteria were articles, monographs, dissertations and theses published in the period between 2018 and 2023, in Portuguese with a pre-established theme, and the exclusion criteria were articles, monographs, dissertations and repeated theses, incomplete manuscripts and with unauthorized access free of charge. As results, 3 categories were obtained: Category 1 – Main causes of skin lesions in newborns and highly complex children. Category 2- Prevention measures in newborns and highly complex children with skin lesions. Category 3- Highly complex skin care strategies for newborns and children. It is evident that due to the high susceptibility of newborns and children to develop highly complex skin lesions, it requires greater attention from the nursing team. Early detection of the risk of skin lesions and the use of prophylaxis enable a better quality of life for newborns hospitalized in high complexity, avoiding and minimizing skin lesions caused by the care provided.

Efficacy and Experience of Bacteriophages in Biofilm-Related Infections.

Bacterial infection has always accompanied human beings, causing suffering and death while also contributing to the advancement of medical science. However, the treatment of infections has become more complex in recent times. The increasing resistance of bacterial strains to antibiotics has diminished the effectiveness of the therapeutic arsenal, making it less likely to find the appropriate empiric antibiotic option. Additionally, the development and persistence of bacterial biofilms have become more prevalent, attributed to the greater use of invasive devices that facilitate biofilm formation and the enhanced survival of chronic infection models where biofilm plays a crucial role. Bacteria within biofilms are less susceptible to antibiotics due to physical, chemical, and genetic factors. Bacteriophages, as biological weapons, can overcome both antimicrobial resistance and biofilm protection. In this review, we will analyze the scientific progress achieved in vitro to justify their clinical application. In the absence of scientific evidence, we will compile publications of clinical cases where phages have been used to treat infections related to biofilm. The scientific basis obtained in vitro and the success rate and safety observed in clinical practice should motivate the medical community to conduct clinical trials establishing a protocol for the proper use of bacteriophages.

Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis.

This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare. This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post-insertion device-associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device-associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported. This review synthesized 114 studies (30,782 devices; 1,635,649 device-days). Skin complications were reported in 40 studies, but none exclusively reported individual device-related pressure injuries. Mechanical dysfunctions were well-reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices. This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device-related complications, particularly for understudied device types. Device-related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications. Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device-related complications. MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist. No Patient or Public Contribution.

Epidemiological indicators and predictors of lethality associated with fungal infections in a NICU: an historical series

ObjectivesFungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. MethodsThis study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. ResultsThirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). ConclusionThese findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU.

Clinical outcomes of intensive care unit patients infected with multidrug-resistant gram-negative bacteria treated with ceftazidime/avibactam and ceftolozane/tazobactam.

In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due to their high frequency of multidrug resistance associated with a scarcity of therapeutic options. However, the drugs Ceftolozane/Tazobactam (C/T) and Ceftazidime/Avibactam (C/A) are demonstrating good clinical and microbiological response in the treatment of severe nosocomial infections. Therefore, this study aims to evaluate the clinical outcome of patients with severe infections caused by Multidrug-Resistant (MDR) GNB treated with C/T and C/A. Our study evaluates a total of 131 patients who received treatment with C/T and C/A due to infections caused by MDR GNB within the period from 2018 to 2021. The main infections were urinary tract (46,6%) and respiratory (26,7%) infections. Pseudomonas aeruginosa was the prevailing agent in the sample evaluation (34.3%), followed by Klebsiella pneumoniae (30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally.

Pattern and Frequency of Nosocomial Infections in the Pediatric Intensive Care Unit at East Jeddah General Hospital, Saudi Arabia.

Background Because of the use of invasive devices and procedures in critically sick patients, patients in the pediatric intensive care unit (PICU) are particularly vulnerable to nosocomial infections. Although a significant illness may necessitate admission to the PICU, infections can also emerge after admission. Nosocomial infection is a major public health issue related to increased morbidity, death, and healthcare costs. This study aimed to determine the pattern, frequency, and outcomes of nosocomial infections among children who were admitted to the PICU. Methodology This retrospective, cross-sectional study was conducted in the pediatric population aged from one month to 14 years old who acquired infections after 48 hours of admission to the PICU at East Jeddah General Hospital, Saudi Arabia from 2021 to 2022. The data were collected from medical and laboratory records. Results A total of 51 patients developed 145 nosocomial infections. Central line-associated bloodstream infections (CLABSIs) were the most commonly reported type of nosocomial infections (28.3%). The majority of the isolated organisms (58.7%) were gram-negative, followed by fungal infections (35.1%) and gram-positive organisms (6.2%). The death rate for patients with nosocomial infections was 29.4%. Increased death rates among individuals with CLABSIs and gram-negative isolates were observed to be significantly correlated (p = 0.001). Conclusions Our findings suggest that regular surveillance systems were necessary to assess the relationship between these well-known risk variables with PICU, implying that preventing these infections through particular treatments could be cost-effective and contribute to the safety of healthcare systems.

Incidence of infections associated with the use of invasive devices in an ICU after application of the Improvement Science Method

Objective: To reduce the incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) in the intensive care unit (ICU) using the Improvement Science method. Methods: This was a single-center retrospective cohort study. A collaborative quality improvement team developed and implemented local changes to HAI-related processes and protocols. Pre-intervention, intervention, and post-intervention periods were compared. The study was conducted at the Adult ICU of a hospital in southern Brazil. Variables were analyzed using interrupted time series analysis with segmented linear regression, simple correlation, and hypothesis testing. Results: There was a reduction in the incidence density of all infections. VAP was reduced from 27.2% to 7.2% (p &lt; 0.001), CLABSI from 3.0% to 0.9% (p = 0.017), and CAUTI from 8.3% to 1.8% (p &lt; 0.001). The ICU stay was also reduced from 6.7 to 6 days (p = 0.018). Conclusion: There was an improvement in all the evaluated parameters. Ongoing monitoring of related indicators and adherence to implemented measures are essential to sustain improvements. Applying the Improvement Science methodology can reduce the incidence of HAIs in the ICU.

Assessment of Healthcare Associated Infections in a Medical Intensive Care Unit

Objective: This study was undertaken to assess the current status of healthcare associated infections (HAIs) in our institution during a 2-year period in relation to causative agents and their distribution, use and duration of invasive mechanical ventilation, and infection rate and incidence in comparison with national data.&#x0D; Methods: Patients admitted to Medical ICUs of Meram State Hospital between 1st Jan 2019 and 31st Dec 2020 wereincluded. During a 2-year period a total of 47 patients were diagnosed with HAIs based on Centers for Disease Control and Prevention (CDC) and National Nosocomial Infection Surveillance Network (NNISN) criteria.&#x0D; Results: During 6041 follow-up days for 922 patients admitted to ICU, a total of 47 HAIs cases were detected. The most common types of HAIs included healthcare-associated pneumonia in 21 patients (45.6%) and other infections of the respiratory system in 12 patients (26.1%). The most common causative agent was Acinetobacter baumannii, which was found in 27 patients (50.9%).&#x0D; Conclusion: HAIs is an unavoidable condition in ICUs owing to a number of factors such as frequent use of invasive devices, prolonged length of admission, and increased number of complications. One of the major health targets in healthcare facilities is to control an manage HAIs. Avoidance from unnecessary catheterizations, timely removal of invasive catheters, increased adherence to infection control measures, prevention of inappropriate antibiotic use, compliance with isolation procedures, and initiation of appropriate antibiotherapy based on documentation of causative organisms will significantly reduce HAIs incidence.

Monitoring the Prevalence of Antimicrobial Resistance in Companion Animals: Results from Clinical Isolates in an Italian University Veterinary Hospital

The role of companion animals in the spread of antimicrobial resistance (AMR) is still not well known. As part of a wider surveillance system, this study aimed to provide data about AMR in bacterial isolates from infections in companion animals referred to an Italian University Veterinary Hospital (VUH) from November 2020 to September 2022. A total of 940 isolates were identified with MALDI-TOF MS and subsequently the antimicrobial susceptibility test (AST) for 12 antimicrobials was performed. Urine was the most commonly submitted specimen (54.92%) and Escherichia coli was the most common bacterial species isolated (36.06%). Out of the 940 isolates, 747 (79.47%) were nonsusceptible to at least one drug (AMR), while 420 (44.68%) were considered multidrug resistant (MDR). The highest nonsusceptibility percentages were recorded for clindamycin (59.65 %), erythromycin (58.96 %), ampicillin (52.85%), and enrofloxacin (48.19%). Alarming percentages were recorded also for ceftiofur (25.51%), amoxicillin–clavulanate (22.99%), and piperacillin–tazobactam (15.85%). In multivariable risk factors analysis, previous use of invasive devices ( p &lt; 0.01 in both cases) and previous use of antimicrobials ( p &lt; 0.01 in both cases) were statistically related with higher AMR and MDR percentages. Apart from a general evaluation, the study focused on specific bacterial species (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) and specimens (blood cultures, urine from suspected healthcare-associated urinary tract infections, and surgical site infections), showing in both cases higher AMR and MDR percentages compared to average. These data highlight the urgency to further investigate AMR spread in pets and how passive surveillance systems can be effective tools to monitor AMR and to optimize antimicrobial use.