Infection Prevention in the ICU

Hospitalised Patients ◽

Tract Infections ◽

Hospital-acquired infections are among the most significant issues within the healthcare system, both in Greece and abroad. This is because they are associated with severe morbidity and mortality. As a rule, in Intensive Care Units (ICU), hospital-acquired infections are caused by multidrug-resistant bacteria. The spread of infections by multidrug-resistant bacteria occurs in steps. Step one is usually considered to be colonisation of the ICU host-patient via indirect contact. A transmission vehicle in these cases are the hands of healthcare professionals. The main infections in this category are the ones that affect the respiratory system, followed by bloodstream infections, mainly through endovascular catheters, and urinary tract infections. Therefore, some simple measures can limit the spread of infections, improving the clinical outcomes for hospitalised patients. These include following hand hygiene, ensuring that the medical and nursing staff change disposable gloves, keeping the ICU areas extremely clean and keeping together hospitalised patients who are colonised by the same multidrug-resistant bacteria. However, many healthcare professionals fail to consistently comply with these guidelines, which leads to the spread of multidrug-resistant bacteria, and increased morbidity and mortality.

Multidrug-Resistant Bacteria with ESBL Genes: A Growing Threat Among HIV Patients in Nepal

10.21203/rs.3.rs-1103790/v1 ◽

2021 ◽

Author(s):

Riju Maharjan ◽

Anup Bastola ◽

Nabaraj Adhikari ◽

Komal Raj Rijal ◽

Megha Raj Banjara ◽

...

Keyword(s):

Multidrug Resistant ◽

Morbidity And Mortality ◽

Diffusion Method ◽

Resistant Bacteria ◽

Bacterial Isolates ◽

Hiv Patients ◽

Microbiological Methods ◽

Tract Infections ◽

Esbl Producers

Abstract Background Bacterial opportunistic infections are quite common in HIV patients. Besides HIV-TB coinfection, lower respiratory tract infections by multidrug-resistant bacteria cause significant morbidity and mortality among HIV patients. This study was done to evaluate the bacterial coinfection of LRT and detect plasmid-mediated blaTEM and blaCTX−M genes among Extended-Spectrum β-Lactamase (ESBL) producing isolates from sputum samples in HIV patients. Methods A total of 263 sputum samples from HIV-positive cases were processed with standard microbiological methods to isolate and identify the possible pathogens. The identified bacterial isolates were assessed for antibiotic susceptibility pattern by using modified Kirby Bauer disk diffusion method following Clinical Laboratory Standard Institute (CLSI) guidelines. Plasmid DNA was extracted from multidrug-resistant and ESBL producers for screening of ESBL genes; blaCTX−M and blaTEM by conventional PCR method using specific primers. Results Of 263 sputum samples, 67 (25.48%) were culture positive showing Klebsiella pneumoniae; 17(25.37%) as the most predominant one. A higher rate of infection (4/8, 50%) was observed among old-aged people of 61 -70 years, whereas no infection was observed below 20 years. About 30.0% (15/50) of smokers, 32.86% (23/70) cases with previous pulmonary tuberculosis and 52.38% (11/21) with CD4 count <200 cells/µl were found to be susceptible to LRTIs. Among 53 bacterial isolates, 52.83% (n=28) were multidrug-resistant and 43.4% (n=23) were ESBL producers. All ESBL producers were sensitive to Colistin and Polymyxin B. Of 23 ESBL producers, 47.83% (11/23) and 8.6% (2/23) possessed only blaCTX−M and blaTEM genes respectively and 43.48% (10/23) possessed both ESBL genes. Conclusion The increasing rate of MDR bacterial infections mainly ESBL producers of LRTIs causes difficulty in the management of diseases leading to high morbidity and mortality of HIV patients.

Enterococci as Fecal Indicator in a Tropical Beach: A Case Study

Fronteiras Journal of Social Technological and Environmental Science ◽

10.21664/2238-8869.2020v9i1.p53-72 ◽

2020 ◽

Vol 9 (1) ◽

pp. 53-72

Author(s):

Fernanda Silva dos Santos ◽

Luiz Affonso de Paula Junior ◽

Gabriel Farias Araujo ◽

Wellington Thadeu de Alcantara Azevedo ◽

Steven Dutt Ross ◽

...

Keyword(s):

Multidrug Resistant ◽

Resistant Bacteria ◽

Intertidal Sediment ◽

Fecal Indicator ◽

Brazilian Legislation ◽

Resistant Strains ◽

Fecal enterococci are generally not virulent; however, multidrug-resistant strains have emerged as leading causes of hospital-acquired infections. Thus, periodic enterococci monitoring should be included in highly populated cities to control the dissemination of multidrug-resistant strains to the marine environment. This study aimed to quantify enterococci bacteria from water and intertidal sediment samples in a beach located near Rio de Janeiro touristic spots. We also intended to accomplish if enterococci should be included in touristic beaches sanitary monitoring. Toward this approach, we monitored from August to December 2014 fecal indicator bacteria (FIB) at a beach close to some touristic spots through multiple tube method. Although FIB quantification was within sanitary standards of Brazilian legislation, high enterococci densities (=30 MNP.100 mL-1) were detected in the water collected in August. Thus, enterococci monitoring should be included in touristic beaches to avoid the risk of multidrug-resistant bacteria dissemination among swimmers and beachgoers.

Mortality attributable to hospital acquired infections with multidrug-resistant bacteria in a large group of German hospitals

Journal of Infection and Public Health ◽

10.1016/j.jiph.2019.07.025 ◽

2020 ◽

Vol 13 (2) ◽

pp. 204-210 ◽

Cited By ~ 3

Author(s):

Alicia Neubeiser ◽

Marzia Bonsignore ◽

Sascha Tafelski ◽

Christof Alefelder ◽

Karin Schwegmann ◽

...

Keyword(s):

Multidrug Resistant ◽

Resistant Bacteria ◽

Large Group ◽

853. Hospital-acquired Infections by Vancomycin-Resistant Enterococcus (VRE): Results in 3 Years of Multicenter Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1042 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S467-S467

Author(s):

Luciana Coelho Tanure ◽

Rafaela Tonholli Pinho ◽

Érico Macedo Pacheco Alves ◽

Bárbara Caldeira Pires ◽

Joice Ribeiro Lopes ◽

...

Keyword(s):

Standard Deviation ◽

Hospital Setting ◽

Bloodstream Infections ◽

Morbidity And Mortality ◽

High Morbidity ◽

Vancomycin Resistant Enterococcus ◽

Vancomycin Resistant ◽

Tract Infections ◽

Abstract Background Vancomycin-Resistant Enterococcus (VRE) is considered one of the main pathogens of hospital-acquired infections (HAI), responsible for high morbidity and mortality rates. HAI caused by this bacteria, especially in intensive care units (ICU), are concerning for the health system, given that the microorganism is multi resistant to most antimicrobials available, especially vancomycin. Therefore, the present study is built from and analyzes the data of VRE, collected by the Infection Prevetion and Control Service of hospitals in Brazil, to clarify: the incidence rate, the gross lethality of these infections and what are the profiles of infected patients. Methods Collection and analysis of epidemiological data, according to the National Healthcare Safety Network (NHSN) protocol of the Centers for Disease Control and Prevention (CDC), in 10 hospitals in Brazil, between Jan/2017 - Dec/2019. Results In three years, 118 VRE infections were diagnosed in the hospitals analyzed: 51 from ICU (43%), 24 from Vascular Acess (20%), 18 from General Clinic (15%), 10 from General Surgery (8%) and 15 from Others (13%). Patients ages ranged from 0 to 93 years, with a mean of 62 years (standard deviation of 20 years) and a median of 66 years. Time between admission and diagnosis of infection was 1 to 1001 days, with a mean of 68 days (standard deviation of 25 days) and a median of 59 days. The gross lethality for VRE infections was 47/118 (40%). The infection sites were: Bloodstream Infections – BSI = 34 (29%); Urinary Tract Infections – UTI = 28 (24%); Surgical Site Infections – SSI = 27 (23%); Skin and Soft Tissue Infections – SST = 14 (12%); Bone and Joint Infections – BJ = 5 (4%); Cardiovascular System Infections – CVS = 5 (4%); Lower Respiratory System Infections, other than pneumonia – LRI = 2 (2%); Pneumonia – PNEU = 2 (2%) and Gastrointestinal System Infections – GI = 1 (1%). Percentage of VRE infections by hospital units Percentage of VRE infections by infection sites Infection sites of VRE infections by hospital Conclusion VRE infection is a highly lethal event that usually occurs after two months of hospitalization. The main site of infection is the BSI, with a higher incidence in patients over 62 years or the ones in ICU. Early and accurate investigations of multiresistant microorganisms in a hospital setting are necessary to reduce patient morbidity and mortality. Disclosures All Authors: No reported disclosures

The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2014.12.022 ◽

2015 ◽

Vol 31 ◽

pp. 31-34 ◽

Cited By ~ 75

Author(s):

P. Cornejo-Juárez ◽

D. Vilar-Compte ◽

C. Pérez-Jiménez ◽

S.A. Ñamendys-Silva ◽

S. Sandoval-Hernández ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Hospital Acquired ◽

The Impact

The Antibacterial Activity of Human Amniotic Membrane against Multidrug-Resistant Bacteria Associated with Urinary Tract Infections: New Insights from Normal and Cancerous Urothelial Models

Biomedicines ◽

10.3390/biomedicines9020218 ◽

2021 ◽

Vol 9 (2) ◽

pp. 218

Author(s):

Taja Železnik Ramuta ◽

Larisa Tratnjek ◽

Aleksandar Janev ◽

Katja Seme ◽

Marjanca Starčič Erjavec ◽

...

Keyword(s):

Antibacterial Activity ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Amniotic Membrane ◽

Multidrug Resistant ◽

Basic Knowledge ◽

Resistant Bacteria ◽

Human Amniotic Membrane ◽

Tract Infections

Urinary tract infections (UTIs) represent a serious global health issue, especially due to emerging multidrug-resistant UTI-causing bacteria. Recently, we showed that the human amniotic membrane (hAM) could be a candidate for treatments and prevention of UPEC and Staphylococcus aureus infections. However, its role against multidrug-resistant bacteria, namely methicillin-resistant S. aureus (MRSA), extended-spectrum beta-lactamases (ESBL) producing Escherichia coli and Klebsiella pneumoniae, vancomycin-resistant Enterococci (VRE), carbapenem-resistant Acinetobacter baumannii, and Pseudomonas aeruginosa has not yet been thoroughly explored. Here, we demonstrate for the first time that the hAM homogenate had antibacterial activity against 7 out of 11 tested multidrug-resistant strains, the greatest effect was on MRSA. Using novel approaches, its activity against MRSA was further evaluated in a complex microenvironment of normal and cancerous urinary bladder urothelia. Even short-term incubation in hAM homogenate significantly decreased the number of bacteria in MRSA-infected urothelial models, while it did not affect the viability, number, and ultrastructure of urothelial cells. The hAM patches had no antibacterial activity against any of the tested strains, which further exposes the importance of the hAM preparation. Our study substantially contributes to basic knowledge on the antibacterial activity of hAM and reveals its potential to be used as an antibacterial agent against multidrug-resistant bacteria.

Risk factors for colonization and infection by resistant microorganisms in kidney transplant recipients

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2021-0219 ◽

2021 ◽

Vol 74 (suppl 6) ◽

Author(s):

Monica Taminato ◽

Richarlisson Borges de Morais ◽

Dayana Souza Fram ◽

Rogério Rodrigues Floriano Pereira ◽

Cibele Grothe Esmanhoto ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Kidney Transplant ◽

Multidrug Resistant ◽

Morbidity And Mortality ◽

Epidemiological Surveillance ◽

Resistant Bacteria ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Tract Infections

ABSTRACT Objectives: to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. Methods: a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. Results: ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p<0.005), dialysis time (p<0.004), length of stay after transplantation, delayed renal function, and length of stay were identified as risk factors. The microorganisms were isolated from surgical site, bloodstream and urinary tract infections. Conclusions: colonization by resistant microorganisms in kidney transplant patients was frequent and risk factors associated with infection were identified. The results should guide the care team in order to minimize morbidity and mortality related to infectious causes in this population.

Avoiding ventilator-associated pneumonia: Curcumin-functionalized endotracheal tube and photodynamic action

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2006759117 ◽

2020 ◽

Vol 117 (37) ◽

pp. 22967-22973

Author(s):

Amanda C. Zangirolami ◽

Lucas D. Dias ◽

Kate C. Blanco ◽

Carolina S. Vinagreiro ◽

Natalia M. Inada ◽

...

Keyword(s):

Endotracheal Tube ◽

Bacterial Infections ◽

Bacterial Resistance ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Ventilator Associated Pneumonia ◽

Hospital Acquired Infection ◽

Hospitalization Costs ◽

Hospital-acquired infections are a global health problem that threatens patients’ treatment in intensive care units, causing thousands of deaths and a considerable increase in hospitalization costs. The endotracheal tube (ETT) is a medical device placed in the patient’s trachea to assist breathing and delivering oxygen into the lungs. However, bacterial biofilms forming at the surface of the ETT and the development of multidrug-resistant bacteria are considered the primary causes of ventilator-associated pneumonia (VAP), a severe hospital-acquired infection for significant mortality. Under these circumstances, there has been a need to administrate antibiotics together. Although necessary, it has led to a rapid increase in bacterial resistance to antibiotics. Therefore, it becomes necessary to develop alternatives to prevent and combat these bacterial infections. One possibility is to turn the ETT itself into a bactericide. Some examples reported in the literature present drawbacks. To overcome those issues, we have designed a photosensitizer-containing ETT to be used in photodynamic inactivation (PDI) to avoid bacteria biofilm formation and prevent VAP occurrence during tracheal intubation. This work describes ETT’s functionalization with curcumin photosensitizer, as well as its evaluation in PDI against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. A significant photoinactivation (up to 95%) against Gram-negative and Gram-positive bacteria was observed when curcumin-functionalized endotracheal (ETT-curc) was used. These remarkable results demonstrate this strategy’s potential to combat hospital-acquired infections and contribute to fighting antimicrobial resistance.

Trends of Bloodstream Infections in a University Greek Hospital during a Three-Year Period: Incidence of Multidrug-Resistant Bacteria and Seasonality in Gram-negative Predominance

Polish Journal of Microbiology ◽

10.5604/01.3001.0010.7834 ◽

2017 ◽

Vol 66 (2) ◽

pp. 171-180 ◽

Cited By ~ 14

Author(s):

Fevronia Kolonitsiou ◽

Matthaios Papadimitriou-Olivgeris ◽

Anastasia Spiliopoulou ◽

Vasiliki Stamouli ◽

Vasileios Papakostas ◽

...

Keyword(s):

Bloodstream Infections ◽

Multidrug Resistant ◽

Blood Cultures ◽

Diffusion Method ◽

Resistant Bacteria ◽

Gram Negative Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Carbapenem Resistant

The aim of the study was to assess the epidemiology, the incidence of multidrug-resistant bacteria and bloodstream infections’ (BSIs) seasonality in a university hospital. This retrospective study was carried out in the University General Hospital of Patras, Greece, during 2011–13 y. Blood cultures from patients with clinical presentation suggestive of bloodstream infection were performed by the BacT/ALERT System. Isolates were identified by Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the disk diffusion method and E-test. Resistance genes (mecA in staphylococci; vanA/vanB/vanC in enterococci; blaKPC/blaVIM/blaNDM in Klebsiella spp.) were detected by PCR. In total, 4607 (9.7%) blood cultures were positive from 47451 sets sent to Department of Microbiology, representing 1732 BSIs. Gram-negative bacteria (52.3%) were the most commonly isolated, followed by Gram-positive (39.5%), fungi (6.6%) and anaerobes bacteria (1.8%). The highest contamination rate was observed among Gram-positive bacteria (42.3%). Among 330 CNS and 150 Staphylococcus aureus, 281 (85.2%) and 60 (40.0%) were mecA-positive, respectively. From 113 enterococci, eight were vanA, two vanB and two vanC-positives. Of the total 207 carbapenem-resistant Klebsiella pneumoniae (73.4%), 202 carried blaKPC, four blaKPC and blaVIM and one blaVIM. A significant increase in monthly BSIs’ incidence was shown (R2: 0.449), which may be attributed to a rise of Gram-positive BSIs (R2: 0.337). Gram-positive BSIs were less frequent in spring (P < 0.001), summer (P < 0.001), and autumn (P < 0.001), as compared to winter months, while Gram-negative bacteria (P < 0.001) and fungi (P < 0.001) were more frequent in summer months. BSIs due to methicillin resistant S. aureus and carbapenem-resistant Gram-negative bacteria increased during the study period. The increasing incidence of BSIs can be attributed to an increase of Gram-positive BSI incidence, even though Gram-negative bacteria remained the predominant ones. Seasonality may play a role in the predominance of Gram-negative’s BSI.