Nosocomial Outbreak of Infection With Multidrug-ResistantAcinetobacter baumanniiin a Medical Center in Taiwan

Objective.To investigate a nosocomial outbreak of infection with multidrug-resistant (MDR)Acinetobacter baumanniiin the intensive care units at China Medical University Hospital in Taiwan.Design.Prospective outbreak investigation.Setting.Three intensive care units in a 2,000-bed university hospital in Taichung, Taiwan.Methods.Thirty-eight stable patients in 3 intensive care units, all of whom had undergone an invasive procedure, were enrolled in our study. Ninety-fourA. baumanniistrains were isolated from the patients or the environment in the 3 intensive care units, during the period from January 1 through December 31, 2006. We characterizedA. baumanniiisolates by use of repetitive extragenic palindromic–polymerase chain reaction (REP-PCR) and random amplified polymorphic DNA (RAPD) fingerprinting. The clinical characteristics of the source patients and the environment were noted.Results.All of the clinical isolates were determined to belong to the same epidemic strain of MDRA. baumanniiby the use of antimicrobial susceptibility tests, REP-PCR, and RAPD fingerprinting. All patients involved in the infection outbreak had undergone an invasive procedure. The outbreak strain was also isolated from the environment and the equipment in the intensive care units. Moreover, an environmental survey of one of the intensive care units found that both the patients and the environment harbored the same outbreak strain.Conclusion.The outbreak strain ofA. baumanniimight have been transmitted among medical staff and administration equipment. Routine and aggressive environmental and equipment disinfection is essential for preventing recurrent outbreaks of nosocomial infection with MDRA. baumannii.

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Dissemination of Two Methicillin-Resistant Staphylococcus aureus Clones Exhibiting Negative Staphylase Reactions in Intensive Care Units

Journal of Clinical Microbiology ◽

10.1128/jcm.37.3.504-509.1999 ◽

1999 ◽

Vol 37 (3) ◽

pp. 504-509 ◽

Cited By ~ 14

Author(s):

Po-Ren Hsueh ◽

Lee-Jene Teng ◽

Pan-Chyr Yang ◽

Hui-Ju Pan ◽

Yu-Chi Chen ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Intensive Care ◽

Intensive Care Units ◽

Random Amplified Polymorphic Dna ◽

Cellular Fatty Acid ◽

University Hospital ◽

Methicillin Resistant ◽

Type Iv ◽

Routine Identification ◽

Arbitrarily Primed Pcr

From December 1997 to March 1998, 25 methicillin-resistantStaphylococcus aureus (MRSA) isolates exhibiting negative Staphylase (Oxoid Ltd., Basingstoke, England) reactions were identified from various clinical specimens from 13 patients in six intensive care units (ICUs) or in wards following a stay in an ICU at the National Taiwan University Hospital. The characteristics of these isolates have not been previously noted in other MRSA isolates from this hospital. Colonies of all these isolates were grown on Trypticase soy agar supplemented with 5% sheep blood and were nonhemolytic and unpigmented. Seven isolates, initially reported as Staphylococcus haemolyticus (5 isolates) and Staphylococcus epidermidis (2 isolates) by the routine identification scheme and with the Vitek GPI system (bioMerieux Vitek, Inc., Hazelwood, Mo.), were subsequently identified as S. aureus by positive tube coagulase tests, standard biochemical reactions, and characteristic cellular fatty acid chromatograms. The antibiotypes obtained by the E test, coagulase types, restriction fragment length polymorphism profiles of the staphylococcal coagulase gene, and random amplified polymorphic DNA patterns generated by arbitrarily primed PCR of the isolates disclosed that two major clones disseminated in the ICUs. Clone 1 (16 isolates) was resistant to clindamycin and was susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ) and was coagulase type II. Clone 2 (eight isolates) was resistant to clindamycin and TMP-SMZ and was coagulase type IV. These two epidemic clones from ICUs are unique and underline the need for caution in identifying MRSA strains with colonial morphologies not of the typical type and with negative Staphylase reactions.

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528. Longitudinal Evaluation of Chlorhexidine Resistance Among Multidrug-Resistant Organisms in Relation to Intervention of Daily Chlorhexidine Bathing in Adult Intensive Care Units

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.597 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S254-S254

Author(s):

Min Ja Kim ◽

You Seung Chung ◽

Hojin Lee ◽

Jin Woong Suh ◽

Yoojung Cheong ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Clinical Laboratory ◽

Multidrug Resistant ◽

University Hospital ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Multidrug Resistant Organisms ◽

Before And After ◽

The Republic

Abstract Background Chlorhexidine digluconate (CHG), the most widely used antiseptic, has recently been applied to patient washing to decolonize the multidrug-resistant organisms (MDROs), but there are little data on susceptibilities of MDROs to CHG. The purpose of this study was to evaluate CHG resistance among MDROs before and after the intervention of daily CHG bathing in adult intensive care units (ICUs). Methods The intervention of daily body washing with 2% CHG cloths were taken in adult patients the medical or surgical ICU of 23-bed by a crossover manner for 6 months (MICU, July to December 2017; SICU, January to June 2018) in a 1,050-bed, university hospital in the Republic of Korea. Available MDRO isolates were randomly selected from clinical cultures of ICU patients within 6 months before, during and after the intervention, including MRSA, MR-CoNS, VRE, Carbapenem-resistant Pseudomonas aeruginosa (CR-PA), CR-Acinetobacter baumannii (CR-AB). Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method set by the Clinical Laboratory Standards Institute. Determination of the minimum bactericidal concentrations (MBCs) was performed by subculturing 10 µL from each well without visible microbial growth. Cumulative amounts of CHG used in both ICUs was estimated across the study period from January 2008 to June 2018. Results The cumulative CHG consumption from both ICUs increased sharply from 27,503 g to 29,556 g after one-year intervention. The ranges of MICs and MBCs of CHG among MDRO clinical isolates selected by a 6-month phase are summarized in Table 1. Particularly, CR-PA and CR-AB isolates revealed four to eight times higher MICs and MBCs compared with the majority of Gram-positives excepting some VRE isolates. On the other hand, neither MICs and MBCs ranges of CHG from the MDRO isolates nor the monthly incidence of the MDROs from both ICUs were significantly increased before and after the intervention of daily CHG bathing. Conclusion This study indicates that some Gram-negative MDRO isolates with higher MICs and MBCs of CHG might be from longstanding exposure to CHG or efflux pumps. Although 2% daily CHG bathing uses over 1,000 times higher concentrations than the lethal concentration, it might be needed to monitor CHG resistance among MDROs. Disclosures All authors: No reported disclosures.

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Assessment, Prevention and Management of Pain, Agitation, Delirium and Sleep Deprivation (PADS) in Intensive Care Units by PADS Protocol, a University Hospital, Thailand

Case Medical Research ◽

10.31525/ct1-nct04270331 ◽

2020 ◽

Author(s):

Keyword(s):

Intensive Care ◽

Sleep Deprivation ◽

Intensive Care Units ◽

University Hospital

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Epidemiology of Ventilator Associated Pneumonia in Hospital Surgery Intensive Care Units of Ain Shams University Hospital

The Egyptian Journal of Community Medicine ◽

10.21608/ejcm.2017.5041 ◽

2017 ◽

Vol 35 (4) ◽

pp. 47-56

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

University Hospital ◽

Ventilator Associated Pneumonia

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Results of screening for emergent highly resistant bacteria in Tunisian intensive care units

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.711 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Ben Rejeb ◽

A Ben Cheikh ◽

S Bhiri ◽

H Ghali ◽

M Kahloul ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Early Identification ◽

Infection Prevention ◽

Screening Program ◽

Control Measures ◽

University Hospital ◽

Infection Prevention And Control ◽

Resistant Bacteria ◽

Prevention Interventions

Abstract Background The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes. Methods Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018. Results During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Conclusions Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital. Key messages eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.

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Effect of applying nurses driven electrolyte repletion protocol on electrolyte disturbances control among critically ill patients

Journal of Nursing Education and Practice ◽

10.5430/jnep.v10n4p72 ◽

2020 ◽

Vol 10 (4) ◽

pp. 72

Author(s):

Mohamed E. Abdelgawad ◽

Nadia T. Ahmed ◽

Ahmed M. Elmenshawy

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Improve Patient Care ◽

University Hospital ◽

Treatment Modalities ◽

Control Group ◽

Electrolyte Disturbances ◽

Electrolyte Loss

Background and objective: Electrolyte disturbances remain a common lifesaving issue in the intensive care units. They are associated with increased morbidity and mortality. They are mostly resulted secondary to critical illness itself or associated treatment modalities. Therefore, electrolytes repletion should be done effectively and timely. This could be ensured using nurse driven protocols rather than traditional methods of repletion. These protocols are nurse initiated and collaboratively developed. They have been shown to improve patient care outcomes through the provision of high quality care. They are increasingly being used in the critical care setting. Objective: Determine the effect of applying nurses driven electrolytes repletion protocol on electrolytes disturbance control among critically ill patients.Methods: Quasi experimental research design was used. Sixty two critically ill patients with electrolytes loss were enrolled in the study at Alexandria Main University Hospital intensive care units, Egypt. All episodes of electrolyte loss were evaluated. Repletion of electrolyte loss was done according to unit routine for the control group and nurses driven electrolytes repletion protocol for the study group. Episodes of electrolyte disturbances, adverse events and timing of repletion were evaluated.Results: Neurological disorders represent the most encountered diagnosis. The most common cause of electrolyte loss in was the use of diuretics. Furthermore, there was a highly statistical difference between the two groups as regard electrolytes levels, effectiveness and timing of replacement.Conclusions: Application of nurses driven electrolyte repletion protocol resulted in improvements in the effectiveness and timeliness of electrolyte replacement.

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Antibiotic Consumption, Bacterial Resistance and their Correlation in a Swiss University Hospital and its Adult Intensive Care Units

Scandinavian Journal of Infectious Diseases ◽

10.1080/00365540310016646 ◽

2003 ◽

Vol 35 (11-12) ◽

pp. 843-850 ◽

Cited By ~ 53

Author(s):

Jutta M. Loeffler ◽

Jorge Garbino ◽

Daniel Lew ◽

Stephan Harbarth ◽

Peter Rohner

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Bacterial Resistance ◽

Antibiotic Consumption ◽

University Hospital

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Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience

SAGE Open Medicine ◽

10.1177/20503121211001144 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110011

Author(s):

Thabit Alotaibi ◽

Abdulrhman Abuhaimed ◽

Mohammed Alshahrani ◽

Ahmed Albdelhady ◽

Yousef Almubarak ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mortality Rate ◽

Acinetobacter Baumannii ◽

Care Setting ◽

Multidrug Resistant ◽

University Hospital ◽

Published Data ◽

Tertiary Teaching ◽

The Mean

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region. Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors. Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

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