scholarly journals A one-year survey of candidemia in Belgium in 2002

2004 ◽  
Vol 132 (6) ◽  
pp. 1175-1180 ◽  
Author(s):  
D. SWINNE ◽  
M. WATELLE ◽  
C. SUETENS ◽  
K. MERTENS ◽  
P.-A. FONTEYNE ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Susceptibility Testing ◽  
The Elderly ◽  
Surveillance Program ◽  
National Surveillance ◽  
Intravascular Catheter ◽  
Predisposing Factor ◽  
One Year

A total of 211 episodes of bloodstream yeast infections in 207 patients, hospitalized in 28 Belgian hospitals participating in a National Surveillance Program, were evaluated. A total of 81% of the patients were more than 50 years of age. Candida albicans was the cause of infections in 55% of patients, 22% were due to C. glabrata and 13% to C. parapsilosis. The most common predisposing factors were antibacterial therapy (42%), residence in an intensive care unit (32·9%) and presence of an intravascular catheter (29·7%). Most patients had more than one predisposing factor. Fluconazole alone or in association with another antifungal agent was the treatment of choice for 89·7% of the cases. In vitro susceptibility testing of the isolates revealed that 99% were susceptible to amphotericin B, 95% to 5-fluorocytosine, 82% to fluconazole and 69% to itraconazole. Resistance to azoles was more common among C. glabrata isolates in the elderly. We conclude that the frequency of C. albicans infection is decreasing in Belgium and this is associated with the emergence of other species, most notably, C. glabrata.

scholarly journals Spatiotemporal dynamics of multidrug resistant bacteria on intensive care unit surfaces

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Alaric W. D’Souza ◽  
Robert F. Potter ◽  
Meghan Wallace ◽  
Angela Shupe ◽  
Sanket Patel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
The United States ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Hospital Infection Control ◽  
Novel Taxa ◽  
Multiple Species ◽  
One Year

Abstract Bacterial pathogens that infect patients also contaminate hospital surfaces. These contaminants impact hospital infection control and epidemiology, prompting quantitative examination of their transmission dynamics. Here we investigate spatiotemporal and phylogenetic relationships of multidrug resistant (MDR) bacteria on intensive care unit surfaces from two hospitals in the United States (US) and Pakistan collected over one year. MDR bacteria isolated from 3.3% and 86.7% of US and Pakistani surfaces, respectively, include common nosocomial pathogens, rare opportunistic pathogens, and novel taxa. Common nosocomial isolates are dominated by single lineages of different clones, are phenotypically MDR, and have high resistance gene burdens. Many resistance genes (e.g., blaNDM, blaOXA carbapenamases), are shared by multiple species and flanked by mobilization elements. We identify Acinetobacter baumannii and Enterococcus faecium co-association on multiple surfaces, and demonstrate these species establish synergistic biofilms in vitro. Our results highlight substantial MDR pathogen burdens in hospital built-environments, provide evidence for spatiotemporal-dependent transmission, and demonstrate potential mechanisms for multi-species surface persistence.

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

2021 ◽  
pp. 0310057X2198971
Author(s):  
M Atif Mohd Slim ◽  
Hamish M Lala ◽  
Nicholas Barnes ◽  
Robert A Martynoga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
One Year ◽  
Maori Health

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

Shortening the Application Time of Alcohol-Based Hand Rubs to 15 Seconds May Improve the Frequency of Hand Antisepsis Actions in a Neonatal Intensive Care Unit

2017 ◽  
Vol 38 (12) ◽  
pp. 1430-1434 ◽  
Author(s):  
Axel Kramer ◽  
Didier Pittet ◽  
Romana Klasinc ◽  
Stefan Krebs ◽  
Torsten Koburger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Application Time ◽  
Improve Hand Hygiene ◽  
Independent Observer ◽  
Hand Antisepsis

BACKGROUNDFor alcohol-based hand rubs, the currently recommended application time of 30 seconds is longer than the actual time spent in clinical practice. We investigated whether a shorter application time of 15 seconds is microbiologically safe in neonatal intensive care and may positively influence compliance with the frequency of hand antisepsis actions.METHODSWe conducted in vitro experiments to determine the antimicrobial efficacy of hand rubs within 15 seconds, followed by clinical observations to assess the effect of a shortened hand antisepsis procedure under clinical conditions in a neonatal intensive care unit (NICU). An independent observer monitored the frequency of hand antisepsis actions during shifts.RESULTSAll tested hand rubs fulfilled the requirement of equal or even significantly higher efficacy within 15 seconds when compared to a reference alcohol propan-2-ol 60% (v/v) within 30 seconds. Microbiologically, reducing the application time to 15 seconds had a similar effect when compared to 30-second hand rubbing, but it resulted in significantly increased frequency of hand antisepsis actions (7.9±4.3 per hour vs 5.8±2.9 per hour; P=.05).CONCLUSIONTime pressure and workload are recognized barriers to compliance. Therefore, reducing the recommended time for hand antisepsis actions, using tested and well-evaluated hand rub formulations, may improve hand hygiene compliance in clinical practice.Infect Control Hosp Epidemiol 2017;38:1430–1434

scholarly journals Recent Exposure to Caspofungin or Fluconazole Influences the Epidemiology of Candidemia: a Prospective Multicenter Study Involving 2,441 Patients

2010 ◽  
Vol 55 (2) ◽  
pp. 532-538 ◽  
Author(s):  
Olivier Lortholary ◽  
Marie Desnos-Ollivier ◽  
Karine Sitbon ◽  
Arnaud Fontanet ◽  
Stéphane Bretagne ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Odds Ratio ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Antifungal Drugs ◽  
Surveillance Program ◽  
Prospective Multicenter Study ◽  
Recent Exposure ◽  
Adults And Children

ABSTRACTA prospective multicenter surveillance program on yeast bloodstream infections was implemented in the Paris, France, area without restrictions on ward of hospitalization (intensive care unit, hematology, and surgery) or age (adults and children). The present analysis concerns 2,618 isolates collected over 7 years from 2,441 patients. Centralized species identification and antifungal susceptibility testing using the EUCAST methodology were performed. Almost 10% (232/2,441) of the patients had recently (≤30 days) been treated with antifungal drugs. We analyzed the effect of recent exposure to fluconazole (n= 159) or caspofungin (n= 61) on the proportions of the five majorCandidaspecies. For both drugs, preexposure was associated with a decreased prevalence ofCandida albicansin favor of less drug-susceptible species (C. glabrataandC. kruseifor the former andC. parapsilosisand, to a lesser extent,C. glabrataandC. kruseifor the latter;P= 0.001). In the multivariate analysis, the risk of being infected with an isolate with decreased susceptibility to fluconazole was independently associated with an age of ≥15 years (odds ratio [OR] = 2.45; 95% confidence interval [CI] = 1.39 to 4.31;P= 0.002) and with recent exposure to fluconazole (OR = 2.17; 95% CI = 1.51 to 3.13;P< 0.001), while the risk of being infected with an isolate with decreased susceptibility to caspofungin was independently associated with an age <15 years (OR = 2.53; 95% CI = 1.43 to 4.48;P= 0.001) and with recent exposure to caspofungin (OR = 4.79; 95% CI = 2.47 to 9.28;P< 0.001). These findings could influence future recommendations for the management of candidemia.

scholarly journals One-year molecular surveillance of carbapenem-susceptible A. baumannii on a German intensive care unit: diversity or clonality

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Andreas F. Wendel ◽  
Monika Malecki ◽  
Robin Otchwemah ◽  
Carlos J. Tellez-Castillo ◽  
Samir G. Sakka ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Molecular Surveillance ◽  
One Year

scholarly journals Intensive care–treated cardiac arrest: A retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs

2021 ◽  
Author(s):  
Ester Elisabet Holmström ◽  
Ilmar Efendijev ◽  
Rahul Raj ◽  
Pirkka T. Pekkarinen ◽  
Erik Litonius ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Retrospective Study ◽  
Cost Effectiveness ◽  
Neurological Outcome ◽  
Age Groups ◽  
The Elderly ◽  
Treatment Intensity ◽  
One Year ◽  
Healthcare Associated

Abstract Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and 75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent association between age group, mortality and neurological outcome. Results: This study included a total of 1,285 patients, of which 212 (16%) were 75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24% of the patients in the elderly group and 47% of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 3.36, 95% CI:2.21-5.11, p < 0.001) and neurological outcome (multivariate OR = 3.27, 95% CI: 2.12-5.03, p < 0.001). Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.

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