A prospective incidence study of nosocomial infections in a neonatal care unit

BACKGROUND: Health care improvements and technical advances for diagnostic and therapeutic management in the neonatal care unit (NCU) have made possible the increasing survival of neonates with severe pathologic conditions. However, nosocomial infections (NI) still represent an important cause of morbidity and mortality in this population. OBJECTIVE: To describe the epidemiologic profile of NI in the NCU. METHODS: A prospective surveillance study was performed in the NCU at a university hospital in Barcelona during 6 months. Two hundred sixty-eight neonates were admitted during the study period. Centers for Disease Control and Prevention criteria were used as standard definitions for NI. Data including risk factors associated with NI were recorded. RESULTS: Sixty-five neonates had a total of 88 NI. The incidence rate of NI was 1.6 per 100 patient-days. The accumulative rate of NI was 32.7 per 100 admissions. Bacteremia (28.4%), conjunctivitis (19.5%), respiratory infection (10.2%), and urinary tract infection (7.9%) were the most common episodes observed. Gram-positive bacteria were the most commonly isolated germs (76.4%), with coagulase-negative Staphylococcus (72.5%) being the main pathogen. Intrinsic risk factors related to NI were low birth weight (<1000 g) and urinary catheter and peripheral venous catheter (P<.01). CONCLUSIONS: NI represent an important and frequent problem in neonates. Knowledge of the incidence of NI allows the targeting and implementation of preventive strategies for reducing morbidity and mortality related to NI in an NCU.     

Molecular assay to detect nosocomial fungal infections in intensive care units

Summary

The aims of this study were to determine the incidence of fungal infections in hospital intensive care units and to evaluate a molecular method to detect these infections.

Material and methods

The participants in this study were patients admitted to any of the 10 intensive care units at Nemazi Hospital (Shiraz, southern Iran) between March 2009 and January 2010. Oral and rectal swabs, urine, and sputum samples from patients were checked for fungal colonization. If a nosocomial fungal infection was suspected, clinical samples were examined for fungal infection by culture, direct microscopic examination and real-time PCR. Blood samples were cultured by bedside inoculation onto BACTEC medium. Susceptibility of the isolates to antifungal agents was also determined.

Results

Of 870 patients, 550 (63.2%) had Candida colonization in different body sites and 17 (1.9%) had fungal infections. The mortality rate in patients with fungal infections was 58.8% (10 cases). The etiologic agents were Candida albicans, Candida glabrata, Aspergillus flavus, Aspergillus fumigatus and Aspergillus spp. Three C. albicans were found to be resistant to amphotericin B and itraconazole, and one A. fumigatus and two A. flavus were resistant to amphotericin B, ketoconazole and itraconazole. One A. fumigatus was additionally resistant to caspofungin.

Conclusions

Considering the incidence of fungal infections and their high mortality rate, early detection, prompt diagnosis and treatment are critical. Molecular assays can serve as a diagnostic tool to manage patients admitted to the intensive care unit. Antifungal susceptibility testing in different geographical regions can support the choice of prophylaxis and treatment for these patients.     

Emerging issues in nosocomial fungal infections

Nosocomial fungal infections remain a serious cause of morbidity and mortality. As immunodeficient populations increase, the incidence of nosocomial fungal infections continues to rise. Although a wide variety of new and emerging fungi can cause nosocomial infections, Candida species remain the major etiologic agent. Candida species vary in their epidemiology and therapy. New diagnostic, epidemiologic, and therapeutic tools have been developed and are discussed in this review. They include the use of polymerase chain reaction-based diagnostic methods, recent advances in antifungal susceptibility testing, and comparative therapeutic and prophylactic trials. As advances in prevention, diagnosis, and therapy continue, nosocomial fungal infections and the morbidity and mortality associated with them can be reduced.     

Epidemiology of nosocomial infections in medicine intensive care unit at a tertiary care hospital in northern India

This prospective observational study describes the rates of nosocomial infections (NI), the sites of infection, the pathogens involved, their antibiogram and the risk factors at a tertiary care hospital in northern India. In 62 of the 182 enrolled patients 95 episodes of NI were recorded (incidence rate 28.6/1000 person days): pneumonia (77%); urinary tract infection (24%) and blood stream infection (24%). All isolates of Acinetobacter, Pseudomonas and Klebsiella and 83.3% of Escherichia coli were resistant to the third generation cephalosporins. An increased duration of the time spent in intensive care units and days of intervention were associated with incident NI.     

The fungal infections in patients hospitalized in an intensive care unit

INTRODUCTION: Over the last years, systemic fungal infections have dramatically increased in hospitalized patients. The Candida is the main pathogen caused nosocomial fungal infections. The aim of the study: The aim was to analyze frequency of occurrence of the yeast-like fungi in different biological materials isolated from the patients of an Intensive Care Unit of the University Hospital of Lodz in the period of 2000-2003. MATERIAL AND METHODS: 123 strains of fungi were analyzed with the use of API 20 C AUX test (bioMarieux). RESULTS: Among all the investigated Candida strains C. albicans accounted for 52.0%. Samples from respiratory system and urine most often contained the strains of C. albicans (56.3 and 60.5%, respectively); blood samples contained C. parapsilosis (44.8%). In patients who were untreated by bacterial antibiotics C. albicans was the most frequent species, whereas in patients who were ordered bacterial antibiotics it was C. parapsilosis that dominated. CONCLUSIONS: (1) Candida is the most frequent cause of fungal infections in patients hospitalized in an intensive care unit. (2) C. parapsilosis is the main pathogen caused bloodstream infections. This species is also more frequent in patients who were ordered antibacterial antibiotics over five days. (3). Species other than C. albicans become more and more frequent and dangerous.     

Effect of an expanded physical facility on nosocomial infections in a neonatal intensive care unit

Fifty-two months' data were reviewed to assess the effect of a threefold increase in space per infant in a neonatal intensive care unit on rates of nosocomial infections (NIs) and colonization with Staphylococcus aureus (39 months in a crowded 18-bed unit and 13 months in a spacious 32-bed unit). Mean length of stay, survival rates, mean birth weights, and other parameters indicated that infant populations in the old and new units were similar. NI rates were not significantly different in the old and new units (11.7% and 9.6%, respectively; p = 0.17) nor were rates of colonization of anterior nares with S. aureus (11.7% and 10.7%; p = 0.5). NI rates, but not S. aureus colonization rates, were significantly higher during months of high patient turnover (p less than 0.01). Sites of infection were similar in the old and new units. There was, however, a significant change in bacterial species causing NI. Klebsiella pneumoniae and Pseudomonas aeruginosa caused 20.4% of NIs in the old unit, but only 2.1% in the new unit (p less than 0.001) and NIs caused by S. epidermidis increased from 4.7% to 14.9% (p = 0.02) in the new unit. There was also a marked decrease in the numbers of clusters of NI occurring in the new unit, indicating that cross-infections between infants were probably minimized.     

Infection control and the prevention of nosocomial infections in the intensive care unit

Nosocomial infections continue to be significant causes of morbidity, mortality, and added costs in the health care setting. Half of all life-threatening nosocomial bloodstream infections and pneumonias occur in intensive care units (ICUs), despite ICUs representing only 15 to 20% of all hospital beds. Thus an efficient focus for prevention and control of life-threatening health care-associated infections should be in ICUs. Further, growing antibiotic resistance complicates the therapy of serious infections. Meticulous infection control practice with continued attention to hand hygiene is of paramount importance. Strict adherence to evidence-based catheter insertion and maintenance policies reduces nosocomial bloodstream infections. Evidence-based prevention strategies for ventilator-associated pneumonia, including management of respiratory equipment according to published guidelines and maintaining backrest elevation at 30 to 45 degrees, are effective. For greatest risk reduction, multifaceted programs ensuring maximal adherence with evidence-based infection control guidelines are needed.     

Epidemiology of burn unit infections in children

OBJECTIVE: The aim of this study was to determine the epidemiology of burn unit infections, the effect of these infections on the mortality rate, and antibiotic resistance pattern of the predominant bacteria isolated from children.Patients and method Epidemiologic data for 610 children, aged 0 to 15 years, admitted to the burn unit at Dicle University Hospital during a 5-year period were collected and analyzed. RESULTS: In 207 patients (33.9%), 279 nosocomial infections were identified. The most common types of infections were burn wound infections (72.4%), urinary tract infections (10.8%), pneumonia (9.3%), and septicemia (7.5%). Pseudomonas aeruginosa (181 isolates) was the most common microorganism. Thirty-six patients (5.9%) died at the hospital. Sepsis was associated with mortality in 18 (50%) cases, pneumonia in 6 (17%), and varied noninfectious reasons in 12 patients (33%). P aeruginosa isolates showed high resistance to commonly used antimicrobials. Antibiotic susceptibility test results suggested that imipenem was the most effective agent for P aeruginosa and Escherichia coli strains. CONCLUSION: The major type of nosocomial infections in the burn unit was burn wound infections, and the majority of nosocomial infections resulted from multiple drug-resistant, gram-negative bacteria.     

Epidemiology of Staphylococcus aureus nosocomial infections in a high-risk neonatal unit

Nosocomial infections are a significant cause of morbidity and mortality throughout the world. In developing countries it is difficult to carry out effective surveillance and control programs for this type of infection because of the cost in both human and material resources. These considerations prompted us to perform a prospective study to determine the epidemiologic and microbiologic characteristics of nosocomial infections due to Staphylococcus aureus in the High-risk Neonatal Unit (HRNU) of the Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), during the period of November 1997 to October 1998. Among a total of 120 microorganisms, 24 (20%) strains of Staphylococcus aureus were isolated; 47% were recovered from blood and 33% from conjunctive samples. Among the cases of conjunctivitis, S. aureus was the only pathogen isolated in 42%. Twenty of the 24 Staphylococcus aureus strains (83%) were methicillin-resistant (MRSA). According to their resistance profiles, we established 12 groups of strains from neonates with nosocomial infections and 1 group of strains from the two carriers among the healthcare personnel detected by microbiological screening. The MeRGmR pattern was the most frequent. Plasmid analysis disclosed two profiles, each having a plasmid molecular weight over 23.130 bp. The MRSA strains isolated from the neonates and those isolated from the carriers showed the same plasmid profile. This suggests that the healthcare personnel may have acted as reservoirs of the MRSA strains found in neonates with nosocomial infection.     

重症监护病房非发酵菌的分离及耐药性

目的了解重症监护病房（ICU）非发酵菌的临床分离状况及常见菌株的耐药性。方法分离出的非发酵菌采用VITEK-60AMS细菌鉴定仪鉴定,K—B法进行体外药敏试验。结果2005年1月～2007年8月共检出非发酵菌366株,铜绿假单胞菌（PAE）最为常见（45．36％）,其次为鲍氏不动杆菌（ABA,23．22％）和嗜麦芽寡养单胞菌（SPM,15．30％）;标本来源主要为痰液、引流液和尿液,分别占42．62％、20．77％和15．85％。PAE、ABA和SPM耐药较为严重,且呈多重耐药性。结论ICU非发酵菌以呼吸道感染常见,其耐药现象严重;应根椐药敏结果选用敏感抗菌药物。     

Annual incidence and risk factors for nosocomial bacterial infections in an acute care geriatric unit

PURPOSE: Elderly inpatients are particularly exposed to the risk of nosocomial infections, thus the study of their risk factors and consequences is of interest. METHODS: Among 1,565 subjects referred to a short-term geriatric unit, patients hospitalised for a year for an acute event and unable to move themselves were followed up for the occurrence of nosocomial infections. RESULTS: Among these 402 immobilised patients (age: 86.3 +/- 7.6 years), 102 nosocomial infections occurred in 91 patients (22.6%), whereas the estimation of the incidence in the total hospitalised population (1,565 subjects, age: 85.1 +/- 6.2 years) was 9.4% (95% confidence interval [CI] 8.3-11.2). Forty-seven point seven percent of nosocomial infections were urinary tract nosocomial infections, 27.5% were lower respiratory nosocomial infections, 9.2% were cutaneous nosocomial infections, 7.3% were septicaemia and 8.2% were of unknown origin. The relative risk (RR) of NI linked to functional dependency for mobility was 5.5 (95% CI: 3.93-7.7, P < 0.001). Other risk factors were: for all nosocomial infections: cancer diagnosis (RR 1.1, 95% CI: 1.1-1.2, P = 0.01); and respectively for urinary tract NI: bladder indwelling (RR 4.8, 95% CI: 2.9-7.7, P < 0.001), pulmonary NI: swallowing disorders (RR 5.4, 95% CI: 2.8-10.5, P < 0.001); and septicaemia: venous catheter (RR 5.4, 95% CI: 1.3-23.3, P = 0.002). NI were associated with an increased length of stay (22.1 +/- 11.7 days in infected patients vs 16.3 +/- 9.5 days in immobilised non-infected subjects, P < 0.001). The mean length of stay for the 1,565 subjects was 10.3 +/- 7.6 days. Death was attributed to nosocomial infections in 13 subjects. In conclusion, functional dependency for mobility, bladder indwelling, venous catheter, swallowing disorders and diagnosis of cancer were risk factors for nosocomial infections in hospitalised elderly subjects in an acutecare setting.     

The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit.

Primary nosocomial bloodstream infection (BSI) is a common occurrence in the intensive care unit (ICU) and is associated with a crude mortality of 31.5 to 82.4%. However, an accurate estimate of the attributable mortality has been limited because of confounding by severity of illness. We undertook this study to assess the attributable mortality and costs associated with an episode of BSI. Infected patients were defined as those who had an episode of BSI during the study period. Uninfected control subjects were matched to the infected patients based upon a number of factors, including predicted mortality on the day prior to infection. The main outcome measures were crude ICU mortality, length of stay, and costs. We found no difference in the crude mortality for the infected and the uninfected patients (35.3 and 30.9%, respectively, p = 0.51). However, among survivors, the patients with nosocomial bloodstream infections did have excess length of stay (mean, 10 d; median, 5 d; p = 0.007) and increased direct costs (mean difference, $34,508; p = 0.008). After matching for severity of illness, we could not detect an association between primary nosocomial bloodstream infections and increased ICU mortality. We did find that primary nosocomial bloodstream infections increased ICU length of stay and costs.     

A prospective study of nosocomial infections in a chronic care facility

To elucidate the epidemiology of nosocomial infections occurring in nursing homes and chronic care facilities, the authors undertook a prospective study of patients requiring two different levels of nursing care. The overall rate of infection was higher on the intermediate care ward than on the nursing home ward (1.35 versus 0.67 infections/100 patient care days). Pneumonias and symptomatic urinary tract infections accounted for 49 per cent of all infections. Eight of ten cases of pneumonia occurring on the nursing home ward were diagnosed in the winter months, and no case was diagnosed in the summer months. Resistance to gentamicin, tobramycin, ampicillin, and trimethoprim-sulfa was common among organisms causing symptomatic urinary tract infections.     

Retrospective analysis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007

Background

Nosocomial infections are a major threat to patients in the intensive care unit (ICU). Limited data exist on the epidemiology of ICU-acquired infections in China. This retrospective study was carried out to determine the current status of nosocomial infection in China.

Methods

A retrospective review of nococomial infections in the ICU of a tertiary hospital in East China between 2003 and 2007 was performed. Nosocomial infections were defined according to the definitions of Centers for Disease Control and Prevention. The overall patient nosocomial infection rate, the incidence density rate of nosocomial infections, the excess length of stay, and distribution of nosocomial infection sites were determined. Then, pathogen and antimicrobial susceptibility profiles were further investigated.

Results

Among 1980 patients admitted over the period of time, the overall patient nosocomial infection rate was 26.8% or 51.0 per 1000 patient days., Lower respiratory tract infections (LRTI) accounted for most of the infections (68.4%), followed by urinary tract infections (UTI, 15.9%), bloodstream (BSI, 5.9%), and gastrointestinal tract (GI, 2.5%) infections. There was no significant change in LRTI, UTI and BSI infection rates during the 5 years. However, GI rate was significantly decreased from 5.5% in 2003 to 0.4% in 2007. In addition, A. baumannii, C. albicans and S. epidermidis were the most frequent pathogens isolated in patients with LRTIs, UTIs and BSIs, respectively. The rates of isolates resistant to commonly used antibiotics ranged from 24.0% to 93.1%.

Conclusion

There was a high and relatively stable rate of nosocomial infections in the ICU of a tertiary hospital in China through year 2003–2007, with some differences in the distribution of the infection sites, and pathogen and antibiotic susceptibility profiles from those reported from the Western countries. Guidelines for surveillance and prevention of nosocomial infections must be implemented in order to reduce the rate.