scholarly journals Risk factors for the development of hospital infections in the intensive care units

2005 ◽  
Vol 62 (4) ◽  
pp. 265-271 ◽  
Author(s):  
Biljana Mijovic ◽  
Slavenka Jankovic ◽  
Natasa Maksimovic ◽  
Jelena Marinkovic
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Surveillance Study ◽  
Prospective Surveillance ◽  
Surgical Interventions ◽  
Endotracheal Tubes ◽  
Icu Discharge ◽  
Independent Risk Factors ◽  
Tract Infections

Background. Patients admitted to intensive-care units (ICU) are at a high risk of nosocomial infections (NI) due to susceptibility associated with severity of their condition, but also the invasive medical procedures they undergo. Aim. To determine the frequency of NI at the ICU of the General Hospital Uzice, and to identify the risk factors for their development. Methods. A prospective surveillance study of NI, conducted between June 27 and December 31 2001, included 914 patients who spent at least 24 hours in the ICU (total of 2 615 days). The surveillance of NI in the ICU was carried out daily. Follow-up period covered the time from the ICU admission to 48 hours after the ICU discharge. To assess risk factors for NI, we performed a case-control study. The variables measuring of extrinsic and intrinsic risk factors for NI were collected. Results. In a six-month prospective surveillance study, the incidence of NI was 16.7% or 58.5 per 1,000 patient-day, respectively. The most frequent were the infections of the surgery wounds (32.6%), urinary tract infections (23.5%), and infections of the blood (7.1%). The identified independent risk factors for NI were: surgical intervention (OR = 5.74; CI = 2.01-16.41), endotracheal tubes (OR = 3.40; CI = 1.07-10.89), cystoscopy (OR = 2.35; CI = 1.38- 4.02), obesity (OR = 1.98; CI = 1.27-3.11), and the duration of the infusion (OR = 1.34; CI = 1.23-1.46). Conclusions. The most important risk factors for NI at ICU were surgical interventions and endotracheal tubes.

scholarly journals Prevalence and Risk Factors for Aminoglycoside Nephrotoxicity in Intensive Care Units

2009 ◽  
Vol 53 (7) ◽  
pp. 2887-2891 ◽  
Author(s):  
João F. P. Oliveira ◽  
Carolina A. Silva ◽  
Camila D. Barbieri ◽  
Giselle M. Oliveira ◽  
Dirce M. T. Zanetta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Odds Ratio ◽  
Kidney Injury ◽  
High Rate ◽  
Iodinated Contrast ◽  
Aminoglycoside Therapy ◽  
Nephrotoxic Drugs ◽  
Independent Risk Factors

ABSTRACT In order to assess the prevalence of and risk factors for aminoglycoside-associated nephrotoxicity in intensive care units (ICUs), we evaluated 360 consecutive patients starting aminoglycoside therapy in an ICU. The patients had a baseline calculated glomerular filtration rate (cGFR) of ≥30 ml/min/1.73 m2. Among these patients, 209 (58%) developed aminoglycoside-associated nephrotoxicity (the acute kidney injury [AKI] group, which consisted of individuals with a decrease in cGFR of >20% from the baseline cGFR), while 151 did not (non-AKI group). Both groups had similar baseline cGFRs. The AKI group developed a lower cGFR nadir (45 ± 27 versus 79 ± 39 ml/min/1.73 m2 for the non-AKI group; P < 0.001); was older (56 ± 18 years versus 52 ± 19 years for the non-AKI group; P = 0.033); had a higher prevalence of diabetes (19.6% versus 9.3% for the non-AKI group; P = 0.007); was more frequently treated with other nephrotoxic drugs (51% versus 38% for the non-AKI group; P = 0.024); used iodinated contrast more frequently (18% versus 8% for the non-AKI group; P = 0.0054); and showed a higher prevalence of hypotension (63% versus 44% for the non-AKI group; P = 0.0003), shock (56% versus 31% for the non-AKI group; P < 0.0001), and jaundice (19% versus 8% for the non-AKI group; P = 0.0036). The mortality rate was 44.5% for the AKI group and 29.1% for the non-AKI group (P = 0.0031). A logistic regression model identified as significant (P < 0.05) the following independent factors that affected aminoglycoside-associated nephrotoxicity: a baseline cGFR of <60 ml/min/1.73 m2 (odds ratio [OR], 0.42), diabetes (OR, 2.13), treatment with other nephrotoxins (OR, 1.61) or iodinated contrast (OR, 2.13), and hypotension (OR, 1.83). In conclusion, AKI was frequent among ICU patients receiving an aminoglycoside, and it was associated with a high rate of mortality. The presence of diabetes or hypotension and the use of other nephrotoxic drugs and iodinated contrast were independent risk factors for the development of aminoglycoside-associated nephrotoxicity.

scholarly journals A genomic epidemiology study of multidrug-resistant Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii in two intensive care units in Hanoi, Vietnam

2020 ◽  
Author(s):  
Leah W. Roberts ◽  
Le Thi Hoi ◽  
Fahad A. Khokhar ◽  
Nguyen Thi Hoa ◽  
Tran Van Giang ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
United Kingdom ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Intensive Care Units ◽  
Surveillance Study ◽  
Community Settings ◽  
Prospective Surveillance ◽  
E Coli

AbstractBackgroundVietnam has high rates of antimicrobial resistance (AMR) but limited genomic surveillance, impeding our ability to assess transmission dynamics. This study aimed to use whole genome ssequencing (WGS) to examine the transmission of key AMR pathogens in two intensive care units in Hanoi, Vietnam.MethodsA prospective surveillance study of all adults admitted to two intensive care units (ICUs) at the National Hospital for Tropical Diseases (NHTD) and Bach Mai Hospital (BMH) was conducted between June 2017 and January 2018. Clinical and environmental samples were cultured on selective media, characterised using MALDI TOF MS, and Illumina sequenced. Phylogenies based on the de novo assemblies (SPAdes) were constructed using Mafft (PARsnp), Gubbins and RAxML. Resistance genes were detected using Abricate against the NCBI database.Findings3,153 Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii isolates from 369 patients were analysed. Phylogenetic analysis revealed predominant lineages within A. baumannii (global clone [GC]2, sequence types [ST]2, ST571) and K. pneumoniae (ST15, ST16, ST656, ST11, ST147) isolates. Colonisation was most common with E. coli (88.9%) followed by K. pneumoniae (62.4%). 91% of E. coli carried a blaCTX-M variant, while 81% of K. pneumoniae isolates carried blaNDM (54%) and/or blaKPC (45%). Transmission analysis using single nucleotide polymorphisms (SNPs) identified 167 clusters involving 251 (68%) patients, in some cases involving patients from both ICUs. There were no significant differences between the lineages or AMR genes recovered between the two ICUs.InterpretationThis study represents the largest prospective surveillance study of key AMR pathogens in Vietnamese ICUs. Clusters of closely related isolates in patients across both ICUs suggests recent transmission prior to ICU admission in other healthcare settings or in the community.FundingThis work was funded by the Medical Research Council Newton Fund, United Kingdom; the Ministry of Science and Technology, Vietnam (HNQT/SPÐP/04.16) and the Wellcome Trust, United Kingdom.Research in contextEvidence before this studyGlobally, antimicrobial resistance (AMR) is projected to cause 10 million deaths annually by 2050. While 90% of these deaths are expected to occur in African and Asian low- and middle-income countries (LMIC), attributing morbidity and mortality is difficult without the availability of comprehensive AMR data in these settings. Whilst efforts have been made to improve AMR surveillance in these settings, this is often hampered by limited infrastructure, training and financial resources.Added value of this studyThis is the largest prospective surveillance study of three key AMR pathogens (E. coli, K. pneumoniae and A. baumannii) conducted in critical care settings in Vietnam. All patients were colonised or infected with one or more extended spectrum beta-lactamase (ESBL) producing and/or carbapenem-resistant organism. Colonisation with more than one organism was very common, with resistant E. coli predominantly isolated from stool. A small number of predominant lineages were identified for K. pneumoniae and A. baumannii, while the E. coli isolates were highly genetically diverse. A large number of genomic clusters were identified within the two ICUs, some of which spanned both ICUs. There were no significant differences between lineages or AMR genes between the two ICUs.Implications of all the available evidenceThis study found high rates of colonisation and infection with three key AMR pathogens in adults admitted to two Vietnamese ICUs. Whilst transmission was common within ICUs the finding of similar lineages and AMR genes in both ICUs suggests that dissemination of AMR occurs prior to ICU admission, from either referral sites or in community settings prior to hospital admission. Strategies to tackle AMR in Vietnam will need to account for this by extending surveillance beyond ICU to hospital and community settings.

Antibiotic Molecules Involved in Increasing Microbial Resistance

2019 ◽  
Vol 70 (7) ◽  
pp. 2622-2626 ◽  
Author(s):  
Letitia Doina Duceac ◽  
Constantin Marcu ◽  
Daniela Luminita Ichim ◽  
Irina Mihaela Ciomaga ◽  
Elena Tarca ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Enterobacter Aerogenes ◽  
Healthcare Associated Infections ◽  
Medical Department ◽  
Microbial Resistance ◽  
Antimicrobial Sensitivity ◽  
Interpretation Criteria ◽  
Tract Infections ◽  
Healthcare Associated

Over the past two decades, the resistance to antibiotics, especially for Gram-negative bacteria, has increased at an alarming rate, requiring constant concern for resolving and controlling this extremely important therapeutic aspect in any medical department but in particular, in Anaesthesia and Intensive Care Units, in units of neonatology, paediatrics, neurosurgery, burned patients and immunosuppressed. Specialists note a particular concern for the resistance of Enterobacteriaceae to third-generation cephalosporins and aztreonam, with a resistance profile frequently associated with the expression of extended-spectrum �-lactamases (ESBL). The Enterobacter genus comprises 14 species, but two are of medical interest, Enterobacter aerogenes and E. cloacae, which are involved in inducing healthcare-associated infections such as urinary tract infections, pneumonia associated with mechanical ventilation, bacteremia, septicemia, etc. The purpose of the study was to highlight the antibiotic molecules in which microbial resistance of some circulating strains of enterobacteria was detected. A descriptive and retrospective study was conducted between 2012-2017, on a batch of 35 patients, admitted to the Sf. Maria Emergency Clinical Hospital for Children of Iasi, from whom various pathological products were collected to highlight the Enterobacter sp strains involved in the production of infections associated with the inpatient medical care. The antimicrobial sensitivity of each strain was determined by diffusimetric method, while the interpretation criteria were considered to be those of the laboratory standards. Most cases were reported in 2017 (31.42%). The majority were registered in new-borns (42.85%) and infants (25.71%). The Anaesthesia and Intensive Care Units and Neonatology Anaesthesia and Intensive Care Units departments were the most involved. Microbial antibacterial resistance of Enterobacter sp isolates showed that all manifested resistance to ampicillin, amoxicillin and clavulanic acid, 48.57% were resistant to Cefuroxime, 42.85% resistant to Ceftazidime and Ceftriaxone, 14.28% to ciprofloxacin, 11.42% to ertapenem, 5.71% to Meronem. Although it showed relatively few cases with infections associated with healthcare in which strains of Enterobacter sp. were isolated our study, which was carried out over a period of 5 years, provides useful indications regarding the prevalence of healthcare associated infections with Enterobacter sp in paediatric patients and guidelines for antibiotic therapy.

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