Healthcare-associated infections in neonatal units: lessons from contrasting worlds

Srivastava, Shivi; Shetty, Nandini

doi:10.1016/j.jhin.2007.01.014

Cited by 64 publications

(51 citation statements)

References 96 publications

(113 reference statements)

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“…The burden of A. baumannii disease is particularly pronounced in the developing world, where this organism is among the top three causes of nosocomial pneumonia and bloodstream infections (2). With these infections, mortality rates can reach up to 100% in certain clinical settings (3,4). Compounding these problems is the growing burden of A. baumannii disease caused by multidrug-resistant (MDR) strains.…”

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confidence: 99%

Genetic Determinants of Intrinsic Colistin Tolerance in Acinetobacter baumannii

et al. 2013

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bAcinetobacter baumannii is a leading cause of multidrug-resistant infections worldwide. This organism poses a particular challenge due to its ability to acquire resistance to new antibiotics through adaptation or mutation. This study was undertaken to determine the mechanisms governing the adaptability of A. baumannii to the antibiotic colistin. Screening of a transposon mutant library identified over 30 genes involved in inducible colistin resistance in A. baumannii. One of the genes identified was lpsB, which encodes a glycosyltransferase involved in lipopolysaccharide (LPS) synthesis. We demonstrate that loss of LpsB function results in increased sensitivity to both colistin and cationic antimicrobial peptides of the innate immune system. Moreover, LpsB is critical for pathogenesis in a pulmonary model of infection. Taken together, these data define bacterial processes required for intrinsic colistin tolerance in A. baumannii and underscore the importance of outer membrane structure in both antibiotic resistance and the pathogenesis of A. baumannii.

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confidence: 99%

Genetic Determinants of Intrinsic Colistin Tolerance in Acinetobacter baumannii

et al. 2013

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“…Non-adherence to infection control practices, such as hand hygiene, is the single most potentially modifiable cause of health care-associated neonatal infections [19]. The burden of HCAI is high in poorresource countries because overcrowding, lack of infrastructure, high patient to HP ratio, and inappropriate use of antimicrobial drugs are common.…”

Section: Discussionmentioning

confidence: 99%

Hand hygiene practices in a neonatal intensive care unit in Ghana

Asare

Enweronu‐Laryea

Newman

2009

J Infect Dev Ctries

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Background: Compliance with hand hygiene recommendations is the most important measure in preventing health care-associated infections. The objective of this study was to assess the nature of patient contact and the hand hygiene practices of nurses and physicians in the neonatal intensive care unit in a tertiary hospital in Ghana. Methodology: Unobtrusive observation of patient contact, hand hygiene practices, and hand washing technique among nurses and physicians attending randomly selected newborns for five hours daily for two weeks. Patient contact categorized as low-risk or high-risk. Hand hygiene practice before and after patient contact categorized as clean uncontaminated, clean recontaminated, new gloves, unchanged gloves. Compliance to alcohol rub use assessed. Results: The patient to nurse/physician ratio varied from 9:1 to 12:1. There were 97 patient contacts of which 49 were high-risk and 48 lowrisk. Most (73%) patient contacts were from nurses. Compliance to hand hygiene recommendations before versus after patient contact was 15.4% versus 38.5% for physicians and 14.1% versus 9.9% for nurses. Gloves were used for 60.8% patient contacts (85.7% high-risk, 35.4% low-risk); however, compliance to recommended procedure occurred in only 12.2% of high-risk contacts and none of the low-risk contacts. Gloves were not changed between patients in 43.7% of high-risk contacts and 88.2% of low-risk contacts. Hand washing protocol was generally followed. Alcohol hand rub was always available but was not used for hand hygiene. Conclusions: Hand hygiene compliance of physicians and nurses was low. Gloves and alcohol rub were not used according to recommended guidelines. Incorporating effective education programs that improve adherence to hand hygiene guidelines into the continuing education curriculum of health professionals is recommended.

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“…In contrast, the predominant organisms isolated from invasive neonatal infections in developing countries are Gram-negative organisms, which account for 18-31.2% of infections 5 .…”

Section: Introductionmentioning

confidence: 99%

Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study

Brito

Resende

et al. 2010

Rev. Soc. Bras. Med. Trop.

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Introduction: Report the incidence of nosocomial infections, causative microorganisms, risk factors associated with and antimicrobial susceptibility pattern in the NICU of the Uberlândia University Hospital. Methods‫׃‬ Data were collected through the National Healthcare Safety Network surveillance from January 2006 to December 2009. The patients were followed five times/week from their birth to their discharge or death. Results‫׃‬ The study included 1,443 patients, 209 of these developed NIs, totaling 293 NI episodes, principally bloodstream infections (203; 69.3%) and conjunctivitis (52; 17.7%). Device-associated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonias per 1000 ventilator-days. The mortality rate in neonates with NI was 11.9%. Mechanical ventilation, total parenteral nutrition, orogastric tube, previous antibiotic therapy, use of CVC and birth weight of 751-1,000g appeared to be associated with a significantly higher risk of NI (p ≤ 0.05). In multiple logistic regression analysis for NI, mechanical ventilation and the use of CVC were independent risk factors (p ≤ 0.05). Coagulase-negative Staphylococcus (CoNS) (36.5%) and Staphylococcus aureus (23.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and S. aureus were 81.8% and 25.3%, respectively. Conclusions‫׃‬ Frequent surveillance was very important to evaluate the association of these well-known risk factors with NIs and causative organisms, assisting in drawing the attention of health care professionals to this potent cause of morbidity.

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Healthcare-associated infections in neonatal units: lessons from contrasting worlds

Cited by 64 publications

References 96 publications

Genetic Determinants of Intrinsic Colistin Tolerance in Acinetobacter baumannii

Genetic Determinants of Intrinsic Colistin Tolerance in Acinetobacter baumannii

Hand hygiene practices in a neonatal intensive care unit in Ghana

Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study

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