scholarly journals Epidemiology of bacterial colonization at intensive care unit admission with emphasis on extended-spectrum β-lactamase- and metallo-β-lactamase-producing Gram-negative bacteria – an Indian experience

2010 ◽  
Vol 59 (8) ◽  
pp. 955-960 ◽  
Author(s):  
Afzal Azim ◽  
Mayank Dwivedi ◽  
P. Bhaskar Rao ◽  
A. K. Baronia ◽  
R. K. Singh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Bacterial Colonization ◽  
Empiric Antibiotic Therapy ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Extended Spectrum ◽  
The Family

An important risk factor for nosocomial infection in an intensive care unit (ICU) is prior colonization. This study was undertaken to determine the spectrum of bacterial colonization and predisposing risk factors in patients being admitted to an ICU in India, with special emphasis on extended-spectrum β-lactamase (ESBL)- and metallo-β-lactamase (MBL)-producing Gram-negative bacteria. Nasal, oral and rectal swab samples were collected and processed for isolation of ESBL-producing Gram-negative bacteria and MBL-producing Pseudomonas aeruginosa and Acinetobacter species. Bacterial colonization (of one or more sites) on admission was detected in 51 out of 96 patients included in the study. Non-fermenters, i.e. P. aeruginosa and Acinetobacter baumannii, were the most common colonizers, present in 37 patients, with simultaneous colonization in 12 patients. A total of 16 patients were colonized with MBL-producing members of the family Enterobacteriaceae, out of which 11 isolates (from 5 patients) were also carrying ESBL-encoding genes. As for MBLs, most of our patients have shown colonization with ESBL-producing bacteria. On admission, 47 of 51 patients (92 %) have been colonized by ESBL-producing members of the family Enterobacteriaceae, at one or more of the three anatomical sites. The most common MBL subtype was bla IMP (51.56 %), whereas bla CTX was the most common gene (84.9 %) identified among ESBL producers. Risk factors for colonization on admission to the ICU were hospitalization for more than 48 h, use of ≥3 groups of antibiotics, co-morbidities and mechanical ventilation for more than 48 h prior to ICU admission. There is an increasing incidence of MBLs and ESBLs in the Indian population. The identified risk factors can be used as a guide for empiric antibiotic therapy targeted to these resistant bacteria.

Colonization Status and Appropriate Antibiotic Therapy for Nosocomial Bacteremia Caused by Antibiotic-Resistant Gram-Negative Bacteria in an Intensive Care Unit

2005 ◽  
Vol 26 (6) ◽  
pp. 575-579 ◽  
Author(s):  
Stijn Blot ◽  
Pieter Depuydt ◽  
Dirk Vogelaers ◽  
Johan Decruyenaere ◽  
Jan De Waele ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative Bacteria ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Nosocomial Bacteremia ◽  
Appropriate Therapy ◽  
Colonization Status

AbstractObjective:Timely initiation of antibiotic therapy is crucial for severe infection. Appropriate antibiotic therapy is often delayed for nosocomial infections caused by antibiotic-resistant bacteria. The relationship between knowledge of colonization caused by antibiotic-resistant gram-negative bacteria (ABR-GNB) and rate of appropriate initial antibiotic therapy for subsequent bacteremia was evaluated.Design:Retrospective cohort study.Setting:Fifty-four-bed intensive care unit (ICU) of a university hospital. In this unit, colonization surveillance is performed through routine site-specific surveillance cultures (urine, mouth, trachea, and anus). Additional cultures are performed when presumed clinically relevant.Patients:ICU patients with nosocomial bacteremia caused by ABR-GNB.Results:Infectious and microbiological characteristics and rates of appropriate antibiotic therapy were compared between patients with and without colonization prior to bacteremia. Prior colonization was defined as the presence (detected ≥ 2 days before the onset of bacteremia) of the same ABR-GNB in colonization and subsequent blood cultures. During the study period, 157 episodes of bacteremia caused by ABR-GNB were suitable for evaluation. One hundred seventeen episodes of bacteremia (74.5%) were preceded by colonization. Appropriate empiric antibiotic therapy (started within 24 hours) was administered for 74.4% of these episodes versus 55.0% of the episodes that occurred without prior colonization. Appropriate therapy was administered within 48 hours for all episodes preceded by colonization versus 90.0% of episodes without prior colonization.Conclusion:Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB (Infect Control Hosp Epidemiol 2005;26:575-579).

scholarly journals COLONIZATION AND ANTIBIOTIC RESISTANCE DYNAMICS OF PATIENTS AT INTENSIVE CARE UNIT (ICU)-OUR EXPERIENCE

2017 ◽  
Vol 10 (4) ◽  
pp. 417
Author(s):  
Mahesh Chandra Sahu ◽  
Ishwar Chandra Behera ◽  
Santosh Kumar Swain
Keyword(s):  
Intensive Care Unit ◽  
Drug Resistance ◽  
Intensive Care ◽  
Liver Abscess ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Specific Medium

introduction: Multidrug resistant strains are developed day by day due to empirical therapy in intensive care unit (ICU). Both gram positive and gram negative strains are found in ICU are drug resistant bacteria. In this study, the prevalence of drug resistance bacteria in ICU were determined.Materials and Methods: The clinical samples; ascitic fluid, blood, central line tip, ET aspiration  pleural fluid, pus from liver abscess, sputum, tracheal aspiration, urine and wound swabs were collected from ICU patients and cultured in specific medium. Subsequently antibiotic sensitivity pattern of isolated bacteria were carried out with disc diffusion methods.Results: A total number of 794 clinical samples were cultured in specific medium and it revealed 191 of single colonies, 145 were double colonies and 87 were 3 or multy-colonies. A total of 963 bacteria were isolated among them 180 were gram positive bacteria, BYC were 135 and rest were gram negative bacteria. There was no significantly difference in growth of microorganisms with respect to clinical samples as t test revealed P= 0.87. Among the gram negative bacteria; Klebsiela pneumonia were predominant and Proteous mirabilis was lowest. Tigecycline and colistin were most effective antibiotics agonist all bacteria. Conclusions: Urine samples of the patient’s revealed higher number of organisms where as pus from liver abscess found only one number of growths. The antibiotic stewardship programs must lead to significant decrease in all antibiotic used in the ICU setting. However, this result may be required further work to determine the fruitful necessary for success.Key words: Antibiotics, Intensive Care Unit, Bacterial infections, Drug resistance.

scholarly journals A study of infections in neonatal intensive care unit at a tertiary care hospital

2017 ◽  
Vol 4 (4) ◽  
pp. 1349 ◽  
Author(s):  
Hemangi D Ingale ◽  
Vaishali A. Kongre ◽  
Renu S. Bharadwaj
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative ◽  
Gram Positive Bacteria

Background: As infection is a major cause of morbidity and mortality in neonates, early diagnosis and prompt treatment can prevent its serious consequences. The present study was conducted to determine the prevalence of infections in neonatal intensive care unit (NICU) of a tertiary care hospital and to study their risk factors, causative organisms and antimicrobial susceptibility pattern.Methods: Appropriate samples were collected from all neonates with clinical signs and symptoms of infections. Isolation of microorganisms, their identification and antimicrobial susceptibility was done according to standard microbiological techniques.Results: Among 1210 neonates admitted in the NICU, 393 (32.4%) were clinically suspected infections. The prevalence of Septicemia, Pneumonia, and Meningitis were 6%, 1.5%, 0.7% respectively. The predominant organisms causing neonatal infection were Gram negative bacteria followed by fungi and Gram positive bacteria. Among Gram negative bacteria, the antimicrobial resistance was highest for third generation Cephalosporins [Ceftazidime (81.1%), Cefotaxime (60.3%)]. In Gram positive bacteria highest resistance was observed for Penicillin and Ampicillin (91.3%). Methicillin resistance was observed in 91.6% of Coagulase negative Staphylococci (CoNS). All isolates of Candida parapsilosis were sensitive to Fluconazole, Voriconazole but resistant to Amphotericin B. Predominant risk factors were low birth weight (87.7%) and prematurity (75%). Maternal risk factors were pregnancy induced hypertension (13.4%) and premature rupture of membranes (PROM) (10.1%). The case fatality rate was 20.7%.Conclusions: There is a need of strict infection control measures and rational antibiotic policy to reduce the economic burden of hospital and community due to neonatal infections. 

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