scholarly journals Increased Rates of Secondary Bacterial Infections, Including Enterococcus Bacteremia, in Patients Hospitalized with COVID-19

2021 ◽  
pp. 1-33
Author(s):  
Catherine DeVoe ◽  
Mark R Segal ◽  
Lusha Wang ◽  
Kim Stanley ◽  
Sharline Madera ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
San Francisco ◽  
Bacterial Infections ◽  
Bloodstream Infections ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Multiple Logistic Regression ◽  
National Healthcare Safety Network ◽  
Increased Risk ◽  
Tract Infections

Abstract Objective: We aimed to compare rates of hospital-onset secondary bacterial infections in patients with COVID-19 with rates in patients with influenza and controls, and to investigate reports of increased incidence of Enterococcus infections in patients with COVID-19. Design: Retrospective cohort study Setting: An academic quaternary care hospital in San Francisco, California Patients: Patients admitted between 10/1/2019 and 10/1/2020 with a positive SARS-CoV-2 PCR (N=314) or influenza PCR (N=82) within 2 weeks of admission were compared with inpatients without positive SARS-CoV-2 or influenza tests during the study period (N=14,332). Methods: National Healthcare Safety Network definitions were used to identify infection-related ventilator-associated complications (IVAC), probable ventilator-associated pneumonia (PVAP), bloodstream infections (BSI), and catheter-associated urinary tract infections (CAUTI). A multiple logistic regression model was used to control for likely confounders. Results: COVID-19 patients had significantly higher rates of IVAC and PVAP compared to controls, with adjusted odds ratios of 4.7 (1.7-13.9) and 10.4 (2.1-52.1), respectively. COVID-19 patients had higher incidence of BSI due to Enterococcus but not BSI generally, and whole genome sequencing of Enterococcus isolates demonstrated that nosocomial transmission did not explain the increased rate. Sub-analyses of patients admitted to the ICU and patients who required mechanical ventilation revealed similar findings. Conclusions: COVID-19 is associated with an increased risk of IVAC, PVAP and Enterococcus BSI compared with hospitalized controls, not fully explained by factors such as immunosuppressive treatments and duration of mechanical ventilation. The mechanism underlying increased rates of Enterococcus BSI in COVID-19 patients requires further investigation.

Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

2020 ◽  
pp. 004947552098245
Author(s):  
Pooja Kumari ◽  
Priya Datta ◽  
Satinder Gombar ◽  
Deepak Sharma ◽  
Jagdish Chander
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Control Measures ◽  
North India ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

scholarly journals Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

2018 ◽  
Vol 6 (8) ◽  
pp. 2754
Author(s):  
David D. M. Rosario ◽  
Anitha Sequeira
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Early Tracheostomy ◽  
Hospital Acquired Infection ◽  
Total Incidence ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: Pneumonia is the most common hospital acquired infection in the intensive care unit. One of the causes for hospital acquired pneumonia is ventilator associated pneumonia. Tracheostomy is known to prevent occurrence of ventilator associated pneumonia as it decreases the respiratory dead space, assists in better clearance of secretions and prevents chances of aspiration. Generally, tracheostomy is done after 2 weeks of endotracheal intubation to prevent tracheal complications. The aim of this study is to identify the incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients and to see if early tracheostomy can prevent development of ventilator associated pneumonia.Methods: The study was conducted at a tertiary care hospital during a period of four years. 100 patients who were on mechanical ventilation for more than 7 days where taken up for the study. APACHE 4 scoring system was used. The incidence of Ventilator associated pneumonia in tracheostomised and non tracheostomised patients was studied.Results: In our study the total incidence of VAP was 44 %. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia. Among the non-tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. In our study the incidence of ventilator associated pneumonia was much lesser (12%) in patients who underwent tracheostomy in the period 7 to 10 days after mechanical ventilation, whereas in those who underwent tracheostomy after 11 days incidence of ventilator associated pneumonia was much higher.Conclusions: Our study showed that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy. Hence patients undergoing earlier tracheostomy had a clear advantage than those undergoing tracheostomy late or non tracheostomised patients in preventing ventilator associated pneumonia.

Abstract P190: Triggering of Coronary Heart Disease by Infection Type: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Logan Cowan ◽  
Pamela Lutsey ◽  
Jim Pankow ◽  
Kunihiro Matsushita ◽  
Junichi Ishigami ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Infection Type ◽  
Bloodstream Infections ◽  
Infection Frequency ◽  
Acute Infections ◽  
Chd Risk ◽  
Increased Risk ◽  
Infection Types ◽  
Tract Infections

Introduction: Acute infections are known triggers of coronary heart disease (CHD). It is unclear how the strength of the association varies by infection type. Hypothesis: We hypothesized that all acute infections increase CHD risk but the level of increased risk varies by infection type. Methods: Incident CHD (myocardial infarction and fatal CHD) cases were identified and adjudicated in the ARIC cohort. ARIC participants were linked to Medicare claims data. We used ICD-9 codes to identify 4 infection types based on infection frequency: cellulitis, pneumonia, urinary tract infections (UTI), and bloodstream infections. We used a case-crossover design and conditional logistic regression to compare infections among CHD cases 90 days before the event with two corresponding control periods 1 year and 2 years prior. The Wald test was used to assess differences between infection types. Results: A total of 1,312 CHD cases were identified. Among cases, 43 had cellulitis, 102 had pneumonia, 116 had a UTI, and 28 had a bloodstream infection within 90 days of the CHD event. All infection types were associated with higher CHD risk within 90 days of the infection; (odds ratios and 95% Cis) (cellulitis = 1.41 (0.93, 2.15), pneumonia = 5.60 (3.72, 8.43), UTI = 2.62 (1.92, 3.57), bloodstream infections = 4.77 (2.34, 9.71)) although cellulitis was not statistically significant (Figure). The association between infection and CHD was significantly stronger for pneumonia, UTI, and bloodstream infections compared to cellulitis (p<0.05). Pneumonia and bloodstream infections were stronger CHD triggers compared to UTI but only pneumonia reached statistical significance (p<0.05). Conclusions: Patients with pneumonia or bloodstream infections may be at particularly elevated CHD risk. Clinical trials of CHD preventive therapies during and immediately following infection to reduce the otherwise elevated CHD risk are needed. Healthcare providers should consider CHD risk during and immediately after infection and optimize preventive therapies.

scholarly journals Incidence and risk factors of non–device-associated pneumonia in an acute-care hospital

2019 ◽  
Vol 41 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Paula D. Strassle ◽  
Emily E. Sickbert-Bennett ◽  
Michael Klompas ◽  
Jennifer L. Lund ◽  
Paul W. Stewart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Prevention ◽  
Acute Care Hospital ◽  
Future Research ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Prevention Strategies ◽  
Increased Risk ◽  
Academic Teaching Hospital ◽  
Male Sex

AbstractObjective:To update current estimates of non–device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia.Design:Cohort study.Setting:Academic teaching hospital.Patients:All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non–device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology.Results:From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40–3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07–2.05), or paralysis (HR, 1.72; 95% CI, 1.09–2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18–2.00) or in the ICU (HR, 1.49; 95% CI, 1.06–2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation.Conclusion:The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non–device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.

scholarly journals The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network

2021 ◽  
pp. 1-14 ◽  
Author(s):  
Lindsey M. Weiner-Lastinger ◽  
Vaishnavi Pattabiraman ◽  
Rebecca Y. Konnor ◽  
Prachi R. Patel ◽  
Emily Wong ◽  
...  
Keyword(s):  
State Level ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infection ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections ◽  
Healthcare Associated ◽  
The Impact

Abstract Objectives: To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019. Methods: Central–line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed. Results: Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020. Conclusions: This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.

scholarly journals A study on poor prognostic factors associated with ventilator associated pneumonia at a tertiary care hospital

2020 ◽  
Vol 7 (6) ◽  
pp. 906
Author(s):  
Raveendra K. R. ◽  
Suraj S. Hegde
Keyword(s):  
Mechanical Ventilation ◽  
Prognostic Factors ◽  
Late Onset ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Cross Sectional ◽  
Beta Lactamases ◽  
Factors Associated ◽  
Hospital Acquired

Background: Ventilator associated pneumonia (VAP) is a hospital acquired infection (HAI) seen among critically ill patients, on mechanical ventilation, due to various causes in intensive care units (ICUs). It is associated with increased morbidity and mortality which increases the cost of health care. The aim of this study was to determine the poor prognostic factors associated with VAP.Methods: In this cross-sectional prospective study,40 patients who developed features of ventilator associated pneumonia on a platform of mechanical ventilator for >48 hrs in ICU were included in the study. VAP was then diagnosed based on clinical pulmonary infection scoring system (CPIS) with a score of >=6. All patients were evaluated and correlated with different parameters for the treatment and outcome.Results: Most of the patients had late onset VAP (60.7%) with average number of days being around 8 days. Pseudomonas, Acinetobacter, Enterobacteriacea, Staphylococcus aureus were commonly isolated organisms. Polymicrobial infections were not detected. Antibiotics like colistin, tigecycline and beta-lactamases are the most commonly effective antibiotics. Of the 40 VAP patients,20 patients survived and  20 died with protocol line of treatment. Following poor prognostic factors were identified-Early onset VAP (42.5%), elderly patients (>65 years) (90%), Type 2 DM (80%), hypertension (70%), prior antibiotic therapy (65%), prolonged supine position (68%) and re-intubation (75%).Conclusions: Ventilator associated pneumonia is associated with a significant increase in length of stay in ICU, time of mechanical ventilation and different complications and certain risk factors further worsens the prognosis.

scholarly journals Bacteriological profile and antimicrobial resistance pattern of ventilator associated pneumonia in tertiary care hospital

2021 ◽  
Vol 8 (3) ◽  
pp. 191-195
Author(s):  
Eshwar Rajesh ◽  
Radhika Katragadda ◽  
C P Ramani
Keyword(s):  
Mechanical Ventilation ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
Endotracheal Aspiration ◽  
Life Threatening

With an occurrence ranging from 6-52%, ventilator-associated pneumonia (VAP) is the most common ICU acquired infection, accounting for a significant portion of hospital-acquired infections (HAIs). VAP is pneumonia that develops after a period of more than 48 hours of mechanical ventilation or endotracheal intubation. To isolate and identify the potential pathogens causing VAP and to study their antimicrobial susceptibility patterns. Endotracheal aspiration (ETA) or bronchoalveolar lavage (BAL) were collected from patients on mechanical ventilation &#62;48 hours. Bacterial isolates were identified based on culture colony characteristics and biochemical parameters. Antibiotic susceptibility profile was determined for these isolates by Kirby-Bauer disc diffusion method as per Clinical and laboratory Standards Institute (CLSI) 2020 guidelines and studied. The collected data was entered in Excel, and analyzed by using SPSS version 16. Among the isolates, the most common were (31.31%) and (31.31%). These were followed by (22.22%), (7.07%), (3.03%) and (3.03%) and (2.02%).Multi Drug Resistant (MDR) microbes causing VAP are on the increase. The patient population at risk will benefit by the application of the results of this study. The antibiotic resistance pattern of these isolates will aid clinicians in selecting the appropriate antimicrobial agents. Hence, it can lead to decreased mortality and morbidity due to life-threatening VAP.

Impact of modified CDC/NHSN surveillance definition on the incidence of CAUTI: a study from an Indian tertiary care hospital

2020 ◽  
pp. 175717742098204
Author(s):  
Bijayini Behera ◽  
Jayanti Jena ◽  
Ashoka Mahapatra ◽  
Jyoti Biswala
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Care Hospital ◽  
Candida Spp ◽  
Surgical Intensive Care ◽  
Control And Prevention ◽  
The Mean ◽  
Tract Infections ◽  
The Impact

Introduction: Catheter-associated urinary tract infections (CAUTIs) are one of the most common infections encountered in healthcare settings. Candida spp. were excluded as the causative agents of CAUTIs as per Centres for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) definitions in 2015. Aim: To determine the impact of the 2015 definition change on the CAUTI rate of patients admitted to medical and surgical intensive care units (ICUs) of a tertiary care and teaching hospital in India. Method: CAUTI rates were compared in both the ICUs over a period of two years with inclusion and exclusion of Candida spp. Results: Out of the total 116 CAUTI episodes during the study period, a mean of 9.08 CAUTIs per 1000 catheter days were observed in both the ICUs when Candida spp. were included, but the mean CAUTI rate was reduced to 4.78/1000 catheter days when Candida spp. were excluded. Discussion/Conclusion: The mean CAUTI rate decreased by 46.03% solely by excluding Candida spp. This significant reduction in CAUTI rates may be applicable to institutions having high rates of candiduria in catheterised patients, but may not be applicable in centres where the incidence of candiduria is already low. Disregarding Candida as a causative agent of CAUTI did not impact rates of central line-associated bloodstream infections during the study period.

scholarly journals 1209. Impact of Respiratory Staphylococcus aureus Abundance on Risk for Ventilator-Associated Pneumonia During Long-Term Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S626-S626
Author(s):  
James J Harrigan ◽  
Hatem Abdallah ◽  
Erik Clarke ◽  
Ebbing Lautenbach ◽  
Emily Reesey ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Mechanical Ventilation ◽  
Bacterial Community ◽  
Acute Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
16S Sequencing ◽  
Wide Range ◽  
The Impact

Abstract Background Patients admitted to long-term acute care hospital (LTACH) for ventilator weaning are at high risk for ventilator-associated pneumonia, which may contribute to adverse ventilator-associated events (VAE). Staphylococcus aureus (Sa) is a common cause of VAP. We sought to evaluate the impact of respiratory Sa colonization and bacterial community dominance on subsequent Sa VAP and VAE during long-term acute care. Methods We enrolled 83 subjects dependent on mechanical ventilation at LTACH admission, collected endotracheal aspirates, performed 16S rRNA gene sequencing (Illumina HiSeq) and bacterial community profiling (QIIME2). Statistical analysis was performed with R and Stan; mixed effects models were fit to relate the abundance of respiratory Sa on admission to clinically-diagnosed VAP and VAE. Results Of the 83 subjects, 8 were diagnosed with Sa pneumonia during the 14 days prior to LTACH admission (“Known Sa”), and 17 additional subjects received anti- Sa antibiotics within 48 hours of admission (“Suspected Sa”); 58 subjects had no known or suspected Sa (“Unknown Sa”). Among the Known Sa group, all 8 had Sa detectable by 16S sequencing, with elevated admission Sa proportional abundance (median 0.36; range 0.0013 - 1). Among the Suspected Sa group, only 7 had Sa detectable by 16S sequencing, with a wide range of admission Sa proportional abundance (median 0; range 0 - 0.96). 25 of 58 subjects in the Unknown Sa group also had detectable respiratory Sa, and a wide range of Sa proportional abundance at admission (median 0; range 0 - 0.93). Incident Sa VAP was observed within 30 days among 2 (25%) of the Known Sa subjects, 0 (0%) of the Suspected Sa subjects, and 3 (5.17%) of the Unknown Sa subjects. VAE was observed within 30 days among 0 (0%) of the Known Sa subjects, 3 (18%) of the Suspected Sa subjects, and 1 (1.7%) of the Unknown Sa subjects. Admission Sa abundance was positively associated with 30-day VAP risk in the Suspected Sa (type S error &lt; 0.001) and Unknown Sa (type S error &lt; 0.001) groups. Conclusion Among patients admitted to LTACH for weaning for mechanical ventilation, we observed a high prevalence of respiratory Sa colonization. Respiratory Sa abundance was associated with risk of incident Sa VAP, particularly among subjects without recognized Sa colonization. Disclosures All Authors: No reported disclosures

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