Ventilator-associated Infections Research Articles

The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation

Respiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associated infections.Aim of the study. To evaluate clinical effectiveness of the original oral care protocol in ICU patients on invasive mechanical ventilation (IMV).Materials and Methods. A multicenter, open-label, randomized, prospective, controlled study was conducted in 55 surgical ICU patients on long-term mechanical ventilation. Oral care for patients in the study group (group 1, N=30) included brushing with disposable toothbrushes and rinsing with an aqueous solution of 0.05% chlorhexidine digluconate three times daily. In the control group (group 2, N=25), patients' oral care was performed twice a day using sterile cotton swabs soaked in 0.05% aqueous chlorhexidine digluconate solution. The results were statistically processed using IBM SPSS Statistics 21. The relative risk (RR) of events was calculated with a 95% confidence interval (95% CI). The 95% CIs for event density parameters such as incidence rate (IR) and incidence rate ratio (IRR) were calculated using the exact Poisson test.Results. The incidence of ventilator-associated pneumonia (VAP) was 13.6 cases [95% CI: 4.4; 31.7] per 1,000 ventilation days in group 1 and 23.6 cases [95% CI: 7.7; 55] per 1,000 ventilation days in group 2. The incidence of VAP was 1.74 times lower [95% CI: 0.4, 7.54] in group 1 vs. group 2 (P=0.398). The identity of oral and tracheal flora on day 7 was 20% in group 1 and 50% in group 2, RR=0.4, 95% CI: 0.165–0.973, P=0.037. Serum C-reactive protein levels were significantly lower in group 1 on day 7 of ventilation compared to group 2 (P=0.04).Conclusion. The original oral care protocol, based on toothbrushing 3 times daily with a set of disposable toothbrushes and 0.05% aqueous solution of chlorhexidine digluconate, is associated with a tendency to lower VAP incidence per 1000 days of ventilation, significantly lower similarity between oral and tracheal flora, and lower serum C-reactive protein levels on day 7 of IMV. Further research on various aspects of oral care in ICU patients is needed, especially in the absence of complete clinical guidelines and clearly effective strategies for the prevention of ventilator-associated infections.

Impact of a tracheal aspirate culture diagnostic test stewardship intervention in a tertiary care PICU.

To assess the impact of a diagnostic test stewardship intervention focused on tracheal aspirate cultures. Quality improvement intervention. Tertiary care pediatric intensive care unit (PICU). Mechanically ventilated children admitted between 9/2018 and 8/2022. We developed and implemented a consensus guideline for obtaining tracheal aspirate cultures through a series of Plan-Do-Study-Act cycles. Change in culture rates and broad-spectrum antibiotic days of therapy (DOT) per 100 ventilator days were analyzed using statistical process control charts. A secondary analysis comparing the preintervention baseline (9/2018-8/2020) to the postintervention period (9/2020-8/2021) was performed using Poisson regression. The monthly tracheal aspirate culture rate prior to the COVID-19 pandemic (9/2018-3/2020) was 4.6 per 100 ventilator days. A centerline shift to 3.1 cultures per 100 ventilator days occurred in 4/2020, followed by a second shift to 2.0 cultures per 100 ventilator days in 12/2020 after guideline implementation. In our secondary analysis, the monthly tracheal aspirate culture rate decreased from 4.3 cultures preintervention (9/2018-8/2020) to 2.3 cultures per 100 ventilator days postintervention (9/2020-8/2021) (IRR 0.52, 95% CI 0.47-0.59, P < 0.01). Decreases in tracheal aspirate culture use were driven by decreases in inappropriate cultures. Treatment of ventilator-associated infections decreased from 1.0 to 0.7 antibiotic courses per 100 ventilator days (P = 0.03). There was no increase in mortality, length of stay, readmissions, or ventilator-associated pneumonia postintervention. A diagnostic test stewardship intervention was both safe and effective in reducing the rate of tracheal aspirate cultures and treatment of ventilator-associated infections in a tertiary PICU.

Murepavadin Enhances the Killing Efficacy of Ciprofloxacin against Pseudomonas aeruginosa by Inhibiting Drug Efflux.

Pseudomonas aeruginosa is a multidrug-resistant Gram-negative pathogen and one of the leading causes of ventilator-associated pneumonia and infections in patients with chronic obstructive pulmonary disease and cystic fibrosis. Murepavadin is a peptidomimetic that specifically targets outer-membrane lipopolysaccharide transport protein LptD of P. aeruginosa. In this study, we find that murepavadin enhances the bactericidal efficacy of ciprofloxacin. We further demonstrate that murepavadin increases intracellular accumulation of ciprofloxacin by suppressing drug efflux. In addition, the murepavadin-ciprofloxacin combination exhibits a synergistic bactericidal effect in an acute murine pneumonia model. In conclusion, our results identify an effective drug combination for the treatment of P. aeruginosa infections.

Intensive care unit-acquired infections more common in patients with COVID-19 than with influenza

Intensive care unit-acquired infections are complicating events in critically ill patients. In this study we analyzed the incidence, microbiological patterns, and outcome in patients with COVID-19 versus influenza in the intensive care unit (ICU). We included all adult patients treated with invasive mechanical ventilation due to (1) COVID-19 between January 2020 and March 2022, and (2) influenza between January 2015 and May 2023 at Sahlgrenska University Hospital, Sweden. Of the 480 participants included in the final analysis, 436 had COVID-19. The incidence rates of ICU-acquired infections were 31.6/1000 and 9.9/1000 ICU-days in the COVID-19 and influenza cohorts, respectively. Ventilator-associated lower respiratory tract infections were most common in both groups. In patients with COVID-19, corticosteroid treatment was associated with an increased risk of ICU-acquired infections and with higher 90-day mortality in case of infection. Furthermore, ICU-acquired infection was associated with a prolonged time in the ICU, with more difficult-to-treat gram-negative infections in late versus early ventilator-associated lower respiratory tract infections. Further research is needed to understand how the association between corticosteroid treatment and incidence and outcome of ICU-acquired infections varies across different patient categories.

Ventilator-associated respiratory infections in children on home invasive mechanical ventilation.

Ventilator-associated respiratory tract infections (VARTI) are among the most common indications for hospitalization among children with chronic respiratory failure requiring at-home ventilation. This review aims to provide an overview of the key clinical features, diagnostic approaches, and management strategies for home VARTIs while highlighting the challenges in diagnosis and management.

A prospective study on clinical profile, severity, microbiology, and outcome of patients with ventilator associated infective complications admitted in intensive care unit of a tertiary care hospital

: Mechanical ventilation epitomizes intensive care medicine. Ventilator‑associated complications are mainly Ventilator associated respiratory infections (VARI); These are a major cause of concern in the intensive care units (ICUs) worldwide, especially in developing countries. VARI includes patients with ventilator‑associated tracheobronchitis (VAT) and ventilator‑associated pneumonia (VAP).The clinical profile, severity, microbiology, and outcomes of such infections is not well described in Eastern India. The primary objective of the study was to study the risk factors, severity scoring, microbiological profile and 28 days outcome of patients admitted in intensive care unit of our hospital.Secondary objective of our study was to find out any correlation between risk factors, severity scoring, microbiological profile, and outcome of patients with VAT and VAP admitted in intensive care unit of our hospital.: This was a prospective observational study done in the ICU of a tertiary care centre in eastern India. A total 50 patients of clinically, microbiologically and/or radiologically diagnosed case of VAP and VAT were included in the study. A structured data collection proforma was prepared and data collection was done. Raw data was tabulated and analysed: 66% of our patients were male, Smoking was the commonest addiction(24%), VARI developed early with 17% on Day 3, 72% developed VARI within 5 days of ventilation. 16% had history of recent admission, Diabetes and hypertension were the commonest comorbidities. 58% of the patients developed VAP, the median SOFA score in VAP was 6 also similar in VAT. Patients with neurological diseases had the maximum number of VAT and VAP. Klebsiella pneumoniae was the commonest organism causing VAT (42%) while Acinetobacter Baumanii was commonest to cause VAP (44%). 51% of VAP patients were on volume control mode, while it was 52% of VAT patients. Most isolates are MDR pathogens with intermediate sensitivity to Polymyxin being most common (66%) 1 isolate was pan resistant. Mortality was 58% for VAP and 19% in VAT. Both Klebsiella and Acinetobacter accounts for 41% death in VAP group, in VAT group Klebsiella was commonest however no statistical significance with other organism.: Gram negative bacteria were the predominant cause of VAT and VAP, Acinetobacter and Klebsiella are the commonest organisms. Most Isolates are MDR with intermediate sensitivity to Polymyxins. Median SOFA scores were the same in both. Mortality was high in VAP group. Volume control mode was predominant mode of ventilation, Neurological causes was predominant cause that leads to ventilation and subsequent VARI.

Outcomes associated with ventilator-associated events (VAE), respiratory infections (VARI), pneumonia (VAP) and tracheobronchitis (VAT) in ventilated pediatric ICU patients: A multicentre prospective cohort study

ObjectivesAn objective categorization of respiratory infections based on outcomes is an unmet clinical need. Ventilator-associated pneumonia and tracheobronchitis remain used in clinical practice, whereas ventilator-associated events (VAE) are limited to surveillance purposes. Research methodology/designThis was a secondary analysis from a multicentre observational prospective cohort study. VAE were defined as a sustained increase in minimum Oxygen inspired fraction (FiO2) and/or Positive end-expiratory pressures (PEEP) of ≥ 0.2/2 cm H2O respectively, or an increase of 0.15 FiO2 + 1 cm H20 positive end-expiratory pressures for ≥ 1 calendar-day. Setting15 Paediatric Intensive Care Units. Main outcome measuresMechanical ventilation duration, intensive care and hospital length of stay; (LOS) and mortality. ResultsA cohort of 391 ventilated children with an age (median, [Interquartile Ranges]) of 1 year[0.2–5.3] and 7 days[5–10] of mechanical ventilation were included. Intensive care and hospital stays were 11 [7–19] and 21 [14–39] days, respectively. Mortality was 5.9 %. Fifty-eight ventilator-associated respiratory infections were documented among 57 patients: Seventeen (29.3 %) qualified as ventilator-associated pneumonia (VAP) and 41 (70.7 %) as ventilator-associated tracheobronchitis (VAT). Eight pneumonias and 16 tracheobronchitis (47 % vs 39 %,P = 0.571) required positive end-expiratory pressure or oxygen increases consistent with ventilator-associated criteria. Pneumonias did not significantly impact on outcomes when compared to tracheobronchitis. In contrast, infections (pneumonia or tracheobronchitis) following VAEs criteria were associated with > 6, 8 and 15 extra-days of ventilation (16 vs 9.5, P = 0.001), intensive care stay (23.5 vs 15; P = 0.004) and hospital stay (39 vs 24; P = 0.015), respectively. ConclusionWhen assessing ventilated children with respiratory infections, VAE apparently is associated with higher ventilator-dependency and LOS compared with pneumonia or tracheobronchitis. Implications for practiceIncorporating the modification of ventilatory settings for further categorization of the respiratory infections may facilitate therapeutic management among ventilated patients.

Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis.

This study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients. Relevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence. We identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P < 0.001), although considerable heterogeneity was observed (I2 = 71%). Conducting trial sequential analysis confirmed the finding, and the GRADE level was moderate. Subgroup analysis demonstrated that CCCP combined with subglottic secretion drainage (SSD) had a more significant effect on reducing VAP (RR = 0.39; 95% CI = 0.29-0.52; P < 0.001). The effect of CCCP on ventilator-associated respiratory infection (VARI) incidence was uncertain (RR = 0.81; 95% CI = 0.53-1.24; P = 0.34; I2 = 61%). Additionally, CCCP significantly reduced the duration of mechanical ventilation (MV) (mean difference [MD] = -2.42 days; 95% CI = -4.71-0.12; P = 0.04; I2 = 87%). Descriptive analysis showed that CCCP improved the qualified rate of cuff pressure. However, no significant differences were found in the length of intensive care unit (ICU) stay (MD = 2.42 days; 95% CI = -1.84-6.68; P = 0.27) and ICU mortality (RR = 0.86; 95% CI = 0.74-1.00; P = 0.05). Our findings suggest that the combination of CCCP and SSD can reduce the incidence of VAP and the duration of MV and maintain the stability of cuff pressure. A combination of CCCP and SSD applications is suggested for preventing VAP.

Ventilator-Associated Lower Respiratory Tract Infections and Their Association With COVID-19: A Retrospective Cohort Study in a Portuguese Intensive Treatment Unit.

Introduction Ventilator-associated pneumonia (VAP) is the most common infectious complication related to admission to an Intensive Treatment Unit (ITU). Ventilator-associated lower respiratory tract infection (VA-LRTI) is a broader diagnosis than VAP. By disregarding radiological criteria, it will include both VAP and ventilator-associated tracheobronchitis. This study,conducted in the setting of a Portuguese ITU, aims to study the incidence, microbiology and clinical outcome of VA-LRTI and its association with COVID-19. Methods A retrospective cohort study included patients admitted to a Portuguese ITU who underwent invasive mechanical ventilation (IMV) for over 48 hours between 01/01/2021 and 31/12/2021. The Hospitals in Europe Link for Infection Control through Surveillance (HELICS) criteria were applied, disregarding the radiological criteria, for the diagnosis of VA-LRTI. Results The group of patients with COVID-19 had 46.38 episodes of VA-LRTI/1000 days of ventilation, while patients without COVID-19 had 16.35 episodes/1000 days of ventilation (RR 2.78, p < 0.001). Of the 85 microorganisms isolated, 82% were gram-negative microorganisms, with species of the genus Klebsiella being the most prevalent (22.4%). There was a lower prevalence of beta-lactam-resistant organisms in patients with COVID-19 (RR 0.35, p = 0.031). The development of VA-LRTI is associated with longer times ofIMV (difference in medians 10 days, p < 0.001), but with no significant differences in mortality (RR 1.21, p = 0.14). Discussion Patients with COVID-19 seem more predisposed to developing VA-LRTI, possibly due to intrinsic characteristics of the disease. Although no increase in mortality has been demonstrated, VA-LRTI can entail important costs related to morbidity, antibiotic pressure and economic costs that must be considered.

ICU-acquired infections in immunocompromised patients.

Immunocompromised patients account for an increasing proportion of the typical intensive care unit (ICU) case-mix. Because of the increased availability of new drugs for cancer and auto-immune diseases, and improvement in the care of the most severely immunocompromised ICU patients (including those with hematologic malignancies), critically ill immunocompromised patients form a highly heterogeneous patient population. Furthermore, a large number of ICU patients with no apparent immunosuppression also harbor underlying conditions altering their immune response, or develop ICU-acquired immune deficiencies as a result of sepsis, trauma or major surgery. While infections are associated with significant morbidity and mortality in immunocompromised critically ill patients, little specific data are available on the incidence, microbiology, management and outcomes of ICU-acquired infections in this population. As a result, immunocompromised patients are usually excluded from trials and guidelines on the management of ICU-acquired infections. The most common ICU-acquired infections in immunocompromised patients are ventilator-associated lower respiratory tract infections (which include ventilator-associated pneumonia and tracheobronchitis) and bloodstream infections. Recently, several large observational studies have shed light on some of the epidemiological specificities of these infections-as well as on the dynamics of colonization and infection with multidrug-resistant bacteria-in these patients, and these will be discussed in this review. Immunocompromised patients are also at higher risk than non-immunocompromised hosts of fungal and viral infections, and the diagnostic and therapeutic management of these infections will be covered. Finally, we will suggest some important areas of future investigation.

Healthcare-Associated Infections' Characteristics Among Burn Patients and Risk Factors of Mortality: A Study Based on Data From a Tertiary Center in Iran: Nosocomial Infections Among Burn Patients.

Background: Burn patients are more likely to get healthcare-associated infections (HAIs). The current study aimed to investigate the characteristics of HAI and mortality risk factors among burn patients admitted to a tertiary center in Iran. Methods: A retrospective study was conducted in 2021 on burn patients who developed HAI after hospitalization in a tertiary center in Ahvaz, Iran. The records of patients admitted and managed between March 2019 and March 2020 were reviewed. Statistical analysis was carried out using IBM SPSS Version 26, with p < 0.05 considered statistically significant. Results: Of the 1,659 admitted patients, 395 (23.8%) developed HAI during the study period. After excluding patients with incomplete medical records and those with fungal or viral infections, 363 patients remained. The majority of these cases occurred in male patients. The most common type of HAI was burn wound infection (56.2%). Patients were mainly affected by Gram-negative bacteria, Pseudomonas aeruginosa (39.7%), while the most common Gram-positive bacteria was Staphylococcus epidermididis (9.6%). The most common antibiotic resistance among P. aeruginosa-infected patients was reported against imipenem, followed by gentamicin and ciprofloxacin; however, the mentioned organism was mainly sensitive to colistin. Gender, age, bloodstream infection (BSI), ventilator-associated infection (VAI), ICU admission, and total burned surface area (TBSA) resulted in 3.585, 1.028, 2.222, 7.469, 5.278-, and 1.031 times higher mortality rates, respectively. Conclusion: Female gender, advanced age, BSI, VAI, and ICU admission are risk factors for HAI. These findings emphasize the need for focused infection prevention and management to improve high-risk burn patient survival.

Etiology of nosocomial infections in intensive care patients in German hospitals: An analysis of trends between 2008 and 2022

PurposeData from the intensive care component of the German hospital infection surveillance system (KISS) was used to investigate the epidemiology of pathogens responsible for the most frequent device-associated infections and their development over time. MethodThe 10 most common pathogens were identified for ventilator-associated lower respiratory tract infections (VALRTI), catheter associated urinary tract infections (CAUTI), and central venous catheter associated bloodstream infections (CVC-BSI). The development over time was analyzed based on three five-year time periods: 2008–2012, 2013–2017, 2018–2022. ResultsData from 1425 ICUs were included together with 121,762 device-associated infections with 138,299 isolated pathogens. A remarkable and significant increase in the frequency of Klebsiella spp. was found for VALRTI, that was almost twice as high during 2018–2022 compared to 2008–2012. For CAUTI, there was a significant increase of all Enterobacterales with the most prominent increase in Klebsiella spp. With regard to CVC-BSI, the situation for coagulase-negative staphylococci and E. coli was relatively stable; while there was a significant increase in Enterococcus spp. and Klebsiella spp. and a decrease in S. aureus. ConclusionKnowledge about the current frequency of pathogens responsible for nosocomial infections in intensive care units is important for guiding empirical antimicrobial therapy. Data from national nosocomial infection surveillance systems can provide relevant information about the development of pathogens.

Knowledge and practices of healthcare workers in prevention and control of hospital-acquired infections in the Maternity Department at Bindura Provincial Hospital, Zimbabwe

Infections acquired in hospitals are the most frequent negative consequences of the healthcare delivery system, which affects both developed and developing nations. Among hospitalized patients and healthcare professionals, they are among the top causes of mortality and morbidity. Therefore, healthcare professionals are crucial in preventing and controlling hospital-acquired illnesses and safeguarding patients. The purpose of this study was to determine the knowledge and practices of healthcare workers (HCWs) in the prevention and control of hospital-acquired infections (HAIs) in the Maternity Department at Bindura Provincial Hospital. A cross-sectional study design was used to collect data from 46 participants using a self-administered questionnaire. Of which, 54.3% had 2 to 5 years of experience. With regard to the knowledge of HAIs, 59% of HCWs did not know what HAIs were, 57% did not know that cleaners and mothers should be engaged in infection prevention and control (IPC) activities, whereas 85% did not know that ventilator-associated infections and COVID-19 (57%) are HAIs. Segregation of waste was shown to be poorly practiced with 56% of HCWs, 65% were unaware of the hospital’s IPC policy, and 7% had never utilize the manuals of standard operating procedures when performing their jobs. This study recommended that every HCW should receive instruction on IPC methods from the facilities’ IPC coordinators, who should also regularly supervise the staff to monitor compliance with IPC. Mothers should receive more education on the prevention of infections when first admitted to the ward.

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic led to a global increase in healthcare-associated infections (HAI) among intensive care unit (ICU) patients. Whether this increase is directly attributable to COVID-19 or whether the pandemic indirectly (via staff shortages or breaches in infection prevention measures) led to this increase, remains unclear. The objectives of this study were to assess HAI incidence and to identify independent risk factors for HAI in COVID-19 and non-COVID-19 ICU patients.MethodsWe established a monocentric prospective HAI surveillance in the medical ICU of our tertiary care center from September 1st 2021 until August 31st 2022, during circulation of the SARS-CoV-2 delta and omicron variants. We consecutively included patients ≥ 18 years of age with an ICU length of stay of > 2 calendar days. HAI were defined according to the European Centre for Disease Prevention and Control definitions. HAI rate was calculated per 1,000 patient-days or device-days; risk ratios (RR) and corresponding 95% confidence intervals (CI) for COVID-19 versus non-COVID-19 patients were calculated. We used multivariable Cox regression to identify independent risk factors for HAI. As a proxy for institutional COVID-19 burden, weekly COVID-19 density (i.e. percentage of COVID-19 patients among all ICU patients) was included in the model as time-dependent co-variable.ResultsWe included 254 patients, 64 (25.1%) COVID-19 and 190 (74.9%) non-COVID-19 patients; 83 HAI in 72 patients were recorded, thereof 45 ventilator-associated lower respiratory tract infections (VA-LRTI) (54.2%) and 18 blood stream infections (BSI) (21.6%). HAI incidence rate was 49.1/1,000 patient-days in COVID-19 and 22.5/1,000 patient-days in non-COVID-19 patients (RR 2.2, 95%-CI 1.4–3.4). This result was mainly due to different VA-LRTI rates (40.3 vs. 11.7/1,000 ventilator days, p < 0.001), whereas BSI rates were not statistically different (9.4 vs. 5.6/1,000 patient days, p = 0.27). Multivariable analysis identified COVID-19 as main risk factor for HAI development, whereas age, mechanical ventilation and COVID-19 density were not significant.ConclusionsThese data from the fourth and fifth wave of the pandemic show a higher HAI incidence in COVID-19 than in non-COVID-19 ICU patients, mainly due to an increase in pulmonary infections. A diagnosis of COVID-19 was independently associated with HAI development, whereas institutional COVID-19 burden was not.

A Survey of PICU Clinician Practices and Perceptions regarding Respiratory Cultures in the Evaluation of Ventilator-Associated Infections in the BrighT STAR Collaborative.

To characterize respiratory culture practices for mechanically ventilated patients, and to identify drivers of culture use and potential barriers to changing practices across PICUs. Cross-sectional survey conducted May 2021-January 2022. Sixteen academic pediatric hospitals across the United States participating in the BrighT STAR Collaborative. Pediatric critical care medicine physicians, advanced practice providers, respiratory therapists, and nurses. None. We summarized the proportion of positive responses for each question within a hospital and calculated the median proportion and IQR across hospitals. We correlated responses with culture rates and compared responses by role. Sixteen invited institutions participated (100%). Five hundred sixty-eight of 1,301 (44%) e-mailed individuals completed the survey (median hospital response rate 60%). Saline lavage was common, but no PICUs had a standardized approach. There was the highest variability in perceived likelihood (median, IQR) to obtain cultures for isolated fever (49%, 38-61%), isolated laboratory changes (49%, 38-57%), fever and laboratory changes without respiratory symptoms (68%, 54-79%), isolated change in secretion characteristics (67%, 54-78%), and isolated increased secretions (55%, 40-65%). Respiratory cultures were likely to be obtained as a "pan culture" (75%, 70-86%). There was a significant correlation between higher culture rates and likelihood to obtain cultures for isolated fever, persistent fever, isolated hypotension, fever, and laboratory changes without respiratory symptoms, and "pan cultures." Respondents across hospitals would find clinical decision support (CDS) helpful (79%) and thought that CDS would help align ICU and/or consulting teams (82%). Anticipated barriers to change included reluctance to change (70%), opinion of consultants (64%), and concern for missing a diagnosis of ventilator-associated infections (62%). Respiratory culture collection and ordering practices were inconsistent, revealing opportunities for diagnostic stewardship. CDS would be generally well received; however, anticipated conceptual and psychologic barriers to change must be considered.

Transcriptomics reveals shared immunosuppressive landscapes in ventilator-associated lower respiratory tract infections (VA-LRTI) patients

ABSTRACT Background Ventilator-associated pneumonia (VAP) represents a transitory status of immunoparalysis, and we hypothesized that ventilator-associated tracheobronchitis (VAT) could share also some degree of immune response to a respiratory infection. Research design and methods A prospective observational study in five medical ICUs to evaluate immunological alterations of patients with VA-LRTI. Immunological gene expression profiles in the blood using whole transcriptome microarrays in the first 24 hours following diagnosis. The area under the receiver operating characteristic curve (AUROC) was used to assess the accuracy of mRNA levels to differentiate VA-LRTI and lack of infection. A principal component analysis (PCA) was employed for analyzing the impact of each genetic expression footprint variable in explaining the variance of the cohort. Results There was overlapping between the three classes of patients encompassing gene expression levels of 8 genes (i.e. HLA, IL2RA, CD40LG, ICOS, CCR7, CD1C, CD3E). HLA-DRA was equally low among VAT and VAP patients characterizing immune depression, and significantly lower than the control group. Conclusions Our findings suggest that VAP and VAT are not so different regarding gene expression levels suggesting a degree of immunosuppression. Our results indicate a state of immunoparalysis in respiratory infections in critically ill patients.

Influence of a Structured Microbiological Endotracheal Monitoring Program on the Outcome of Critically Ill COVID-19 Patients: An Observational Study.

In past influenza pandemics and the current COVID-19 pandemic, bacterial endotracheal superinfections are a well-known risk factor for higher morbidity and mortality. The goal of this study was to investigate the influence of a structured, objective, microbiological monitoring program on the prognosis of COVID-19 patients with mechanical ventilation. A structured microbiological monitoring program (at intubation, then every 3 days) included collection of endotracheal material. Data analysis focused on the spectrum of bacterial pathogens, mortality, as well as intensive care unit (ICU), hospital, and mechanical ventilation duration. A total of 29% of the patients showed bacterial coinfection at the time of intubation, and within 48 h, 56% developed ventilator-associated pneumonia (VAP). Even though patients with VAP had significantly longer ICU, hospital, and mechanical ventilation durations, there was no significant difference in mortality between patients with VAP pneumonia and patients without bacterial infection. VAP is a common complication in COVID-19 patients. In contrast to already published studies, in our study implementing a structured microbiological monitoring program, COVID-19 patients with bacterial coinfection or VAP did not show higher mortality. Thus, a standardized, objective, microbiological screening can help detect coinfection and ventilator-associated infections, refining anti-infective therapy and positively influencing patient outcomes.

Virtual Reality Simulation for Advanced Infection Control Education in Neonatal Intensive Care Units: Focusing on the Prevention of Central Line-Associated Bloodstream Infections and Ventilator-Associated Infections.

This study examined the effects of a virtual reality simulation for advanced infection control education in neonatal intensive care units (VR_AICENICU) on nurses' infection control knowledge and performance confidence. We examined nurses' presence, empathy, and program satisfaction using a non-equivalent control group pre-post design. Nurses were divided into an experimental group (n = 20) experiencing VR simulation and routine NICU practice and a control group (n = 20) with routine NICU practice. The VR_AICENICU program comprised three scenarios: high-risk medication with lipid solution, dressing and management for peripheral inserted central line, and aspiration prevention and skincare management during ventilator use for premature infants. Data were collected between February and July 2022. The experimental group showed significantly greater improvements in infection control knowledge and performance confidence compared to the pre-test. The average scores of presence, empathy, and program satisfaction of the experimental group were 4.39 ± 0.36, 4.33 ± 0.75, and 4.90 ± 0.31, respectively. The VR_AICENICU program has implications for the education needs of nurses working in NICUs and enhances their knowledge and performance of infection control. Future studies should apply the VR_AICENICU program to different severity grades of NICU patients and develop additional VR programs.

Study of incidence, microbiological profile of nosocomial infections in pediatric intensive care unit of tertiary care center

Background: Prevalence of nosocomial infections in pediatric intensive care unit (PICU) ranges between from 6-26%. Increased use of broad-spectrum antibiotics, urinary and central venous catheterization and endotracheal intubation put patients at an increased risk of affecting with nosocomial infections in pediatric patients. Methods: A hospital based prospective study was carried out on 725 patients aged between 1 month and 12 years admitted in PICU of Al-Ameen medical college hospital, Bijapur, Karnataka, India and institute of child health and hospital for children, Madras medical college, Chennai, Tamil Nadu, India from 15-09-2020 to 15-08-2022. All patients who were admitted with fever or developed fever in first 48 hours of life were excluded from the study. The data obtained in the course of study was analyzed by appropriate statistical methods. Results: Out of 725 pediatric admissions, the incidence of nosocomial infection in the present was found to be 108 (14.8%). Concerning the type of infection, the commonest reported types were central-line associated bloodstream infection (CABI) 59 (54.6%) and ventilator-associated infection (VAI) 52 (48.1%), followed by bloodstream infection 45 (41.6%), catheter associated urinary tract infection (CA-UTI) 38 (35.1%) and urinary tract infection (UTI) 30 (27.7%) respectively. Conclusions: The incidence of nosocomial infection was 14.8%. The central line associated blood stream infection was the predominant cause of nosocomial infection. This information can help decision makers establish preventive strategies and implement effective and reliable plans.

Cefto Real-Life Study: Real-World Data on the Use of Ceftobiprole in a Multicenter Spanish Cohort.

Ceftobiprole is a fifth-generation cephalosporin that has been approved in Europe solely for the treatment of community-acquired and nosocomial pneumonia. The objective was to analyze the use of ceftobiprole medocaril (Cefto-M) in Spanish clinical practice in patients with infections in hospital or outpatient parenteral antimicrobial therapy (OPAT). This retrospective, observational, multicenter study included patients treated from 1 September 2021 to 31 December 2022. A total of 249 individuals were enrolled, aged 66.6 ± 15.4 years, of whom 59.4% were male with a Charlson index of four (IQR 2-6), 13.7% had COVID-19, and 4.8% were in an intensive care unit (ICU). The most frequent type of infection was respiratory (55.8%), followed by skin and soft tissue infection (21.7%). Cefto-M was administered to 67.9% of the patients as an empirical treatment, in which was administered as monotherapy for 7 days (5-10) in 53.8% of cases. The infection-related mortality was 11.2%. The highest mortality rates were identified for ventilator-associated pneumonia (40%) and infections due to methicillin-resistant Staphylococus aureus (20.8%) and Pseudomonas aeruginosa (16.1%). The mortality-related factors were age (OR: 1.1, 95%CI (1.04-1.16)), ICU admission (OR: 42.02, 95%CI (4.49-393.4)), and sepsis/septic shock (OR: 2.94, 95%CI (1.01-8.54)). In real life, Cefto-M is a safe antibiotic, comprising only half of prescriptions for respiratory infections, that is mainly administered as rescue therapy in pluripathological patients with severe infectious diseases.