scholarly journals Two different clones of Candida pelliculosa bloodstream infection in a tertiary neonatal intensive care unit

2021 ◽  
Vol 15 (06) ◽  
pp. 870-876
Author(s):  
Yulan Yang ◽  
Weiyuan Wu ◽  
Lu Ding ◽  
Lin Yang ◽  
Jinzhen Su ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Clinical Features ◽  
Neonatal Intensive Care ◽  
Genetic Relatedness ◽  
Antifungal Drugs ◽  
In Vitro Susceptibility ◽  
Broth Microdilution Method

Introduction: Fungemia in preterm infants results in high mortality and morbidity. The genotypes, drug susceptibilities of Candida pelliculosa strains, and clinical features of two outbreaks of neonatal candidemia caused by C. pelliculosa were analyzed, in order to provide evidence for the outbreaks and characteristics of C. pelliculosa neonatal candidemia. Methodology: The strains were genotyped by pulsed-field gel electrophoresis to investigate their genetic relatedness. The broth microdilution method was used to determine in vitro susceptibility of the isolates to antifungal drugs. Clinical features of the infected patients were collected to analyze the risks for C. pelliculosa infection. Results: Fourteen neonates, hospitalized in the neonatal intensive care unit from November 2012 to October 2013, were infected by C. pelliculosa. All 14 patients were cured after treatment with fluconazole and discharged without any complications. The C. pelliculosa isolates from the 14 patients were clustered into two groups, indicating that the outbreaks were caused by two types of strains. Eight of nine strains isolated from the 2013 outbreak were clustered into the same group, while one isolate was grouped together with five isolates from the 2012 outbreak. In vitro experiments demonstrated high antifungal activity of fluconazole, voriconazole, amphotericin B, and 5-fluorocytosine to C. pelliculosa. The common symptoms of C. pelliculosa candidaemia were fever, cyanosis, polypnea, hypoactivity, and apnea. Conclusions: The current study revealed high in vitro susceptibility of C. pelliculosa to antifungals. As C. pelliculosa candidaemia cannot be characterized by clinical symptoms and routine blood testing alone, monitoring unusual strains isolated from immunodeficient hosts is very important to prevent possible outbreaks.

scholarly journals Non albicans Candidemia: an emerging menace in neonatal intensive care unit

2018 ◽  
Vol 5 (2) ◽  
pp. 436
Author(s):  
Chandrashekar G. Shettigar ◽  
Sanchita Shettigar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
High Mortality ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Antifungal Susceptibility ◽  
Resistant Organism ◽  
In Vitro Susceptibility

Background: Candidemia has become an increasingly major problem in neonatal intensive care unit (NICU) which is associated with high mortality and morbidity. In this study we evaluated the epidemiology of Candidemia in neonates who were admitted to NICU and their in vitro susceptibility to commonly used antifungal drugs.Methods: This was a retrospective study of candidemia in NICU from October 2014 to September 2017. The isolates were identified as per standard mycological techniques and antifungal susceptibility was determined by disk diffusion method.Results: Out of 563 blood culture analyzed, 54(9.59%) culture yielded Candida in their blood. The non albicans Candida (NAC) species were the predominant organism for candidemia in neonates, accounting for 35 (64.81%) and the remaining 19 (35.18%) isolates were of C. albicans. Among the NAC species, the maximum isolates were of C. krusei (31.48%) followed by C. glabrata (22.22%). Non albican Candida were more resistant to azole group of antifungal, especially commonly used antifungal like fluconazole (51.43%). Among NAC species, C. glabrata was most resistant and C. tropicalis was least resistant organism. Prematurity <34 weeks, very low birth weight (<1500gm), prolonged use of broad spectrum antibiotic therapy, prolonged use of central venous catheter, mechanical ventilation, parenteral nutrition, prolonged NICU stays and concomitant bacterial sepsis were significantly associated with Candida infection in blood stream. NAC species were also associated with high mortality rate.Conclusions: Increased incidences of candidemia along with emergence of NAC species have become an important health care issue. Therefore, knowledge of local epidemiological data on candidemia is essential which will guide on therapeutic decision making. 

Shortening the Application Time of Alcohol-Based Hand Rubs to 15 Seconds May Improve the Frequency of Hand Antisepsis Actions in a Neonatal Intensive Care Unit

2017 ◽  
Vol 38 (12) ◽  
pp. 1430-1434 ◽  
Author(s):  
Axel Kramer ◽  
Didier Pittet ◽  
Romana Klasinc ◽  
Stefan Krebs ◽  
Torsten Koburger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Application Time ◽  
Improve Hand Hygiene ◽  
Independent Observer ◽  
Hand Antisepsis

BACKGROUNDFor alcohol-based hand rubs, the currently recommended application time of 30 seconds is longer than the actual time spent in clinical practice. We investigated whether a shorter application time of 15 seconds is microbiologically safe in neonatal intensive care and may positively influence compliance with the frequency of hand antisepsis actions.METHODSWe conducted in vitro experiments to determine the antimicrobial efficacy of hand rubs within 15 seconds, followed by clinical observations to assess the effect of a shortened hand antisepsis procedure under clinical conditions in a neonatal intensive care unit (NICU). An independent observer monitored the frequency of hand antisepsis actions during shifts.RESULTSAll tested hand rubs fulfilled the requirement of equal or even significantly higher efficacy within 15 seconds when compared to a reference alcohol propan-2-ol 60% (v/v) within 30 seconds. Microbiologically, reducing the application time to 15 seconds had a similar effect when compared to 30-second hand rubbing, but it resulted in significantly increased frequency of hand antisepsis actions (7.9±4.3 per hour vs 5.8±2.9 per hour; P=.05).CONCLUSIONTime pressure and workload are recognized barriers to compliance. Therefore, reducing the recommended time for hand antisepsis actions, using tested and well-evaluated hand rub formulations, may improve hand hygiene compliance in clinical practice.Infect Control Hosp Epidemiol 2017;38:1430–1434

Genetic Relatedness among Extended-Spectrum β-Lactamase-ProducingKlebsiella pneumoniaeOutbreak Isolates Associated with Colonization and Invasive Disease in a Neonatal Intensive Care Unit

2005 ◽  
Vol 11 (1) ◽  
pp. 21-25 ◽  
Author(s):  
Valéria Câmara De Almeida ◽  
Carmem Lúcia Pessoa-Silva ◽  
Jorge Luiz Mello Sampaio ◽  
Paulo Pinto Gontijo Filho ◽  
Lúcia Martins Teixeira ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Genetic Relatedness ◽  
Invasive Disease ◽  
Extended Spectrum

scholarly journals Machine Learning Approaches to Predict In-Hospital Mortality among Neonates with Clinically Suspected Sepsis in the Neonatal Intensive Care Unit

2021 ◽  
Vol 11 (8) ◽  
pp. 695
Author(s):  
Jen-Fu Hsu ◽  
Ying-Feng Chang ◽  
Hui-Jun Cheng ◽  
Chi Yang ◽  
Chun-Yuan Lin ◽  
...  
Keyword(s):  
Machine Learning ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Neonatal Intensive Care Unit ◽  
Clinical Features ◽  
Neonatal Intensive Care ◽  
Learning Approaches ◽  
Suspected Sepsis ◽  
Test Sets

Background: preterm and critically ill neonates often experience clinically suspected sepsis during their prolonged hospitalization in the neonatal intensive care unit (NICU), which can be the initial sign of final adverse outcomes. Therefore, we aimed to utilize machine learning approaches to predict neonatal in-hospital mortality through data-driven learning. Methods: a total of 1095 neonates who experienced clinically suspected sepsis in a tertiary-level NICU in Taiwan between August 2017 and July 2020 were enrolled. Clinically suspected sepsis was defined based on clinical features and laboratory criteria and the administration of empiric antibiotics by clinicians. The variables used for analysis included patient demographics, clinical features, laboratory data, and medications. The machine learning methods used included deep neural network (DNN), k-nearest neighbors, support vector machine, random forest, and extreme gradient boost. The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC). Results: the final in-hospital mortality of this cohort was 8.2% (90 neonates died). A total of 765 (69.8%) and 330 (30.2%) patients were randomly assigned to the training and test sets, respectively. Regarding the efficacy of the single model that most accurately predicted the outcome, DNN exhibited the greatest AUC (0.923, 95% confidence interval [CI] 0.953–0.893) and the best accuracy (95.64%, 95% CI 96.76–94.52%), Cohen’s kappa coefficient value (0.74, 95% CI 0.79–0.69) and Matthews correlation coefficient value (0.75, 95% CI 0.80–0.70). The top three most influential variables in the DNN importance matrix plot were the requirement of ventilator support at the onset of suspected sepsis, the feeding conditions, and intravascular volume expansion. The model performance was indistinguishable between the training and test sets. Conclusions: the DNN model was successfully established to predict in-hospital mortality in neonates with clinically suspected sepsis, and the machine learning algorithm is applicable for clinicians to gain insights and have better communication with families in advance.

scholarly journals Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital

2010 ◽  
Vol 59 (6) ◽  
pp. 687-692 ◽  
Author(s):  
Ali A. Dashti ◽  
Mehrez M. Jadaon ◽  
Huda H. Gomaa ◽  
Bobby Noronha ◽  
Edet E. Udo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Genetic Relatedness ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Disc Diffusion

The spread of antibiotic-resistant bacteria has become a large problem in most countries including Kuwait. This antibiotic resistance is usually due to the production of extended-spectrum β-lactamase (ESBL) enzymes such as SHV, TEM and CTX-M. This study reports the emergence and spread of an ESBL-producing Klebsiella pneumoniae clone in a neonatal intensive care unit (NICU) in a Kuwaiti hospital. Eight ESBL-producing K. pneumoniae isolates were from blood cultures of seven neonates, and two were from the fingers of two healthcare workers in a NICU in Al Jahra Hospital, Kuwait. All isolates were obtained in February–March 2006, except for one, which was obtained in August 2005. Identification of the bacteria was based on traditional bacteriological and biochemical tests using the Vitek system. Antibiotic susceptibility was tested by the disc diffusion method using 16 different antibiotics. ESBLs were detected using disc approximation and double-disc synergy methods and confirmed as ESBLs using Etest. PCR and DNA sequencing were performed to determine the genotypes and mutations in the β-lactamase genes (bla TEM, bla SHV and bla CTX-M). Genetic relatedness was determined by PFGE. All isolates were confirmed to have ESBLs by the Vitek system, disc approximation test, double-disc diffusion test and Etest, being resistant to cefotaxime, ceftazidime, cefepime, gentamicin, tobramycin and ciprofloxacin but susceptible to tetracycline and trimethoprim–sulfamethoxazole. Molecular studies showed the isolates to have TEM-1 β-lactamase, a CTX-M-15-like ESBL and the newly discovered SHV-112 ESBL. PFGE showed that all isolates had identical banding patterns. The results indicate that a single clone of ESBL-producing K. pneumoniae caused bloodstream infections among babies in a NICU of a Kuwaiti hospital, and may have emerged at least 5 years ago. This clone was also present on the hands of healthcare workers, suggesting that they may have been involved in its transmission. Further studies are recommended to determine whether this clone is also spreading in other Kuwaiti hospitals.

Performance of a radiometer transcutaneous oxygen monitor in a neonatal-intensive-care unit.

1980 ◽  
Vol 26 (5) ◽  
pp. 629-633 ◽  
Author(s):  
G Graham ◽  
M A Kenny
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Partial Pressure ◽  
Neonatal Intensive Care ◽  
Partial Pressure Of Oxygen ◽  
Specific Patient ◽  
Transcutaneous Oxygen ◽  
Oxygen Monitor

Abstract We evaluated the performance of the Radiometer TCM-1 Transcutaneous Oxygen Monitor in a Class III neonatal-intensive-care unit during an 11-month clinical trial (in excess of 4000 h) in which we monitored 115 infants ranging in gestational age from 25 to 43 weeks and in birthweight from 595 to 4220 g. In vitro transcutaneous partial pressure of oxygen (ptcO2) measurements were accurate within 1% of the theoretical value and precise (1.4% CV at 156 mmHg) at 44 degrees C. Determinations at other temperature were less accurate except in rare instances when specific patient-associated ptcO2/paO2 bias was identified. In vitro comparison of ptcO2 (y) and arterial partial pressure of oxygen (paO2) (x) measurements agreed well (y = 0.90x + 6.9, r = 0.94) except when infants were less than 24 h old. In this latter group the ptcO2/paO2 ratio usually exceeded 1.0 and fluctuated unpredictably. ptcO2 measurements on infants less than 24 h old had to be interpreted cautiously. In general, the ptcO2 and paO2 measurements agreed sufficiently well for the physicians to use them as the basis for directing patient care.

scholarly journals Clinical characteristics and outcomes of neonates with polymicrobial ventilator-associated pneumonia in the intensive care unit

2021 ◽  
Author(s):  
Hsiao-Chin Wang ◽  
Ming-Horng Tsai ◽  
Shih-Ming Chu ◽  
Chen-Chu Liao ◽  
Mei-Yin Lai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Treatment Failure ◽  
Clinical Features ◽  
Neonatal Intensive Care ◽  
Clinical Characteristics ◽  
Ventilator Associated Pneumonia ◽  
Prolonged Intubation ◽  
Therapeutic Responses

Abstract Background: Ventilator associated pneumonia (VAP) caused by more than one microorganisms is not uncommon and may be potentially challenging, but the relevant data is scarce in ventilated neonates. We aimed to investigate the clinical characteristics and outcomes of polymicrobial VAP in the neonatal intensive care unit (NICU).Methods: All neonates with definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and September 2020 were prospectively observed and enrolled for analyses. All clinical features, therapeutic interventions and outcomes were compared between the polymicrobial VAP and monomicrobial VAP episodes. Multivariate regression analyses were used to find the independent risk factors for treatment failure. Results: Among 236 episodes of neonatal VAP, 60 (25.4%) were caused by more than one microorganisms. Polymicrobial VAP episodes were more likely to be associated with multidrug-resistant pathogens (53.3% versus 34.7%, P = 0.014), more often occurred in later days of life and in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. Otherwise most clinical characteristics of polymicrobial VAP were similar to those of monomicrobial VAP. The therapeutic responses and treatment outcomes were also comparable between these two groups, although modification of therapeutic antibiotics were significantly more common in polymicrobial VAP episodes than monomicrobial VAP episodes (63.3% versus 46.2%; P<0.001). None of any specific pathogens was significantly associated with worse outcomes. Instead, it is the severity of illness, including presence of concurrent bacteremia, septic shock, and requirement of high-frequency oscillatory ventilator and underlying neurological sequelae that are independently associated with treatment failure.Conclusions: Polymicrobial VAP accounted for 25.4% of all neonatal VAP in the NICU, and frequently occurred in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. In our cohort, most clinical features, therapeutic responses and final outcomes of neonates with monomicrobial and polymicrobial VAP did not differ significantly.

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