Genodiversity of ResistantPseudomonas aeruginosaIsolates in Relation to Antimicrobial Usage Density and Resistance Rates in Intensive Care Units

2008 ◽  
Vol 29 (4) ◽  
pp. 350-357 ◽  
Author(s):  
Daniel Jonas ◽  
Elisabeth Meyer ◽  
Frank Schwab ◽  
Hajo Grundmann
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
High Resistance ◽  
Resistance Rate ◽  
Fisher Exact Test ◽  
Indirect Measure ◽  
Antimicrobial Usage ◽  
Defined Daily Doses ◽  
Cross Transmission ◽  
Resistance Rates

Objective.To evaluate the assumption that resistance rates in intensive care units (ICUs) are markedly influenced by cross-transmission events in addition to high rates of antimicrobial usage.Methods.This was a prospective ICU- and laboratory-based surveillance study involving 35 German ICUs from 1999 through 2004. A total of 585 ciprofloxacin- or imipenem-resistant isolates ofPseudomonas aeruginosawere investigated together with resistance rate and unit-based antimicrobial usage density. Antimicrobial use was reported in terms of defined daily doses per 1,000 patient-days. All the strains were assigned to ICU-based genotypes. Genodiversity was calculated as the numbers of indistinguishable ICU-based genotypes found per isolates tested. Reduced ICU-based genodiversity was taken as an indirect measure of frequently occurring cross-transmission events.Results.The genodiversity of ciprofloxacin- and imipenem-resistant P.aeruginosaisolates was significantly lower (P≤ .05, by Fisher exact test) in ICUs with high resistance rate and low antimicrobial usage density (genodiversity, 0.50 and 0.50, respectively) than in ICUs that featured low resistance rate in the presence of high antimicrobial usage density (genodiversity, 0.90 and 0.95, respectively). In ICUs with low genodiversity, there was a greater rise in resistance rate with increasing antimicrobial usage density, compared with that in ICUs with high diversity.Conclusions.This study on resistant P.aeruginosaisolates supports the assumption that high resistance rate in the presence of low antimicrobial usage density results from more-frequent cross-transmission events. A greater rise in resistance rate with increasing antimicrobial usage density in ICUs with low genodiversity indicates that resistance rate in ICUs might be markedly determined by cross-transmission events other than antimicrobial usage.

scholarly journals High Prevalence of Antimicrobial Resistance Among Gram-Negative Isolated Bacilli in Intensive Care Units at a Tertiary-Care Hospital in Yucatán Mexico

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 588 ◽  
Author(s):  
Andrés H. Uc-Cachón ◽  
Carlos Gracida-Osorno ◽  
Iván G. Luna-Chi ◽  
Jonathan G. Jiménez-Guillermo ◽  
Gloria M. Molina-Salinas
Keyword(s):  
Escherichia Coli ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Intensive Care Units ◽  
High Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Gram Negative ◽  
Resistance Rates

Background and Objectives: Antimicrobial resistance (AMR) is increasing worldwide and imposes significant life-threatening risks to several different populations, especially to those in intensive care units (ICU). The most commonly isolated organisms in ICU comprise gram-negative bacilli (GNB), and these represent a leading cause of serious infections. This study was conducted to describe the prevalence of resistance in GNB isolated from patients in adults, pediatric, and neonatal ICU in a tertiary-care hospital in Mérida, Mexico. Materials and Methods: A retrospective study was done on samples collected in Neonatal (NICU), Pediatric (PICU) and Adult (AICU) ICU of Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social in Mérida, México. The identification of isolates and antimicrobial susceptibility testing were performed using an automated system. Results: A total of 517 GNB strains were isolated. The most common positive culture was bronchial secretions. Pseudomonas aeruginosa was the prevalent pathogen in NICU and PICU, whereas Escherichia coli was common in the AICU. Overall, GNB exhibited a high resistance rates for Ampicillin (95.85%), Cefuroxime (84.17%), Piperacillin (82.93%), Cefotaxime (78.07%), Ceftriaxone (77.41%), Aztreonam (75.23%), Cefazolin (75.00%), and Ceftazidime (73.19%). There are significant differences in the resistance rates of GNB from different ICUs for penicillins, cephalosporins, carbapenems and fluoroquinolones drugs. Escherichia coli (multidrug-resistant [MDR] = 91.57%, highly resistant microorganisms [HRMO] = 90.36%) and Acinetobacter baumannii (MDR = 86.79%, HRMO = 83.02%) exhibited the highest percentage of MDR and HRMO profiles. The prevalence of the extended-spectrum beta-lactamases (ESBL)-producing isolates was 83.13% in E. coli, 78.84% in Klebsiella pneumoniae, and 66.67% in Proteus mirabilis, respectively. Conclusions: The high resistance rates to drugs were exhibited by our GNB isolates. Continuous surveillance and control of the use of antimicrobials are urgently needed to reduce the emergence and spreading of MDR, HRMO, and/or ESBL-producing bacilli.

scholarly journals Resistance Rates of Acinetobacter baumannii Against Some Antibiotics: Comparison of 2018 and 2006 Results

ANKEM Dergisi ◽  
2020 ◽  
Author(s):  
Nurullah Uzuner ◽  
Selahhattin Atmaca ◽  
Muhammet Çelik ◽  
Handan Kangül
Keyword(s):  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Treatment Options ◽  
Resistance Rate ◽  
Serious Infection ◽  
One Year ◽  
The One ◽  
Comparison Of The Results ◽  
Resistance Rates

Acinetobacter baumannii is a type of bacteria that causes serious hospital infections in intensive care units (ICUs) and immunocompromised patients. In this study, the one-year cumulative antibiogram results of A.baumannii strains, which are serious infection factors especially in intensive care patients, were retrospectively analyzed, at the same time, the results of sensitivity in a similar study conducted in our hospital in 2006 were compared with our results. Of the 388 isolates included in the study, 208 were isolated from male (53.6 %), 180 from female (46.4 %) patients, 87 % of the strains were from adults, 13 % from children (including newborns). 46.4 % of the factors were produced by the respiratory tract, 26.80 % from blood culture, 11.85 % from urine, 9.53 % from the wound 85 % of the samples were sent from intensive care units, 15 % from services (9.4 % internal service, 5.6 % surgical service), 6.95 % from the burn unit. The vast majority of the isolated A.baumannii strains were found to be adults. As a result of the antibiogram, the highest resistance rate to imipenem with 94.84 %; the lowest resistance rate was determined against colistin with 20 %. In the comparison of the results obtained in our hospital with the results of similar studies conducted in 2006, a significant increase in resistance was found for amikacin, ciprofloxacin, imipenem and meropenem (p<0.005), For trimethoprim / sulfamethoxazole, the resistance rate decreased (p>0.005). In this study, we showed that the resistance rates against A.baumannii strains increased over time, and the treatment options related to this are now very limited. Determining the resistance rates of common infectious agents at certain intervals by each hospital will be a guide in the effective treatment of infections that develop due to strains with limited antibiotic options.

scholarly journals Factors associated with admission to intensive care units in COVID-19 patients in Lyon-France

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0243709
Author(s):  
Philippe Vanhems ◽  
Marie-Paule Gustin ◽  
Christelle Elias ◽  
Laetitia Henaff ◽  
Cédric Dananché ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Ward ◽  
Fisher Exact Test ◽  
Forward Selection ◽  
Multivariable Logistic Regression Model ◽  
Chi Square ◽  
Exact Test ◽  
Total Hospital Stay

Introduction A new respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analysing clinical presentation on admission and the determinants associated with admission in intensive care units (ICUs) in hospitalized COVID-19 patients. Patients and methods In this prospective hospital-based study, socio-demographic, clinical and biological characteristics, on admission, of adult COVID-19 hospitalized patients presenting from the community for their first admission were prospectively collected and analysed. Characteristics of patients hospitalized in medical ward to those admitted in ICU were compared using Mann-Whitney and Chi-square or Fisher exact test when appropriate. Univariate logistic regression was first used to identify variables on admission that were associated with the outcome i.e. admission to an ICU versus total hospital stay in a medical ward. Forward selection was then applied beginning with sex, age and temperature in the multivariable logistic regression model. Results Of the 412 patients included, 325 were discharged and 87 died in hospital. Multivariable regression showed increasing odds of ICU hospitalization with temperature (OR, 1.56 [95% CI, 1.06–2.28] per degree Celsius increase), oxygen saturation <90% (OR, 12.45 [95% CI, 5.27–29.4]), abnormal lung auscultation on admission (OR, 3.58 [95% CI, 1.58–8.11]), elevated level of CRP (OR, 2.7 [95% CI, 1.29–5.66for CRP>100mg/L vs CRP<10mg/L). and monocytopenia (OR, 3.28 [95% CI, 1.4–7.68]) were also associated with increasing odds of ICU hospitalization. Older patients were less likely to be hospitalized in ICU (OR, 0.17 [95%CI, 0.05–0.51]. Conclusions Age and delay between onset of symptoms and hospital admission were associated with the risk of hospitalisation in ICU. Age being a fixed variable, interventions that shorten this delay would improve the prognosis of Covid-19 patients.

Predictive Validity of the Cubbin-Jackson and Braden Skin Risk Tools in Critical Care Patients: A Multisite Project

2021 ◽  
Vol 30 (2) ◽  
pp. 140-144
Author(s):  
Jill M. Delawder ◽  
Samantha L. Leontie ◽  
Ralitsa S. Maduro ◽  
Merri K. Morgan ◽  
Kathie S. Zimbro
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Assessment Tool ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Braden Scale ◽  
Skin Integrity

Background Patients in intensive care units are 5 times more likely to have skin integrity issues develop than patients in other units. Identifying the most appropriate assessment tool may be critical to preventing pressure injuries in intensive care patients. Objectives To validate the Cubbin-Jackson skin risk assessment in the critical care setting and to compare the predictive accuracy of the Cubbin-Jackson and Braden scales for the same patients. Methods In 5 intensive care units, the Cubbin-Jackson and Braden assessments were completed by different clinicians within 61 minutes of each other for 4137 patients between October 2017 and March 2018. Bivariate correlations and the Fisher exact test were used to check for associations between the scores. Results The Cubbin-Jackson and Braden scores were significantly and positively correlated (r = 0.80, P &lt; .001). Both tools were significant predictors of skin changes and identified as “at risk” 100% of the patients who had a change in skin integrity occur. The specificity was 18.4% for the Cubbin-Jackson scale and 27.9% for the Braden scale, and the area under the curve was 0.75 (P &lt; .001) for the Cubbin-Jackson scale and 0.76 (P &lt; .001) for the Braden scale. These findings show acceptable construct validity for both scales. Conclusions The predictive validities of the Cubbin-Jackson and Braden scales are similar, but both are sub-optimal because of poor specificity and positive predictive value. Change in practice may not be warranted, because there are no differences between the 2 scales of practical benefit to bedside nurses.

scholarly journals Impact of Antimicrobial Stewardship Programs in Latin American Adult Intensive Care Units: PROA-LATAM Project

2020 ◽  
Vol 41 (S1) ◽  
pp. s520-s520
Author(s):  
Rodolfo Quirós ◽  
Patricia Angeleri ◽  
Jeannete Zurita ◽  
Washington Aleman ◽  
Marcelo Carneiro ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Latin American ◽  
Antimicrobial Stewardship ◽  
Cost Effective ◽  
Therapeutic Monitoring ◽  
Self Assessment ◽  
Surgical Intensive Care ◽  
Defined Daily Doses ◽  
The Impact

Background: Antimicrobial stewardship programs (ASPs) are useful in improving clinical outcomes in a cost-effective way and in reducing antimicrobial resistance. Objective: We sought to determine the impact of ASP in adult medical-surgical intensive care units (MS-ICUs). Methods: A multicenter study, in 77 MS-ICUs of 9 Latin-American countries, was conducted along 12 months (July 2018–June 2019). A self-assessment survey using a tool based on CDC recommendations (0–100 scale) was performed at the beginning, after 6 months, and at the end of the study. The impact of ASP was evaluated monthly using the following indicators: antimicrobial consumption (defined daily doses [DDD] per 100 patient days), appropriateness of antimicrobial prescriptions (percentage of total prescriptions), crude mortality rate (events per 100 discharges), and hospital-acquired multidrug-resistant microorganisms (MDRs) and Clostridioides difficile infections (CDI events per 1,000 patient days). These indicators were compared between MS-ICUs that reached the 75th percentile and those that maintained the 25th percentile at the final self-assessment. Results: Of all indicators evaluated, only surgical prophylaxis ≤24 hours, vancomycin therapeutic monitoring, and aminoglycosides (1 dose per day) did not show significant differences between MS-ICUs at the 75th percentile and the 25th percentile. CDI events were significantly higher at the 75th percentile MS-ICUs, probably related to better detection of C. difficile (Table 1). Conclusions: This study confirmed that MS-ICUs with more comprehensive ASPs had significantly better indicators.Funding: Proprietary Organization: MERCKDisclosures: None

scholarly journals The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1146
Author(s):  
Aleksa Despotovic ◽  
Branko Milosevic ◽  
Andja Cirkovic ◽  
Ankica Vujovic ◽  
Ksenija Cucanic ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Health Concern ◽  
Positive Trend ◽  
Hospital Acquired Infections ◽  
Acinetobacter Spp ◽  
Tract Infections ◽  
Resistance Rates ◽  
Hospital Acquired ◽  
The Impact

Hospital-acquired infections (HAIs) are a global public health concern. As the COVID-19 pandemic continues, its contribution to mortality and antimicrobial resistance (AMR) grows, particularly in intensive care units (ICUs). A two-year retrospective study from April 2019–April 2021 was conducted in an adult ICU at the Hospital for Infectious and Tropical Diseases, Belgrade, Serbia to assess causative agents of HAIs and AMR rates, with the COVID-19 pandemic ensuing halfway through the study. Resistance rates >80% were observed for the majority of tested antimicrobials. In COVID-19 patients, Acinetobacter spp. was the dominant cause of HAIs and more frequently isolated than in non-COVID-19 patients. (67 vs. 18, p = 0.001). Also, resistance was higher for imipenem (56.8% vs. 24.5%, p < 0.001), meropenem (61.1% vs. 24.3%, p < 0.001) and ciprofloxacin (59.5% vs. 36.9%, p = 0.04). AMR rates were aggregated with findings from our previous study to identify resistance trends and establish empiric treatment recommendations. The increased presence of Acinetobacter spp. and a positive trend in Klebsiella spp. resistance to fluoroquinolones (R2 = 0.980, p = 0.01) and carbapenems (R2 = 0.963, p = 0.02) could have contributed to alarming resistance rates across bloodstream infections (BSIs), pneumonia (PN), and urinary tract infections (UTIs). Exceptions were vancomycin (16.0%) and linezolid (2.6%) in BSIs; tigecycline (14.3%) and colistin (0%) in PNs; and colistin (12.0%) and linezolid (0%) in UTIs. COVID-19 has changed the landscape of HAIs in our ICUs. Approval of new drugs and rigorous surveillance is urgently needed.

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