Bacterial Resistance and Mortality in an Intensive Care Unit

The goal was to identify risk factors for healthcare-associated infections by resistant microorganisms and patient mortality in an Intensive Care Unit. A prospective and descriptive epidemiological research was conducted from 2005 till 2008, involving 2300 patients. Descriptive statistics, bivariate and multivariate logistic regression analysis were used. In bivariate analysis, infection caused by resistant microorganism was significantly associated to patients with community-acquired infection (p=0.03; OR=1.79) and colonization by resistant microorganism (p<0.01; OR=14.22). In multivariate analysis, clinical severity (p=0.03; OR=0.25) and colonization by resistant microorganism (p<0.01; OR=21.73) were significant. Mortality was associated to the following risk factors: type of patient, average severity index, besides mechanical ventilation. The relation between resistant microorganisms and death shows the need to monitor adherence to infection control measures so as to improve care quality and mainly survival of critical patients.

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VENTILATOR ASSOCIATED PNEUMONIA IN TRAUMA PATIENTS; ASSOCIATED RISK FACTORS, MICROBIAL ETIOLOGY AND OUTCOME

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.6278 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1476-80

Author(s):

Sohaima Manzoor ◽

Farzana Batool ◽

Muneeba Ahsan Sayeed ◽

Azizullah Khan Dhiloo ◽

Humera Muhammad Ismail ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Emergency Room ◽

Therapeutic Option ◽

Significant Risk ◽

Control Measures ◽

P Value ◽

Trauma Patients ◽

Ventilator Associated Pneumonia

Objective: To assess the incidence, risk factors and outcome of ventilator associated pneumonia in trauma patients. Study Design: Prospective observational study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from Jul to Dec 2019. Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the emergency room or intensive care unit, were enrolled. Patients that developed a clinical pulmonary infection score of less than 6 were diagnosed with ventilator associated pneumonia. Results: A total of 113 patients were enrolled in this study. Mean age was 32.9 ± 14.4 years. Thirty eight (33.6%) developed ventilator associated pneumonia. Patients with ventilator associated pneumonia, compared to non-ventilator associated pneumonia, had a longer emergency room stay of 7.8 ± 10.1 vs. 4.7 ± 7.4 days (p-value=0.013), greater ventilator days of 18.5 ± 12.6 vs. 7.9 ± 5.5 (p-value=0.001), longer hospital stay of >14 days in 65.8% vs. 33.3% (p-value=0.001) and higher mortality of 65.8% vs. 56% (p-value=0.213). Nurse to patient ratio and infection control measures for prevention of ventilator associated pneumonia were significantly reduced in emergency room compared to intensive care unit (p-value=0.001). Out of 43 respiratory isolates in 38 ventilator associated pneumonia patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option. Conclusion: There was a high incidence of ventilator associated pneumonia in patients with trauma. Prolonged retention in the emergency room is a significant risk factor for ventilator associated pneumonia, due to understaffing..................

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Risk Factors for Surgical Site Infections in Pediatric General Surgery: A Case–Control Study

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0041-1726469 ◽

2021 ◽

Author(s):

Gassan T. Almogbel ◽

Tariq I. Altokhais ◽

Abdulaziz Alhothali ◽

Abdulaziz Sami Aljasser ◽

Khalid M. Al-Qahtani ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Surgical Procedures ◽

Case Control Study ◽

Case Control ◽

Bivariate Analysis ◽

Retrospective Case ◽

Asa Classification ◽

Control Study

Abstract Objective Despite being the most common postoperative complication and having associated morbidity and mortality that increase health care costs, surgical site infection (SSI) has not received adequate attention and deserves further study. Previous reports in children were limited to SSI in certain populations. We conducted this retrospective case–control study to determine the incidence and possible risk factors for SSI following pediatric general surgical procedures. Methods This was a retrospective case–control matched cohort study of all patients aged 0 to 14 years who underwent pediatric general surgical procedures between June 2015 and July 2018. The electronic medical records were searched for a diagnosis of SSI. Control subjects were randomly selected at a 4:1 ratio from patients who underwent identical procedures. Multiple risk factors were evaluated by bivariate analysis and multivariable conditional logistic regression. Results A total of 1,520 patients underwent a general pediatric procedure during the study period, and of these, 47 (3.09%) developed SSIs. A bivariate analysis showed that patients with SSIs were younger, were admitted to the neonatal intensive care unit/pediatric intensive care unit (NICU/PICU) preoperatively, were more severely ill as measured by the ASA classification, underwent multiple procedures, had more surgical complications, and were transferred to the NICU/PICU postoperatively. A multivariate analysis identified four independent predictors of SSI: age, preoperative NICU/PICU admission, number of procedures, and ASA classification. Conclusion Younger children with preoperative admission to the NICU/PICU, those who underwent multiple procedures and those who were severely ill as measured by their ASA classification were significantly more likely to develop SSIs.

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Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066616661152 ◽

2016 ◽

Vol 32 (3) ◽

pp. 204-211 ◽

Cited By ~ 5

Author(s):

Elizabeth K. Landry ◽

Rodney A. Gabriel ◽

Sascha Beutler ◽

Richard P. Dutton ◽

Richard D. Urman

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Patients ◽

Pediatric Population ◽

Multivariate Logistic Regression Analysis ◽

Data Set ◽

Icu Admission ◽

Increased Risk ◽

Wide Range

Background: Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. Aim: To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. Methods: Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. Results: Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age <1 year) and children who were classified as American Society of Anesthesiologists physical status classification of III or IV. Likewise, longer case duration and cases requiring general anesthesia were also associated with unplanned ICU admissions. Conclusion: This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.

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Atrial Fibrillation in a Tertiary Care Multidisciplinary Intensive Care Unit—Incidence and Risk Factors

Anaesthesia and Intensive Care ◽

10.1177/0310057x0703500508 ◽

2007 ◽

Vol 35 (5) ◽

pp. 707-713 ◽

Cited By ~ 31

Author(s):

S. Arora ◽

I. Lang ◽

V. Nayyar ◽

E. Stachowski ◽

D. L. Ross

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Intensive Care Unit ◽

Intensive Care ◽

Confidence Interval ◽

Tertiary Care ◽

Multivariate Logistic Regression Analysis ◽

Apache Ii ◽

Resource Utilisation ◽

Apache Ii Score

Atrial fibrillation is a common arrhythmia in an intensive care unit. We performed a prospective observational study over a period of three months, to study the incidence, risk factors and outcome of patients who develop atrial fibrillation in a multidisciplinary intensive care unit. All patients above the age of 50 years were eligible. Exclusion criteria were: cardiac or oesophageal surgery during current hospitalisation, atrial fibrillation at admission, implanted pacemaker and expected intensive care unit stay of less than 24 hours. Sixty-one patients were included in the study. Eighteen patients (29.5%, confidence interval 18-40) developed atrial fibrillation. Incidence of atrial fibrillation was 4.02 episodes per 100 patient days. Patients who developed atrial fibrillation had higher age (71.3 years vs. 63.2 years, P=0.001), severity of illness (APACHE II 25.4 vs. 20.0, P=0.005) and sepsis at admission (9/18 vs. 9/43, P=0.01). They also had higher in-hospital mortality (Risk ratio 2.7, 95% confidence interval 1.3-5.4). Standardised mortality ratio was higher in patients who developed atrial fibrillation (1.08 vs. 0.63). Patients who developed atrial fibrillation required a longer period of mechanical ventilation and inotropic support. Multivariate logistic regression analysis showed age > 75 years, APACHE II score >20 and sepsis at admission were independent predictors for development of atrial fibrillation in critically ill patients. Although atrial fibrillation by itself is unlikely to be the cause of higher mortality, it is likely to be a marker for increased mortality and resource utilisation in the intensive care unit.

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Risk factors for vancomycin-resistant Enterococcus colonization in hematologic patients

Vojnosanitetski pregled ◽

10.2298/vsp1312109m ◽

2013 ◽

Vol 70 (12) ◽

pp. 1109-1116 ◽

Cited By ~ 4

Author(s):

Vesna Mioljevic ◽

Ljiljana Markovic-Denic ◽

Ana Vidovic ◽

Milica Jovanovic ◽

Tanja Tosic ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Bacterial Resistance ◽

Antimicrobial Agents ◽

Demographic Data ◽

Disk Diffusion Test ◽

Microbiological Methods ◽

Vancomycin Resistant

Background/Aim. Vancomycin-resistant Enterococci (VRE) is one of the most important hospital pathogens. The aim of the study was to evaluate VRE colonization in patients hospitalized at the Hematology Intensive Care Unit, as well as the associated risk factors. Methods. A prospective cohort study involved 70 patients hospitalized at the Intensive Care Unit (ICU), Clinic for Hematology, Clinical Center of Serbia, Belgrade, during 3 months. Baseline demographic data, data about antibiotic usage and other risk factors for VRE colonization during the present and previous hospitalizations (within 6 months) were recorded for each patient using the questionnaire. Feces or rectal swab was collected for culture from patients on admission and at discharge in case when VRE was not isolated on admission. Enterococci were isolated by standard microbiological methods. Isolate sensitivity was tested by disk-diffusion test using 30 ?g/mL (BBL) Vancomycin plates according to the Clinical and Laboratory Standards Institute (CLSI) standard. Results. Analysing results showed that 7% of the patients had been already colonized with VRE upon ICU admission. The rate of VRE colonization during present hospitalization was 41.5%. Univariate logistic regression demonstrated the statistically significant differences in diagnosis, length of present stay, use of aminoglycosides and piperacillin/tazobactam in present hospitalization, duration of use of carbapenem and piperacillin/ tazobactam in present hospitalization between the VREcolonized and non-colonized patients. Acute myeloid leukemia (AML), use of carbapenem in previous hospitalization and duration of use of piperacillin/tazobactam in present hospitalization were independent risk factors for VRE-colonized patients according to multivariate logistic regression. Conclusion. VRE colonization rate was high among the patients admitted to hematology ICU. Rational use of antibiotics and active surveillance may be helpful preventive measures against the development of bacterial resistance to antimicrobial agents.

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Risk Factors forBurkholderia cepaciaComplex Bacteremia Among Intensive Care Unit Patients Without Cystic Fibrosis: A Case-Control Study

Infection Control and Hospital Epidemiology ◽

10.1086/519177 ◽

2007 ◽

Vol 28 (8) ◽

pp. 951-958 ◽

Cited By ~ 31

Author(s):

Adam M. Bressler ◽

Keith S. Kaye ◽

John J. LiPuma ◽

Barbara D. Alexander ◽

Christopher M. Moore ◽

...

Keyword(s):

Risk Factors ◽

Cystic Fibrosis ◽

Intensive Care Unit ◽

Intensive Care ◽

Point Source ◽

Burkholderia Cepacia ◽

Central Venous Access ◽

Multivariable Analysis ◽

Control Measures ◽

Onset Date

Background.TheBurkholderia cepaciacomplex is associated with colonization or disease in patients with cystic fibrosis (CF). For patients without CF, this complex is poorly understood apart from its presence in occasional point source outbreaks.Objective.To investigate risk factors forB. cepaciabacteremia in hospitalized, intensive care unit patients without CF.Methods.We identified patients with 1 or more blood cultures positive forB. cepaciabetween May 1, 1996, and March 31, 2002, excluding those with CF. Control patients were matched to case patients by ward, duration of hospitalization, and onset date of bacteremia. Matched analyses were used to identify risk factors forB. cepaciabacteremia.Results.We enrolled 40 patients withB. cepaciabacteremia into the study. No environmental or other point source forB. cepaciacomplex was identified, although horizontal spread was suspected. Implementation of contact precautions was effective in decreasing the incidence ofB. cepaciabacteremia. We selected 119 matched controls. Age, sex, and race were similar between cases and controls. In multivariable analysis, renal failure that required dialysis, recent abdominal surgery, 2 or more bronchoscopic procedures before detection ofB. cepaciabacteremia, tracheostomy, and presence of a central line before detection ofB. cepaciabacteremia were independently associated with development ofB. cepaciabacteremia, whereas presence of a percutaneous feeding tube was associated with a lower risk of disease.Conclusions.B. cepaciacomplex is an important emerging group of nosocomial pathogens in patients with and patients without CF. Nosocomial spread is likely facilitated by cross-transmission, frequent pulmonary procedures, and central venous access. Infection control measures appear useful for limiting the spread of virulent, transmissible clones ofB. cepaciacomplex.

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P0592RISK FACTORS FOR SEPSIS ASSCOCIATED-ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0592 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Xin Wang ◽

Jiaojiao Zhou ◽

Jia Yang ◽

Siwen Wang ◽

Lichuan Yang

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Laboratory Data ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Multivariate Statistical ◽

Related Data ◽

Mild Anemia

Abstract Background and Aims To explore the risk factors of acute kidney injury in patients with sepsis in intensive care unit (ICU). Method The medical records of patients diagnosed with sepsis in ICU of west China hospital of Sichuan university from March 2009 to June 2016 were retrospectively analyzed. Differences between AKI group and Non-AKI group in general data, background disease, ICU entry and exit dates, complications, laboratory data and other related data were analyzed through univariate and multivariate statistical methods. Results A total of 2331 patients with sepsis were included in the study, including 626 patients in the AKI group and 1695 patients in the Non-AKI group. The multivariate logistic regression analysis confirmed that age >40 yr. [odds ratio (OR) =2.811], diabetes (OR=2.818), hypertension/coronary heart disease (OR=1.781), CKD (OR=13.221), the length of ICU stay ≥14 days (OR=3.327), heart failure (OR=2.316), ARDS (OR=2.105), SAP (OR=2.566), hypotension (OR=2.048), hypoproteinemia (OR=1.607), lactic acidosis (OR=2.380), hypoproteinemia (OR=1.607), organ failure >1 (OR=4.604),WBC > 10 ×109/L (OR=4.197), serum creatinine (OR=4.535), PCT (OR=1.808), Cys-C (OR=7.066), mild anemia (OR=2.321), moderate anemia (OR=4.047), and severe anemia (OR=6.100) were all independent risk factors of SA-AKI. Conclusion A variety of risk factors are related to the occurrence of SA-AKI. Early identification and monitoring of risk factors for SA-AKI and early prevention of AKI can improve the prognosis of sepsis patients.

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Bloodstream Infections Caused by Metallo-β-Lactamase/Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae among Intensive Care Unit Patients in Greece: Risk Factors for Infection and Impact of Type of Resistance on Outcomes

Infection Control and Hospital Epidemiology ◽

10.1086/657135 ◽

2010 ◽

Vol 31 (12) ◽

pp. 1250-1256 ◽

Cited By ~ 116

Author(s):

Eleni Mouloudi ◽

Euthymia Protonotariou ◽

Alexia Zagorianou ◽

Elias Iosifidis ◽

Areti Karapanagiotou ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Bloodstream Infections ◽

Control Measures ◽

Hospital Death ◽

Control Group ◽

Case Control Studies ◽

Klebsiella Pneumoniae Carbapenemase

Objective.To determine risk factors for bloodstream infections (BSIs) caused by Klebsiella pneumoniae producing metallo-β-lactamases (MBLs) or K. pneumoniae carbapenemases (KPCs), as well as risk factors for mortality associated with carbapenem-resistant K. pneumoniae, among intensive care unit (ICU) patients.Methods.Two case-control studies were conducted in a patient cohort with K. pneumoniae BSIs in an 8-bed ICU in a Greek hospital from January 1, 2007, through December 31, 2008. In study 1, patients with K. pneumoniae BSIs were allocated among 3 groups according to isolate susceptibility profile: (1) carbapenem-susceptible insolates (control group), (2) MBL-producing isolates, or (3) KPC-producing isolates. The MBL and KPC groups were compared with the control group to identify risk factors for development of K. pneumoniae BSI. In study 2, patients with K. pneumoniae BSIs who died were compared with survivors to identify risk factors for mortality.Results.Fifty-nine patients had K. pneumoniae BSIs (22 with carbapenem-susceptible isolates, 18 with MBL-producing isolates, and 19 with KPC-producing isolates). All KPC-producing isolates carried the blaKPC-2 gene, and 17 of 18 MBL-producing isolates carried blaVIM-1 Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.13 [95% confidence interval, 1.03–1.25]; P = .02) was independently associated with KPC-producing K. pneumoniae BSIs. Nine (41%) of 22 control patients, 8 (44%) of 18 MBL group patients, and 13 (68%) of 19 KPC group patients died in the ICU. Nine (41%) of 22 control patients, 10 (56%) of 18 MBL group patients, and 15 (79%) of 19 KPC group patients died in the hospital. Isolation of KPC-producing K. pneumoniae was an independent predictor of ICU death (P = .04) and in-hospital death (P = .03) but not infection-attributable death.Conclusions.BSIs due to KPC-producing K. pneumoniae resulted in significantly increased mortality. The accurate and rapid detection of these pathogens is necessary for therapeutic considerations and for the implementation of infection control measures to contain them.

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Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures

Infectious Disease Reports ◽

10.3390/idr13020039 ◽

2021 ◽

Vol 13 (2) ◽

pp. 411-417

Author(s):

Teresa L. Almeida ◽

Tânia Mendo ◽

Raquel Costa ◽

Cristina Novais ◽

Mónica Marçal ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Infection Control ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Control Measures ◽

Infection Prevention And Control ◽

Infection Control Measures ◽

Gut Colonization

Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student’s t-test or Mann–Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.

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