Nosocomial bloodstream infections in ICU and non-ICU patients

BACKGROUND: Nosocomial bloodstream infections (BSI) create a serious health problem in hospitals all over the world. The objectives of our study were to explore putative disease markers and potential risk factors with nosocomial BSI in patients in intensive care units (ICU) and non-ICU patients and to determine risk factors associated with increased 28-day mortality rate in patients with nosocomial BSI acquired in combined medical-surgical ICU. However, the major purposes of this report were to identify epidemiologic differences between nosocomial BSI acquired in ICU and non-ICU, as well as analyses outcomes for patients with nosocomial BSI acquired in ICU. METHODS: A 1-year prospective cohort study was performed to determine the incidence of nosocomial BSI in hospitalized patients. Patient characteristics, risk factors related to health care, and source of infection of patients with BSI acquired in non-ICU were compared with those patient with BSI acquired in ICU. Also, nested case-control study of patients to nosocomial BSI acquired in ICU was performed to evaluate outcome. Patients were identified by active surveillance and positive blood culture during the study period. RESULTS: The incidence of nosocomial BSI was 2.2 per 1000 admission in non-ICU patients and 17.4 per 1000 admission in ICU patients. The 28-day crude mortality rate was 69% in ICU patients. A multivariate model showed that nasogastric tube (RR, 25.1; 95% CI: 3.845-163.85; P=.001), mechanical ventilation (RR, 13.04; 95% CI: 1.974-96.136; P=.008), and H2 blockers (RR, 12.16; 95% CI: 1.748-84.623; P=.012) were more prevalent among patients with BSI acquired in ICU, and aggressive procedures (RR, 8.65; 95% CI: 1.70-44.00; P=.009) were more prevalent among patients with BSI acquired in non-ICU patients. Risk factors independently associated with increased 28-day mortality rate in ICU patients were mechanical ventilation (OR, 8.63; 95% CI: 1.5-49.8; P=.016) and SAPS II >40 (OR, 6.0; 95% CI: 1.0-35.7; P=.049). The most common isolated nosocomial BSI pathogens (in both groups of patients) were coagulase-negative staphylococci (21%), Staphylococcus aureus (14%), and Klebsiella species (13%). Klebsiella species was the only organism independently influencing the poor outcome of nosocomial BSI in ICU patients (OR, 4.3; 95% CI: 1.2-15.3; P=.022). CONCLUSIONS: Our results show epidemiologic differences between non-ICU and ICU BSI. Also, this study suggests that severity of underlying host conditions, mechanical ventilation, and microbial agents (Klebsiella species) affect the outcome of NBI in patients in ICU.     

Nosocomial bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology, and antimicrobial susceptibility.

We examined the clinical and epidemiological features of nosocomial bloodstream infections (BSIs) caused by Acinetobacter species and observed from 1 March 1995 through 28 February 1998 at 49 United States hospitals (SCOPE National Surveillance Program). Acinetobacter species were found in 24 hospitals (49%) and accounted for 1.5% of all nosocomial BSIs reported. One hundred twenty-nine isolates were identified either as A. baumannii (n=111) or other Acinetobacter species (n=18). Patients with A. baumannii BSI, compared with patients with nosocomial BSI caused by other gram-negative pathogens, were more frequently observed in the intensive care unit (69% vs. 47%, respectively; P<.001; odds ratio [OR] 2.4; 95% confidence interval [CI] 1.6-3.7) and were more frequently receiving mechanical ventilation (58% vs. 30%, respectively; P<.001; OR 3.2; 95% CI 2.1-4.8). Crude mortality in patients with A. baumannii BSI was 32%. Molecular relatedness of strains was studied by use of polymerase chain reaction-based fingerprinting. Clonal spread of a single strain occurred in 5 hospitals. Interhospital spread of epidemic A. baumannii strains was not observed. The most active antimicrobial agents against A. baumannii (90% minimum inhibitory concentration values) were imipenem (1 mg/L; 100% of isolates susceptible), amikacin (8 mg/L; 96%), tobramycin (4 mg/L; 92%), and doxycycline (4 mg/L; 91%). Thirty percent of isolates were resistant to > or =4 classes of antimicrobials and were considered to be multidrug resistant.     

Genotypic analysis of Acinetobacter bloodstream infection isolates in a Turkish university hospital

Acinetobacter baumannii is a significant pathogen of bloodstream infections in hospital patients that frequently causes single clone outbreaks. We aimed to evaluate the genetic relatedness and antimicrobial susceptibility of Acinetobacter spp. bloodstream isolates, in order to obtain insight into their cross-transmission. This prospective study was conducted at the Erciyes University Hospital. During a 1-y period, all patients with nosocomial BSI caused by Acinetobacter spp. were included in the study. All data with regard to the patients, underlying diseases and risk factors for BSI and the severity of disease were collected. Blood culture isolates of Acinetobacter spp. were identified according to their morphology and biochemical reactions. The antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion test according to the NCCLS; the genetic relatedness of isolates was determined by RAPD-PCR analysis and pulsed-field gel electrophoresis (PFGE). 41 patients acquired a nosocomial bloodstream infection caused by A. baumanii during this period. 88% of these infections (36 of 41) occurred while the patients were treated in the intensive care unit. Nearly 80% of the isolates belonged to 3 genotypes, suggesting cross-transmission in ICU settings where infection control practices are poor. All Acinetobacter isolates were multidrug-resistant and the crude mortality of patients infected with A. baumanii was 80.5%. We concluded that the genetic relatedness of Acinetobacter spp. causing BSI was very high, indicating cross-transmission within the ICU setting. Essential components of an infection control programme to prevent nosocomial transmission of A. baumannii are early detection of colonized patients, followed by strict attention to standard precautions and contact isolation.     

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.     

Risk factors and mortality for nosocomial bloodstream infections in elderly patients

Objective

To determine risk factors for nosocomial bloodstream infection (BSI) and associated mortality in geriatric patients in geriatric and internal medicine wards at a university hospital.

Methods

Single-center retrospective (1992–2007), pairwise-matched (1:1-ratio) cohort study. Geriatric patients with nosocomial BSI were matched with controls without BSI on year of admission and length of hospitalization before onset of BSI. Demographic, microbiological, and clinical data are collected.

Results

One-hundred forty-two BSI occurred in 129 patients. Predominant microorganisms were Escherichia coli (23.2%), coagulase-negative Staphylococci (19.4%), Pseudomonas aeruginosa (8.4%), Staphylococcus aureus (7.1%), Klebsiella pneumoniae (5.8%) and Candida spp. (5.8%). Matching was successful for 109 cases. Compared to matched control subjects, cases were more frequently female, suffered more frequently from arthrosis, angina pectoris and pressure ulcers, had worse Activities of Daily Living-scores, had more often an intravenous or bladder catheter, and were more often bedridden. Logistic regression demonstrated presence of an intravenous catheter (odds ratio [OR] 7.5, 95% confidence interval [CI] 2.5–22.9) and being bedridden (OR 2.9, 95% CI 1.6–5.3) as independent risk factors for BSI. In univariate analysis nosocomial BSI was associated with increased mortality (22.0% vs. 11.0%; P = 0.029). After adjustment for confounding co-variates, however, nosocomial BSI was not associated with mortality (hazard ratio 1.3, 95% CI 0.6–2.6). Being bedridden and increasing age were independent risk factors for death.

Conclusion

Intravenous catheters and being bedridden are the main risk factors for nosocomial BSI. Although associated with higher mortality, this infectious complication seems not to be an independent risk factor for death in geriatric patients.     

Age- and sex-associated trends in bloodstream infection: a population-based study in Olmsted County, Minnesota

BACKGROUND: Despite increasing concerns about antimicrobial resistance and emerging pathogens among blood culture isolates, contemporary population-based data on the age- and sex-specific incidence of bloodstream infections (BSIs) are limited. METHODS: Retrospective, population-based, cohort study of all residents of Olmsted County, Minnesota, with a BSI between January 1, 2003, and December 31, 2005. The medical record linkage system of the Rochester Epidemiology Project and microbiology records were used to identify incident cases. RESULTS: A total of 1051 unique patients with positive blood culture results were identified; 401 (38.2%) were classified as contaminated. Of 650 patients with cultures deemed clinically relevant, the mean +/- SD age was 63.1 +/- 23.1 years, and 52.5% were male. The most common organisms identified were Escherichia coli (in 163 patients with BSIs [25.1%]) and Staphylococcus aureus (in 108 patients with BSIs [16.6%]). Nosocomial BSIs were more common in males than females (23.8% vs 13.9%; P = .002). The age-adjusted incidence rate of BSI was 156 per 100 000 person-years for females and 237 per 100 000 person-years for males (P<.001), with an age- and sex-adjusted rate of 189 per 100 000 person-years. Rates of BSI due to gram-positive cocci were 64 per 100 000 person-years for females and 133 per 100 000 person-years for males (P<.001); gram-negative bacillus BSI rates (85/100 000 person-years for females and 79/100 000 person-years for males) were not significantly different between sexes (P = .79). The rate of S aureus BSI was 23 per 100 000 person-years for females and 46 per 100 000 person-years for males (P = .005). CONCLUSIONS: There are significant differences in the age and sex distribution of organisms among patients with BSIs. The incidence of BSI increases sharply with increasing age and is significantly higher in males, mainly because of nosocomial organisms, including S aureus.     

2007-2010年医院鲍曼不动杆菌感染的耐药分析

目的 了解医院鲍曼不动杆菌感染的分布及耐药情况.方法 分析鲍曼不动杆菌菌株的标本来源和临床分布情况,用最低抑菌浓度(minimal inhibitory concentration,MIC)法结合纸片扩散法(K-B法)检测其对抗菌药物的敏感性.结果 2007-2010年共分离鲍曼不动杆菌62株,其中53株(占85.5%)分离自痰标本,21株(占33.9%)分离自重症监护室(intensive care units,ICU).62例患者中54.8%(34例)的患者患有严重的肺部感染疾病.分离菌对头孢哌酮/舒巴坦的耐药率为20.0%、敏感率为73.3%,对其他抗菌药物的耐药率超过60.0%.泛耐药菌占33.9%(21株),其中52.4%(11株)的泛耐药鲍曼不动杆菌感染发生在ICU病房.结论 鲍曼不动杆菌的耐药率较高,且呈多重耐药趋势.加强菌株的耐药性监测,以药敏结果指导临床用药有助于减少耐药菌株的出现.

Abstract：

Objective To investigate the prevalence and antimicrobial resistance of Acinetobacter baumannii in nosocomial infection.Methods Clinical features and the origin of A.baumannii samples were analyzed retrospectively.The minimal inhibitory concentration(MIC)and Kriby-Bauer diffusion test(K-B)were used to determine the Susceptibility to the antimicrobial agents.Results A total of 62 strains of A.baumannii were isolated from 2007 to 2010.Fifty-three strains(85.5%) of specimens were separated from respiratory tract.The isolation rate of A.baumannii was the highest in intensive care units(ICU)(21 strains,33.9%).54.8%(34/62)of patients suffered from severe lung infection.The resistance rate of cefoperazon/sulbactam was 20.0%.and the susceptible rate was 73.3%.The resistance rate to other antimicrobial agents is above 60.0%.The prevalence of multi-drug resistance of A.baumannii Was about 33.9%,and 52.4% of this kind of A.baumannii were occured in ICU.Condusion The infection of A.baumannii is more and more severe and tends to be resistant to multiple-drug and pan-drugs.The susceptible testing should be conducted to help the clinic to decrease the resistance rate.     

Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii.

Sixty nosocomial infections caused by Pseudomonas aeruginosa and Acinetobacter baumannii resistant to aminoglycosides, cephalosporins, quinolones, penicillins, monobactams, and imipenem were treated with colistin (one patient had two infections that are included as two different cases). The infections were pneumonia (33% of patients), urinary tract infection (20%), primary bloodstream infection (15%), central nervous system infection (8%), peritonitis (7%), catheter-related infection (7%), and otitis media (2%). A good outcome occurred for 35 patients (58%), and three patients died within the first 48 hours of treatment. The poorest results were observed in cases of pneumonia: only five (25%) of 20 had a good outcome. A good outcome occurred for four of five patients with central nervous system infections, although no intrathecal treatment was given. The main adverse effect of treatment was renal failure; 27% of patients with initially normal renal function had renal failure, and renal function worsened in 58% of patients with abnormal baseline creatinine levels. Colistin may be a good therapeutic option for the treatment of severe infections caused by multidrug-resistant P. aeruginosa and A. baumannii.     

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.     

Bloodstream infection in adults with sickle cell disease: association with venous catheters, Staphylococcus aureus, and bone-joint infections

ABSTRACT:: Although well documented in children with sickle cell disease (SCD), the incidence, cause, and outcome of bloodstream infection (BSI) are poorly defined in adults with SCD. Through a 5-year retrospective analysis of a cohort of 900 patients followed at our institution, we identified 56 episodes of BSI in 47 patients. The incidence rate of BSI was 1.2 episodes per 100 patient-years. As compared to the patients followed in the cohort, those with BSI were more likely to be younger (p = 0.001), to have Hb-S disease (p = 0.008), severe disease (p = 0.001), or additional immunosuppression (p = 0.05). BSI was hospital-acquired in 46% of cases and mainly associated with venous catheters (41%) and Staphylococcus aureus (34%). Pneumococci were rarely identified (10.7%). Despite an adequate duration of antibiotic therapy, the course of BSI was marked by a high frequency of associated bone-joint infection. Bone-joint infection was noted in 18 patients (32% of episodes) and occurred either during the initial BSI episode (13 patients) or 1-6 months after BSI resolution (5 patients). Factors associated with the occurrence of bone-joint infection were previous osteonecrosis (relative risk, 2.5; 95% confidence interval, 1.2-5.3) and S. aureus infection (relative risk, 3.8; 95% confidence interval, 1.8-8.4). In conclusion, BSI is a rare event in adults with SCD compared to children. It mainly occurs in those with a severe underlying disease and a venous catheter. These patients have a high risk of associated bone-joint infection and therefore must be closely monitored.     

Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections.

OBJECTIVES: To identify the risk factors for nosocomial imipenem-resistant Acinetobacter baumannii (IRAB) infections. METHODS: A prospective case-control study, set in an 1100-bed referral and tertiary-care hospital, of all patients who had nosocomial A. baumannii infections between January 1 and December 31, 2004. Only the first isolation of A. baumannii was considered. RESULTS: IRAB was isolated from 66 (53.7%) patients and imipenem-sensitive Acinetobacter baumannii (ISAB) was isolated from 57 (46.3%) patients during the study period. The mean duration of hospital stay until A. baumannii isolation was 20.8+/-13.6 days in IRAB infections, whereas it was 15.4+/-9.4 days in ISAB infections. Of the patients, 65.2% with IRAB infections and 40.4% with ISAB infections were followed at the intensive care unit (ICU). Previous carbapenem use was present in 43.9% of the patients with IRAB and 12.3% of the patients with ISAB infection. In univariate analysis female sex, longer duration of hospital stay until infection, ICU stay, emergent surgical operation, total parenteral nutrition, having a central venous catheter, endotracheal tube, urinary catheter or nasogastric tube, previous antibiotic use, and previous administration of carbapenems were significant risk factors for IRAB infections (p<0.05). In multivariate analysis, longer duration of hospital stay until A. baumannii isolation (odds ratio (OR) 1.043; 95% confidence interval (CI) 1.003-1.084; p=0.032), previous antibiotic use (OR 5.051; 95% CI 1.004-25.396; p=0.049), and ICU stay (OR 3.100; 95% CI 1.398-6.873; p=0.005) were independently associated with imipenem resistance. CONCLUSIONS: Our results suggest that the nosocomial occurrence of IRAB is strongly related to an ICU stay and duration of hospital stay, and that IRAB occurrence may be favored by the selection pressure of previously used antibiotics.     

综合重症监护病房老年患者医院感染现状及危险因素分析

目的 了解综合重症监护病房(intensive care unit,ICU)老年患者医院感染现状,探讨老年患者发生医院感染的危险因素.方法 回顾性调查2015年1月-2019年6月期间在上海市某三甲医院综合ICU内年龄≥65岁的老年住院患者发生医院感染的情况,分析主要感染类型和检出病原菌种类,采用病例对照研究方法,比较...     

Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit

BACKGROUND: We report the effectiveness of preemptive enhanced barrier precautions in containing a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a university hospital burn unit and further controlling endemic nosocomial MRSA infection in the unit during the succeeding 27 months. METHODS: During a 6-month period, 12 patients in a 7-bed burn unit were found to be colonized (7) or infected (5) by MRSA. An epidemiologic study was undertaken. RESULTS: Seven of the 10 strains of MRSA from patients that were available for DNA typing were clonally identical. Early in the outbreak, a health care worker was found to be a concordant nasal carrier and was successfully decolonized with nasal mupirocin. However, despite stringent compliance with isolation of MRSA-positive patients (targeted precautions), new cases of MRSA colonization or infection continued to occur. The outbreak was rapidly terminated after implementing preemptive barrier precautions with all patients in the unit: a new, clean gown and gloves for any physical contact with the patient or their environment. Although 25% of all nosocomial S aureus isolates in our hospital are resistant to methicillin, the incidence of endemic MRSA colonization and infection in the burn unit has remained very low since implementing barrier precautions unit wide (baseline rate, 2.2 [95% CI: 1.0-4.2] cases per 1000 patient-days; outbreak rate, 7.2 [95% CI: 4.4-11.0] cases per 1000 patient-days; post-outbreak termination endemic rate, 1.1 (95% CI: 0.4-2.3) cases per 1000 patient-days). The rate ratio comparing the outbreak and the baseline period was 3.20 (95% CI: 1.40-7.95, P = .002); the rate ratio comparing the post-outbreak period with the baseline period was 0.48 (95% CI: 0.14-1.53, P = .10), and it has not been necessary to screen personnel for MRSA carriage to prevent nosocomial MRSA infections in this highly vulnerable population. CONCLUSION: Preemptive barrier precautions were highly effective in controlling the outbreak and, most notably, have also been highly effective in maintaining a very low incidence of nosocomial MRSA infection endemically in the succeeding 27 months of follow-up. Use of clean gloves, with or without a gown, bears consideration for all high-risk hospitalized patients to prevent cross transmission of all multiresistant nosocomial pathogens.     

2005至2007年北京大学第三医院血流感染的微生物学分析

目的 研究北京大学第三医院近年来血流感染的微生物学和流行病学特征.方法 回顾性分析2005年1月1日至2007年12月31日的全部血液培养检查中培养阳性的患者的临床资料和微生物学资料.成组设计资料构成比的差异比较采用X2检验.结果 3年中共对3 795例患者和5 138个病程进行了血液普通细菌培养,标本共6 488套.按有氧瓶统计,阳性率为9.9%.住院患者3年平均血流感染发生率为40.8/1万.共检出导致感染的菌株593株,其中医院内获得感染病原483株,占81.5%.全部菌株和院内感染菌株构成比:革兰阳性菌分别占38.5%和42.0%,革兰阴性菌分别占54.7%和49.9%,真菌(全部是假丝酵母菌)分别占6.8%和8.1%.全部菌株中,大肠埃希菌占25.3%,血浆凝固酶阴性葡萄球菌占18.8%,金黄色葡萄球菌和肺炎克雷伯菌分别占7.1%和7.4%,肠球菌属占8.3%,铜绿假单胞菌和鲍曼不动杆菌分别占3.2%和2.2%,厌氧菌占0.7%.复数菌感染共10例,占全部感染的1.7%.院内感染中链球菌(X2=9.240,P=0.002)和大肠埃希菌(X2=23.609,P<0.01)明显多见于非ICU病房,而假丝酵母菌则明显多见于ICU病房(X2=5.498,P=0.019).入院至标本留取时间差为15.1(大肠埃希菌)～29.7 d(鲍曼不动杆菌).3年中主要菌株的耐药性无明显变化.结论 北京大学第三医院住院患者血流感染发生率为40.8/1万.致病菌株以革兰阴性菌为主.     

Systemic inflammatory response syndrome in nosocomial bloodstream infections with Pseudomonas aeruginosa and Enterococcus Species: comparison of elderly and nonelderly patients

OBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients. DESIGN: Historical cohort study. SETTING: An 820-bed tertiary care facility. PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI. MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (> or =65, n=37) were compared with nonelderly patients (<65, n=90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model. RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology And Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78-23.47), cardiovascular failure (OR=4.7, 95% CI=1.69-13.10), and adjusted APACHE II > or = 15 at BSI onset (OR=3.1, 95% CI=1.12-8.81) independently predicted death. CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients.     

Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study

BACKGROUND: The incidence of cardiac device infection is not well understood. Bloodstream infection (BSI) in patients with permanent pacemakers or implantable cardioverter-defibrillators (hereafter, defibrillators) may reflect device infection. METHODS: Retrospective, population-based cohort study of all adult patients with cardiac devices who resided in Olmsted County, Minnesota, from 1975 to 2004. The medical linkage-system of the Rochester Epidemiology Project and standardized criteria were used to identify all cases of BSI and device infection. The incidence of device infection was calculated with person-years of follow-up after device implantation. RESULTS: A total of 1524 patients with cardiac devices were included in the cohort. Total person-time of follow-up was 7578 years. The incidence of definite device infection was 1.9 per 1000 device-years (95% confidence interval [CI], 1.1-3.1). The incidence of pocket infection without BSI was 1.37 per 1000 device-years (95% CI, 0.62-3.05), and pocket infection with BSI or device-related endocarditis 1.14 per 1000 device years (95% CI, 0.47-2.74). The cumulative probability of device infection was higher among patients with defibrillators compared with those with pacemakers, P<.001. Twelve (54.6%) of 22 cases of Staphylococcus aureus BSI had definite or possible cardiac device infection vs 3 (12.0%) of 25 cases of bloodstream infection due to gram-negative bacilli (P = .004). CONCLUSIONS: To our knowledge, this is the first population-based study to describe the incidence of cardiac device infection. Device infection was common during episodes of S aureus BSI. The rate of cardiac device infection was higher in patients with defibrillators than in those with pacemakers.     

老年重症破伤风患者的临床特点及救治经验

目的分析12例老年重症破伤风患者的临床表现、治疗及转归,总结老年重症破伤风患者的患病特点及救治经验。方法回顾性分析我科2013年6月24日—2017年5月6日救治的12例老年重症破伤风患者资料。结果总体救治成功9例(75.00%),死亡3例(25.00%)。气管切开者11例,气管切开后存活率81.82%;11例发生院内感染者,以呼吸道及泌尿道感染最多见,主要病原体为鲍曼不动杆菌及嗜麦芽窄食单胞菌,最常见的真菌感染是酵母菌。抗生素治疗时间平均为(11.29±7.50)d,抗感染治疗有效率100%。12例患者平均住院时间(27.50±15.21)d。结论老年重症破伤风患者潜伏期长,病初症状不典型。及早识别重症患者,尽早气管切开、合理抗感染及营养支持是老年重症破伤风救治成功的关键。     

四川省二级综合医院耐碳青霉烯类鲍曼不动杆菌感染发生的相关危险因素分析

目的探讨四川省二级综合医疗机构耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant acinetobacter baumannii, CRAB)的耐药情况及相关临床危险因素。 方法采取回顾性病例-对照研究方法,调查2015年1月至2016年1月四川地区6家二级甲等综合医院鲍曼不动杆菌感染患者病例,根据药敏结果分为CRAB组和碳青霉烯敏感组(CSAB)。 结果共收集到非重复Ab菌株202株,其中CRAB 90株,耐药率40.1%。CRAB发生的4个独立危险因素为留置尿管(OR＝9.576,95%CI：4.964～18.474,P＝0.000)、中央静脉置管(OR＝2.707,95%CI：1.158～6.330,P＝0.022)、氟喹诺酮类(OR＝3.869,95%CI：1.603～9.377,P＝0.003)及碳青霉烯类抗菌药物(OR＝2.755,95%CI：1.164～6.521,P＝0.021)的使用。 结论二级综合医院CRAB感染的发生与侵袭性操作、氟喹诺酮类及碳青霉烯类等抗菌药物的选择压力有关。     

Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital

We conducted a case-control study to determine the attributable direct costs of multidrug-resistant Acinetobacter baumannii (MDRAB) in the burn unit of a public teaching hospital. The mean total hospital cost of patients who acquired MDRAB was 98,575 dollars higher than that of control patients who had identical burn severity of illness indices ( P <.01). These data should help infection control practitioners and others determine the cost-effectiveness of specific interventions designed to control this emerging nosocomial pathogen.     

失代偿期乙型肝炎肝硬化患者发生医院感染临床特点及危险因素分析*

目的 分析失代偿期乙型肝炎肝硬化患者住院期间发生医院感染的临床特点及其危险因素。方法 2016年2月～2018年12月我院收治的失代偿期乙型肝炎肝硬化患者100例,查阅出院病历资料,分析患者发生医院感染的临床特点,应用Logistic 回归分析影响感染发生的因素。结果 100例失代偿期乙型肝炎肝硬化患者在住院期间发生医院感染者25例(25.0%),其中呼吸道感染10例(40.0%),腹膜感染7例(28.0%),肠道感染4例(16.0%);大肠埃希菌感染5例(29.4%),金黄色葡萄球菌感染4例(23.5%),肺炎克雷伯菌感染2例(11.8%),铜绿假单孢菌感染2例(11.8%),肺炎链球菌感染2例(11.8%);单因素分析显示不同性别、是否发生肝性脑病、是否预防性应用抗菌药物患者感染发生率无显著性差异(P>0.05),而不同年龄、住院时间长短、不同肝功能分级、是否行侵入性操作、血清白蛋白和血清胆红素高低、有无腹水和是否应用抗病毒药物患者医院感染发生率差异显著,经多因素回归分析显示年龄≥60岁(OR=4.176,P=0.023)、住院时间≥1月(OR=44.116,P=0.021)、肝功能分级差(OR=5.160,P=0.009)、进行了侵入性操作(OR=5.265,P=0.003)和有腹水(OR=2.921,P=0.033)为影响患者发生院内感染的独立危险因素。结论 失代偿期乙型肝炎肝硬化患者在住院期间易发生医院感染,对于感染高危人群应予以高度关注,重视手卫生和适度隔离,以减少院内感染的发生。