Highly Resistant Microorganisms in a Teaching Hospital: The Role of Horizontal Spread in a Setting of Endemicity

2008 ◽  
Vol 29 (12) ◽  
pp. 1110-1117 ◽  
Author(s):  
Ina Willemsen ◽  
Marlies Mooij ◽  
Marsha van der Wiel ◽  
Diana Bogaers ◽  
Madelon van der Bijl ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Transmission ◽  
Incidence Density ◽  
Reproduction Rate ◽  
Gram Negative ◽  
Relative Contribution ◽  
Admission Data ◽  
Horizontal Spread

Objective.To determine the incidence density of highly resistant organisms (HROs) and the relative contribution of horizontal spread in a setting of endemicity.Methods.Prospective surveillance was performed among hospitalized patients during an 18-month period. Enterobacteriaceae, non-fermentative gram-negative bacilli,Staphylococcus aureus, Streptococcus pneumoniae,andEnterococcus faecium—all considered highly resistant, according to Dutch guidelines—were included. Epidemiological linkage and nosocomial transmission were determined on the basis of molecular typing and hospital admission data.Results.From 119 patients, we recovered a total of 170 unique HRO isolates, as follows:Escherichia coli,96 isolates;Klebsiellaspecies, 11 isolates;Enterobacterspecies, 8 isolates;Proteusspecies, 9 isolates;Citrobacterspecies, 5 isolates;Pseudomonasspecies, 5 isolates;Aci-netobacterspecies, 3 isolates;Morganellaspecies, 2 isolates;Salmonellaspecies, 1 isolate;Serratiaspecies, 1 isolate;S. pneumoniae,20 isolates; andS. aureus,9 isolates. No vancomycin-resistantE. faeciumwas found. The incidence density was 4.3 HRO isolates per 10,000 patient-days. The majority of HRO isolates were unique, and nosocomial transmission was observed 4 times for highly resistant gram-negative bacilli (case reproduction rate, 0.05) and 4 times for penicillin-nonsusceptibleS. pneumoniae(case reproduction rate, 0.29). A stay on the intensive care unit was the main determinant for the recovery of an HRO.Conclusion.Nosocomial transmission of HROs was observed 8 times during the 18-month period. The intensive care unit was identified as the main reservoir of horizontal spread of HROs. This study shows that nosocomial transmission of HROs is largely preventable using transmission precautions.

Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission

2007 ◽  
Vol 35 (4) ◽  
pp. 222-230 ◽  
Author(s):  
Caterina Mammina ◽  
Paola Di Carlo ◽  
Domenico Cipolla ◽  
Mario Giuffrè ◽  
Alessandra Casuccio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Cross Transmission

The role of intestinal colonization with Gram-negative bacteria as a source for intensive care unit-acquired bacteremia*

2011 ◽  
Vol 39 (5) ◽  
pp. 961-966 ◽  
Author(s):  
Evelien A. N. Oostdijk ◽  
Anne Marie G. A. de Smet ◽  
Jozef Kesecioglu ◽  
Marc J. M. Bonten
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Gram Negative Bacteria ◽  
Intestinal Colonization ◽  
Gram Negative

Highly Resistant Gram-Negative Microorganisms Incidence Density and Occurrence of Nosocomial Transmission (TRIANGLe Study)

2011 ◽  
Vol 32 (4) ◽  
pp. 333-341 ◽  
Author(s):  
I. Willemsen ◽  
S. Elberts ◽  
C. Verhulst ◽  
M. Rijnsburger ◽  
M. Filius ◽  
...  
Keyword(s):  
Molecular Typing ◽  
Transmission Rate ◽  
Epidemiological Data ◽  
University Hospital ◽  
Nosocomial Transmission ◽  
Incidence Density ◽  
University Hospitals ◽  
Gram Negative ◽  
Transmission Index ◽  
Horizontal Spread

Objectives.The objectives of this study were to determine the incidence density and the occurrence of horizontal spread of highly resistant gram-negative rods (HR-GNRs) in Dutch hospitals. The factors that influence these outcome measures were also investigated.Methods.All patients with HR-GNRs, as determined by sample testing, who were hospitalized in 1 of 18 hospitals during a 6-month period (April through October 2007) were included in this study. For all available isolates, the species was identified, susceptibility was determined (including the presence of extended-spectrumβ-lactamases [ESBLs]), and molecular typing was performed. On the basis of a combination of species identification, molecular typing, and epidemiological data, the occurrence of nosocomial transmission was determined.Results.The mean incidence density of patients with HR-GNRs was 55 per 100,000 patient-days (cumulative incidence, 39 per 10,000 patients admitted). A facility being a university hospital was a statistically significant (P= .03) independent determinant of a higher incidence of patients with HR-GNRs. The majority of HR-GNR isolates were ESBL producers. The adjusted transmission index—the ratio between secondary and primary cases—in the participating hospitals ranged from 0.0 to 0.2. The overall adjusted transmission index of HR-GNRs was 0.07. No determinants for a higher transmission index were identified.Discussion.The nosocomial transmission rate of HR-GNRs was relatively low in all hospitals where well-established transmission-based precautions were used. The incidence density of patients with HR-GNRs was higher in university hospitals, probably due to the patient population and the complexity of the care provided.

Role of Unit-Specific Combination Antibiograms for Improving the Selection of Appropriate Empiric Therapy for Gram-Negative Pneumonia

2011 ◽  
Vol 32 (3) ◽  
pp. 289-292 ◽  
Author(s):  
Jason M. Pogue ◽  
Cesar Alaniz ◽  
Peggy L. Carver ◽  
Melissa Pleva ◽  
Duane Newton ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Combination Therapy ◽  
Empiric Therapy ◽  
Gram Negative ◽  
Specific Combination ◽  
Selection Of

In an effort to improve the selection of appropriate empiric gram-negative therapy for pneumonia, we examined intensive care unit-specific combination antibiograms. These antibiograms were able to predict appropriate empiric gram-negative therapy. Empiric combination therapy based on unit-specific combination antibiograms may aid in the selection of therapy for gram-negative pneumonia.

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Cardiac Intensive Care ◽  
Hospital Protocol

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

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