Epidemiology of Hospital-Acquired Infections in a Tertiary Care Center in Lebanon

The SARS-CoV-2 pandemic has resulted in a surge of critically ill patients. Hospitals have had to adapt to the demand by repurposing areas as intensive care units. This has resulted in high workload and disruption of usual hospital workflows. Surge capacity guidelines and pandemic response plans do not contemplate how to limit collateral damage from issues like hospital-acquired infections. It is vital to ensure quality of care in surge scenarios.

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Antimicrobial Resistance Patterns and Antibiotic Use during Hospital Conversion in the COVID-19 Pandemic

Antibiotics ◽

10.3390/antibiotics10020182 ◽

2021 ◽

Vol 10 (2) ◽

pp. 182

Author(s):

Bernardo A. Martinez-Guerra ◽

Maria F. Gonzalez-Lara ◽

Nereyda A. de-Leon-Cividanes ◽

Karla M. Tamez-Torres ◽

Carla M. Roman-Montes ◽

...

Keyword(s):

Antibiotic Treatment ◽

Care Center ◽

Tertiary Care ◽

Bloodstream Infections ◽

Coagulase Negative Staphylococci ◽

Hospital Acquired Infections ◽

Empiric Antibiotic ◽

Empiric Antibiotic Treatment ◽

Hospital Acquired ◽

Antimicrobial Prescription

Objective: To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. Methods: In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. Results: 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). Conclusion: A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.

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723Community vs Hospital Acquired Staphylococcus aureus Bacteremia in A Canadian Tertiary Care Center: A Retrospective Chart Review, 2010-2012

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.431 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S204-S204

Author(s):

Arienne King ◽

Byron Berenger ◽

Jeffrey Fuller ◽

Stephanie Smith

Keyword(s):

Staphylococcus Aureus ◽

Chart Review ◽

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Tertiary Care Center ◽

Staphylococcus Aureus Bacteremia ◽

Hospital Acquired

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The effect of increased mobility on morbidity in the neurointensive care unit

Journal of Neurosurgery ◽

10.3171/2012.2.jns111881 ◽

2012 ◽

Vol 116 (6) ◽

pp. 1379-1388 ◽

Cited By ~ 84

Author(s):

W. Lee Titsworth ◽

Jeannette Hester ◽

Tom Correia ◽

Richard Reed ◽

Peggy Guin ◽

...

Keyword(s):

Unit Length ◽

Care Center ◽

Tertiary Care ◽

Neurointensive Care ◽

Neurointensive Care Unit ◽

Hospital Acquired Infections ◽

Medical Icus ◽

Hospital Acquired ◽

Observation Period

Object The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients. Methods All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus. Results Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p < 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p < 0.004), hospital LOS (p < 0.004), hospital-acquired infections (p < 0.05), and ventilator-associated pneumonias (p < 0.001), and decreased the number of patient days in restraints (p < 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections. Conclusions Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.

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Contemporary Epidemiology of Catheter-Associated Urinary Tract Infections (CAUTIs) in a Tertiary Care Center: Is Foley Re-Insertion a Novel Risk Factor?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.838 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S349-S349

Author(s):

Cima Nowbakht ◽

Kelley M Boston ◽

Nicole Harrison ◽

Bela Patel ◽

Jeffrey Katz ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Multi Drug Resistance ◽

High Risk Population ◽

Tertiary Care Center ◽

Case Control Studies ◽

Large Tertiary Care ◽

Prevention Interventions ◽

Tract Infections ◽

Hospital Acquired

Abstract Background CAUTIs are one of the most common causes of hospital-acquired infections. We report on a retrospective analysis performed on prospectively collected CAUTI surveillance data from 2014 to 2016 at a large tertiary care academic hospital Methods A total of 181 CAUTIs by NHSN definition were reviewed to describe contemporary demographics, risk factors, microbiology, and outcomes. Results The 181 CAUTIs involved 178 patients. 61% were female. Events mostly occurred in an ICU setting (65%), specifically our neurosurgical unit (23%), followed by floors (24%) and intermediate units (11%). Most episodes occurred within a week after the initial catheter insertion (60%). 40% of CAUTIs occurred within an average of 5.5 days (SD ± 5.12) after a Foley re-insertion. Of the 221 cultured micro-organisms, Gram-negatives accounted for 74% (predominately K. pneumoniae and E. coli), followed by Gram-positives and yeast at 18% and 8%, respectively. 8% of organisms showed multi-drug resistance, 8% of patients developed C. difficile co-infections, 23% had concomitant bacteremia, and the length of stay averaged 28 days (SD ± 26.74). 55% of patients were discharged to another facility. 12% of patients expired and 4% were discharged to hospice Conclusion We describe the contemporary demographics, microbiology and outcomes of CAUTIs in a large tertiary care center. We also found that 40% of our CAUTIS are associated with a Foley removal and re-insertion event. Reasons requiring catheter exchanges and reinsertions include leakage, bleeding, obstruction, failed voiding trial, and general malfunction. Although this observation needs to be confirmed case control studies and larger observational trials, this new insight may provide an opportunity to intervene and focus infection prevention interventions in this novel high-risk population. Disclosures All authors: No reported disclosures.

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