scholarly journals 783. Impact of Universal Decolonization on Intensive Care Unit Bloodstream Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S488-S488
Author(s):  
Lauren Dea ◽  
Shubha Kerkar ◽  
Xolani Mdluli ◽  
Ger Vang
Keyword(s):  
Prospective Study ◽  
Medical Center ◽  
Intervention Group ◽  
Bloodstream Infections ◽  
P Value ◽  
Icu Patients ◽  
Icu Stay ◽  
Baseline Group ◽  
Nasal Mupirocin ◽  
Tract Infections

Abstract Background Interventions used to reduce the incidence of hospital-acquired infections (HAIs) include hand hygiene, isolation, and decolonization. The routine use of chlorhexidine gluconate (CHG) and nasal mupirocin ointment has been shown to be an effective universal decolonization option to reduce bacterial transmission and prevent HAIs. The objective of this study is to compare the pre- and post-intervention of universal decolonization among ICU patients at Desert Regional Medical Center, an acute care Level II trauma center. Methods The first part of this study is a retrospective chart review of all ICU patients from June 2020 to August 2020. The second part of this research is a prospective study from December 2020 to March 2021. The prospective study will include all patients admitted to the ICU who completed the decolonization regimen of mupirocin for 5 days and daily CHG baths. In the intervention phase, all ICUs patients will be decolonized with nasal mupirocin twice daily for 5 days and CHG baths daily for the entire ICU stay. The primary outcome is the number of ICU bloodstream infections (BSIs). Secondary outcomes include the number of ICU-related central line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator associated pneumonia (VAP). An infection attributed to ICU stay is defined as an infection onset occurring more than 48 hours after ICU admission. Fisher’s exact and chi square test was used for the statistical analysis. Results A total of 130 patients were included in this study. Universal decolonization resulted in a reduction in overall ICU infections in the baseline group vs intervention group using a p-value of 0.05 (ICU-BSI 5 vs 4, p=0.73; CLABSI 2 vs 1, p=0.56; CAUTI 4 vs 2, p=0.41; VAP 23 vs 17, p=0.25). Conclusion Patients in the intervention group had a lower incidence of ICU infections compared to the baseline group. These findings suggest that universal decolonization may be an effective strategy in reducing ICU incidence rates of BSI, CLABSI, CAUTI, and VAP. Further studies need to be conducted to validate this finding with a greater population enrolled to achieve adequate power. Disclosures All Authors: No reported disclosures

Middle meatal vs antral lavage cultures in intensive care unit patients

2002 ◽  
Vol 126 (4) ◽  
pp. 377-381 ◽  
Author(s):  
Stilianos E. Kountakis ◽  
Ioannis G. Skoulas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Study ◽  
Medical Center ◽  
Icu Patients

OBJECTIVE: The study goal was to compare endoscopically guided middle meatal cultures with cultures of antral lavage aspirate in intensive care unit (ICU) patients with sinusitis. METHODS: Prospective study of febrile ICU patients seen for sinusitis at a tertiary medical center. RESULTS: Of 31 antral lavages performed in 18 patients, 19 lavages yielded purulent or mucopurulent aspirate. Endoscopically guided middle meatal cultures yielded the same pathogen, as did cultures of the lavage aspirate in 4 (21%) of these 19 cases. The antral lavage was negative (absence of purulent/mucopurulent aspirate) in 12 cases, and of those, 5 (42%) of the 12 middle meatal cultures showed no growth (sensitivity = 21%, specificity = 58%, χ2-1.52, P = 0.218). CONCLUSION: Endoscopically guided middle meatal cultures did not correlate well with cultures from the antral lavage aspirate in febrile ICU patients evaluated for sinusitis.

scholarly journals Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center

2016 ◽  
Vol 37 (4) ◽  
pp. 448-454 ◽  
Author(s):  
Mohamed Sarg ◽  
Greer E. Waldrop ◽  
Mona A. Beier ◽  
Emily L. Heil ◽  
Kerri A. Thom ◽  
...  
Keyword(s):  
Intensive Care ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antimicrobial Use ◽  
Post Intervention ◽  
Icu Patients ◽  
Antimicrobial Utilization ◽  
Academic Medical

OBJECTIVETo assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected.DESIGNQuasi-experimental studySETTINGA 700-bed academic medical centerPATIENTSPatients admitted to any adult ICUMETHODSAggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January–December 2012) and after the intervention (January–December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared.RESULTSStatistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed.CONCLUSIONA change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams.Infect. Control Hosp. Epidemiol. 2016;37(4):448–454

scholarly journals Nosocomial Primary Bloodstream Infections in Intensive Care Unit Patients in a Nonteaching Community Medical Center: A 21‐Month Prospective Study

2001 ◽  
Vol 33 (8) ◽  
pp. 1329-1335 ◽  
Author(s):  
David K. Warren ◽  
Jeanne E. Zack ◽  
Alexis M. Elward ◽  
Michael J. Cox ◽  
Victoria J. Fraser
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Study ◽  
Medical Center ◽  
Bloodstream Infections

scholarly journals 2575. Dramatic Time-Dependent Changes of Bacterial and Fungal Taxonomic Signatures in 4 Body Regions of ICU Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S895-S895
Author(s):  
Philipp Wurm ◽  
Bettina Halwachs-Wenzl ◽  
Karl Kashofer ◽  
Dirk von Lewinski ◽  
Florian Eisner ◽  
...  
Keyword(s):  
Fecal Microbiota ◽  
P Value ◽  
Rrna Gene ◽  
Multiple Time ◽  
Its Sequencing ◽  
Candida Spp ◽  
Icu Patients ◽  
Icu Stay ◽  
Body Regions ◽  
Staphylococcus Spp

Abstract Background It has been hypothesized that intensive care unit (ICU)-related complications like nosocomial pneumonia or gastrointestinal dysfunction are associated with disturbances of normal host microorganisms. However, these alterations are largely unknown in ICU patients. The bacterio- and mycobiota in 4 body regions in 14 ICU patients was investigated after admission until death or discharge to other wards. Methods Medical ICU patients were sampled with pharyngeal swabs, endotracheal aspirates, gastric secretions and stools or rectal swabs (in constipated patients). V1-V2 (16S rRNA gene) and eukaryoitic ITS sequencing was performed as previously described as well as denoizing, transformation into amplicon sequence variants and analysis using qiime2 and LEfSe (LDA Score > 3.0, P-value < 0.05). For sequence classification databases SILVA 132 (16S) and UNITE version 7.2 (ITS) were used. Results Samples were obtained at multiple time points from day 1 up to day 47 with a median of 11 samples per patient (range 2 to 17). In 11 patients all intended body regions were sampled (stool was missing in two patients and gastric secretion in two patients). The length of ICU stay and number of antibiotics administered during ICU stay was associated with loss of diversity in all investigated body sites. Taxonomic profiling showed a significant reduction of physiological members from the oral and fecal microbial community (e.g., Clostridiales, Bacteroidales, Faecalibacterium spp. etc.) after 2 weeks at the ICU. In contrast, Enterococcus spp. and Staphylococcus spp. were enriched in the gastric and fecal microbiota. Candida spp. dominated fungal communities of all body sites investigated. Staphylococcus aureus was associated with ITS positive, Candida spp. dominated samples throughout all body sites, while Pseudomonas aeruginosa was associated with ITS-negative samples. Conclusion The length of the ICU stay and the number of different antibiotics administered during the stay at the ICU are associated with severe intestinal dysbiosis, determined by loss of physiological microbes, decreased bacterial richness and domination of low-diversity fecal microbiota. Early colonization of Candida spp. might favor a co-existance of a Staphylococcus spp.-dominated microbiota in the ICU. Disclosures All authors: No reported disclosures.

Prevalence of Nosocomial Infection and Antibiotic Use at a University Medical Center in Malaysia

2005 ◽  
Vol 26 (1) ◽  
pp. 100-104 ◽  
Author(s):  
Andrew J. Hughes ◽  
Norliza Ariffin ◽  
Tan Lien Huat ◽  
Habibah Abdul Molok ◽  
Salbiah Hashim ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Medical Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Developed Countries ◽  
High Rate ◽  
Antibiotic Prescribing ◽  
Tract Infections

AbstractBackground and Objective:Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We exMnined the rate of N1 in our institution.Methods:A point-prevalence study of N1 and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for N1, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication.Setting:Tertiary-care referral center in Malaysia.Patients:All inpatients during the time of the study.Results:Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.29-6), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%).Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. N1 treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for N1 treatment was estimated to be approximately 2 million per year (Malaysian dollars).Conclusion:Whereas the rate of N1 is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.

scholarly journals 1583. In Vitro Activity of Imipenem/Relebactam against Klebsiella pneumoniae and Pseudomonas aeruginosa from Patients in ICUs in the Asia/Pacific region – SMART 2015-2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S789-S789
Author(s):  
Sibylle Lob ◽  
Meredith Hackel ◽  
Wei-Ting Chen ◽  
Yivonne Khoo ◽  
Kanchan Balwani ◽  
...  
Keyword(s):  
Hong Kong ◽  
Urinary Tract ◽  
Antimicrobial Susceptibility ◽  
Bloodstream Infections ◽  
Asia Pacific ◽  
Surveillance Program ◽  
Independent Contractor ◽  
Icu Patients ◽  
Tract Infections

Abstract Background Relebactam (REL) is an inhibitor of class A and C β-lactamases approved in the USA in combination with imipenem (IMI) and cilastatin for the treatment of complicated intraabdominal and urinary tract infections. Elevated antimicrobial resistance rates have been reported in ICUs. Using isolates collected in Asia/Pacific for the SMART surveillance program, we evaluated the activity of IMI/REL and comparators against K. pneumoniae (KP) and P. aeruginosa (PA) from ICU patients. Methods In 2015-2018, 51 clinical laboratories in Australia, Hong Kong, Malaysia, New Zealand, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam each collected up to 250 consecutive aerobic gram-negative pathogens per year. Susceptibility was determined using CLSI broth microdilution and CLSI and FDA (IMI/REL) breakpoints. IMI-nonsusceptible KP and PA were screened for β-lactamase genes. Results Analyzing only the 6322 isolates from ICU patients, the 3 most common species collected were KP (21.4%), E. coli (20.5%), and PA (19.7%). Tables 1 and 2 show % susceptible and % MBL- and/or OXA-48-like-positive for the most common Enterobacterales species (KP; 70.6% from lower respiratory tract, 17.6% from intraabdominal, 7.1% from urinary tract, and 4.1% from bloodstream infections) and the most common non-Enterobacterales species (PA; 83.6%, 9.9%, 4.3%, and 1.9%, respectively). % IMI/REL-susceptible ranged from 66-79% in Thailand and Vietnam (where 13-36% of isolates carried MBL and/or OXA-48-like carbapenemases, which REL does not inhibit) to ≥95% in 6 countries (0-3% MBL- and/or OXA-48-like-positive). Among 103 IMI/REL-nonsusceptible KP isolates, 66.0% carried MBL, 20.4% OXA-48-like carbapenemases, 2.9% KPC, 2.9% acquired AmpC and/or ESBL, and in 7.8% no acquired β-lactamases were detected. Among 145 IMI/REL- nonsusceptible PA, 54.5% carried MBL, 1.4% GES carbapenemases, 4.1% only ESBL, and 40.0% no acquired β-lactamases. Table 1. Antimicrobial susceptibility of K. pneumoniae collected from ICU patients Table 2. Antimicrobial susceptibility of P. aeruginosa collected from ICU patients Conclusion IMI/REL was active against 92% of KP and 88% of PA from ICU patients in Asia/Pacific overall, with higher activity in countries with lower prevalence of MBL or OXA-48-like carbapenemases. IMI/REL provides a potential treatment option for ICU patients in Asia/Pacific with infections caused by KP and PA. Disclosures Sibylle Lob, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Wei-Ting Chen, MD, Merck, Sharp & Dohme, Taiwan (Employee) Yivonne Khoo, PhD, Merck, Sharp & Dohme, Malaysia (Employee) Kanchan Balwani, MBBS, MS, Merck, Sharp & Dohme, Hong Kong (Employee) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Mary Motyl, PhD, Merck & Co, Inc (Employee, Shareholder) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)

scholarly journals Chlorhexidine and gauze and tape dressings for central venous catheters: a randomized clinical trial

2014 ◽  
Vol 22 (5) ◽  
pp. 764-771 ◽  
Author(s):  
Edivane Pedrolo ◽  
Mitzy Tannia Reichembach Danski ◽  
Stela Adami Vayego
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Randomized Clinical Trial ◽  
Intervention Group ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
University Hospital ◽  
Control Group ◽  
P Value ◽  
Central Venous

OBJECTIVE: to assess the effectiveness of the chlorhexidine antimicrobial dressing in comparison to the gauze and tape dressing in the use of central venous catheters.METHOD: a randomized clinical trial was conducted in the intensive care and adult semi intensive care units of a university hospital in the south of Brazil. The subjects were patients using short-term central venous catheters, randomly assigned to the intervention (chlorhexidine antimicrobial dressing) or control (gauze and micro porous tape) groups.RESULTS: a total of 85 patients were included: 43 in the intervention group and 42 in the control group. No statistically significant differences were found between dressings in regard to the occurrence of: primary bloodstream infections (p-value = 0.5170); local reactions to the dressing (p-value = 0.3774); and dressing fixation (p-value = 0.2739).CONCLUSION: both technologies are effective in covering central venous catheters in regard to the investigated variables and can be used for this purpose. Registry ECR: RBR-7b5ycz.

scholarly journals 2161. Organism-Specific Turn Around Time Improvement in Urinary Specimens as a Result of Microbiological Laboratory Automation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S733-S733
Author(s):  
Nouman Farooq ◽  
Alanna Emrick ◽  
Carolyn Gonzalez-Ortiz ◽  
David Sellers ◽  
Ying P Tabak ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Streptococcus Pyogenes ◽  
Medical Center ◽  
Data Availability ◽  
P Value ◽  
Research Database ◽  
Laboratory Automation ◽  
Turn Around Time ◽  
Tract Infections ◽  
The Impact

Abstract Background University Medical Center in Lubbock, TX is one of few medical centers using Becton Dickinson (BD) Kiestra Total Laboratory Automation (TLA) system since May 2015. The impact on organism-specific turn around time (TAT) in urinary specimens after implementation of TLA was evaluated. Methods After approval from the Quality Improvement Review Board, a retrospective analysis of microbiological data from urinary specimens in BD research database was performed. Before vs. after implementation (2013 vs. 2016) TAT was compared. Ten clinically relevant organisms were analyzed. Statistical analysis was performed with SAS software version 9.2. Data were analyzed using Chi-squared test. A P-value of < 0.05 was considered statistically significant. Results Overall, 2282 specimens from 2013 and 2306 specimens from 2016 were analyzed. Compared with before vs. after implementation of TLA, an overall improvement in TAT was observed (expressed as mean hours for each organism): Enterococcus faecalis (55.2 vs. 38.8), Enterococcus faecium (68.4 vs. 43.8), Escherichia coli (44.2 vs. 41.0), Klebsiella pneumoniae (45.0 vs. 44.0), Proteus mirabilis (44.8 vs. 38.6), Pseudomonas aeruginosa (58.9 vs. 37.7), Staphylococcus aureus (49.2 vs. 36.0), Streptococcus agalactiae (49.2 vs. 31.4), Streptococcus pneumoniae (51.7 vs. 61.8), Streptococcus pyogenes (62.6 vs. 26.6). It was also observed that improvement in TAT was more pronounced for Gram-positive organisms than Gram-negative organisms. P-value was < 0.01 for all organisms except Streptococcus pneumoniae (0.7985) and Streptococcus pyogenes (0.2562). The number of specimens with these two organisms was too small to be considered significant. Conclusion Automation of microbiology laboratory leads to significant TAT improvement in urinary specimens, making early data availability to clinicians. This improves efficiency as well as supporting earlier antibiotic switch, antimicrobial stewardship and optimal patient care in treating urinary tract infections. Disclosures All authors: No reported disclosures.

scholarly journals Trends of Multidrug-Resistant Pathogens, Difficult to Treat Bloodstream Infections, and Antimicrobial Consumption at a Tertiary Care Center in Lebanon from 2015–2020: COVID-19 Aftermath

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1016
Author(s):  
Amanda Chamieh ◽  
Rita Zgheib ◽  
Sabah El-Sawalhi ◽  
Laure Yammine ◽  
Gerard El-Hajj ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Infection Prevention And Control ◽  
P Value ◽  
Tertiary Care Center ◽  
Antimicrobial Consumption ◽  
Dynamic Collaboration

Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of the most isolated organisms from 1 January 2015–31 December 2020 that included: E. coli (Eco), K. pneumoniae (Kp), P. aeruginosa (Pae), A. baumannii (Ab), S. aureus (Sau), and E. faecium (Efm). We considered March–December 2020 a surrogate of COVID-19. We considered one culture/patient for each antimicrobial susceptibility and excluded Staphylococcus epidermidis, Staphylococcus coagulase-negative, and Corynebacterium species. We analyzed the trends of the overall isolates, the antimicrobial susceptibilities of blood isolates (BSI), difficult-to-treat (DTR) BSI, carbapenem-resistant Enterobacteriaceae (CRE) BSI, and restricted antimicrobial consumption as daily-defined-dose/1000 PD. DTR implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable. Results and Discussion: After applying exclusion criteria, we analyzed 1614 blood cultures out of 8314 cultures. We isolated 85 species, most commonly Eco, at 52%. The isolation density of total BSI in 2020 decreased by 16%: 82 patients were spared from bacteremia, with 13 being DTR. The isolation density of CRE BSI/1000 PD decreased by 64% from 2019 to 2020, while VREfm BSI decreased by 34%. There was a significant decrease of 80% in Ab isolates (p-value < 0.0001). During COVID-19, restricted antimicrobial consumption decreased to 175 DDD/1000 PD (p-value < 0.0001). Total carbapenem consumption persistently decreased by 71.2% from 108DDD/1000 PD in 2015–2019 to 31 DDD/1000 PD in 2020. At SGHUMC, existing epidemics were not worsened by the pandemic. We attribute this to our unique and dynamic collaboration of antimicrobial stewardship, infection prevention and control, and infectious disease consultation.

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