Candidemia in Intensive Care Units Over Nine Years at a Large Italian University Hospital 

2020 ◽  
Author(s):  
Sara Mazzanti ◽  
Lucia Brescini ◽  
Gianluca Morroni ◽  
Elena Orsetti ◽  
Antonella Pocognoli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Incidence Rate ◽  
Intensive Care Units ◽  
Antifungal Therapy ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
University Hospital ◽  
Related Factors ◽  
Icu Patients ◽  
Over Time

Abstract Purpose: Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years. Methods: A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results: During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Incidence rate was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates were 19% and 41%, respectively and did not increased significantly over time. Independent risk factors for higher mortality were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Conclusion: Neither incidence rate nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors.

scholarly journals Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252165
Author(s):  
Sara Mazzanti ◽  
Lucia Brescini ◽  
Gianluca Morroni ◽  
Elena Orsetti ◽  
Antonella Pocognoli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antifungal Therapy ◽  
Cumulative Incidence ◽  
Mortality Rates ◽  
University Hospital ◽  
Icu Patients ◽  
Risk Of Death ◽  
Significant Difference ◽  
Over Time

Purpose Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years. Methods A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Non-ICU patients with candidemia hospitalized during the same time period were considered for comparison purposes. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Cumulative incidence was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). There was not a significant difference in species distribution between ICU and non-ICU patients. With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates, were 19% and 41% respectively, the latter being significantly higher than that observed in non-ICU patients. At multivariate analysis, factors associated with increased risk of death were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Mortality did not increased significantly over time. Conclusion Neither cumulative incidence nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors in the majority of cases.

scholarly journals Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality

2019 ◽  
Author(s):  
Guang-Wen Xiao ◽  
Wan-qing Liao ◽  
Yuenong Zhang ◽  
Xiaodong Luo ◽  
Cailing Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Serum Albumin ◽  
Roc Curve ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Candida Spp ◽  
Icu Patients

Abstract Background : Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China. Methods Eighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and receiver operating characteristics (ROC) curve analysis were used to assess the risk factors for mortality among the cases. Results The prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 35.8% (29/81). Ninety-eight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (42.9%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs.. Logistic multiple regression showed that age, serum albumin, Acute Physiology and Chronic Health Evaluation (APACHE) II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤ 25g/L were the best predictors of mortality. Conclusion Candida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and especially monitor fungal susceptibility to reduce mortality rates.

Incidence of Methicillin-Resistant Staphylococcus aureus Nosocomial Infections in Intensive Care Units in Lyon University Hospitals, France, 2003-2006

2008 ◽  
Vol 29 (5) ◽  
pp. 454-456 ◽  
Author(s):  
M. Moalla ◽  
D. Baratin ◽  
M. Giard ◽  
P. Vanhems
Keyword(s):  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Incidence Rate ◽  
Intensive Care Units ◽  
Nosocomial Infections ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
University Hospitals ◽  
Icu Patients ◽  
Methicillin Resistant

We describe the trends in the incidence of methicillin-resistant Staphylococcus aureus nosocomial infection in intensive care units in Lyon hospitals from January 1, 2003, through December 31, 2006. The incidence rate decreased from 1.77 cases per 100 ICU patients in 2003 to 1.16 cases per 100 ICU patients in 2006, a reduction of 38.0% (P = .05).

scholarly journals Prevalence and Related Risk Factors of Low Back Pain among Nurses Working in Intensive Care Units

2019 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Intensive Care Units ◽  
Working Hours ◽  
University Hospital ◽  
Low Back ◽  
Related Factors ◽  
Related Risk

Studies have shown that low back pain is a common health problem among hospital nurses especially those working in Intensive Care Units. However, prevalence and the related risk factors in intensive care units needs to be widely investigated. The aims: of this study were to identify prevalence of low back pain and determine its related risk factors among nurses working in Intensive Care Units. Subjects: A purposive sample of all nurses who worked in intensive care units and meet the inclusion criteria. Setting: The study was conducted at four intensive care units of Menoufia University hospital. Tools of the study: Two tools were utilized for data collection as follow; Tool I: Interviewing questionnaire and Tool II: Observational checklist. Results: The prevalence of low back pain among studied nurses was 85%. The most important and preventable risk factors for low back pain among studied nurses were higher body mass index, more average working hours/day, not enough working space, lower compliance of nurses with proper body mechanics and range of motion exercises during work. Conclusion: prevalence of low back pain among nurses working in intensive care units was high. There were multi interrlatrelatede risk factors for low back pain among studied nurses: work, patients and personnel related factors. Recommendations: Periodic and continuous in-services training for nurses working in intensive care units on preventing and coping strategies for low back pain should be implemented.

scholarly journals Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality

2019 ◽  
Author(s):  
Guang-Wen Xiao ◽  
Wan-qing Liao ◽  
Yuenong Zhang ◽  
Xiaodong Luo ◽  
Cailing Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Serum Albumin ◽  
Roc Curve ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Candida Spp ◽  
Icu Patients

Abstract Background : Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China. Methods Eighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and receiver operating characteristics (ROC) curve analysis were used to assess the risk factors for mortality among the cases. Results The prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 35.8% (29/81). Ninety-eight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (42.9%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs.. Logistic multiple regression showed that age, serum albumin, Acute Physiology and Chronic Health Evaluation (APACHE) II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤ 25g/L were the best predictors of mortality. Conclusion Candida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and especially monitor fungal susceptibility to reduce mortality rates.

scholarly journals Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality

2020 ◽  
Author(s):  
Guang-Wen Xiao ◽  
Wan-qing Liao ◽  
Yuenong Zhang ◽  
Xiaodong Luo ◽  
Cailing Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Serum Albumin ◽  
Roc Curve ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Candida Spp ◽  
Icu Patients

Abstract Background : Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China. Methods Eighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and receiver operating characteristics (ROC) curve analysis were used to assess the risk factors for mortality among the cases. Results The prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 35.8% (29/81). Ninety-eight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (42.9%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs.. Logistic multiple regression showed that age, serum albumin, Acute Physiology and Chronic Health Evaluation (APACHE) II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤ 25g/L were the best predictors of mortality. Conclusion: Candida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and concurrently monitor fungal susceptibility to reduce mortality rates.

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

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.

scholarly journals The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s407-s409
Author(s):  
Ksenia Ershova ◽  
Oleg Khomenko ◽  
Olga Ershova ◽  
Ivan Savin ◽  
Natalia Kurdumova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Negative Slope ◽  
Infection Prevention And Control ◽  
Ventilator Associated Pneumonia ◽  
Related Factors ◽  
Icu Patients ◽  
The Impact ◽  
Adf Test ◽  
Over Time

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

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