Removal of sinks and bathing changes to control multi-drug resistant Gram negative bacteria in a neonatal intensive care unit: a retrospective investigation.:
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Removal of sinks and bathing changes to control multi-drug resistant Gram negative bacteria in a neonatal intensive care unit: a retrospective investigation.
J Hosp Infect. 2020 Jan 23;:
Authors: Tracy M, Ryan L, Samarasekara H, Leroi M, Polkinghorne A, Branley J
PMID: 31982431 [PubMed - as supplied by publisher]
1.
J Hosp Infect. 2020 Jan 23. pii: S0195-6701(20)30038-4. doi: 10.1016/j.jhin.2020.01.014. [Epub ahead of print]
Removal of sinks and bathing changes to control multi-drug resistant Gram negative bacteria in a neonatal intensive care unit: a retrospective investigation.
Tracy M1, Ryan L2, Samarasekara H3, Leroi M4, Polkinghorne A5, Branley J6.
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PMID: 31982431 DOI: 10.1016/j.jhin.2020.01.014
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Select item 302759452.
Antimicrob Resist Infect Control. 2018 Sep 26;7:114. doi: 10.1186/s13756-018-0404-3. eCollection 2018.
Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal- a prospective cohort study.
Siwakoti S1, Subedi A2, Sharma A1, Baral R1, Bhattarai NR1, Khanal B1.
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Abstract
BACKGROUND:
Infections caused by multi-drug resistant gram-negative bacterial infections are the principle threats to the critically ill patients of intensive care units. Increasing reports of these infections from the Nepalese intensive care unit underline the clinical importance of these pathogens. However, the impact of these infections on the patient's clinical outcome has not yet been clearly evaluated. The objective of our study was to determine the incidence and associated clinical outcome of multi-drug resistant gram-negative bacterial infections in intensive care unit from a tertiary care center of Nepal.
METHODS:
A prospective cohort study was conducted among adult patients admitted in intensive care unit of B. P Koirala Institute of Health Sciences from July to December 2017. Patients infected with multi-drug resistant gram-negative bacteria, non-multi-drug resistant gram-negative bacteria and those without infection were included. Identification of gram-negative bacteria and their antibiotic susceptibility pattern was performed with standard microbiological methods. Demographic, clinical profiles and outcomes (in-hospital-mortality, intensive care unit and hospital length of stay) were documented.
RESULTS:
The incidence rate of multi-drug resistant gram-negative bacteria infections was 47 per 100 admitted patients (64/137) with 128 episodes. Acinetobacter species (41%, 52/128) was the commonest followed by Klebsiella pneumoniae (28%, 36/128) and Pseudomonas spp (21%, 27/128). Patients with multi-drug resistant gram-negative bacteria in comparison to non-multi-drug resistant gram-negative bacteria had high healthcare-associated infections (95%, 61/64 versus 20%, 2/10; p = < 0.001). In-hospital-mortality was 38% (24/64), 20% (2/10) and 10% (4/41) in multi-drug resistant, non-multi-drug resistant and uninfected group respectively (p = 0.007). After adjustment for independent risk factors, compared to uninfected patients, the odds ratio (CI) for in-hospital-mortality in multi-drug resistant and non-multi-drug resistant group was (4.7[1.4-15.5], p = 0.01) and 2.60 [0.38-17.8], p = 0.32) respectively. Multi-drug resistant patients also had longer intensive care unit and hospital stay, however, it was statistically insignificant.
CONCLUSION:
The incidence of multi-drug resistant gram-negative bacterial infections was remarkably high in our intensive care unit and showed a significant association with healthcare-associated infections and in-hospital-mortality.
KEYWORDS:
Healthcare-associated infection; ICU; Incidence; Multidrug-resistant gram-negative bacteria; Outcome
PMID: 30275945 PMCID: PMC6158849 DOI: 10.1186/s13756-018-0404-3
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Select item 291041243.
J Hosp Infect. 2018 Mar;98(3):275-281. doi: 10.1016/j.jhin.2017.10.025. Epub 2017 Nov 28.
Control of endemic multidrug-resistant Gram-negative bacteria after removal of sinks and implementing a new water-safe policy in an intensive care unit.
Shaw E1, Gavaldà L2, Càmara J3, Gasull R4, Gallego S4, Tubau F5, Granada RM4, Ciercoles P6, Dominguez MA7, Mañez R4, Carratalà J8, Pujol M9.
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Abstract
BACKGROUND:
Contaminated handwashing sinks have been identified as reservoirs that can facilitate colonization/infection of patients with multidrug-resistant (MDR) Gram-negative bacteria (GNB) in intensive care units (ICUs).
AIM:
To assess the impact of removing patients' sinks and implementing other water-safe strategies on the annual rates of ICU-acquired MDR-GNB.
METHODS:
This six-year quasi-experimental study was conducted from January 2011 to December 2016. The intervention was carried out in August 2014 in two adult ICU wards with 12 rooms each. To assess the changes in annual MDR-GNB rates before and after the intervention, we used segmented regression analysis of an interrupted time-series. Crude relative risk (RR) rates were also calculated.
FINDINGS:
The incidence rates of MDR-GNB were 9.15 and 2.20 per 1000 patient-days in the pre- and post-intervention periods, respectively. This yielded a crude RR of acquiring MDR-GNB of 0.24 (95% confidence interval: 0.17-0.34). A significant change in level was observed between the MDR-GNB rate at the first point of the post-intervention period and the rate predicted by the pre-intervention time trend.
CONCLUSION:
The implementation of a new water-safe policy, which included the removal of sinks from all patient rooms, successfully improved the control of MDR-GNB spread in an ICU with endemic infection. Our results support the contribution of sink use with the incidence of MDR-GNB in endemic environments.
Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Contaminated sink; Endemic environment; Infection control; Intensive care unit; Multidrug-resistant Gram-negative bacteria
Comment in
Response to Shaw et al. [J Hosp Infect. 2018]
Response to Aho Glele et al. [J Hosp Infect. 2018]
PMID: 29104124 DOI: 10.1016/j.jhin.2017.10.025
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Select item 286162034.
Antimicrob Resist Infect Control. 2017 Jun 10;6:59. doi: 10.1186/s13756-017-0213-0. eCollection 2017.
Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of 'water-free' patient care.
Hopman J#1, Tostmann A#1, Wertheim H1, Bos M1, Kolwijck E1, Akkermans R2, Sturm P1,3, Voss A1,4, Pickkers P5, Vd Hoeven H5.
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Abstract
BACKGROUND:
Sinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of 'water-free' patient care on gram-negative bacilli colonization rates.
METHODS:
We conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention using segmented regression analysis of interrupted time series data. Five ICUs of a tertiary care medical center were included. Participants were all patients of 18 years and older admitted to our ICUs for at least 48 h who also received selective digestive tract decontamination during the twelve month pre-intervention or the twelve month post-intervention period. The effect of sink removal and the introduction of 'water-free' patient care on colonization rates with gram-negative bacilli was evaluated. The main outcome of this study was the monthly colonization rate with gram-negative bacilli (GNB). Yeast colonization rates were used as a 'negative control'. In addition, colonization rates were calculated for first positive culture results from cultures taken ≥3, ≥5, ≥7, ≥10 and ≥14 days after ICU-admission, rate ratios (RR) were calculated and differences tested with chi-squared tests.
RESULTS:
In the pre-intervention period, 1496 patients (9153 admission days) and in the post-intervention period 1444 patients (9044 admission days) were included. Segmented regression analysis showed that the intervention was followed by a statistically significant immediate reduction in GNB colonization in absence of a pre or post intervention trend in GNB colonization. The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67-0.99; P = 0.02). The reduction in GNB colonization rate became more pronounced in patients with a longer ICU-Length of Stay (LOS): from a 1.22-fold reduction (≥2 days), to a 1.6-fold (≥5 days; P = 0.002), 2.5-fold (for ≥10 days; P < 0.001) to a 3.6-fold (≥14 days; P < 0.001) reduction.
CONCLUSIONS:
Removal of sinks from patient rooms and introduction of a method of 'water-free' patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.
KEYWORDS:
Colonization; Gram-negative bacilli; Intensive care unit; Length of stay; Multidrug resistance; Sinks; ‘Water-free’ patient care
PMID: 28616203 PMCID: PMC5466749 DOI: 10.1186/s13756-017-0213-0
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Select item 286421395.
Pediatr Neonatol. 2018 Feb;59(1):35-41. doi: 10.1016/j.pedneo.2017.06.001. Epub 2017 Jun 9.
Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: A retrospective review.
Yusef D1, Shalakhti T2, Awad S3, Algharaibeh H3, Khasawneh W4.
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Abstract
BACKGROUND:
Sepsis in the neonatal intensive care unit (NICU) remains one of the most significant causes of morbidity and mortality, especially for preterm newborns. Multi-drug resistant organisms (MDROs) are emerging as important pathogens that cause neonatal sepsis in NICU. Therefore, studying the epidemiology, clinical features, and outcome caused by MDROs vs. non-MDROs, and identifying risk factors that may predispose patients to sepsis by MDROs are important.
METHODS:
Episodes of blood culture-proven sepsis (age: 0-90 days) in the NICU at our institution from January 2012 to December 2015 were retrospectively reviewed. Collected data included demographics, signs at time of sepsis, laboratory values, microbiologic results, and final outcome. We compared clinical and laboratory data and final outcome for patients with sepsis due to MDROs vs. non-MDROs. Multivariate analysis was performed on variables with a P value of <0.05 from univariate analysis.
RESULTS:
Sixty-eight episodes of sepsis (ages 0-54 days, median 7 days; 34 female; 81% premature) were caused by Gram-negative bacteria (n = 42; 62%), Gram-positive bacteria (n = 21; 31%), or Candida (n = 5; 7%). The most common organisms that were isolated were Acinetobacter baumannii (27%), Klebsiella pneumoniae (22%), coagulase-negative staphylococcus (CoNS) (18%), group B streptococcus (10%), and Escherichia coli (6%). Compared with non-MDROs (n = 16; 31%, excluding CoNS and Candida), MDROs (n = 35; 69%) were associated with higher mortality (P = 0.002) and more delay in providing targeted antimicrobial therapy (P = 0.002) (based on antimicrobial susceptibility tests). Sepsis due to the most resistant organisms (A. baumannii and K. pneumoniae Carbapenemase [KPC]-producing bacteria, n = 20; 39%) was associated with higher mortality (P = 0.001) and significantly associated with exposure to carbapenem and vancomycin before onset of sepsis (cases exposed = 13/20; 65%, P < 0.001).
CONCLUSION:
MDROs are the most common cause of sepsis at our NICU and are associated with higher mortality compared with non-MDROs. Previous exposure to carbapenem and vancomycin was associated with sepsis caused by the most resistant organisms.
Copyright © 2017. Published by Elsevier B.V.
KEYWORDS:
multiple antibacterial drug resistance; neonatal intensive care unit; sepsis
PMID: 28642139 DOI: 10.1016/j.pedneo.2017.06.001
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Select item 257484056.
Zhonghua Er Ke Za Zhi. 2015 Jan;53(1):51-6.
[Analysis of pathogenic bacteria and drug resistance in neonatal purulent meningitis].
[Article in Chinese]
Zhu M1, Hu Q1, Mai J1, Lin Z2.
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Abstract
OBJECTIVE:
To study the clinical characteristics, pathogenic bacteria, and antibiotics resistance of neonatal purulent meningitis in order to provide the guide for early diagnosis and appropriate treatment.
METHOD:
A retrospective review was performed and a total of 112 cases of neonatal purulent meningitis (male 64, female 58) were identified in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical University seen from January 1, 2004 to December 31, 2013. The clinical information including pathogenic bacterial distribution, drug sensitivity, head imageology and therapeutic outcome were analyzed. Numeration data were shown in ratio and chi square test was applied for group comparison.
RESULT:
Among 112 cases, 46 were admitted from 2004 to 2008 and 66 from 2009 to 2013, 23 patients were preterm and 89 were term, 20 were early onset (occurring within 3 days of life) and 92 were late onset meningitis (occurring after 3 days of life). In 62 (55.4%) cases the pathogens were Gram-positive bacteria and in 50 (44.6%) were Gram-negative bacteria. The five most frequently isolated pathogens were Escherichia coli (32 cases, 28.6%), coagulase-negative staphylococcus (CNS, 20 cases, 17.9%), Streptococcus (18 cases, 16.1%, Streptococcus agalactiae 15 cases), Enterococci (13 cases, 11.6%), Staphylococcus aureus (9 cases, 8.0%). Comparison of pathogenic bacterial distribution between 2004-2008 and 2009-2013 showed that Gram-positive bacteria accounted for more than 50% in both period. Escherichia coli was the most common bacterium, followed by Streptococcus in last five years which was higher than the first five years (22.7% (15/66) vs. 6.5% (3/46), χ(2) = 5.278, P < 0.05). Klebsiella pneumoniae was more common isolate in preterm infants than in term infants (13.0% (3/23) vs. 1.1% (1/89), χ(2) = 7.540, P < 0.05). Streptococcus (most were Streptococcus agalactiae) was the most common bacteria in early onset meningitis and higher than those in late onset meningitis (35.0% (7/20) vs. 12.0% (11/92), χ(2) = 4.872, P < 0.05). Drug sensitivity tests showed that all the Gram-positive bacterial isolates were sensitive to linezolid. Staphylococci were resistant to penicillin, and most of them were resistant to erythromycin, oxacillin and cefazolin; 77.8%of CNS isolates were methicillin-resistant staphylococcus. No Streptococcus and Enterococcus faecalis was resistant to penicillin. None of enterococci was resistant to vancomycin. Among the Gram-negative bacterial isolates, more than 40% of Escherichia coli were resistant to commonly used cephalosporins such as cefuroxime, cefotaxime and ceftazidime, and all of them were sensitive to amikacin, cefoperazone sulbactam and imipenem. Isolates of Klebsiella pneumoniae were all resistant to ampicillin, cefuroxime, cefotaxime and ceftazidime, but none of them was resistant to piperacillin tazobactam and imipenem. Of the 112 patients, 69 were cured, 23 improved, 9 uncured and 11 died. There were 47 cases (42.0%) with poor prognosis, they had abnormal head imageology, severe complications and some cases died, 13 of 18 (72.2%) patients with meningitis caused by Streptococcus died.
CONCLUSION:
Escherichia coli, CNS and Streptococcus are the predominant pathogens responsible for neonatal purulent meningitis over the past ten years. There were increasing numbers of cases with Streptococcus meningitis which are more common in early onset meningitis with adverse outcome, therefore careful attention should be paid in clinic. Linezolid should be used as a new choice in intractable neonatal purulent meningitis cases caused by gram positive bacteria.
PMID: 25748405
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Select item 146082627.
Minerva Pediatr. 2003 Oct;55(5):385-93.
Colonization with antibiotic-resistant Gram-negative bacilli in the neonatal intensive care unit.
Toltzis P1.
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Abstract
Infections with Gram-negative bacilli have affected critically ill newborns throughout the era of modern neonatal intensive care. Selected topics regarding the acquisition of Gram-negative bacteria, particularly those expressing antibiotic resistance, in the neonatal intensive care unit (NICU) are reviewed. Some data suggest that the recent introduction of intrapartum antibiotic prophylaxis programs, through which selected women are administered penicillin or ampicillin during labor to prevent vertically transmitted Group B streptococcal disease, has increased the incidence and resistance of early onset Gram-negative bacillary infection in the newborn over the past 5 years. Additional data suggest that late onset, nosocomially-acquired Gram-negative bacillary infections also are increasing among critically-ill newborns. The seminal event in Gram-negative bacterial infection in the hospitalized infant is colonization of the gastrointestinal tract and nasopharynx. Newborns admitted to the intensive care unit acquire hospital-associated Gram-negative bacterial colonization throughout their NICU stay, presumably transmitted from the environmental flora via the hands of caregivers. Colonization specifically by antibiotic-resistant bacilli follows a similar pattern, suggesting that such bacteria make up part of the modern NICU ecology and are acquired by infants similar to susceptible microorganisms. Althou-gh some clinically-undetected cross-transmission of resistant bacilli occurs during non-outbreak periods, most colonizing antibiotic-resistant bacilli are unique to each infant. The role of antibiotic exposure on the acquisition of antibiotic resistant bacilli in the intensive care nursery is difficult to calculate given the covariance of such exposure to other markers of severe disease. Experience has demonstrated, however, that use of the aminoglycosides is infrequently associated with emergence of resistance in the newborn, whereas the use of higher-generation cephalosporins may be associated with the rapid appearance of bacilli resistant to betha-lactams.
PMID: 14608262
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Select item 128218218.
Curr Opin Infect Dis. 2003 Jun;16(3):279-83.
Descriptive and molecular epidemiology of Gram-negative bacilli infections in the neonatal intensive care unit.
Dent A1, Toltzis P.
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Abstract
PURPOSE OF REVIEW:
The critically ill neonate is particularly prone to life threatening bacterial infections compared with other patient populations. Current patterns of neonatal sepsis caused by Gram-negative bacilli are reviewed to enable the clinician to better anticipate and effectively respond to neonatal infection by these serious pathogens.
RECENT FINDINGS:
With increasing use of intrapartum antibiotics for prophylaxis against early-onset group B streptococcal infection, there is growing concern that the incidence of neonatal sepsis by Gram-negative pathogens may rise. Although several surveys indicate no such increase to date, studies in selected neonatal intensive care unit populations have suggested a recent elevation in newborn infection caused by Escherichia coli and other bacillary pathogens. Most recent investigations reveal growing antibiotic resistance in those Gram-negative bacilli causing neonatal infection. Modern molecular genotyping methods have been applied to Gram-negative bacilli in the neonatal intensive care unit in order to understand their epidemiology in greater detail. In most instances these techniques have been used to identify the sources and prevalence of an outbreak strain, and to devise rational interventions to control the epidemic. Studies utilizing molecular genotyping during non-outbreak periods indicate that Gram-negative bacilli, even those expressing antibiotic resistance, may be acquired very early in the intensive care unit course, and that different clones are introduced and lost in the infants' indigenous flora throughout their stay. These studies further indicate that cross-transmission of bacillary pathogens occurs regularly even in the absence of a recognized epidemic.
SUMMARY:
Gram-negative bacilli are prominent causes of infection in the neonatal intensive care unit. Their incidence, antibiotic susceptibility pattern, and modes of acquisition continue to evolve in the modern intensive care unit setting.
PMID: 12821821 DOI: 10.1097/00001432-200306000-00016
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Select item 299501629.
BMC Pediatr. 2018 Jun 27;18(1):208. doi: 10.1186/s12887-018-1176-x.
Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal.
Pokhrel B1, Koirala T2, Shah G3, Joshi S3, Baral P4.
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Abstract
BACKGROUND:
Neonatal sepsis, one of the leading causes of mortality in neonatal intensive care units (NICU) of developing countries like Nepal, is often not extensively studied. In order to decrease the morbidity and mortality associated with neonatal sepsis, neonatologists should have a keen knowledge of the existing bacteriological flora and their antibiotic susceptibility pattern. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of culture positive neonatal sepsis in the NICU of a tertiary teaching hospital in Nepal.
METHODS:
This was a retrospective cross-sectional study of all blood culture positive sepsis cases among neonates admitted to the neonatal intensive care unit of Patan Hospital, Nepal between April 15, 2014 and April 15, 2017. All neonates with a clinical suspicion of sepsis with a positive blood culture were identified. Patient demographics, clinical details, maternal risk factors, and laboratory data including bacteriological profiles and antimicrobial susceptibilities were recorded and analyzed.
RESULTS:
Of the 336 neonates admitted in the NICU, 69 (20.5%) had culture-positive sepsis. The majority were early-onset sepsis (n = 54, 78.3%) and were among the preterm babies (n = 47, 68.1%). Most bacterial isolates were gram-negative, predominantly the Klebsiella species (n = 23, 33.3%). Klebsiella showed high resistance to commonly used antibiotics such as; Cefotaxime (90.5%), Gentamicin (75%), Ciprofloxacin (76.2%), Ofloxacin (72.2%) and Chloramphenicol (65%). However, they showed good susceptibility to Carbapenems (100%), Colistin (88.8%) and Tigecycline (81.8%). Among cultures with gram-positive species, Coagulase-negative Staphylococci (CONS) (n = 14, 20.3%) predominated. CONS showed high resistance to Oxacillin (80%), Cefotaxime (66.7%) and Meropenem (80%) but good susceptibility (100%) to Vancomycin and Linezolid. Prevalence of multidrug-resistant strain was 73.9%.
CONCLUSIONS:
Klebsiella species and CONS were the most common causes of neonatal sepsis in our study. A significant proportion of the isolates were multidrug resistant strains, which pose a great threat to neonatal survival, and thereby, warrant modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed. We recommend a combination of Piperacillin-Tazobactam and Ofloxacin as the first line therapy and combination of Vancomycin and Meropenem as the second line empirical therapy in our NICU.
KEYWORDS:
Antibiotic susceptibility; Klebsiella; Multi-drug resistance; NICU; Neonatal sepsis
PMID: 29950162 PMCID: PMC6020420 DOI: 10.1186/s12887-018-1176-x
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Select item 2505127910.
Braz J Infect Dis. 2014 Nov-Dec;18(6):591-9. doi: 10.1016/j.bjid.2014.05.012. Epub 2014 Jul 19.
Predictors of 7- and 30-day mortality in pediatric intensive care unit patients with cancer and hematologic malignancy infected with Gram-negative bacteria.
Costa Pde O1, Atta EH2, Silva AR3.
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Abstract
BACKGROUND:
Infection with Gram-negative bacteria is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of 7- and 30-day mortality in pediatric patients in an intensive care unit with cancer and/or hematologic diseases and Gram-negative bacteria infection.
METHODS:
Data were collected relating to all episodes of Gram-negative bacteria infection that occurred in a pediatric intensive care unit between January 2009 and December 2012, and these cases were divided into two groups: those who were deceased seven and 30 days after the date of a positive culture and those who survived the same time frames. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, infection by multidrug resistant-Gram-negative bacteria, colonization by multidrug resistant-Gram-negative bacteria, neutropenia in the preceding seven days, neutropenia duration ≥3 days, healthcare-associated infection, length of stay before intensive care unit admission, length of intensive care unit stay >3 days, appropriate empirical antimicrobial treatment, definitive inadequate antimicrobial treatment, time to initiate adequate antibiotic therapy, appropriate antibiotic duration ≤3 days, and shock. In addition, use of antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy in the previous 30 days was noted.
RESULTS:
Multivariate logistic regression analysis resulted in significant relationship between shock and both 7-day mortality (odds ratio 12.397; 95% confidence interval 1.291-119.016; p=0.029) and 30-day mortality (odds ratio 6.174; 95% confidence interval 1.760-21.664; p=0.004), between antibiotic duration ≤3 days and 7-day mortality (odds ratio 21.328; 95% confidence interval 2.834-160.536; p=0.003), and between colonization by multidrug resistant-Gram-negative bacteria and 30-day mortality (odds ratio 12.002; 95% confidence interval 1.578-91.286; p=0.016).
CONCLUSIONS:
Shock was a predictor of 7- and 30-day mortality, and colonization by multidrug resistant-Gram-negative bacteria was an important risk factor for 30-day mortality.
Copyright © 2014 Elsevier Editora Ltda. All rights reserved.
KEYWORDS:
Cancer; Infection with Gram-negative bacteria; Mortality; Pediatric intensive care unit
PMID: 25051279 DOI: 10.1016/j.bjid.2014.05.012
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Select item 2349640311.
Med J Aust. 2013 Mar 18;198(5):267-9.
"Down the drain": carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks.
Kotsanas D1, Wijesooriya WR, Korman TM, Gillespie EE, Wright L, Snook K, Williams N, Bell JM, Li HY, Stuart RL.
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Abstract
OBJECTIVES:
Clinical utility of carbapenem antibiotics is under threat because of the emergence of acquired metallo-β-lactamase (MBL) genes. We describe an outbreak in an intensive care unit (ICU) possibly associated with contaminated sinks.
DESIGN, SETTING AND PARTICIPANTS:
Four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 were detected in the ICU at Dandenong Hospital between November 2009 and July 2012. Epidemiological investigations were undertaken in order to identify a common point source. During September 2012, screening using rectal swabs for all ICU patients, and environmental swabs targeting all ICU handwashing sinks and taps were collected. Samples were cultured onto selective carbapenem-resistant Enterobacteriaceae (CRE) agar. Suspected CRE isolates were further characterised using the modified Hodge test and VITEK 2 and confirmed by polymerase chain reaction and sequencing of MBL genes. Clinical and environmental CRE isolates were typed by pulsed-field gel electrophoresis.
RESULTS:
Ten clinical isolates and one screening isolate of CRE (consisting of Klebsiella pneumoniae [5], Serratia marcescens [4], Enterobacter cloacae [1] and Escherichia coli [1]) were detected with the blaIMP-4 gene over the 30-03 period. S. marcescens was isolated persistently from the grating and drain of eight central sinks. Molecular typing confirmed that clinical and environmental isolates were related. Tap water cultures were negative. Several attempts to clean and decontaminate the sinks using detergents and steam cleaning proved unsuccessful.
CONCLUSION:
This report highlights the importance of identification of potential environmental reservoirs, such as sinks, for control of outbreaks of environmentally hardy multiresistant organisms.
PMID: 23496403 DOI: 10.5694/mja12.11757
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Select item 794392712.
Am J Infect Control. 1994 Jun;22(3):163-71.
Epidemic gram-negative bacteremia in a neonatal intensive care unit in Guatemala.
Pegues DA1, Arathoon EG, Samayoa B, Del Valle GT, Anderson RL, Riddle CF, O'Hara CM, Miller JM, Hill BC, Highsmith AK, et al.
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Abstract
BACKGROUND:
Nosocomial bloodstream infection is an important cause of morbidity and mortality among neonates. From September 1 through December 5, 1990 (epidemic period), gram-negative bacteremia developed in 26 neonates after their admission to the neonatal intensive care unit (NICU) of Hospital General, a 1000-bed public teaching hospital in Guatemala with a 16-bed NICU. Twenty-three of the 26 patients (88%) died.
METHODS:
To determine risk factors for and modes of transmission of gram-negative bacteremia in the NICU, we conducted a cohort study of NICU patients who had at least one blood culture drawn at least 24 hours after admission to the NICU and performed a microbiologic investigation in the NICU.
RESULTS:
The rate of gram-negative bacteremia was significantly higher among patients born at Hospital General, delivered by cesarian section, and exposed to selected intravenous medications and invasive procedures in the NICU during the 3 days before the referent blood culture was obtained. During the epidemic period, the hospital's chlorinated well-water system malfunctioned; chlorine levels were undetectable and tap water samples contained elevated microbial levels, including total and fecal coliform bacteria. Serratia marcescens was identified in 81% of case-patient blood cultures (13/16) available for testing and from 57% of NICU personnel handwashings (4/7). Most S. marcescens blood isolates were serotype O3:H12 (46%) or O14:H12 (31%) and were resistant to ampicillin (100%) and gentamicin (77%), the antimicrobials used routinely in the NICU.
CONCLUSIONS:
We hypothesize that gram-negative bacteremia occurred after invasive procedures were performed on neonates whose skin became colonized through bathing or from hands of NICU personnel.
PMID: 7943927 DOI: 10.1016/0196-6553(94)90005-1
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Select item 3138414513.
Turk Pediatri Ars. 2019 Jul 11;54(2):105-112. doi: 10.14744/TurkPediatriArs.2019.00086. eCollection 2019.
Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care center.
Atay G1, Kara M2, Sütçü M2, Aydın YŞ3, Torun SH2, Karapınar BA4, Kayacan ZÇ4, Gürler N4, Çıtak A1, Nişli K1, Salman N2, Somer A2.
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Abstract
AIM:
Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital.
MATERIAL AND METHODS:
In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively.
RESULTS:
One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1-205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance.
CONCLUSION:
Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.
KEYWORDS:
Children; intensive care unit; resistant gram-negative infections
PMID: 31384145 PMCID: PMC6666360 DOI: 10.14744/TurkPediatriArs.2019.00086
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Select item 1169469414.
Pediatrics. 2001 Nov;108(5):1143-8.
Molecular epidemiology of antibiotic-resistant gram-negative bacilli in a neonatal intensive care unit during a nonoutbreak period.
Toltzis P1, Dul MJ, Hoyen C, Salvator A, Walsh M, Zetts L, Toltzis H.
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Abstract
OBJECTIVE:
Gram-negative organisms that are resistant to parenteral antibiotics are a growing threat to hospitalized patients. This study was conducted to define the epidemiologic characteristics of these organisms during a nonoutbreak period in a neonatal intensive care unit (NICU).
METHODS:
Nasopharyngeal and rectal swab specimens were obtained 3 times a week from every infant in a tertiary care NICU during a 12-month period. Specimens were processed to identify aerobic Gram-negative species resistant to gentamicin, piperacillin-tazobactam, or ceftazidime. Selected clinical parameters were tested for their association with colonization with a resistant organism. Restriction endonuclease digests of genomic DNA were derived from isolates of the most frequently occurring species. The fragments were analyzed by pulsed-field gel electrophoresis (PFGE) to determine the genetic relatedness of the various isolates and thereby determine the length of colonization, the frequency of horizontal transmission, and the size and duration of clusters.
RESULTS:
A total of 101 infants (8.6%) of 1180 admissions were colonized with at least 1 antibiotic-resistant bacillus before NICU discharge. Multiple parameters indicating a prolonged, complicated NICU course were associated with resistant colonization, including gestational age, length of stay, and exposure to several classes of antibiotics. Colonization with resistant bacilli occurred as early as the first NICU day, but acquisition continued throughout the infants' stay. A total of 436 isolates were analyzed by PFGE. On the basis of this molecular analysis, it was determined that duration of colonization was usually very short; the median for all species tested was <1 week. In addition, cross-colonization occurred in only 12% of all PFGE-analyzed isolates. Most clusters of cross-colonized infants were small, with the majority involving only 2 patients.
CONCLUSIONS:
During endemic periods, acquisition of antibiotic-resistant Gram-negative bacilli in the NICU may occur very soon after admission, but colonization continues over many weeks of NICU stay. The duration of colonization with resistant bacilli is short, and horizontal transmission is unusual. These characteristics suggest a gradual but temporary incorporation of these organisms from the NICU environment into the nascent newborn microflora over time with little cross-colonization. These observations may aid the rational development of infection-control strategies to contain the reservoir of resistant Gram-negative organisms in the NICU.antibiotic resistance, Gram-negative bacilli, neonatal intensive care, antibiotic utilization, colonization, pulsed-field gel electrophoresis.
Comment in
Molecular epidemiology of antibiotic-resistant Gram-negative bacilli in a neonatal intensive care unit during a nonoutbreak period. [Pediatrics. 2002]
PMID: 11694694 DOI: 10.1542/peds.108.5.1143
[Indexed for MEDLINE]
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Select item 2880366115.
Am J Infect Control. 2017 Oct 1;45(10):1069-1073. doi: 10.1016/j.ajic.2017.06.029. Epub 2017 Aug 10.
Daily bathing strategies and cross-transmission of multidrug-resistant organisms: Impact of chlorhexidine-impregnated wipes in a multidrug-resistant gram-negative bacteria endemic intensive care unit.
Ruiz J1, Ramirez P2, Villarreal E1, Gordon M3, Saez I3, Rodríguez A3, Castañeda MJ3, Castellanos-Ortega Á3.
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Abstract
BACKGROUND:
Health-care associated infections are a major cause of morbidity and mortality in critical care units. The aim of this study is to evaluate the effectiveness of chlorhexidine gluconate (CHG)-impregnated wipes in the daily bathing of patients in an intensive care unit (ICU) to prevent cross-transmission and colonization by multidrug-resistant organisms (MDROs) METHODS: Prospective cohort study with an intervention of 11 months. The intervention consisted of using CHG-impregnated wipes for the daily bathing of patients on mechanical ventilation or colonized by MDROs. Monthly trends in the number of patients colonized by MDROs and the incidence of nosocomial infections were evaluated.
RESULTS:
A total of 1,675 patients were admitted to the unit during the intervention period, and 430 (25.7%) were bathed with chlorhexidine wipes. A significant decrease was observed in the incidence of colonization by MDROs over the months (β = -0.209; r2 = 0.549; P = .027), and in the number of patients colonized compared with the equivalent period of the previous year (22.0% vs 18.4%; P = .01). No significant decrease was observed in the incidence of nosocomial infection between the two periods (4.11% vs 4.57%; P = .355). No dermatologic problems were observed in the treated patients.
CONCLUSIONS:
The use of CHG-impregnated wipes reduces cross-transmission and colonization by MDROs in the ICUs in an endemic situation because of multidrug-resistant Enterobacteriaceae.
Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Chlorhexidine; Gram-negative bacteria; Intensive care unit; Nosocomial infection
PMID: 28803661 DOI: 10.1016/j.ajic.2017.06.029
[Indexed for MEDLINE]
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Select item 2711085816.
J Egypt Public Health Assoc. 2016 Mar;91(1):31-8. doi: 10.1097/01.EPX.0000482038.76692.3.
Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt.
Awad HA1, Mohamed MH, Badran NF, Mohsen M, Abd-Elrhman AS.
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Abstract
BACKGROUND:
Neonatal sepsis remains a serious problem in any neonatal intensive care unit (NICU). Bacterial organisms have developed increased resistance to commonly used antibiotics. Because not enough data are available from Egypt, the aim of the present study was to determine the causative bacteria and the level of their resistance to commonly used antibiotics in tertiary NICUs in Cairo, Egypt.
MATERIALS AND METHODS:
A 3.5-year retrospective study was carried out at NICUs of the Children's Hospital of Ain Shams University and that of El-Hussein Hospital, Al-Azhar University, Egypt. Records of neonates were reviewed. All neonates with culture-proven sepsis were included in the study.
RESULTS:
Almost one-third of the admitted neonates (33.4%) were diagnosed as having neonatal sepsis, 32.25% of them culture-proven. Early/late onset sepsis was found in 35.4 and 64.6%, respectively. Gram-negative/gram-positive bacteria was found in 68 to 25.6%. Fungal infection was detected in 9% of the isolates. Escherichia coli was the main pathogen isolated in both early-onset sepsis (41.2%) and late-onset sepsis (24.5%). Overall, 77% of the isolates were multidrug-resistant (60% of gram-positive bacteria and 83.4% of gram-negative bacteria). Nearly 80% (79%) of mortality was caused by multidrug-resistant organisms. Gram-positive and gram-negative bacteria showed high resistance against commonly used antibiotics such as ampicillin, amoxicillin, cefotaxime, ceftriaxone, and gentamicin.
CONCLUSION AND RECOMMENDATIONS:
There is an alarming increase in antibiotic resistance to the commonly used antibiotics. Continuous surveillance for antibiotic susceptibility is needed to ensure proper empirical therapy. Improvement of infection control practices, avoidance of irrational use of antibiotics, and revision of the protocols are mandatory in the prevention of neonatal sepsis.
PMID: 27110858 DOI: 10.1097/01.EPX.0000482038.76692.3
[Indexed for MEDLINE]
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Select item 2579877817.
Am J Infect Control. 2015 Jun;43(6):640-3. doi: 10.1016/j.ajic.2015.02.010. Epub 2015 Mar 19.
Chlorhexidine daily bathing: impact on health care-associated infections caused by gram-negative bacteria.
Cassir N1, Thomas G2, Hraiech S2, Brunet J3, Fournier PE4, La Scola B4, Papazian L2.
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Abstract
BACKGROUND:
Health care-associated infections (HAIs) are a major cause of morbidity and mortality in intensive care unit (ICU) patients. Our objective was to evaluate the impact of daily bathing with chlorhexidine gluconate (CHG) on the incidence rates of HAIs, with a focus on their causative bacteria, in a French ICU.
METHODS:
From March 2012-May 2013, we enrolled 325 patients with at least 1 episode of suspected sepsis in the ICU, during two 6-month periods. The intervention group was subjected daily to skin cleansing with 2% CHG-impregnated cloths, whereas the control group was bathed daily with soap and water. HAI included bloodstream infections, ventilator-associated pneumonia, and urinary tract infections. Incidence rates corresponded to the number of infections per 1,000 patient days.
RESULTS:
Incidence of HAI was significantly decreased in the intervention group (29 vs 56; P = .01). After adjustment for baseline patient characteristics, the increased risk of HAI in the water and soap group was significant (odds ratio = 1.993; 95% confidence interval [CI], 1.132-3.508; P = .017). The incidence rate of clinical cultures positive for gram-negative bacteria, including Enterobacteriaceae and nonfermenting bacilli, decreased in the intervention group (risk ratio = 0.588; 95% CI, 0.346-0.978; P = .04).
CONCLUSIONS:
CHG daily cleansing reduced the incidence rate of HAI caused by gram-negative bacteria, highlighting the role of the transient gram-negative bacteria skin colonization in the pathogenesis of HAI.
Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Chlorhexidine daily bathing; Gram-negative bacteria; Health care–associated infections; Intensive care unit
Comment in
Role of chlorhexidine bathing in infection control. [Am J Infect Control. 2015]
Role of chlorhexidine bathing in infection control: reply. [Am J Infect Control. 2015]
PMID: 25798778 DOI: 10.1016/j.ajic.2015.02.010
[Indexed for MEDLINE]
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Select item 1902549618.
Clin Infect Dis. 2009 Jan 1;48(1):13-21. doi: 10.1086/594120.
Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines.
Gill CJ1, Mantaring JB, Macleod WB, Mendoza M, Mendoza S, Huskins WC, Goldmann DA, Hamer DH.
Author information
Abstract
BACKGROUND:
The growing burden of neonatal mortality associated with hospital-acquired neonatal sepsis in the developing world creates an urgent need for cost-effective infection-control measures in resource-limited settings.
METHODS:
Using a before-and-after comparison design, we measured how rates of staff hand-hygiene compliance, colonization with drug-resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative bacilli and drug-resistant gram-positive cocci), bacteremia, and overall mortality changed after the introduction of a simplified package of infection-control measures at 2 neonatal intensive care units (NICUs) in Manila, The Philippines.
RESULTS:
Of all 1827 neonates admitted to the NICU, 561 (30.7%) arrived from delivery already colonized with drug-resistant bacteria. Of the 1266 neonates who were not already colonized, 578 (45.6%) became newly colonized with drug-resistant bacteria. Of all 1827 neonates, 358 (19.6%) became bacteremic (78.2% were infected with gram-negative bacilli) and 615 (33.7%) died. Of 2903 identified drug-resistant colonizing bacteria, 85% were drug-resistant gram-negative bacilli (predominantly Klebsiella species, Pseudomonas species, and Acinetobacter species) and 14% were methicillin-resistant Staphylococcus aureus. Contrasting the control period with the intervention period at each NICU revealed that staff hand-hygiene compliance improved (NICU 1: relative risk, 1.3; 95% confidence interval 1.1-1.5; NICU 2: relative risk, 1.6; 95% confidence interval, 1.4-2.0) and that overall mortality decreased (NICU 1: relative risk, 0.5; 95% confidence interval, 0.4-0.6; NICU 2: relative risk, 0.8; 95% confidence interval, 0.7-0.9). However, rates of colonization with drug-resistant pathogens and of sepsis did not change significantly at either NICU.
DISCUSSION:
Nosocomial transmission of drug-resistant pathogens was intense at these 2 NICUs in The Philippines; transmission involved mostly drug-resistant gram-negative bacilli. Infection-control interventions are feasible and are possibly effective in resource-limited hospital settings.
Comment in
Feasibility and efficacy of infection-control interventions to reduce the number of nosocomial infections and drug-resistant microorganisms in developing countries: what else do we need? [Clin Infect Dis. 2009]
PMID: 19025496 PMCID: PMC3866590 DOI: 10.1086/594120
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Select item 3099549119.
J Hosp Infect. 2019 Oct;103(2):151-155. doi: 10.1016/j.jhin.2019.04.004. Epub 2019 Apr 14.
Antimicrobial-resistant Gram-negative colonization in infants from a neonatal intensive care unit in Thailand.
Roberts T1, Limmathurotsakul D2, Turner P3, Day NPJ2, Vandepitte WP4, Cooper BS2.
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Abstract
Antimicrobial-resistant Gram-negative bacteria are a major cause of morbidity and mortality in hospitalized neonates in South and South-East Asia. This study aimed to determine the dynamics of colonization with antimicrobial-resistant Gram-negative bacteria amongst patients in a neonatal intensive care unit (NICU) in Thailand. From 97 enrolled patients, 52% were colonized by an extended-spectrum β-lactamase (ESBL) organism at some point during their stay and 64% were colonized by a carbapenem-resistant organism. Rapid acquisition of ESBL-positive and carbapenem-resistant organisms was found. Once colonized with an antibiotic-resistant organism, patients remained colonized for the remainder of their NICU stay.
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.
KEYWORDS:
Antimicrobial resistance; Carbapenem resistance; Colonization; Extended-spectrum beta-lactamase; Neonate
PMID: 30995491 PMCID: PMC6863035 DOI: 10.1016/j.jhin.2019.04.004
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Select item 2483160720.
J Hosp Infect. 2014 Jun;87(2):126-30. doi: 10.1016/j.jhin.2014.02.013. Epub 2014 Apr 18.
The sink as a correctable source of extended-spectrum β-lactamase contamination for patients in the intensive care unit.
Wolf I1, Bergervoet PW2, Sebens FW2, van den Oever HL3, Savelkoul PH4, van der Zwet WC2.
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Abstract
Between December 2010 and April 2012, intensive care unit (ICU) patients in our hospital were infrequently colonized with extended-spectrum β-lactamase-positive bacteria (ESBLs). We hypothesized that these ESBLs originated from patients' room sinks, and this was prospectively investigated by weekly culturing of patients and sinks during a 20-week period. ESBLs were isolated from all 13 sinks. Four patients became colonized with ESBLs that were genetically identical to ESBLs that had previously been isolated from the sink. One of these patients died of pneumonia caused by the ESBL. Transmission from sinks to patients was stopped by integrating self-disinfecting siphons to all sinks on the ICU.
Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Amplified fragment length polymorphism; Extended-spectrum β-lactamase-positive bacteria; Hospital reservoir; Intensive care unit; Sink
PMID: 24831607 DOI: 10.1016/j.jhin.2014.02.013
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