Risk factors for multidrug-resistant Gram-negative bacteria infection in intensive care units: A meta-analysis

2018 ◽  
Vol 24 (4) ◽  
pp. e12644 ◽  
Author(s):  
Hui Ang ◽  
Xuan Sun
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative

scholarly journals Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in Adult Intensive Care Units: A Systematic Review and Network Meta-analysis

2017 ◽  
Vol 64 (suppl_2) ◽  
pp. S51-S60 ◽  
Author(s):  
Nattawat Teerawattanapong ◽  
Kirati Kengkla ◽  
Piyameth Dilokthornsakul ◽  
Surasak Saokaew ◽  
Anucha Apisarnthanarak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Prevention And Control ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
And Control

Controlling the Diffusion of Multidrug-Resistant Organisms in Intensive Care Units

2019 ◽  
Vol 40 (04) ◽  
pp. 558-568 ◽  
Author(s):  
Solen Kernéis ◽  
Jean-Christophe Lucet
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Intensive Care Units ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Behavioral Approach ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Contact Precautions ◽  
Multidrug Resistant Organisms

AbstractThe prevalence of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) is increasing worldwide, with very large variations across countries, microorganisms, and settings. Emerging MDR gram-negative bacteria and fungi raise particular concerns that require improved prevention and control strategies. Vertical approaches are mainly based on screening and contact precautions and/or decolonization of MDRO carriers. On the other hand, horizontal strategies are not pathogen-specific and include standard precautions (i.e., hand hygiene), universal decolonization, antimicrobial stewardship, and environmental cleaning. The impacts of the different strategies vary between MDROs and compliance with control measures, and are intermixed in most infection control programs. Based on historical data, hand hygiene remains the cornerstone to prevent transmission of MDROs in ICUs. In the context of high hand hygiene compliance, screening and contact precautions for carriers seem to have a limited additional effect, particularly for MDR gram-negative bacteria. Studies on skin decolonization with chlorhexidine bathing show conflicting results, impairing its widespread adoption. Selective oral and digestive decontaminations have shown positive impact on clinical outcomes in ICUs with low levels of antibiotic resistance, but raised ecological concerns in high-prevalence settings. Antibiotic stewardship programs have been associated with reductions in antimicrobial use, duration of stay, and costs with no negative impact on mortality and should be widely promoted in ICUs. Whatever the strategy, compliance with the recommended measures is of crucial importance and implementation should rely on behavioral approach and change in the institutional and safety culture.

scholarly journals High Carriage Rates of Multidrug-Resistant Gram-Negative Bacteria in Neonatal Intensive Care Units From Ghana

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Appiah-Korang Labi ◽  
Stephanie Bjerrum ◽  
Christabel C Enweronu-Laryea ◽  
Prosper K Ayibor ◽  
Karen L Nielsen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Neonatal Intensive Care Units ◽  
Snp Analysis ◽  
Gram Negative Bacteria ◽  
Cross Sectional ◽  
Gram Negative ◽  
Klebsiella Spp

Abstract Background Carriage of multidrug resistant (MDR) Gram-negative bacteria (GN) in hospitalized neonates may increase the risk of difficult-to-treat invasive infections at neonatal intensive care units (NICUs). Data on MDRGN carriage among hospitalized newborns in Africa are limited. Methods We conducted a cross-sectional study at the NICUs of 2 tertiary hospitals in Ghana. Swabs from the axilla, groin, perianal region, and the environment were cultured, GN were identified, and antibiotic susceptibility was tested. We obtained blood culture isolates from neonates with sepsis. Whole-genome sequencing was used to characterize carbapenemase-producing Klebsiella pneumoniae. Typing was done by multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis. Results A total of 276 GN were isolated from 228 screened neonates. Pathogenic GN were cultured in 76.8% (175 of 228) of neonates. Klebsiella spp (41.7%; 115 of 276) and Escherichia coli (26.4%; 73 of 276) were the commonest organisms. Carriage rates of MDRGN and third-generation cephalosporin resistant organisms were 49.6% (113 of 228) and 46.1% (105 of 228), respectively. Among Klebsiella spp, 75.6% (87 of 115) phenotypically expressed extended-spectrum β-lactamase activity, whereas 15.6% expressed carbapenemase and harbored bla-OXA-181 and bla-CTX-M-15. Overall, 7.0% (16 of 228) of neonates developed GN bloodstream infection. In 2 of 11 neonates, sequencing showed the same identity between carriage and the bloodstream isolate. Length of stay before specimen collection and antibiotic use were independently associated with carriage rates, which increased from 13% at admission to 42% by day 2 and reached a plateau at 91% by day 15. Conclusions High carriage rates of MDRGN, including carbapenemase-producing enterobacterales may be an emerging problem in NICUs in Africa.

scholarly journals Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand

2018 ◽  
Vol 62 (8) ◽  
Author(s):  
Anong Kiddee ◽  
Kanit Assawatheptawee ◽  
Anamai Na-udom ◽  
Pornpit Treebupachatsakul ◽  
Apirath Wangteeraprasert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Tertiary Care ◽  
Control Measures ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Content Type ◽  
Predominant Species ◽  
Carbapenem Resistant

ABSTRACTThis study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. The phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. The overall carriage rate of CR-GNB at admission was 11.6% (32/275), with the most predominant species carried beingAcinetobacter baumannii(n= 15), followed byKlebsiella pneumoniae(n= 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months (P= 0.002). During the ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), with the most predominant species carried beingA. baumannii(n= 28) andK. pneumoniae(n= 13). Risk factors associated with CR-GNB acquisition were the use of an enteral feeding tube (P= 0.008) and administration of third-generation cephalosporins (P= 0.032) and carbapenems (P= 0.045). The most common carbapenemase genes inA. baumanniiandK. pneumoniaewereblaOXA-23/51andblaNDM, respectively. Patient-to-patient transmission was demonstrated in three cases, resulting in the acquisition of CRA. baumannii(2 cases) andK. pneumoniae(1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients, examining patients for the carriage of CR-GNB, and further demonstrating the transfer of CR-GNB isolates in ICUs. Our study suggests that effective infection control measures are required to limit the spread of CR-GNB within hospitals.

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