scholarly journals The added value of the selective SuperPolymyxin™ medium in detecting rectal carriage of Gram-negative bacteria with acquired colistin resistance in intensive care unit patients receiving selective digestive decontamination

2019 ◽  
Vol 39 (2) ◽  
pp. 265-271 ◽  
Author(s):  
Denise van Hout ◽  
Axel B. Janssen ◽  
Rob J. Rentenaar ◽  
Judith P.M. Vlooswijk ◽  
C.H. Edwin Boel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Conventional Method ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
Selective Medium ◽  
Colistin Resistance ◽  
Icu Patients ◽  
Gram Negative ◽  
Inoculation Methods

Abstract The objective of this study was to determine the value of using SuperPolymyxin™ selective medium (ELITech Group, Puteaux, France) in addition to conventional non-selective inoculation methods in the detection of acquired colistin resistance in a Dutch intensive care unit (ICU) that routinely uses selective decontamination of the digestive tract (SDD). We performed a cross-sectional study with prospective data collection in a tertiary-care ICU. All consecutive surveillance rectal swabs of ICU-patients receiving SDD were included and cultured in an observer-blinded approach using (1) a conventional culture method using non-selective media and (2) SuperPolymyxin™ selective medium. MIC values for colistin of non-intrinsically colistin-resistant Gram-negative isolates were determined with broth microdilution (BMD) using Sensititre™ and colistin resistance was confirmed using BMD according to EUCAST guidelines. One thousand one hundred five rectal swabs of 428 unique ICU-patients were inoculated using both culture methods, yielding 346 and 84 Gram-negative isolates for BMD testing with the conventional method and SuperPolymyxin™ medium, of which 308 and 80 underwent BMD, respectively. The number of identified rectal carriers of isolates with acquired colistin resistance was 3 (0.7%) for the conventional method, 4 (0.9%) for SuperPolymyxin™, and 5 (1.2%) for both methods combined. The number of isolates with acquired colistin resistance was 4 (1.0%) for the conventional method, 8 (2.1%) for SuperPolymyxin™ and 9 (2.3%) for both methods combined. In a surveillance setting of low prevalence of acquired colistin resistance in patients that receive SDD in a Dutch tertiary-care ICU, SuperPolymyxin™ had a higher diagnostic yield than conventional inoculation methods, but the combination of both had the highest diagnostic yield.

scholarly journals Increased colistin resistance of Acinetobacter species in intensive care unit-acquired infections in a tertiary care hospital

10.3823/815 ◽  
2017 ◽  
Vol 7 (3) ◽  
Author(s):  
Sanem Karadag Gecgel ◽  
Canan Demir
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
Tertiary Care ◽  
Care Hospital ◽  
Colistin Resistance ◽  
Acinetobacter Species ◽  
Gram Negative ◽  
Resistance Rates

Background: The aim of our study was to evaluate the antimicrobial resistance rates among pathogen microorganisms especially colistin resistant rates of Acinetobacter baumannii in intensive care unit (ICU)-acquired infections and to determine infection-specific correct treatment strategies. Methods: The data of adult and newborn infant patients diagnosed with ICU-acquired infection in a tertiary education and research hospital in Bursa in 2014 and 2016 were analyzed, retrospectively. Results: Acinetobacter baumannii was the most frequent pathogen of ICU-acquired infections in 2014 and 2016. There was a significant increase in colistin (CO) resistance rates in A. baumanii (0.0%-6.8%). A significant increase in CO, cefepime (FEP), ciprofloxacin (CIP) resistance rates was established in all gram negative bacteria (0.0%-7.9%, 50.0%-91.9%, 54.7%-74.6%), respectively. A significant increase in the rate of detection of A. baumanii as the pathogen microorganism in respiratory tract infection (RTI) was established (53.9% -79.5%). In addition, the average ventilator-associated pneumonia (VIP) infection rate also increased in 2016 compared to 2014 (VIP rate 2014: 7.12, 2016: 7.45, per 1000 ventilator days). A significant decrease in the rate of detection of all gram negative microorganisms in the surgical site infection (SSI), and a significant increase in the rate of detection of all gram positive microorganisms in the SSI was determined. Conclusion: Increased antimicrobial resistance, especially increased colistin resistance rates in ICU-acquired infections, necessitates the creation of new strategies in empirical therapy. Detection of antimicrobial resistance profiles of local and infectious pathogen microorganisms in ICUs is a good guide for correct antimicrobial management.

scholarly journals Patterns of Antimicrobial Resistance Among Intensive Care Unit Patients of A Private Medical College Hospital in Dhaka

2015 ◽  
Vol 25 (2) ◽  
pp. 47-51 ◽  
Author(s):  
Quazi Tarikul Islam ◽  
Md Mahmudur Rahman Siddiqui ◽  
Farhana Raz ◽  
Mohammad Asrafuzzaman ◽  
Md Robed Amin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Aspirate ◽  
College Hospital ◽  
Icu Patients ◽  
Gram Negative ◽  
Pseudomonas Spp ◽  
Medical College ◽  
Acinetobacter Spp ◽  
Klebsiella Spp

Because of importance of Hospital acquired infections (HAIs), it is critical to conduct surveillance studies to obtain the required data about the regional microorganisms and their susceptibility to antibiotics. This study to investigate antimicrobial resistance pattern among Intensive Care Unit (ICU) patients in a private medical college hospital setup. In a cross sectional study, 100 specimens from patients admitted in the ICU who had signs or symptoms of nosocomial infection were collected from 2012 - 2013. For each patient, samples of blood, urine, tracheal aspirate, sputum, wound swab, pus, and endotracheal tubes were obtained, cultured and analyzed with antibiogram. The most common primary diagnosis were aspiration pneumonia (49%) and UTI (20%) respectively. The most common locations for infection were tracheal aspirate (54%). The most frequent gram negative microorganisms derived from samples were Acinetobacter spp (29%), Klebsiella spp (26%) and Pseudomonas spp (18%). Klebsiella spp, Acinetobacter spp and Pseudomonas spp were most common resistant organisms among all. Klebsiella spp were resistant against Ceftriaxone (84.6%), Ceftazidime (82.6%), Amikacin (46.1%), Gentamicin (66.6%) and Quinolones (65-66.6%) respectively. Acinetobacter spp were resistant against Ceftriaxone (85%), Ceftazidime (88.8%), Cefotaxime (85.7%), Meropenem (79.3%),Amikacin (86.2%), Gentamicin (84.5%) and Quinolons (86.2-89.2%) respectively. Pseudomonas spp were resistant against Ceftriaxone (70.5%), Ceftazidime (66.6%), Amikacin (68.7%), Gentamicin (58.8%), Meropenem (52.9%) and Quinolones (81.2-86.6%) respectively. Meropenem was the most sensitive antibiotic against Klebsiella spp (84.6%) but Cotrimoxazole in case of Acinetobacter spp (60%) respectively. Escherichia coli were mostly isolated from urine, which was sensitive to Amikacin (73.3%) and Meropenem (86.6%) respectively. Gram-negative pathogens obtained from ICU patients in our settings show high resistance to antibiotics. Regular monitoring of the pattern of resistance of common pathogens in the ICUs is essential to up-to-date the use of rational antibiotics regiments.Bangladesh J Medicine Jul 2014; 25 (2) : 47-51

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

Predictive Factors for the Development of Central Line–Associated Bloodstream Infection Due to Gram-Negative Bacteria in Intensive Care Unit Patients After Surgery

2008 ◽  
Vol 29 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Pranavi V. Sreeramoju ◽  
Jocelyn Tolentino ◽  
Sylvia Garcia-Houchins ◽  
Stephen G. Weber
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infection ◽  
Predictive Factors ◽  
Tertiary Care ◽  
Central Line ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria

Objectives.To examine the relative proportions of central line-associated bloodstream infection (BSI) due to gram-negative bacteria and due to gram-positive bacteria among patients who had undergone surgery and patients who had not. The study also evaluated clinical predictive factors and unadjusted outcomes associated with central line-associated BSI caused by gram-negative bacteria in the postoperative period.Design.Observational, case-control study based on a retrospective review of medical records.Setting.University of Chicago Medical Center, a 500-bed tertiary care center located on Chicago's south side.Patients.Adult intensive care unit (ICU) patients who developed central line-associated BSI.Results.There were a total of 142 adult patients who met the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System definition for central line-associated BSI. Of those, 66 patients (46.5%) had infections due to gram-positive bacteria, 49 patients (34.5%) had infections due to gram-negative bacteria, 23 patients (16.2%) had infections due to yeast, and 4 patients (2.8%) had mixed infections. Patients who underwent surgery were more likely to develop central line-associated BSI due to gram-negative bacteria within 28 days of the surgery, compared with patients who had not had surgery recently (57.6% vs 27.3%; P = .002). On multivariable logistic regression analysis, diabetes mellitus (adjusted odds ratio [OR], 4.6 [95% CI, 1.2-18.1]; P = .03) and the presence of hypotension at the time of the first blood culture positive for a pathogen (adjusted OR, 9.8 [95% CI, 2.5-39.1]; P = .001 ) were found to be independently predictive of central line-associated BSI caused by gram-negative bacteria. Unadjusted outcomes were not different in the group with BSI due to gram-negative pathogens, compared to the group with BSI due to gram-positive pathogens.Conclusions.Clinicians caring for critically ill patients after surgery should be especially concerned about the possibility of central line-associated BSI caused by gram-negative pathogens. The presence of diabetes and hypotension appear to be significant associated factors.

scholarly journals Antimicrobial Sensitivity Pattern in the Mixed Intensive Care Unit in a Tertiary Care Hospital of Eastern Nepal

2020 ◽  
Vol 2 (2) ◽  
pp. 9-15
Author(s):  
Niraj Kumar Keyal ◽  
Mahendra Shrestha ◽  
Partima Sigdel Ghimire
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Polymyxin B ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Sensitivity Pattern

 Background: Empirical antibiotics are used in the intensive care unit based on developing countries’ guidelines due to a lack of a bacteriological profile of individual ICU and institution policy. Therefore, this study was conducted to know the antibiogram of the intensive care unit and to make institution policy for antibiotic use in ICU. Materials and methods: It was a prospective descriptive cross-sectional study conducted in the mixed surgical and medical intensive care unit of a tertiary care hospital for one year in 625 patients. Various clinical samples were collected aseptically and organisms were identified by the cultural characteristics, morphology, gram stain, and different biochemical test. Antimicrobial susceptibility was done with a disc diffusion test. Data collection was done in a preformed sheet that included all tested antibiotic and demographic variables. Statistical analysis was done by using statistical package for the social sciences. The result was presented as frequency and percentage. Results: Out of 625 samples, 135(22%) showed growth in culture. Among them, 96(71%) and 39(29%) were gram-negative bacilli and gram-positive cocci respectively. The tracheal aspirate was the most common type of specimen which comprised 49(36.29%) isolates. The most common organism was Staphylococcus aureus which accounts for 27(20%) isolates, followed by Acinetobacter baumanni 25(18.51%), Klebsiella pneumoniae 22(16.29%) and Pseudomonas aeurignosa 21(15.55%). The incidence of multidrug-resistant and extended drug resistance was 44(32.5%) and 45(33%) respectively. Meanwhile, the incidence of methicillin-resistant staphylococcus aureus was 70%. However, in the case of Acinetobacter baumannii and Enterobacteriaceae, all were sensitive to polymyxin B and meropenem. Conclusion:Antibiotics should be prescribed based on the antibiogram of individual intensive care units that can decrease antibiotic resistance. Polymyxin B and meropenem can be prescribed for gram-negative bacilli and vancomycin for Staphylococcus aureus.

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.

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.

scholarly journals Frequency and predictors of colonization of the respiratory tract by VIM-2-producing Pseudomonas aeruginosa in patients of a newly established intensive care unit

2006 ◽  
Vol 55 (10) ◽  
pp. 1435-1439 ◽  
Author(s):  
Maria Horianopoulou ◽  
Nicholas J. Legakis ◽  
Maria Kanellopoulou ◽  
Sotiris Lambropoulos ◽  
Athanassios Tsakris ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Respiratory Tract ◽  
Tertiary Care ◽  
Nucleotide Sequencing ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative ◽  
Icu Stay

The aim of this study was to examine the frequency and predictors of colonization of the respiratory tract by metallo-β-lactamase (MBL)-producing Gram-negative bacteria in patients admitted to a newly established intensive care unit (ICU) of a tertiary care hospital. Specimens of tracheobronchial aspirates for microbiological studies were obtained every day for the first 3 days of the ICU stay and subsequently every third day for the rest of the ICU stay. PCR analysis and nucleotide sequencing were performed to identify bacteria that had MBL genes. Thirty-five patients (20 male, 15 female) were hospitalized during the initial 3 month period of functioning of the ICU. Colonization of the lower respiratory tract by Gram-negative bacteria was found in 29 of 35 patients (83 %) during the first 6–20 days (median 13 days) following admission to the ICU (13 patients with Acinetobacter baumannii, ten with Pseudomonas aeruginosa, three with Enterobacter aerogenes, two with Klebsiella pneumoniae and one with Stenotrophomonas maltophilia). Six of 29 patients (21 %) colonized with Gram-negative bacteria had bla VIM-2-positive P. aeruginosa isolates; one of these patients developed clinical infection due to this micro-organism. Previous use of carbapenems (P=0.01) or other β-lactams (P=0.03), as well as a stay in the ICU of >20 days (P<0.001), were associated with colonization with bla VIM-2-producing P. aeruginosa. In conclusion, colonization by Gram-negative bacteria of the respiratory tract of patients in this newly established ICU was common (83 %). Use of β-lactams, including carbapenems, was associated with subsequent colonization of the respiratory tract with MBL-positive P. aeruginosa.

scholarly journals Burkholderia cepacia an emerging cause of septicaemia, in an intensive care unit from a tertiary care hospital, Nellore, India

2020 ◽  
Vol 7 (3) ◽  
pp. 413
Author(s):  
Usham Gangaram ◽  
Tupili Ramya ◽  
Kandati Jithendra ◽  
Desu Rama Mohan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Conventional Method ◽  
Burkholderia Cepacia ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Blood Stream ◽  
Resistant Organism ◽  
Care Hospital ◽  
Mortality And Morbidity

Background: Burkholderia cepacia is highly virulent and multidrug resistant organism to cause fatal and serious infections in ICUs leads to rise in mortality and morbidity. aim of present study was to know the prevalence of Burkholderia cepacia in blood stream infection in Intensive Care Unit and to know the drug susceptibility.Methods: This is a prospective study was carried out in the Intensive Care Unit and Department of Microbiology, Narayana Medical College, Nellore, from February to March 2018. As a part of routine investigations Blood, urine, sputum or tracheal secretions sent for culture and sensitivity to the Microbiology laboratory. By conventional method, all the samples were cultured (except blood) onto Blood agar, Chocolate agar and MacConkey, s agar; incubated for 18-24 hours at 37⁰C. Blood cultures were performed in BACT/ Alert 3D (Biomeriux), only positives were subculture by conventional method. Further analysis was done in culture positive samples only.Results: A total of 448 patients admitted in ICU were included in the study, from them 586 samples were collected. out of which we got 238 culture positives. Among them 19 patients were positive for Burkholderia cepacia, most of them isolated from blood (78.9%), followed by respiratory secretions (21.1%) and none of them were isolated from urine samples. Most of the isolates were sensitive to Meropenam and Tigecycline (89.4%) followed by minocycline (84.2%), ceftazidime (73.6%), levofloxacin (63.1%). While B. cepacia isolates showed high resistance to cefaperazone-sulbactam, ciprofloxacin, ticarcillin-clavulanic acid with (84.2%), (89.4%), (89.4%) respectively.Conclusions: To conclude that, Burkholderia cepacia is one of the emerging causes of septicemia with multidrug resistance, cross contamination may be the root cause so it should be treated quickly and effectively.

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