scholarly journals Methicillin-ResistantStaphylococcus aureusin a Canadian Intensive Care Unit: Delays in Initiating Effective Therapy Due to the Low Prevalence of Infection

2007 ◽  
Vol 18 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Wendy Sligl ◽  
Geoffrey Taylor ◽  
RT Noel Gibney ◽  
Robert Rennie ◽  
Linda Chui
Keyword(s):  
Intensive Care ◽  
Cohort Analysis ◽  
Antimicrobial Treatment ◽  
Cost Of Care ◽  
Alberta Hospital ◽  
University Of Alberta ◽  
General Systems ◽  
Mrsa Infection ◽  
The University ◽  
Hospital Acquired

INTRODUCTION: Methicillin-resistantStaphylococcus aureus(MRSA) infection in intensive care units (ICUs) has increased dramatically in prevalence in recent years, and is associated with increased morbidity, mortality and cost of care. The aim of the present study was to describe the epidemiology and outcomes of MRSA infection in the general systems ICU at the University of Alberta Hospital in Edmonton, Alberta.METHODS: A retrospective cohort analysis of patients infected with MRSA in a general systems ICU was conducted from January 1, 1997, to August 15, 2005.RESULTS: Forty-six cases of MRSA were identified, of which 36 (78.3%) were infected. The most common admitting diagnoses included respiratory failure (41.7%) and sepsis or septic shock (36.1%). Infection was hospital acquired in 58.3% of cases (10 cases ICU acquired), with a median time to infection of 11 days. The most common sites of infection were the respiratory tract, skin and blood. Median lengths of stay were 13 days in the unit and 27 days in-hospital. Crude mortality was 55.6%. Time to appropriate antimicrobial treatment was delayed in 80.5% of patients. Four prototypical Canadian MRSA (CMRSA) strains were identified by pulsed-field gel electrophoresis. Hospital-acquired strains were predominantly CMRSA-2 (59%), indicating that this clone circulates at the University of Alberta Hospital.CONCLUSIONS: MRSA infection remains uncommon at the University of Alberta Hospital, resulting in delays in instituting appropriate antimicrobial therapy. To date, only a few community-acquired strains have been noted. ICU acquisition of MRSA remains rare, with only 10 cases over the past nine years. The majority of hospital-acquired strains were CMRSA-2.

scholarly journals Trends in Nosocomial Bloodstream Infections following Health Care Restructuring in Alberta between 1999 and 2005

2010 ◽  
Vol 21 (1) ◽  
pp. e1-e5 ◽  
Author(s):  
Mao-Cheng Lee ◽  
Lynora Saxinger ◽  
Sarah E Forgie ◽  
Geoffrey Taylor
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Alberta Hospital ◽  
University Of Alberta ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The University

OBJECTIVE: A previous study at the University of Alberta Hospital/Stollery Children’s Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring.DESIGN: Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records.SETTING: The University of Alberta Hospital/Stollery Children’s Hospital (617 adult and 139 pediatric beds, respectively).PATIENTS: All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs.RESULTS: There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged.CONCLUSIONS: These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.

Epidemiology, antimicrobial resistance, and incremental medical costs of hospital-acquired infections in the Intensive Care Unit: 2-year experience from Serbia

2019 ◽  
Author(s):  
Aleksa Jovan Despotovic ◽  
Branko Milosevic ◽  
Ivana Milosevic ◽  
Andja Cirkovic ◽  
Snezana D Jovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Length Of Stay ◽  
Fold Increase ◽  
Antimicrobial Treatment ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Resistance Rates ◽  
Hospital Acquired

Abstract Background: Hospital-acquired infections are a major complication of hospital treatment. The growing presence of multidrug-resistant pathogens contributes to increased mortality and costs, particularly in intensive care units where patients are predisposed to numerous risk factors. Comprehensive data about hospital-acquired infections from Serbian intensive care units is scarce. The aim of this study was to determine the presence of hospital-acquired infections among intensive care unit patients and look into the patterns of antimicrobial resistance, risk factors, and incremental costs of diagnosis and antimicrobial treatment. Methods: This retrospective study included 355 patients over a two-year period. Etiology, antimicrobial resistance patterns, and incremental costs of diagnosis and antimicrobial treatment were examined. Risk factors for infection acquisition, as well as length of stay, were statistically analyzed using Pearson’s chi-square tests and logistic regression analysis. Results: At least one hospital-acquired infection was identified in 32.7% of patients. A total of 204 infection episodes were documented, the most common type being urinary tract infections (36.3%). Clostridium difficile , Klebsiella spp. , and Acinetobacter baumanii were the most common isolates. Antimicrobial resistance rates < 20% were observed for linezolid (0%), colistin (9%), and tigecycline (14%). Resistance rates > 50% were seen in all other tested antibiotic agents. Mortality rates were not higher in patients who acquired only one hospital-acquired infection (p=0.09), but were significantly higher for patients in whom more than one episode occurred (p=0.038). Length of stay > 20 days carried a 7.5-fold increase in odds of acquiring an infection (CI 4.4-12.7, p<0.001), whereas length of stay > 30 days carried a 10-fold increase (CI 5.5-16.1, p<0.001). During the study period, over 37,000 EUR was incrementally spent on diagnosis and antimicrobial treatment for hospital-acquired infections. Conclusion: Our results suggest a high prevalence of hospital-acquired infections and very high antimicrobial resistance rates compared to most European countries. Together with the first published results regarding incremental costs from Serbia, our observations require large-scale prospective follow-up studies in order to obtain a deeper insight into the actual burden of hospital-acquired infections.

The Psychodynamic Psychiatry Service of the University of Alberta Hospital: A Thirty Year History

2004 ◽  
Vol 54 (4) ◽  
pp. 521-538 ◽  
Author(s):  
Paul Ian Steinberg ◽  
John S. Rosie ◽  
Anthony S. Joyce ◽  
John G. O’Kelly ◽  
William E. Piper ◽  
...  
Keyword(s):  
Alberta Hospital ◽  
University Of Alberta ◽  
The University

scholarly journals Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Philippe Guerci ◽  
◽  
Hugo Bellut ◽  
Mokhtar Mokhtari ◽  
Julie Gaudefroy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Primary Endpoint ◽  
Antimicrobial Therapy ◽  
Stenotrophomonas Maltophilia ◽  
Antimicrobial Treatment ◽  
Hospital Death ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Abstract Background There is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy. Methods This nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy. Results Of the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5–18] days. The Simplified Acute Physiology Score II was 47 [36–63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively). Conclusions S. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival. Trial registration clinicaltrials.gov, NCT03506191

scholarly journals Comparing administrative and clinical data for central line associated blood stream infections in Pediatric Intensive Care Unit and Pediatric Cardiothoracic Intensive Care Unit

2016 ◽  
Vol 8 (3) ◽  
Author(s):  
Jory Bond ◽  
Mohamed Issa ◽  
Ali Nasrallah ◽  
Sheena Bahroloomi ◽  
Roland A. Blackwood
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Administrative Data ◽  
Chart Review ◽  
Pediatric Intensive Care ◽  
Central Line ◽  
University Of Michigan ◽  
Coding System ◽  
The University ◽  
Hospital Acquired

Central line associated bloodstream infections (CLABSIs) are a frequent source of health complication for patients of all ages, including for patients in the pediatric intensive care unit (PICU) and Pediatric Cardiothoracic Intensive Care Unit (PCTU). Many hospitals, including the University of Michigan Health System, currently use the International Classification of Disease (ICD) coding system when coding for CLABSI. The purpose of this study was to determine the accuracy of coding for CLABSI infections with ICD-9CM codes in PICU and PCTU patients. A retrospective chart review was conducted for 75 PICU and PCTU patients with 90 events of hospital acquired central line infections at the University of Michigan Health System (from 2007-2011). The different variables examined in the chart review included the type of central line the patient had, the duration of the stay of the line, the type of organism infecting the patient, and the treatment the patient received. A review was conducted to assess if patients had received the proper ICD-9CM code for their hospital acquired infection. In addition, each patient chart was searched using Electronic Medical Record Search Engine to determine if any phrases that commonly referred to hospital acquired CLABSIs were present in their charts. Our review found that in most CLABSI cases the hospital’s administrative data diagnosis using ICD-9CM coding systems did not code for the CLABSI. Our results indicate a low sensitivity of 32% in the PICU and an even lower sensitivity of 12% in the PCTU. Using these results, we can conclude that the ICD-9CM coding system cannot be used for accurately defining hospital acquired CLABSIs in administrative data. With the new use of the ICD- 10CM coding system, further research is needed to assess the effects of the ICD-10CM coding system on the accuracy of administrative data.

scholarly journals The Use of Guidelines for the Empiric Treatment of Hospital-Acquired Pneumonia

2001 ◽  
Vol 8 (4) ◽  
pp. 255-260 ◽  
Author(s):  
Michael S Miletin ◽  
Charles K Chan
Keyword(s):  
Empirical Therapy ◽  
Treated Group ◽  
Antimicrobial Treatment ◽  
University Teaching ◽  
Health Network ◽  
Hospital Acquired Pneumonia ◽  
The University ◽  
Hospital Acquired ◽  
To Receive ◽  
Microbiological Data

BACKGROUND: Several practice guidelines for the empirical antimicrobial treatment of hospital-acquired pneumonia (HAP) have been developed, but the acceptance and use of such guidelines are unknown.OBJECTIVE: To assess physicians' use of empirical HAP guidelines published by the American Thoracic Society (ATS) and by The University Health Network, Toronto, Ontario.DESIGN: A retrospective assembly and chart review.SETTING: A university teaching hospital.PATIENTS: One hundred fifteen consecutive patients who had been diagnosed with pneumonia more than 48 h after admission to hospital over a 10-month period.RESULTS: The charts of 115 patients were reviewed. Seventy-five patients (65%) were treated empirically. Forty patients (35%) were treated based on microbiological data that were available before the initiation of antibiotics. Patients who received nonempirical treatment for HAP had a significantly greater acuity of illness than the empirically treated group. Thirty-seven patients (49%) who received empirical therapy were treated according to either ATS or hospital guidelines for HAP. The use of guideline-concordant antimicrobial therapy had no measurable effect on in-hospital mortality (eight of 37 patients [21.6%] versus seven of 38 patients [18.4%], P=0.96) or median length of stay (19 days versus 21 days, P=0.30). Patients whose treatment did not follow guideline recommendations tended to receive appropriate antimicrobial coverage more often than did those patients whose treatment was guideline concordant (15 of 18 patients [83%] versus six of 11 patients [55%], P=0.49).CONCLUSIONS: Institutional and ATS guidelines for the empirical treatment of HAP are less widely used than would be predicted by chance at The University Health Network. The clinical utility of these guidelines remains to be proven.

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