An Outbreak ofAcinetobacter baumannii:The Importance of Cross-Transmission

2000 ◽  
Vol 21 (9) ◽  
pp. 588-591 ◽  
Author(s):  
Erika M.C. D'Agata ◽  
Valerie Thayer ◽  
William Schaffner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Infections ◽  
Attack Rate ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Number Of Patients ◽  
Cross Transmission

AbstractObjective:To investigate an outbreak of nosocomial infections due to multidrug-resistant (MDR)Acinetobacter baumanniiand to analyze the contribution of cross-transmission in the rise in infection rates.Design:Epidemiological investigation; molecular typing using pulsed-field gel electrophoresis (PFGE); matched case-control study to identify risk factors for infection.Setting:A 34-bed surgical intensive care unit at a tertiary-care hospital.Patients:Eighteen patients who developed MDRA baumanniinosocomial infection were matched to 36 patients who were admitted to the same surgical intensive care unit (SICU) room and did not develop an infection during the outbreak period.Results:Prior to the outbreak, the baseline attack rate of MDRA baumanniinosocomial infections was 3 per 100 patients per month. From February 1 through March 22, 1998, the attack rate rose to 16 per 100 patients per month, with a total of 18 infections. All isolates had indistinguishable PFGE patterns. Seventy environmental cultures were negative for MDRA baumannii. Following intense infection control education, the attack rate decreased to 4 per 100 patients per month. By conditional logistic regression, cases were exposed to a significantly higher number of patients with MDRA baumanniiinfections compared to controls (odds ratio, 1.1; 95% confidence interval, 1.01-1.2;P=.02), even after adjusting for length of SICU admission and exposure to antibiotics and invasive devices.Conclusion:Cross-transmission between patients contributed to the rise in rates of MDRA baumanniiinfections. A common environmental source was not detected.

scholarly journals A COMPARATIVE STUDY ON DRUG USE OF ANTIMICROBIAL AGENTS IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL.

2018 ◽  
Vol 11 (1) ◽  
pp. 310
Author(s):  
Nimin Paul ◽  
Santhosh Kumar V
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clavulanic Acid ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Total Drug ◽  
Surgical Intensive Care

 Objective: To identify the pattern of drug utilization of antimicrobials in prescriptions of patients admitted at medical intensive care unit (MICU) and surgical intensive care unit (SICU) department and to analyze the utilization of different classes of drugs.Methods: A prospective observational study was carried out in 10 bedded medical and surgical intensive care unit (ICU) of tertiary care hospital, Adayar, from October 1st 2016 to March 1st 2016. The study was performed in 100 prescriptions. The relevant data on drug prescription of each patient were collected from in-patient records. The demographic data, disease data, and the utilization of different classes of antimicrobial agents (AMAs) were analyzed.Results: In MICU, a total of 648 drugs were prescribed during the period of stay and AMAs accounted for 15% of total drug. The average length of stay was found to be 8 (±8.73). The mean number of drugs received by patients is 11.6 ± 2 drugs. The most frequently prescribed AMAs were ceftriaxone followed by meropenem and clindamycin. Cephalosporin is commonly prescribed due to their relatively lower toxicity and broader spectrum activity. The generally prescribed AMA combination was amoxicillin + clavulanic acid (32.50%) and piperacillin + tazobactam (27.50%). The laboratory reported positive cultures for 30 patients. The most prevailing organisms were Escherichia coli (50%). In SICU, a total of 780 drugs were prescribed during the period of stay and AMAs accounted for 18% of total drug. An average of 5 (±2.0) drugs was prescribed for each patient and each prescription contains an average of 2 (±0.9) AMAs. The results indicated that ceftriaxone was the most commonly prescribed AMAs (22%), followed by meropenem (18%), ciprofloxacin (18%), and colistin (8%). A total of five AMA combination therapies were used in SICU. Among them, piperacillin+clavulanic acid (36.84%) was the most commonly prescribed combination. In the study, 30 (60 %) cases had microbial growth and have performed sensitivity test.Conclusion: A wide class and percentage of AMAs were prescribed in ICUs. There is a need of antimicrobial agent’s usage guidelines and restriction policies for the rational prescribing of antimicrobials in critically ill patients.

scholarly journals Incidence and risk factors of delirium in surgical intensive care unit

2021 ◽  
Vol 6 (1) ◽  
pp. e000564
Author(s):  
Muhammad Asghar Ali ◽  
Madiha Hashmi ◽  
Waqas Ahmed ◽  
Syed Amir Raza ◽  
Muhammad Faisal Khan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Low Income ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care

BackgroundTo evaluate the incidence and modifiable risk factors of delirium in surgical intensive care unit (SICU) of tertiary care hospital in a low-income and middle-income country.MethodsWe conducted a single cohort observational study in patients over 18 years of age who were admitted to the SICU for >24 hours in Aga Khan University Hospital from January to December 2016. Patients who had pre-existing cognitive dysfunction were excluded. Intensive Care Delirium Screening Checklist was used to assess delirium. Incidence of delirium was computed, and univariate and multivariable analyses were performed to observe the relationship between outcome and associated factors.ResultsThe average patient age was 43.29±17.38 and body mass index was 26.25±3.57 kg/m2. Delirium was observed in 19 of 87 patients with an incidence rate of 21.8%. Multivariable analysis showed chronic obstructive pulmonary disease, pain score >4 and hypernatremia were strong predictors of delirium. Midazolam (adjusted OR (aOR)=7.37; 95% CI 2.04 to 26.61) and propofol exposure (aOR=7.02; 95% CI 1.92 to 25.76) were the strongest independent predictors of delirium while analgesic exposures were not statistically significant to predict delirium in multivariable analysis.ConclusionDelirium is a significant risk factor of poor outcome in SICU. There was an independent association between pain, sedation, COPD, hypernatremia and fever in developing delirium.Level of evidenceIV.

scholarly journals A COMPARATIVE STUDY ON DRUG USE OF ANTIMICROBIAL AGENTS IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL.

2018 ◽  
Vol 11 (1) ◽  
pp. 310
Author(s):  
Nimin Paul ◽  
Santhosh Kumar V
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clavulanic Acid ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Total Drug ◽  
Surgical Intensive Care

 Objective: To identify the pattern of drug utilization of antimicrobials in prescriptions of patients admitted at medical intensive care unit (MICU) and surgical intensive care unit (SICU) department and to analyze the utilization of different classes of drugs.Methods: A prospective observational study was carried out in 10 bedded medical and surgical intensive care unit (ICU) of tertiary care hospital, Adayar, from October 1st 2016 to March 1st 2016. The study was performed in 100 prescriptions. The relevant data on drug prescription of each patient were collected from in-patient records. The demographic data, disease data, and the utilization of different classes of antimicrobial agents (AMAs) were analyzed.Results: In MICU, a total of 648 drugs were prescribed during the period of stay and AMAs accounted for 15% of total drug. The average length of stay was found to be 8 (±8.73). The mean number of drugs received by patients is 11.6 ± 2 drugs. The most frequently prescribed AMAs were ceftriaxone followed by meropenem and clindamycin. Cephalosporin is commonly prescribed due to their relatively lower toxicity and broader spectrum activity. The generally prescribed AMA combination was amoxicillin + clavulanic acid (32.50%) and piperacillin + tazobactam (27.50%). The laboratory reported positive cultures for 30 patients. The most prevailing organisms were Escherichia coli (50%). In SICU, a total of 780 drugs were prescribed during the period of stay and AMAs accounted for 18% of total drug. An average of 5 (±2.0) drugs was prescribed for each patient and each prescription contains an average of 2 (±0.9) AMAs. The results indicated that ceftriaxone was the most commonly prescribed AMAs (22%), followed by meropenem (18%), ciprofloxacin (18%), and colistin (8%). A total of five AMA combination therapies were used in SICU. Among them, piperacillin+clavulanic acid (36.84%) was the most commonly prescribed combination. In the study, 30 (60 %) cases had microbial growth and have performed sensitivity test.Conclusion: A wide class and percentage of AMAs were prescribed in ICUs. There is a need of antimicrobial agent’s usage guidelines and restriction policies for the rational prescribing of antimicrobials in critically ill patients.

Dissemination of Bacillus cereus in an Intensive Care Unit

1993 ◽  
Vol 14 (8) ◽  
pp. 459-462 ◽  
Author(s):  
E.A. Bryce ◽  
J.A. Smith ◽  
M. Tweeddale ◽  
B.J. Andruschak ◽  
M.R. Maxwell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bacillus Cereus ◽  
Tertiary Care ◽  
Control Measures ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Assembly Area ◽  
Effective Manner

AbstractObjective:To report the contamination of ventilator equipment with Bacillus cereus and to outline the measures taken to trace the source of the organism.Design:A prospective survey of all intensive care unit patients who were culture-positive for B cereus and obtaining of environmental cultures of the cleaning and assembly area of the respiratory services division between October 1991 and September 1992.Setting And Patients:Ventilated patients from a 16-bed medical and surgical intensive care unit (ICU) in a 1,000-bed adult tertiary care hospital.Interventions And Results:From October 1991 to April 1992, B cereus colonized the ventilator circuitry of patients in the ICU. One of two washer/decontaminators in the cleaning and assembly area of the respiratory services division was found to yield the microorganism consistently from the water intake port. The design of the machine precluded easy decontamination of the port with 2% gluteraldehyde and a second outbreak occurred. Following the second outbreak, aqueous chlorhexidine in a final concentration of 0.05% was added to the first of two pasteurization cycles in an attempt to achieve sporicidal activity. This ended the outbreak. Sixty-two patients became colonized with the organism including two with nonfatal Bacillus sepsis and one death due to pneumonia associated with the organism.Conclusion:This experience emphasizes the importance of obtaining cultures of machine parts to identify the source of contamination and thereby direct control measures. Use of chlor-hexidine gluconate at high temperatures effectively eradicated B cereus from ventilator circuitry in a practical and cost-effective manner.

scholarly journals A study of wound infections and its antibiogram in surgical intensive care unit of a tertiary care hospital

2019 ◽  
Vol 5 (7) ◽  
pp. 473-478
Author(s):  
Dr. Upasana Bhumbla ◽  
◽  
Dr. Safaa Muneer Ahmed ◽  
Dr. Dinesh Raj Mathur ◽  
Dr. A.S. Dalal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Wound Infections ◽  
Surgical Intensive Care
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