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Background . Inappropriate empirical antibiotics promote antibiotic resistance. Antibiograms guide empirical antibiotic therapy by outlining the percentage susceptibility of each pathogen to individual antibiotics. In 2016, the Trauma Intensive Care Unit at Charlotte Maxeke Johannesburg Academic Hospital escalated empirical antibiotic therapy for nosocomial infections from piperacillin-tazobactam to imipenem plus amikacin. Objectives. This study assessed the impact of escalation in empirical antimicrobial treatment on organism prevalence and resistance profile. Methods. A retrospective analysis of bacterial and fungal microscopy, culture and susceptibility reports from the laboratory information system of the National Health Laboratory Services, from 1 January 2015 to 31 December 2015 and 1 January 2017 to 31 December 2017, was conducted. Data were de-duplicated according to standard guidelines. Fisher’s exact test was used to determine p-values. Results. Organism prevalence shifted between the years, with a 2.7% increase in streptococci ( p =0.0199), 1.7% increase in Candida auris ( p =0.0031) and 4.6% and 4.4% reduction in Acinetobacter baumannii ( p =0.0508) and Pseudomonas aeruginosa ( p =0.0196), respectively. Similarly, there was a change in the resistance profile, with a 28.9% reduction in multi-drug resistant (MDR) A. baumannii ( p =0.0001), 60.4% reduction in MDR P. aeruginosa ( p =0.0001) and a 6.5% increase in carbapenem-resistant Enterobacterales ( p =0.007). The predominant specimen type differed between the years, with significantly more pus, tissue and fluid samples and fewer respiratory samples sent for investigation in 2017 than 2015. Conclusion. Escalation in the use of empirical antibiotics showed a change in organism prevalence and an improvement in the susceptibility profile of MDR non-fermenters.

SmartCoat is a novel technology with titanium dioxide (TiO2) nanoparticles, isopropyl alcohol, and distilled water as the active ingredients. TiO2, along with water and oxygen, generates highly reactive OH radicals that can neutralize bacteria and other microorganisms and remove volatile organic compounds (VOCs). Smart coat requires air circulation and a light source for its catalytic activity. The efficacy of TiO2 in industrial setups and dental devices has been documented. The present study aimed to evaluate the efficacy of TiO2 in preventing microbial growth in an operating theater (OT) where maximum sterility is desired to prevent sepsis and nosocomial infections. Among the four operating theaters, two were selected. Periodic swab samples taken over a period of nine months from OT 3 (Smart coated) and OT 4 (Control) showed minimal variations in terms of microbial growth in the processed swabs. The findings were statistically analyzed using a paired-sample t-test. The computed value of ‘t’ i.e., 2.084 was lower than the critical value of 3.18 at 3 deg of freedom (df) and hence was not significant. The null hypothesis cannot be rejected (p=0.129>0.05) at the 5% level of significance. SmartCoat with TiO2 was not effective in preventing microbial growth on biomedical devices in the OT. The product may not be suitable for operating theaters unless it is supplemented by other sterilization procedures. However, it can be used in other healthcare settings and in public places.

Background Healthcare-associated infections (HAI) are considered one of the most common adverse events in health care service provision. In order to prevent the occurrence of HAIs, it is important to implement several prevention strategies. Objectives This study aims to determine the incidence of healthcare-associated infections in a military hospital in Alkharj and the adherence to the HAIs’ prevention strategies. Methods This study included exporting data for all infected cases confirmed by the infection disease specialists in 2019. The data were collected from the reports that were written by infection control unit and infectious disease department. Results The rate of healthcare associated infections (HAIs) in 2019 was 0.43% of total patient admissions. The rate of central line associated bloodstream infections in 2019 was 1.15 per 1000 central line days. The rate of catheter associated urinary tract infections in 2019 was 1.00 per 1000 catheter days. The rate of ventilator associated pneumonia in 2019 was 2.11 per 1000 ventilator days and the rate of surgical site infections in 2019 was 0.41 %. Conclusion The rate of overall healthcare-associated infections (HAI) was low. The compliance rate of health care workers to preventive measures that control HAIs was generally high but there was a need for more awareness particularly regarding personal protective equipment and hand hygiene. So it is important to attend more awareness activities and workshops particularly regarding personal protective equipment and hand hygiene. Furthermore, infection control unit and infectious disease department in the hospital should support the robust HAI prevention programs.

Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively collected data from the Sentinel Stroke National Audit Programme were analysed. Thrombolysis was performed in 451 patients (52.1% men; 75.3 years ± 13.2) admitted with acute ischaemic stroke (AIS) in four UK centres between 2014 and 2016. Adverse consequences following immediate TRC were assessed using logistic regression, adjusted for age, sex and co-morbidities. Twenty-nine patients (6.4%) acquired immediate TRC. Compared to patients without, individuals with immediate TRC had greater adjusted risks of: moderately-severe or severe stroke (National Institutes of Health for Stroke Scale score ≥ 16) at 24-h (5.7% vs 24.7%, OR 3.9, 95% CI 1.4–11.1); worst level of consciousness (LOC) in the first 7 days (score ≥ 1; 25.0 vs 60.7, OR 4.6, 95% CI 2.1–10.2); urinary tract infection or pneumonia within 7-days of admission (13.5% vs 39.3%, OR 3.2, 95% CI 1.3–7.7); length of stay (LOS) on hyperacute stroke unit (HASU) ≥ 2 weeks (34.7% vs 66.7%, OR 5.2, 95% CI 1.5–18.4); mortality (13.0% vs 41.4%, OR 3.7, 95% CI 1.6–8.4); moderately-severe or severe disability (modified Rankin Scale score ≥ 4) at discharge (26.8% vs 65.5%, OR 4.7, 95% CI 2.1–10.9); palliative care by discharge date (5.1% vs 24.1%, OR 5.1, 95% CI 1.7–15.7). The median LOS on the HASU was longer (7 days vs 30 days, Kruskal–Wallis test: χ2 = 8.9, p = 0.003) while stroke severity did not improve (NIHSS score at 24-h post-thrombolysis minus NIHSS score at arrival = − 4 vs 0, χ2 = 24.3, p

Background Traumatic brain injury (TBI) is a major global health concern, it being a leading cause of morbidity and mortality in young adults. Infections acquired in the hospital setting are one of many risk factors that are associated with higher mortality in this population. Despite significant impact on the overall outcome, infections in TBI patients are largely understudied and underreported. The purpose of this study was to study the profile of infectious complications in patients with TBI and impact of these infections on the hospital outcome of these patients. Materials and Methods The medical records of all the patients with a diagnosis of TBI admitted in our hospital from January 2017 to January 2020 were reviewed. They were screened for presence of any predefined infection acquired at any time during their hospital stay. Data regarding demographics, focus of infection, results of various cultures, and hospital outcome was recorded. Results A total of 60 patients with TBI who had developed nosocomial infections were included in this observational study. Patients were mostly young, with a mean age of 36.6 years. Majority (66.6%) of patients who developed infectious complications had Glasgow coma scale (GCS) score of less than 10. Respiratory tract and urinary tract were the most common sites of infections in these patients. Burkholderia cepecia and Acinetobacter baumannii were the two most common isolated organisms. All-cause mortality in this population was 23.3%. Conclusions Most TBI patients are young, in their productive period of lives, and do not have major comorbidities. Invariably, they have low GCS scores and encounter a breach of their surface immunity due to catheters, procedures, and intubation. Such patients make an extremely significant impact on hospital resources as well as poor economic outcomes.

Background The coronavirus (SARS-COV-2) pandemic has provoked the global healthcare industry by potentially affecting more than 20 14 million people across the globe, causing lasting damage to the lungs, notably pneumonia, ARDS (acute respiratory distress 15 syndrome), and sepsis with the rapid spread of infection. To aid the functioning of the lungs and to maintain the blood oxygen 16 saturation (SpO2) in coronavirus patients, ventilator assistance is required. Materials and methods The main purpose of this article is to outline the need 17 for the introduction of a non-invasive negative pressure ventilator (NINPV) as a promising alternative to positive pressure 18 ventilator (PPV) by elucidating the cons of non-invasive ventilators in clinical conditions like ARDS. Another motive is to 19 profoundly diminish the rate of infection spread by the employment of oxygen helmets, instead of endotracheal intubation in 20 invasive positive pressure ventilator (IPPV) or non-invasive positive pressure ventilator (NIPPV) like face masks and high-flow 21 nasal cannula (HFNC). Result and conclusion The integration of oxygen helmet with NPV would result in a number of notable facets including the 22 degree of comfort delivered to patients who are exposed to various ventilator-induced lung injuries (VILI) in the forms of 23 atelectasis, barotrauma, etc. Likewise, preventing the aerosol-generating procedures (AGP) diminishes the rate of nosocomial 24 infections and providing a better environment to both the patients and the healthcare professionals.

Adverse outcomes in coronavirus infection disease‐19 (COVID‐19) patients are not always due to the direct effects of the viral infection, but often due to bacterial coinfection. However, the risk factors for such bacterial coinfection are hitherto unknown. A case‐control study was conducted to determine risk factors for bacterial infection in moderate to critical COVID‐19. Out of a total of 50 cases and 50 controls, the proportion of cases with severe/critical disease at presentation was 80% in cases compared to 30% in controls (p

Background Knowledge on the epidemiology, genotypic and phenotypic features of antimicrobial-resistant (AMR) ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli) and their association with hospital-acquired infections (HAIs) are limited in Malaysia. Therefore, we evaluated the AMR features and resistance mechanisms of the ESKAPEE pathogens collected in a tertiary hospital located in the capital of Malaysia. Methods A total of 378 AMR-ESKAPEE strains were obtained based on convenience sampling over a nine-month study period (2019–2020). All strains were subjected to disk diffusion and broth microdilution assays to determine the antimicrobial susceptibility profiles. Polymerase chain reaction (PCR) and DNA sequence analyses were performed to determine the AMR genes profiles of the non-susceptible strains. Chi-square test and logistic regression analyses were used to correlate the AMR profiles and clinical data to determine the risk factors associated with HAIs. Results High rates of multidrug resistance (MDR) were observed in A. baumannii, K. pneumoniae, E. coli, and S. aureus (69–89%). All organisms except E. coli were frequently associated with HAIs (61–94%). Non-susceptibility to the last-resort drugs vancomycin (in Enterococcus spp. and S. aureus), carbapenems (in A. baumannii, P. aeruginosa, and Enterobacteriaceae), and colistin (in Enterobacteriaceae) were observed. Both A. baumannii and K. pneumoniae harbored a wide array of extended-spectrum β-lactamase genes (blaTEM, blaSHV, blaCTX-M, blaOXA). Metallo-β-lactamase genes (blaVEB, blaVIM, blaNDM) were detected in carbapenem-resistant strains, at a higher frequency compared to other local reports. We detected two novel mutations in the quinolone-resistant determining region of the gyrA in fluoroquinolone-resistant E. coli (Leu-102-Ala; Gly-105-Val). Microbial resistance to ampicillin, methicillin, and cephalosporins was identified as important risk factors associated with HAIs in the hospital. Conclusion Overall, our findings may provide valuable insight into the microbial resistance pattern and the risk factors of ESKAPEE-associated HAIs in a tertiary hospital located in central Peninsular Malaysia. The data obtained in this study may contribute to informing better hospital infection control in this region.

BackgroundThe Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.MethodsA quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (≤5 days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).ResultsAmong 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, pConclusionsImplementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.

Klebsiella pneumoniae is an important pathogen causing hospital‐acquired infections in human beings. Samples from suspected patients of K pneumoniae associated with respiratory and urinary tract infections were collected at Bolan Medical Complex, Quetta, Balochistan. Clinical samples (n = 107) of urine and sputum were collected and processed for K pneumoniae isolation using selective culture media. Initially, 30 of 107 isolates resembling Klebsiella spp. were processed for biochemical profiling and molecular detection using gyrase A (gyrA) gene for conformation. The K pneumoniae isolates were analysed for the presence of drug resistance and virulence genes in their genomes. The 21 of 107 (19.6%) isolates were finally confirmed as K pneumoniae pathogens. An antibiogram study conducted against 17 different antibiotics showed that a majority of the isolates are multidrug resistant. All the isolates (100%) were resistant to amoxicillin, cefixime, amoxicillin‐clavulanic acid, cefotaxime, and ceftriaxone followed by tetracycline (95.2%), ciprofloxacin and gentamicin (76.2%), sulphamethoxazol (66.7%), nalidixic acid (61.9%), norfloxacine (42.9%), piperacillin‐tazobactam (23.8%), cefoperazone‐sulbactam (19%), and cefotaxime‐clavulanic acid (33.3%), whereas all the isolates showed sensitivity to amikacin, chloramphenicol, and imipenem. The presence of tetracycline, sulphamethoxazol‐resistant genes, and extended‐spectrum beta‐lactamase was reconfirmed using different specific genes. The presence of virulence genes fimH1 and EntB responsible for adherence and enterobactin production was confirmed in the isolates. The high virulence and drug resistance potential of these Klebsiella isolates are of high public health concern. Multidrug resistance and virulence potential in K. pneumoniae are converting these nosocomial pathogens into superbugs and making its management harder.

Aim: Nosocomial infection is one the most important health problem in the world. In trauma patients, nosocomial infection is one the most important factor of morbidity and mortality, increased hospitalization days, economic costs, and patient dissatisfaction. This study aimed at assessing the frequency of nosocomial infection and its related factors in hospitalized trauma patients in Beheshti Hospital in Kashan, Iran. Materials and Methods: This descriptive study was conducted on 338 trauma patients who had been admitted to Kashan Beheshti Hospital during 2015. Data were collected using the questionnaire containing demographic and paraclinical results in trauma patients. The patients were examined for fever and nosocomial infection daily. The data were analyzed using t-test and Chi-square by the SPSS software version 16. Results: Twenty-one (6.2%) out of 338 trauma patients had nosocomial infection. There were 7 (33.3%) surgical site infections, 5 (23.8%) pneumonia, 5 (23.8%) soft-tissue infection, and 3 (14.2%) urinary tract infection and 4 (19.04%) fever with of unknown origin. There was a significant statistical association between underlying disease, duration of hospitalization, multiple trauma, surgical intervention, using the device, and history of admission to ICU with the rate of the infections. However, there was no significant association between sex, age, body mass index, and smoking with the rate of the infection. Conclusions: The rate of nosocomial infection was 6.2% and it was lower than other studies. The nosocomial infection is more frequent in patients with underlying diseases, with surgical intervention, admission in ICU, using device, multiple trauma, and more duration of hospitalization.

Phage therapy is recognized as a promising alternative to antibiotics in treating pulmonary bacterial infections, however, its use has not been reported for treating secondary bacterial infections during virus pandemics such as coronavirus disease 2019 (COVID-19). We enrolled 4 patients hospitalized with critical COVID-19 and pulmonary carbapenem-resistant Acinetobacter baumannii (CRAB) infections to compassionate phage therapy (at 2 successive doses of 109 plaque-forming unit phages). All patients in our COVID-19-specific intensive care unit (ICU) with CRAB positive in bronchoalveolar lavage fluid or sputum samples were eligible for study inclusion if antibiotic treatment failed to eradicate their CRAB infections. While phage susceptibility testing revealed an identical profile of CRAB strains from these patients, treatment with a pre-optimized 2-phage cocktail was associated with reduced CRAB burdens. Our results suggest the potential of phages on rapid responses to secondary CRAB outbreak in COVID-19 patients.

Background: Enterococcus is a part of normal gastrointestinal flora in human body. Nevertheless, antibiotic-resistant Enterococcus (ARE) is considered a key factor in nosocomial infections which result in a considerable increase in the rate of patient death due to referring of numerous patients to health centers annually, or lead to extended disease convalescence. Objective: This study aimed to evaluate the bactericidal effect at 405nm diode at a laser power of 30 mW on ARE viability of clinical infections. Materials and Methods: In the present study, 30 isolates underwent antibiotic susceptibility test (AST) in which sensitivity to piperacillin (100 µg), rifampin (5 µg), and oxacillin (1 µg) were measured based on the Clinical and Laboratory Standards Institute (CLSI) guidelines. Afterwards, ten most resistant isolates were selected and irradiated by a 405 nm diode laser at a power of 30 mW for 180 and 240 seconds. The data were reported statistically as mean ± standard deviation, and the analysis of the data on varied bacteria was performed using ANOVA. The result was evaluated by SPSS software and P value ≤0.05 was interpreted to be significant. Results: Bacterial viability decreased unsteadily to 10 resistant isolates. Moreover, enhancing irradiation time caused a lower viability rate in such a way that the viability of isolate 9 having the lowest viability rate was reduced from 2.94% in 180 seconds to 0.58% in 240 seconds. The result was evaluated by SPSS software and P value was determined to be significant, and P≤0.05 was laser irradiation for either 180 s or 240 s. Conclusion: Following the study results, 405 nm diode laser could be applied as a tool for eliminating clinical ARE, and it was useful for preventing hospital-acquired infections.

The problem of global expansion of multidrug-resistant nosocomial infections pathogens is under special attention at the moment. Antibiotic resistance increasing give us the limited treatment options. This problem is particularly acute for transplant clinics, because of patients need lifelong immunosuppressive therapy. From the one hand this ensures stable allograft functioning, but from the other increases the risk of severe infectious complications in the postoperative period. The purpose of this article is analysis carbapenem resistance dynamics of Klebsiella spp., Acinetobacter spp., Pseudomonas spp. and Staphylococcus spp. isolated from the blood of recipients of donor organs from 2009 to 2019 in the Shumakov National Medical Research Center of Transplantology and Artificial Organs. A significant annual decrease of carbapenem-sensitive strains of Klebsiella spp. and Acinetobacter spp. are shown. The study of a distinctive pathogen resistance profile specific to each institution can help one in selecting an adequate antimicrobial strategy and is an effective predictive tool for controlling the growth of multidrug-resistant microorganisms.Актуальность работы обусловлена проблемой глобального распространения возбудителей тяжелых нозокомиальных инфекций, характеризующихся множественной лекарственной устойчивостью. Нарастание антибиотикорезистентности неизбежно влечет ограниченность вариантов лечения. Особенно остро данная проблема стоит в клиниках трансплантологического профиля, пациенты которых нуждаются в пожизненной иммуносупрессивной терапии, которая, с одной стороны, обеспечивает стабильное функционирование пересаженного органа, но с другой повышает риск развития тяжелых инфекционных осложнений в послеоперационном периоде. Целью настоящей статьи является анализ данных о характере динамики лекарственной устойчивости к имипенему и меропенему штаммов Klebsiella spp., Acinetobacter spp., Pseudomonas spp. и Staphylococcus spp., выделенных из крови реципиентов донорских органов с 2009 по 2019 г. в ФГБУ НМИЦ ТИО им. акад. В.И. Шумакова. Полученные результаты демонстрируют значимое ежегодное снижение доли чувствительных к карбапенемам штаммов Klebsiella spp. и Acinetobacter spp. Изучение отличительного профиля резистентности патогенов, характерного для каждого конкретного учреждения, может помочь в подборе адекватной антимикробной стратегии и является эффективным прогностическим инструментом в вопросах сдерживания роста множественной лекарственной устойчивости микроорганизмов.

The analysis of the current state of antimicrobial resistance was performed and used as the basis for the implementation of modern tools of antimicrobial stewardship program in hospital practice. As a result, the structure of nosocomial pathogens and the prevalence of resistant isolates in a hospital were affected. Antibiotic consumption and economic burden of antimicrobial resistance have decreased, and treatment quality indicators for nosocomial infections have changed.

Objective: The aim of this study is to identify nosocomial infections and causative mikroorganisms in adult intensive care units of hospital and also to investigate the changes in antimicrobial resistance profiles over a nine-year period.Methods: The infection control committee surveillance data of 29318 patients hospitalized in adult intensive care units between 01 January 2010 and 31 December 2018 were evaluated retrospectively.Results: A total of 29318 patients were followed up in adult intensive care units of hospital in nine-year period and nosocomial infection was detected in 2593 patients (8.8%). The most common infections were; ventilator-associated pneumonia (34.1%), catheter-related urinary tract infection (21.8%), primary bacteremia (17.1%), central venous catheter-related bloodstream infection (14.7%) and pneumonia (8.5%). The most common causative agents were Gram-negative bacteria (72.9%; 2056/2822). Carbapenem resistance in gram negative bacteria responsible for nosocomial infections was 33% in 2010 and reached 75% in 2018. Colistin resistance of Klebsiella spp. strains reached up to 34% in 2018.Conclusion: In Turkey, nosocomial infections in intensive care units are an important problem as well as in the world. With increasing antibiotic resistance, treatment of infections is becoming difficult. Therefore; each center should follow its own infectious agent distribution and antibiotic susceptibility, empirical treatment should be selected appropriate to the flora of the intensive care unit and the broad use of broad spectrum antibiotics should be limited.

Objectives To analyze the microbiota of the physiotherapist’s work environment to understand the existing potential risks and to adopt appropriate preventive measures. Design Cross-sectional descriptive observational study. Setting Physiotherapist’s working environment. Participants Physiotherapy and rehabilitation centers (N=19). Interventions A microbiological sampling was carried out in the physiotherapy centers. The samples were studied using the usual culture and analysis methodology for characterization and isolation of a range of bacteria. Main Outcome Measures Absolute and relative frequency of microorganism isolation. Results In the analysis, pathogens normally responsible for nosocomial infections were detected, especially on instruments and equipment used by the physiotherapist such as sponge electrodes, and were significantly more contaminated than the rest of the places studied (P Conclusion This situation confirms the absence of measures and protocols for the prevention and control of such infections in the physiotherapist's environment, which is why they must be considered to protect both physiotherapy professionals and patients.

BackgroundImmune suppression contributes to nosocomial infections (NIs) and poor prognosis in sepsis. Recent studies revealed that CD71+ erythroid cells had unappreciated immunosuppressive functions. This study aimed to investigate the values of CD71+ erythroid cells (CECs) in predicting NIs and prognosis among adult septic patients. The potential factors associated with the expansion of CECs were also explored.MethodsIn total, 112 septic patients and 32 critically ill controls were enrolled. The frequencies of CD71+ cells, CD71+CD235a+ cells, and CD45+ CECs were measured by flow cytometry. The associations between CECs and NIs and 30-day mortality were assessed by ROC curve analysis and Cox and competing-risk regression models. Factors associated with the frequency of CECs were identified by linear regression analysis.ResultsThe percentage of CD71+ cells, CECs, and CD45+ CECs were higher in septic patients than critically ill controls. In septic patients, the percentages of CD71+ cells, CECs, and CD45+ CECs were associated with NI development, while CD71+ cells and CECs were independently associated with 30-day mortality. Linear regression analysis showed that the levels of interleukin (IL)-6 and interferon (IFN)-γ were positively associated with the frequencies of CD71+ cells, CECs, and CD45+ CECs, while IL-10 was negatively associated with them. Additionally, the levels of red blood cells (RBCs) were negatively associated with the percentage of CD45+ CECs.ConclusionsCECs were expanded in sepsis and can serve as independent predictors of the development of NI and 30-day mortality. Low levels of RBCs and high levels of IL-6 and IFN-γ may contribute to the expansion of CECs in sepsis.Trial RegistrationChiCTR, ChiCTR1900024887. Registered 2 August 2019, http://www.chictr.org.cn/showproj.aspx?proj=38645

Made available in DSpace on 2022-04-28T19:50:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54-74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course. Department of Nephrology Universidad de la República Clinical Hospital of Botucatu School Medicine HCFMB University of Sao Paulo State UNESP Hospital Obrero #2-C. N.S. School of Medicine Universidad Mayor de San Simón Universidad Simón Bolívar Hospital Nacional Arzobispo Loayza Servicio de Nefrología School of Medicine University of São Paulo Division of Nephrology Hospital Civil de Guadalajara Departamento de Nefrología Hospital General de Agudos Dr Cosme Argerich Serviço de Nefrología, Jau Santa Casa de Jau Department of Nephrology Hospital Provincial Nefrologia Pontificia Universidade Catolica do Rio de Janeiro Internal Medicine University of Rio de Janeiro Nephrology Hospital Universitario Dr JoséEleuterio González Centros de Diagnóstico y Medicina Avanzada Servicio de Nefrología Hospital Italiano Departamento de Medicina Interna Salud Renal MSP Department of Nephrology Pontificia Universidad Católica de Chile Servicio de Nefrología Hospital Español Departamento de Nefrología Hospital de Especialidades de las Fuerzas Armadas Servicio de Nefrología y Diálisis Hospital Rojas Nephrology School of Medicine University of São Paulo Hospital Federal Cardozo Fontes Universidade de Sá Departamento de Nefrología Hospital Regional General Dr Carlos Mac Gregor Sanchez Navarro Departamento de Nefrología Hospital de Pediatría CMN Siglo XXI Department of Nephrology School of Medicine University of Sao Paulo Centro Infantil del Riñón, Tucumán Hospital Regional de Ica Hospital Nacional Hipólito Unanue Clinical Hospital of Botucatu School Medicine HCFMB University of Sao Paulo State UNESP

Objective Multi and extensively drug-resistant (MDR and XDR), Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) are two main causative agents of nosocomial infections leading to increased morbidity and mortality. We aim to study the prevalence of MDR and XDR-A. baumannii and P. aeruginosa phenotypes in clinical specimens. We conducted this for 1 year (2017–2018) and isolated bacteria from the clinical samples. Then, XDR and MDR strains were determined by susceptibility testing (disc diffusion). Results Out of 3248 clinical samples, A. baumannii and P. aeruginosa strains were detected in 309(9.51%) of them. Susceptibility testing indicated that (16.50%) and (15.53%) of the P. aeruginosa and (74.75%) and (73.13%) of the A. baumannii isolates were screened as the MDR and XDR strains. The frequency of MDR isolates was higher in wound samples 222 (71.8%). This rate in behavioral intensive care unit (BICU) and restoration ward, were 187 (60.5%) and 63 (20.4%). The frequency of XDR isolates in BICU 187 (59.54%), restoration 58(18.77%), and burns 30 (9.70%) were assessed as well. Considering high isolation rates of MDR and XDR of mentioned strains, it is necessary to apply prevention criteria for eradication of the mentioned bacteria from hospital wards.

Clostridioides difficile infection (CDI) and recurrent CDI (rCDI) remain associated with a reduction in the patients’ quality of life and with increased healthcare costs. Bezlotoxumab is a monoclonal antibody against toxin B of C. difficile, approved for prevention of rCDI. In this narrative review, we briefly discuss the pathophysiology of CDI and the mechanism of action of bezlotoxumab, as well as the available evidence from investigational and observational studies in terms of efficacy, effectiveness, and safety of bezlotoxumab for the prevention of rCDI. Overall, bezlotoxumab has proved efficacious in reducing the burden of rCDI, thereby providing clinicians with an important novel strategy to achieve sustained cure. Nonetheless, experiences outside randomized controlled trials (RCTs) remain scant, and mostly represented by case series without a control group. Along with the conduction of RCTs to directly compare bezlotoxumab with faecal microbiota transplantation (or to precisely evaluate the role of their combined use), further widening our post-marketing experience remains paramount to firmly guide the use of bezlotoxumab outside RCTs, and to clearly identify those real-life settings where its preventive benefits can be exploited most.

Aim. To study of the antibiotic resistance of S. aureus strains isolated from nosocomial infections (pneumonia, surgical site infections and sepsis) in a multidisciplinary surgical clinic. Methods. Microbiological testing of sputum in 41 patients with pneumonia, of samples (wound, abscess, drainage) obtained from 40 patients with surgical site infections (SSI) and of blood from 46 patients with signs of sepsis was performed. The obtaining cultures were identified by conventional methods (including morphological, cultural, biochemical features, etc.). Disc diffusion method was used to detect methicillin-resistant S. aureus (MRSA) strains. Inducible clindamycin resistance (ICR) of S. aureus strains was determined by double disk approximation test (D-test). Results. Methicillin-resistant S. aureus was found in 14.3% (2 of 14) of the patients with surgical site infections, in the sputum 27.3% (3 of 11) of the patients with pneumonia, and in the blood 50.0% (7 of 14) of the patients with sepsis (p 0.05). The rate of inducible clindamycin resistance of isolated S. aureus strains in patients with surgical site infections (2 of 14 cases, 14.3%) and with pneumonia (2 of 11 cases, 18.2%) did not statistically significant difference with the rate of methicillin resistance (p 0.05). However the rate was significantly lower septic infections 7.1% and 50.0% respectively (p=0.0328). Conclusion. Among S. aureus strains isolated from nosocomial infections, the rate of methicillin-resistant S. aureus had not depended on the type of nosocomial infection; the rate of inducible clindamycin resistance in septic infections was lower than resistance to methicillin.

Candida auris is an emerging fungal pathogen that is typically resistant to fluconazole and is known to cause healthcare-associated outbreaks. We retrospectively reviewed 28 patients who had >1 positive culture for C. auris within a multisite health system in Illinois, USA, during May 2018–April 2019. Twelve of these patients were treated as inpatients for C. auris infections; 10 (83%) met criteria for clinical success, defined as absence of all-cause mortality, C. auris recurrence, and infection-related readmission at 30 days from the first positive culture. The other 2 patients (17%) died within 30 days. Most patients (92%) were empirically treated with micafungin. Four (14%) of 28 total isolates were resistant to fluconazole, 1 (3.6%) was resistant to amphotericin B, and 1 (3.6%) was resistant to echinocandins. Our findings describe low rates of antifungal resistance and favorable clinical outcomes for most C. auris patients.

The accuracy of the signs and tests that clinicians use to diagnose ventilator-associated pneumonia (VAP) and initiate antibiotic treatment has not been well characterized. We sought to characterize and compare the accuracy of physical examination, chest radiography, endotracheal aspirate (ETA), bronchoscopic sampling cultures (protected specimen brush [PSB] and bronchoalveolar lavage [BAL]), and CPIS > 6 to diagnose VAP. We searched six databases from inception through September 2019 and selected English-language studies investigating accuracy of any of the above tests for VAP diagnosis. Reference standard was histopathological analysis. Two reviewers independently extracted data and assessed study quality. We included 25 studies (1639 patients). The pooled sensitivity and specificity of physical examination findings for VAP were poor: fever (66.4% [95% confidence interval [CI]: 40.7–85.0], 53.9% [95% CI 34.5–72.2]) and purulent secretions (77.0% [95% CI 64.7–85.9], 39.0% [95% CI 25.8–54.0]). Any infiltrate on chest radiography had a sensitivity of 88.9% (95% CI 73.9–95.8) and specificity of 26.1% (95% CI 15.1–41.4). ETA had a sensitivity of 75.7% (95% CI 51.5–90.1) and specificity of 67.9% (95% CI 40.5–86.8). Among bronchoscopic sampling methods, PSB had a sensitivity of 61.4% [95% CI 43.7–76.5] and specificity of 76.5% [95% CI 64.2–85.6]; while BAL had a sensitivity of 71.1% [95% CI 49.9–85.9] and specificity of 79.6% [95% CI 66.2–85.9]. CPIS > 6 had a sensitivity of 73.8% (95% CI 50.6–88.5) and specificity of 66.4% (95% CI 43.9–83.3). Classic clinical indicators had poor accuracy for diagnosis of VAP. Reliance upon these indicators in isolation may result in misdiagnosis and potentially unnecessary antimicrobial use. Electronic supplementary material The online version of this article (10.1007/s00134-020-06036-z) contains supplementary material, which is available to authorized users.

Methicillin-Resistant Staphylococcus aureus (MRSA) represents one of the major causes of nosocomial infections, leading to high mortality. Surfaces in clinics, as well as the attending uniform and the hands of the dental doctor can be MRSA reservoirs. Having this in mind, the purpose of this study was to evaluate the presence of Methicillin-Sensitive Staphylococcus aureus (MSSA) and MRSA on dental medicine equipment surfaces. 354 Samples were collected from six equipment surfaces in six attendance areas before and after patient consultation and cultured in a selective medium. Polymerase Chain Reaction (PCR) was used to confirm the identity of bacterial strains as MRSA or MSSA. Data analysis was performed with chi-square tests with Bonferroni correction. It was observed 55.6% of uncontaminated samples. Contamination was: 17.5% MRSA (5.9% of samples collected before patient attendance and 11.6% after); 39.3% MSSA (14.1% collected before and 25.2% after). The prevalence of MRSA and MSSA was significantly higher after patient care. Integrated Clinic represented the most contaminated attendance area (MRSA − 41.7%, MSSA − 51.2%), the chair arm rest was the most contaminated surface for MRSA (29.7%) and the dental spittoon the most contaminated surface for MSSA (23.5%). Although a low level of contamination was observed, dental clinics, through patients possibly carrying bacteria, may be reservoirs for MRSA and MSSA transmission, and might contribute to potential nosocomial infections. Keywords: Nosocomial infections, mecA gene, Methicillin-Sensitive Staphylococcus aureus, Methicillin-Resistant Staphylococcus aureus, Dental clinics

Nosocomial infections or healthcare associated infections occur in patients under medical care. Infections acquired in hospitals have existed since the very inception of hospitals themselves, and continue to be an important health problem even in the modern era of antibiotics. Today, they result in high morbidity and mortality, extended hospitalization, greater use of antibiotics, and increased costs. The overuse and inappropriate consumption and application of antibiotics have driven the rapid emergence of multidrug-resistant drugs (MDR) pathogens. Combating MDRs which cause serious life threatening nosocomial infections and appear to be biologically compatible with their environment, are difficult to manage due to the limited treatment options. The worldwide emergence of multidrug resistance (MDR) among Gram negative and Gram-positive bacteria has caused a great threat to fight the bacterial pathogens. It is clear that in the lack of a timely, efficient solution the challenge of antibiotic resistance becomes alarming and will cause a great challenge in the forthcoming years. In this review article we will discuss the most important MDR nosocomial infection agents, including Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa as major threats throughout the world.

Introduction The work environment of healthcare professionals is important for good patient care and is receiving increasing attention in scientific research. A clear and unambiguous understanding of a positive work environment, as perceived by healthcare professionals, is crucial for gaining systematic objective insights into the work environment. The aim of this study was to gain consensus on the concept of a positive work environment in the hospital. Methods This was a three-round Delphi study to establish consensus on what defines a positive work environment. A literature review and 17 semi-structured interviews with experts (transcribed and analyzed by open and thematic coding) were used to generate items for the Delphi study. Results The literature review revealed 228 aspects that were clustered into 48 work environment elements, 38 of which were mentioned in the interviews also. After three Delphi rounds, 36 elements were regarded as belonging to a positive work environment in the hospital. Discussion The work environment is a broad concept with several perspectives. Although all 36 elements are considered important for a positive work environment, they have different perspectives. Mapping the included elements revealed that no one work environment measurement tool includes all the elements. Conclusion We identified 36 elements that are important for a positive work environment. This knowledge can be used to select the right measurement tool or to develop interventions for improving the work environment. However, the different perspectives of the work environment should be considered.

Background Surveillance of healthcare-associated infections (HAI) is the basis of each infection control programme and, in case of acute care hospitals, should ideally include all hospital wards, medical specialties as well as all types of HAI. Traditional surveillance is labour intensive and electronically assisted surveillance systems (EASS) hold the promise to increase efficiency. Objectives To give insight in the performance characteristics of different approaches to EASS and the quality of the studies designed to evaluate them. Methods In this systematic review, online databases were searched and studies that compared an EASS with a traditional surveillance method were included. Two different indicators were extracted from each study, one regarding the quality of design (including reporting efficiency) and one based on the performance (e.g. specificity and sensitivity) of the EASS presented. Results A total of 78 studies were included. The majority of EASS (n = 72) consisted of an algorithm-based selection step followed by confirmatory assessment. The algorithms used different sets of variables. Only a minority (n = 7) of EASS were hospital-wide and designed to detect all types of HAI. Sensitivity of EASS was generally high (> 0.8), but specificity varied (0.37–1). Less than 20% (n = 14) of the studies presented data on the efficiency gains achieved. Conclusions Electronically assisted surveillance of HAI has yet to reach a mature stage and to be used routinely in healthcare settings. We recommend that future studies on the development and implementation of EASS of HAI focus on thorough validation, reproducibility, standardised datasets and detailed information on efficiency.

BACKGROUND Nosocomial infections are one of the leading causes of death with considerable economic costs in the form of prolonged stay, loss of work hours, increased use of drugs, need for isolation, and drugs. Diagnostic equipment is used for the diagnosis, risk assessment, monitoring of disease or response to treatment for outpatient or inpatient in emergency or as a routine procedure. Ultrasound (US) is one of the most commonly used diagnostic equipment from nearly half a century. With the increasing use of ultrasound in medical diagnosis, the risk of infections via the ultrasound probe, couch, or gel from one patient to another patient is on the rise. Ultrasound equipment has been investigated to determine its role in cross infection as these devices come into direct contact with patients and sonographers during scanning procedures. We wanted to assess the microbiological flora of the ultrasound equipment used for non-invasive examinations and assess the efficacy of decontamination regimes currently used for ultrasound equipment. METHODS Swabs from 6 ultrasound machines were taken 15 times over a 3-month duration. Swabs were collected from the surface of the probe, keyboard, gel and probe holder using sterile swab soaked in thioglycolate broth. Swabs were inoculated on Blood agar and MacConkey agar at 37 oC for 24 hours. The isolated organisms were identified by standard microbiological techniques. The protocol of decontamination of the ultrasound equipment was noted. The data was then analysed as number and percentage. RESULTS A total of 80 swabs were taken from four ultrasound machines. Sixty swabs (70%) did not grow any organisms out of the total 80 swabs. Twenty swabs (30%) grew 23 organisms, out of which 3 swabs grew two organisms. Swabs collected from the gel grew the most number of organisms. Pseudomonas species was the most common organism isolated followed by Klebsiella species. CONCLUSIONS Due to increase in the patient load and ultrasound being used more commonly in day to day practice for diagnosis as well as prognosis, a routine methodology needs to be followed for the patient safety. Protocol for ultrasound equipment decontamination as well as regular swab culture has to be framed to prevent nosocomial infections.

Aims: Our primary objective is to investigate the baseline status of patients' awareness, knowledge, and attitudes to patient safety. The secondary objective of this research is to determine factors that influence patients' knowledge regarding patient safety. Methods: We performed a cross-sectional study with a targeted sample of 410 patients at King Khalid University Hospital, Riyadh, Saudi Arabia. Self-administered paper-based questionnaires were distributed to outpatient clinics on February 2, 2019 until March 20, 2019. Finally, the data were analyzed by (SPSS). Results: There were 450 questioners distributed, and 410 were completed and returned (91% response rate). Most of the patients were below the age of 50 (77.9%), 54.8%, of them were females, and almost half received higher education (54.1%). Among the respondents who are taking drugs, 21.6% do not have any knowledge about the side effects of their drugs, and 47.8% of patients said that their physicians do not tell them the side effects of their prescribed drugs. Whereas 20.7% of patients claimed that they experienced a medical error, 66.3% did not report the errors, and the reason was not knowing how to report or to whom in 54.4% of the patients. In regards of infection control, 47% of the participants misunderstood means to prevent the spread of the infections and how it could be transmitted. Conclusion: Patients' knowledge about patient safety need to be improved. We suggest educating the patients by providing training programs for patients, and we recommend further studies.