Outbreak of Multidrug-ResistantPseudomonas aeruginosaColonization and Infection Secondary to Imperfect Intensive Care Unit Room Design

Background.Pseudomonas aeruginosahas been increasingly recognized for its ability to cause significant hospital-associated outbreaks, particularly since the emergence of multidrug-resistant strains. Biofilm formation allows the pathogen to persist in environmental reservoirs. Thus, multiple hospital room design elements, including sink placement and design, can impact nosocomial transmission ofP. aeruginosaand other pathogens.Methods.From December 2004 through March 2006, 36 patients exposed to the intensive care unit or transplant units of a tertiary care hospital were infected with a multidrug-resistant strain ofP. aeruginosa. All phenotypically similar isolates were examined for genetic relatedness by means of pulsed-field gel electrophoresis. Clinical characteristics of the affected patients were collected, and a detailed epidemiological and environmental investigation of potential sources was carried out.Results.Seventeen of the infected patients died within 3 months; for 12 (71%) of these patients, infection with the outbreak organism contributed to or directly caused death. The source of the outbreak was traced to hand hygiene sink drains, where biofilms containing viable organisms were found. Testing by use of a commercial fluorescent marker demonstrated that when the sink was used for handwashing, drain contents splashed at least 1 meter from the sink. Various attempts were made to disinfect the drains, but it was only when the sinks were renovated to prevent splashing onto surrounding areas that the outbreak was terminated.Conclusion.This report highlights the importance of biofilms and of sink and patient room design in the propagation of an outbreak and suggests some strategies to reduce the risks associated with hospital sinks.

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Genetic relatedness of clinical and environmental Acinetobacter baumanii isolates from an intensive care unit outbreak

The Journal of Infection in Developing Countries ◽

10.3855/jidc.6726 ◽

2015 ◽

Vol 9 (06) ◽

pp. 665-669 ◽

Cited By ~ 12

Author(s):

Abiola Senok ◽

Ghada Garaween ◽

Adeola Raji ◽

Harish Khubnani ◽

Garwin Kim Sing ◽

...

Keyword(s):

Intensive Care Unit ◽

Saudi Arabia ◽

Intensive Care ◽

Genetic Relatedness ◽

Tertiary Care ◽

Multidrug Resistant ◽

Automated System ◽

Clinical Strain ◽

Care Hospital

Introduction: Determination of microbial genetic relatedness is important for improving efficiency of infection control measures during hospital outbreaks. This study aimed to analyze the clonal relationships of clinical and environmental Acinetobacter baumannii strains isolated during an outbreak in the intensive care unit (ICU) of a secondary care hospital in Saudi Arabia. Methodology: Twelve clinical and fourteen environmental A. baumannii isolates identified during an outbreak in February 2013 in the 14-bed adult intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia, were studied. Bacterial identification and antimicrobial susceptibility testing were carried out using Microscan Walkaway 96 automated system. Determination of clonal diversity was investigated by repetitive-sequence-based polymerase chain reaction (rep-PCR) with the semi-automated DiversiLab system. Results: The majority of the clinical isolates were from endotracheal tube aspirates (n = 9), one from a wound swab and two were from urine and sputum, respectively. Environmental isolates were from bed railings (n = 10) and with one each from curtain, stethoscope, computer mouse and telephone. Isolates were categorized into 6 clusters (Groups 1-6). Most of the isolates were associated with two clusters namely Groups 2 (n = 11) and 3 (n = 9). All isolates were multidrug resistant showing resistance to three or more classes of antibiotics. One clinical strain from Cluster 3 was resistant to colistin (MIC > 4ug/ml). Conclusion: This outbreak was caused by two clonal groups of multidrug resistant A. baumannii. The presence of multiple environmental clones was suggestive of environmental source dissemination via healthcare workers within the ICU.

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Association of Biofilm Formation with Antimicrobial Resistance Among the Acinetobacter Species in A Tertiary Care Hospital in Bangladesh

Journal of Medicine ◽

10.3329/jom.v14i1.14533 ◽

2013 ◽

Vol 14 (1) ◽

pp. 28-32 ◽

Cited By ~ 2

Author(s):

Azizun Nahar ◽

Shaheda Anwar ◽

Md. Ruhul Amin Miah

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antimicrobial Resistance ◽

Biofilm Formation ◽

Tertiary Care ◽

Multidrug Resistant ◽

Clinical Isolates ◽

Clinical Samples ◽

Care Hospital ◽

Acinetobacter Species

Purpose: The purpose of this study was to detect biofilm formation in clinical isolates of Acinetobacter species and to observe correlation between biofilm formation and antimicrobial resistance among Acinetobacter isolates. Methods: Two hundred fifty six clinical samples collected from patients who were admitted in Intensive Care Unit (ICU) and on device, patients from Surgery, Medicine, Gynae & Obs and Urology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) and from Burn unit of Dhaka Medical College Hospital were included in this study. Biofilm formation and antibiotyping were performed for the isolates of Acinetobacter species recovered from clinical samples including tracheal aspirates, blood, urine, wound swab, pus, throat swab, endotracheal tubes, burn samples, ascitic fluid, sputum, aural swab, oral swab, cerebrospinal fluid, and catheter tip. Correlation of biofilm formation with antimicrobial resistance pattern among Acinetobacter isolates were also observed in this study. Result: A total of 256 various specimens were studied of which 95 Intensive Care Unit (ICU) and 161 Non ICU samples. Out of 95 ICU and 161 Non ICU samples, Acinetobacter species were isolated from 32 (33.7%) and 20(12.4%) respectively. From 32 ICU and 20 Non ICU Acinetobacter isolates, 28 (87.5%) and 11 (55%) were biofilm producers. Biofilm forming capacity of Acinetobacter species was significantly (p<0.008) greater in ICU than in Non ICU isolates. In both ICU and Non ICU isolates, biofilm forming Acinetobacter species were 100% resistant to amoxicillin, ceftriaxone, ceftazidime, cefotaxime, cefuroxime, and aztreonam. Resistance to antibiotics such as gentamicin, amikacin, netilmicin, ciprofloxacin and imipenem was higher among biofilm forming Acinetobacter isolates in ICU than Non ICU isolates. Susceptibility to colistin was 100% in Non ICU isolates but in ICU it showed 7.1% resistance. Conclusions: This investigation showed that most of the clinical isolates of Acinetobacter species were biofilm producers especially from ICU samples and they were multidrug resistant. Even polymixin resistant Acinetobacter isolates are slowly emerging. This is very alerming for us that biofilm forming multidrug resistant Acinetobacter species represents a severe threat in the treatment of hospitalized patients. So, antibiotic policy and guidelines are essential to eliminate major outbreak in future.DOI: http://dx.doi.org/10.3329/jom.v14i1.14533 J MEDICINE 2013; 14 : 28-32

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Gram-negative bacilli causing infections in an intensive care unit of a tertiary care hospital in Istanbul, Turkey

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4277 ◽

2014 ◽

Vol 8 (05) ◽

pp. 597-604 ◽

Cited By ~ 1

Author(s):

Seniha Senbayrak Akcay ◽

Asuman Inan ◽

Simin Cevan ◽

Ayse Nilufer Ozaydın ◽

Naz Cobanoglu ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care ◽

Multidrug Resistant ◽

Diffusion Method ◽

Care Hospital ◽

Chi Square ◽

Disk Diffusion Method ◽

Gram Negative ◽

E Coli

Introduction: This study aimed to demonstrate the changing epidemiology of infecting microorganisms and their long-term resistance profiles and to describe the microbiological point of view in anti-infective management of intensive care unit (ICU) patients. Methodology: A total of 5,690 isolates of Gram-negative bacilli were included in this study. Antibiotic susceptibility was tested using the disk diffusion method and Vitek 2 system. Chi-square tests were used for hypothesis testing. Results: The most frequently isolated organisms were A. baumannii (37.3%), P. aeruginosa (30.3%), Enterobacter spp. (10.4%), E. coli (10.4%), and Klebsiella spp. (8.9%). A. baumannii was the most frequently isolated organism from the respiratory tract (43.4%); the susceptibility rates for imipenem and meropenem decreased to 7% and 6% (p < 0.0001), respectively. The percentage of multidrug-resistant (MDR) A. baumannii isolates continuously increased from 18.7% in 2004 to 69% in 2011 (p < 0.0001), whereas MDR P. aeruginosa isolates increased from 1.5% to 22% (p < 0.0001). Carbapenem-resistant Klebsiella isolates emerged in 2010 and increased to 20% in the next year. The rates of ESBL-producing Enterobacteriaceae in the ICU was very high in 2011 – 50% for E. coli and 80% for Klebsiella strains. Conclusion: The most common isolated Gram-negative bacillus in our study was A. baumannii and that the prevalence of MDR isolates has increased markedly over. Accordingly, the comparison of antibiotic resistance of other pathogens in 2004 and 2011 displayed an increasing trend. These data imply the urgent need for new and effective strategies in our hospital and in the region.

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Antimicrobial Resistanceamong Intensive Care Unit Patients in A Tertiary Care Hospital of Bangladesh

Bangladesh Journal of Medicine ◽

10.3329/bjm.v32i1.51088 ◽

2021 ◽

Vol 32 (1) ◽

pp. 5-11

Author(s):

Humayra Jesmin ◽

HAM Nazmul Ahasan ◽

Md Asaduzzaman ◽

AKM Monwarul Islam

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antimicrobial Resistance ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Positive Culture ◽

Tracheal Aspirate ◽

Multidrug Resistant ◽

Care Hospital ◽

Klebsiella Species

Background: Antimicrobial resistance is a growing concern specially among the critically ill patients who are often treated by multiple antibiotics. But, the data regarding the pattern of antimicrobial resistance in this population are often insufficient. Objective: To observe the pattern of antimicrobial resistance among the patients admitted into the intensive care unit (ICU). Methodology: This prospective observational study was carried out in the ICU of a tertiary care hospital of Bangladesh over 6 months. Samples of blood, urine, tracheal aspirate, wound swab and pus were obtained from the patients, cultured and analyzed. Results: Among 100 subjects, the most common primary diagnoses were aspiration pneumonia (29%) and urinary tract infection (UTI) (24%). Out of 315 samples, microorganisms were isolated from 125 samples (39.68%). The most common sample yielding positive culture was tracheal aspirate (67.2%), and the most frequently isolated microorganisms were Pseudomonas spp. (35%), Escherichia coli (28%), Acinetobacterspp. (24%) andKlebsiellaspp. (18%). Acinetobacterspp., Pseudomonasspp. and Klebsiellaspp.were the commonest resistant organisms. Overall prevalence of resistance to antibiotics were: ceftriaxone 72%, ceftazidime 78.4%, ciprofloxacin 81.6%, gentamicin 84%, meropenem 49.6% andnetilmicin 39.2%. Meropenem was the most sensitive antibiotic against Klebsiellaspp.(66.67%) but Acinetobacterspp.was still resistant to meropenem and amikacin but sensitive to cotrimoxazole (66.67%). Multidrug resistant Pseudomonas, Acinetobacter and, Klebsiella species were found; piperacillin-tazobactam combination showed <40% resistance against them. No single antibiotic showed good efficacy against Acinetobacterspp. Conclusion: The prevalence of antibiotic resistance is high among the ICU patients, and the majority of the isolated organisms are resistant to conventional antibiotics. Bangladesh J Medicine January 2021; 32(1) : 5-11

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Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Clinical Pediatrics ◽

10.1177/00099228211047242 ◽

2021 ◽

pp. 000992282110472

Author(s):

Andrew Brown ◽

Mary Quaile ◽

Hannah Morris ◽

Dmitry Tumin ◽

Clayten L. Parker ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Discharge ◽

Care Coordination ◽

Chronic Conditions ◽

Tertiary Care ◽

Care Hospital ◽

Icu Admission ◽

Complex Chronic Conditions

Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

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Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

BMJ Open Quality ◽

10.1136/bmjoq-2017-000239 ◽

2018 ◽

Vol 7 (2) ◽

pp. e000239 ◽

Cited By ~ 2

Author(s):

Krishna Aparanji ◽

Shreedhar Kulkarni ◽

Megan Metzke ◽

Yvonne Schmudde ◽

Peter White ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Tertiary Care ◽

Care Hospital ◽

Icu Patients ◽

Quality Metric ◽

Risk Of Mortality ◽

Simulation Based ◽

Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

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