scholarly journals The Epidemiology of Vancomycin-Resistant Enterococcus Colonization in a Medical Intensive Care Unit

2003 ◽  
Vol 24 (4) ◽  
pp. 257-263 ◽  
Author(s):  
David K. Warren ◽  
Marin H. Kollef ◽  
Sondra M. Seiler ◽  
Scott K. Fridkin ◽  
Victoria J. Fraser
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multiple Logistic Regression Analysis ◽  
Control Measures ◽  
Icu Patients ◽  
Icu Admission ◽  
Contact Precautions ◽  
Icu Stay ◽  
Vancomycin Resistant

AbstractObjective:To determine the epidemiology of colonization with vancomycin-resistant Enterococcus (VRE) among intensive care unit (ICU) patients.Design:Ten-month prospective cohort study.Setting:A 19-bed medical ICU of a 1,440-bed teaching hospital.Methods:Patients admitted to the ICU had rectal swab cultures for VRE on admission and weekly thereafter. VRE-positive patients were cared for using contact precautions. Clinical data, including microbiology reports, were collected prospectively during the ICU stay.Results:Of 519 patients who had admission stool cultures, 127 (25%) had cultures that were positive for VRE. Risk factors for VRE colonization identified by multiple logistic regression analysis were hospital stay greater than 3 days prior to ICU admission (adjusted odds ratio [AOR], 3.6; 95% confidence interval [CI95], 2.3 to 5.7), chronic dialysis (AOR, 2.4; CI95, 1.2 to 4.5), and having been admitted to the study hospital one to two times (AOR, 2.3; CI95,1.4 to 3.8) or more than two times (AOR, 6.5; CI95, 3.7 to 11.6) within the past 12 months. Of the 352 VRE-negative patients who had one or more follow-up cultures, 74 (21%) became VRE positive during their ICU stay (27 cases per 1,000 patient-ICU days).Conclusion:The prevalence of VRE culture positivity on ICU admission was high and a sizable fraction of ICU patients became VRE positive during their ICU stay despite contact precautions for VRE-positive patients. This was likely due in large part to prior VRE exposures in the rest of the hospital where these control measures were not being used.

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

2021 ◽  
pp. 000992282110472
Author(s):  
Andrew Brown ◽  
Mary Quaile ◽  
Hannah Morris ◽  
Dmitry Tumin ◽  
Clayten L. Parker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Care Coordination ◽  
Chronic Conditions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Admission ◽  
Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

scholarly journals A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Stefanie Kampmeier ◽  
Hauke Tönnies ◽  
Carlos L. Correa-Martinez ◽  
Alexander Mellmann ◽  
Vera Schwierzeck
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Prevention ◽  
Control Measures ◽  
Whole Genome Sequence ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Background Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. Methods Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). Results WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. Conclusions Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

The epidemiology, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit from 2012 to 2018

2020 ◽  
Author(s):  
Ping Wang ◽  
Xiaocui Zou ◽  
Boting Zhou ◽  
Tao Yin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Control Measures ◽  
Icu Patients ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Incidence And Mortality ◽  
Changing Trend ◽  
Different Sources

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing globally threat for human health, but the trends and clinical characteristics of CRKP infections in the intensive care unit(ICU) remain uninvestigated.Methods: A retrospective study was conducted among ICU patients infected with KP isolates from January 2012 to December 2018. Carbapenem resistant to Klebsiella pneumoniae was defined according to Clinical and Laboratory Standards Institute (CLSI) criteria. The incidence and changing trend of CRKP were determined. CRKP patient sources, specimen types, infection sources and outcomes were investigated. Results: There were 256(40.13%) patients with CRKP and 382(59.87%) patients with CSKP. The incidence of CRKP increased from 2012(11.11%) to 2017(63.48%) and decreased in 2018(51.52%). The proportion of isolates not susceptible to three carbapenems increased from 0 to 98.04%. The rates of CRKP isolated from blood, wound, urine and pleural fluid were higher than that of CSKP. CRKP infections were mainly ICU acquired, rather than input acquired. Conclusion: The incidence of CRKP was high in ICU, but showed a downward trend. Implementation of different infection control measures to different sources of patients, specimen types, and KP infections are necessary. Surveillance data will be needed for ICU patients to decrease the incidence and mortality of CRKP.

Intensive Care Admissions and Associated Severity of Influenza B Versus A During Influenza B Vaccine–mismatched Seasons

2019 ◽  
Vol 69 (6) ◽  
pp. 1049-1052 ◽  
Author(s):  
Maya Korem ◽  
Efrat Orenbuch-Harroch ◽  
Eli Ben-Chetrit ◽  
Sarah Israel ◽  
Matan J Cohen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Influenza B ◽  
Icu Patients ◽  
Icu Admission ◽  
Severe Influenza ◽  
Trivalent Vaccine ◽  
Quadrivalent Vaccines

Abstract Patients admitted to hospital with influenza B and A in Jerusalem, Israel, during the 2015–2016 and 2017–2018 influenza seasons demonstrated similar rates of intensive care unit (ICU) admission and associated disease severity. Most (63%) influenza B ICU patients received influenza B–mismatched trivalent vaccine. These findings call into question the equivalence of trivalent and quadrivalent vaccines in preventing severe influenza B.

The Use Of Platelet Transfusions In The Intensive Care Unit and Impact On Platelet Count: A 30,000 Patient Registry Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1154-1154
Author(s):  
Shuoyan Ning ◽  
Rebecca Barty, MLT ◽  
Yang Liu ◽  
Nancy Heddle ◽  
Donald Arnold
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Research Funding ◽  
Platelet Transfusion ◽  
Large Cohort ◽  
Clinical Effects ◽  
Icu Patients ◽  
Icu Admission ◽  
Platelet Transfusions

Abstract Background Thrombocytopenia is a common complication of critical illness and an independent risk factor for bleeding and death in the intensive care unit (ICU). Platelet transfusions are commonly used to improve platelet counts; however, the expected platelet increment from a transfusion in this setting has not been established. The objective of this study was to describe the frequency of platelet transfusion administration and their effect on platelet count increments in a large cohort of non-oncology critically ill adults. Methods We performed an analysis of a registry database, which was developed to capture clinical and laboratory data on all blood transfusions administered in 3 academic hospitals in Hamilton, Ontario, Canada. We included all patients ≥18 years who received one or more platelet transfusion during an ICU admission. Data validation was done by integrity checks with medical records and laboratory information system performed by a biostatistician. Non-transfused ICU patients were used as controls. The absolute increment in platelet count was calculated for each single platelet transfusion using the closest platelet count taken within 24 hours before the transfusion and 4-24 hours after the transfusion. Results Between April 2006 and October 2012, 33,222 patients were admitted to ICU, including 29,511 (88.8%) who did not have a diagnosis of cancer. Of those, 4,502 (15.3%) received one or more platelet transfusion during any ICU admission (n=4,690); 31.9% were female and median age at the time of first admission was 69 years (IQR 59-77). Among the 25,009 non-transfused patients admitted to ICU during the same period, 38.1% were female and the median age was 65 years (IQR 52–76). Median pre-transfusion platelet count was 87 x109/L (IQR 59-131) and a single platelet transfusion resulted in a median platelet count increment of 21 x109/L (IQR 6-40) as measured 6.7 hours (IQR 5.1-9.8) after the transfusion. There were 277 (25.4%) transfusions that yielded a platelet count increment of 5 x109/L or less. ICU mortality was 562/4,690 (12.4%) for patients who received a platelet transfusion, compared with 2,251/33,033(6.8%) for patients who were not transfused during their ICU stay. Summary/Conclusion Among this large cohort of non-oncology ICU patients, platelet transfusions were commonly administered for thrombocytopenia that was generally mild. In this setting one platelet transfusion resulted in a median platelet count rise of 21 x109/L. Many transfusion episodes yielded no appreciable increase in platelet count. Further studies are needed to determine the clinical effects of platelet transfusion in this setting controlling for confounding. Disclosures: Heddle: CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees; Health Canada: Research Funding; Macopharma: Consultancy; ASH: Honoraria.

Risk Factors Associated With Resistance to Ciprofloxacin in Clinical Bacterial Isolates From Intensive Care Unit Patients

2007 ◽  
Vol 28 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Phillip D. Levin ◽  
Robert A. Fowler ◽  
Cameron Guest ◽  
William J. Sibbald ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prior Treatment ◽  
Bacterial Isolates ◽  
Icu Patients ◽  
Gram Negative ◽  
Factors Associated ◽  
Icu Admission ◽  
Ciprofloxacin Resistance

Objective.To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.Design.Prospective cohort study.Setting.Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.Patients.All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.Methods.Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.Results.Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent ofPseudomonas aeruginosaisolates and 29% ofEscherichia coliisolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23];P< .001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91];P= .04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03];P= .005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate;P= .58 ) nor in-hospital mortality (30% vs 34%;P= .81 ) were statistically significantly associated with ciprofloxacin resistance.Conclusions.ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.

scholarly journals Staphylococcus aureusNasal Colonization and Subsequent Infection in Intensive Care Unit Patients: Does Methicillin Resistance Matter?

2010 ◽  
Vol 31 (6) ◽  
pp. 584-591 ◽  
Author(s):  
Hitoshi Honda ◽  
Melissa J. Krauss ◽  
Craig M. Coopersmith ◽  
Marin H. Kollef ◽  
Amy M. Richmond ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Methicillin Resistance ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Patient Specific ◽  
Icu Patients ◽  
Icu Admission

Background.Staphylococcus aureusis an important cause of infection in intensive care unit (ICU) patients. Colonization with methicillin-resistantS. aureus(MRSA) is a risk factor for subsequentS. aureusinfection. However, MRSA-colonized patients may have more comorbidities than methicillin-susceptibleS. aureus(MSSA)-colonized or noncolonized patients and therefore may be more susceptible to infection on that basis.Objective.To determine whether MRSA-colonized patients who are admitted to medical and surgical ICUs are more likely to develop anyS. aureusinfection in the ICU, compared with patients colonized with MSSA or not colonized withS. aureus,independent of predisposing patient risk factors.Design.Prospective cohort study.Setting.A 24-bed surgical ICU and a 19-bed medical ICU of a 1,252-bed, academic hospital.Patients.A total of 9,523 patients for whom nasal swab samples were cultured forS. aureusat ICU admission during the period from December 2002 through August 2007.Methods.Patients in the ICU for more than 48 hours were examined for an ICU-acquired S.aureusinfection, defined as development ofS. aureusinfection more than 48 hours after ICU admission.Results.S. aureuscolonization was present at admission for 1,433 (27.8%) of 5,161 patients (674 [47.0%] with MRSA and 759 [53.0%] with MSSA). An ICU-acquiredS. aureusinfection developed in 113 (2.19%) patients, of whom 75 (66.4%) had an infection due to MRSA. Risk factors associated with an ICU-acquiredS. aureusinfection included MRSA colonization at admission (adjusted hazard ratio, 4.70 [95% confidence interval, 3.07-7.21]) and MSSA colonization at admission (adjusted hazard ratio, 2.47 [95% confidence interval, 1.52-4.01]).Conclusion.ICU patients colonized with S.aureuswere at greater risk of developing aS. aureusinfection in the ICU. Even after adjusting for patient-specific risk factors, MRSA-colonized patients were more likely to developS. aureusinfection, compared with MSSA-colonized or noncolonized patients.

Management of an Outbreak of Vancomycin-Resistant Enterococci in the Medical Intensive Care Unit of a Cancer Center

2001 ◽  
Vol 22 (4) ◽  
pp. 217-219 ◽  
Author(s):  
Hend Hanna ◽  
Jan Umphrey ◽  
Jeffrey Tarrand ◽  
Michelle Mendoza ◽  
Issam Raad
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Control Measures ◽  
Cancer Center ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Medical Intensive Care ◽  
Vancomycin Resistant

AbstractBetween November 1996 and February 1997, 17 episodes of vancomycin-resistant enterococci (VRE) infection or colonization (9 infections, 8 colonizations), all with the same or a similar genomic DNA pattern, were identified in the medical intensive care unit (MICU) of a tertiary-care cancer hospital. The cases were genotypically traced to a patient who was admitted to the hospital in September 1996 and who, by December 1996, had four different admissions to the MICU. Multifaceted infection control measures, including decontamination of the environment and of nondisposable equipment, halted the nosocomial transmission of VRE in the MICU.

Rapid Eradication of a Cluster ofSerratia marcescensin a Neonatal Intensive Care Unit: Use of Epidemiologic Chromosome Profiling by Pulsed-Field Gel Electrophoresis

2004 ◽  
Vol 25 (9) ◽  
pp. 730-734 ◽  
Author(s):  
Kwan Kew Lai ◽  
Stephen P. Baker ◽  
Sally A. Fontecchio
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Gel Electrophoresis ◽  
Neonatal Intensive Care ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Pulsed Field ◽  
Contact Precautions ◽  
Control Study

AbstractObjective:To investigate a cluster of patients infected and colonized withSerratia marcescensin a neonatal intensive care unit (NICU).Methods:In June 2001, two neonates in the NICU had clinical infections withS. marcescensand one died. Infection control surveillance data for the NICU revealed that S.marcescenswas rarely isolated from clinical specimens. Surveillance and environmental cultures were performed and isolates were typed using pulsed-field gel electrophoresis. Staff and neonates were cohorted and a waterless, alcohol-based handwashing agent was introduced. A case-control study was performed.Results:From June 2 through August 20, 2001, 11 neonates withS. marcescensinfection and colonization were identified. The incidence ofS. marcescensinfections increased from 0.19 per 1,000 patient-days in 2000 to 0.52 per 1,000 patient-days in 2001 (P< .0001). In the first 3 weeks of the investigation, there were 2 sets of patients and sinks with indistinguishable strains; however, in subsequent weeks, all isolates were of unique strains, signifying no further transmission of the two initial predominant strains. Neonates withS. marcescenswere more likely to have a lower gestational age and birth weight. There was no association between cases and healthcare workers (HCWs).Conclusions:A cluster ofS. marcescenswas quickly terminated after the introduction of preventive measures including cohorting of infected and colonized neonates and HCWs, contact precautions, surveillance cultures, and a waterless, alcohol-based hand antiseptic. Chromosomal typing determined that strains with an indistinguishable pattern were no longer present in the unit after control measures were implemented.

Exogenous Sources ofPseudomonas aeruginosain Intensive Care Unit Patients Implementation of Infection Control Measures and Follow-Up With Molecular Typing

2006 ◽  
Vol 27 (9) ◽  
pp. 953-957 ◽  
Author(s):  
Christiane Petignat ◽  
Patrick Francioli ◽  
Immaculée Nahimana ◽  
Aline Wenger ◽  
Jacques Bille ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Pfge Pattern ◽  
Control Measures ◽  
Icu Patients ◽  
Infection Control Measures ◽  
Exogenous Origin

Background.In 1998, a study in the intensive care unit (ICU) of our institution suggested possible transmission of Pseudomonas aeruginosa from faucet to patient and from patient to patient. Infection-control measures were implemented to reduce the degree ofP. aeruginosacolonization in faucets, to reduce the use of faucet water in certain patient care procedures, and to reduce the rate of transmission from patient to patient.Objective.To evaluate the effect of the control measures instituted in 1999 to preventP. aeruginosainfection and colonization in ICU patients.Design.Prospective, molecular, epidemiological investigation.Setting.A 870-bed, university-affiliated, tertiary care teaching hospital.Methods.The investigation was performed in a manner identical to the 1998 investigation. ICU patients with a clinical specimen positive forP. aeruginosawere identified prospectively. Swab specimens from the inner part of the ICU faucets were obtained for the culture on 9 occasions between September 1997 and December 2000. All patients and environmental isolates were typed by pulsed-field gel electrophoresis (PFGE).Results.Compared with the 1998 study, in 2000 we found that the annual incidence of ICU patients colonized or infected withP. aeruginosahad decreased by half (26.6 patients per 1,000 admissions in 2000 vs 59.0 patients per 1,000 admissions in 1998), although the populations of patients were comparable. This decrease was the result of the decreased incidence of cases in which an isolate had a PFGE pattern identical to that of an isolate from a faucet (7.0 cases per 1,000 admissions in 2000, vs 23.6 per 1,000 admissions in 1998) or from another patient (6.5 cases per 1,000 admissions in 2000 vs 16.5 cases per 1,000 admissions in 1998), whereas the incidence of cases in which the isolate had a unique PFGE pattern remained nearly unchanged (13.1 cases per 1,000 admissions in 2000 vs 15.6 cases per 1,000 admissions in 1998).Conclusions.These results suggest that infection control measures were effective in decreasing the rate ofP. aeruginosacolonization and infection in ICU patients, confirming thatP. aeruginosastrains were of exogenous origin in a substantial proportion of patients during the preintervention period.

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