Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality

Despotović, Aleksa; Milošević, Branko; Milošević, Ivana; Mitrović, Nenad; Ćirković, Andja; Jovanović, Svetlana P.; Stevanović, Goran

doi:10.1016/j.ajic.2020.01.009

Cited by 96 publications

(91 citation statements)

References 21 publications

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“…According to published data, in the last decade, the continuous pre-dominance of HAIs caused by strains of GNB ( A. baumannii, P. aeruginosa, K. pneumoniae ) was observed, among which the percentage of MDR bacteria was very high (in Serbia, 88.9–97%; Egypt, 42.5–92.8%; Greece, 92.9%; India, 35–68%; Poland, 98.36% ( Acinetobacter only), Italy, 66.7%; the U.S., 14.6–73.1%) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. During the same period, the frequency of HAIs with MRSA etiology was variable and amounted to 2.7% in Greece, 4.56% in Egypt, 10% in Poland, 13.8% in France, 25.8% in Spain, and 10.3% in Germany [ 12 , 13 , 17 , 18 , 19 ]. Microbiological analysis of infections (also called “microbiological mapping”), which is the subject of this paper, aims to evaluate the epidemiological situation in the hospital unit and is a necessary element of the proper antibiotic policy [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

Litwin

Fedorowicz

Duszyńska

2020

IJERPH

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Introduction: In recent years, an increase in healthcare-associated infections (HAIs) caused by resistant pathogens, which is a clinically troublesome trend, has been observed. The aim of the study was to analyze the microbial factors of HAIs and the drug resistance of microorganisms to selected antibiotics and their consumption. Material and Methods: The retrospective study included 3708 patients hospitalized in the intensive care unit (ICU) of the University Teaching Hospital in Wroclaw, who were diagnosed with 742 HAIs in the period from 1 January 2011 to 31 December 2018. The aim of the study was the analysis of microorganisms isolated in the respective clinical forms of HAIs, including the occurrence of “alert pathogens”, presence of multidrug-resistant (MDR) strains, and consumption of selected antibiotics. Findings: During the study period, 846 microorganisms were cultured in patients with HAIs, and among them, Acinetobacter baumannii MDR represented 31.8%; Klebsiella pneumoniae ESBLs, 11.3%; Pseudomonas aeruginosa MDR, 4.1% and MRSA, 2.2%; and Enterococcus spp. vancomycin-resistant enterococci (VRE), 1.3%. Among all the pathogens, Gram-negative bacteria (GNB) were dominant (71.6%). Gram-positive bacteria and fungi accounted for 21.6% and 7%, respectively. The total number of strains responsible for ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and central line-associated blood stream infection (CLA-BSI) was as follows: 458 (54.1%), 274 (32.4%), and 114 (13.5%), respectively. Among the etiological factors of VAP, there was a prevalence of A. baumannii MDR (41.9%), as well as in the case of UTI (21.9%). With regards to CLA-BSI, MRCNS (29.8%) was the dominant pathogen. The “alert pathogens” accounted for 54.7% of all the analyzed strains. The MDR strains represented 72.6% and 9.7% among A. baumannii and P. aeruginosa, respectively. In the years 2011 vs. 2018, an increase in infections with MDR bacilli was observed, 34.6% vs. 61.0% (p = 0.0008), respectively, including A. baumannii MDR 16.54% vs. 34.56 % (p = 0.0009) and Enterobacterales ESBL+/AMPC 11.8% vs. 15.44 % (p = 0.3921). Resistance to methicillin was confirmed in 35.2% of S. aureus strains. Resistance to vancomycin was found among 30.9% of Enterococcus spp. The observed period was marked by an increase in the consumption of carbapenems: 197.7 vs. 235.9 defined daily dose (DDD)/1000 patients-days. Conclusions: Gram-negative bacteria were found to be dominant pathogens in healthcare-associated infections. The most frequently cultured pathogens were multidrug-resistant A. baumannii, K. pneumoniae ESBL(+), and P. aeruginosa. The study showed an increase in the incidence of “alert pathogens” and MDR bacilli, as well as the tendency of a growing resistance to antibiotics during the observed period. Microbiological analysis of HAIs and the consumption of antibiotics is the necessary element of the proper antibiotic policy in hospitals.

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Section: Introductionmentioning

confidence: 99%

Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

Litwin

Fedorowicz

Duszyńska

2020

IJERPH

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“…In this retrospective study, we collected the patient comorbidities, disease severity (Charlson index, APACHE II score), 30 invasive procedures (tracheotomy, parenteral nutrition), status (sepsis), and coadministered antibiotics, which has an association with mortality in ICU. 31 No statistically significant differences were seen in these variables for both groups.…”

Section: Discussionmentioning

confidence: 83%

<p>High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant <em>Acinetobacter baumannii</em> in Intensive Care Unit</p>

Bai¹,

Jiang²,

Yan³

2020

IDR

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Purpose: The association between clinical and microbiological outcomes and high-dose tigecycline (TGC) was assessed in elderly (≥60 years old) patients with hospital-acquired and ventilator-associated pneumonia due to multidrug-resistant Acinetobacterbaumannii (A. baumannii). This study also assessed tigecycline combination with different antibiotics and its influence on the outcome. Patients and Methods: An observational retrospective cohort study was conducted. Patients over 60 years old were treated with standard-dose (SD) TGC (100-mg intravenous TGC initially, followed by 50-mg doses administered intravenously twice daily) and high-dose (HD) TGC (200-mg intravenous TGC initially, followed by 100-mg doses administered intravenously twice daily) for a microbially confirmed infection. The outcome was 30-day crude mortality, coadministered antimicrobial agent and the microbial eradication percentage in both groups. Results: A total of 48 multidrug-resistant A. baumannii respiratory patients were identified. Tigecycline was administered to 85% of ventilation-associated pneumonia (VAP) patients (28/33) in the SD group and 80% of VAP patients (12/15) in the HD group. Combined therapy was the major treatment option in both groups, accounting for 85% and 87%, respectively. Median treatment duration in both groups was 7.36 vs 8.6 days, respectively. Survival days were 13.61 vs 12.4 days (P=0.357), respectively. The 30-day crude mortality was 39.4% (13/33) for the SD group and 14% (2/15) for the HD group (P=0.098). The microbial eradication rate of respiratory specimens in the SD group was higher than that in the HD group (P=0.02). The variables associated with 30-day crude mortality were chronic obstructive pulmonary disease (hazard ratio [HR] 11.63, 95% CI 1.094-123.058; P=0.042), tigecycline treatment duration (HR 0.690, 95% CI 0.515-0.926; P=0.013), and surgery before infection (HR 79.276, 95% CI 6.983-899.979; P=0.000). High-dose tigecycline was not associated with 30-day crude mortality (adjusted HR 0.329, 95% CI 0.074-1.460; P=0.145). Combined antibiotics was also not different between the two groups. Conclusions: High-dose tigecycline was not associated with 30-day crude mortality in elderly patients with pneumonia due to multidrug-resistant A. baumannii, although the microbial eradication rate was high.

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“…Smatra se da su stariji pacijenti u visokom riziku od bolničkih infekcija zbog postojanja komorbiditeta kao što su npr. dijabetes, kardiovaskularna i neurološka obolenja [22][23][24]. U ovde prikazanom istraživanju više od polovine izolovanih MDR bakterija činio je Acinetobacter spp., a u drugoj polovini 2019. godine primećen je i značajan porast infekcija uzrokovanih MDR P. aeruginosa i KNS.…”

Section: Diskusijaunclassified

Frequency and characteristics of multi-resistant bacteria in the intensive care unit

Knežević¹,

Trifunović²,

Jović³

et al. 2021

Sestrinska vizija

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Introduction: Patients in intensive care units (ICUs) are at higher risk of infections due to invasive procedures and antibiotic therapy. Infections caused by multidrug-resistant (MDR) bacteria represent a global problem, limiting the choice of antimicrobial therapy. Objective: To determine the rate of infections in ICUs, as well as the type of MDR bacteria associated with such infections. Material and methods: The study included strains of MDR bacteria isolated from laboratory samples of hospitalized patients in surgical ICUs in a one-year period. All strains of MDR bacteria were isolated and identified by standard microbiological methods for aerobic bacteria according to the recommendations and guidelines are given by the Clinical and Laboratory Standards Institute (CLSI). Results: Infections caused by MDR bacterial isolates were confirmed in 199 (19.17%) patients in ICUs. The frequency of Gram-negative isolates was significantly higher than Gram-positive (88.35% and 11.65%, p <0.001). The most common infections in ICUs caused by MDR bacteria were respiratory tract infections (49%), followed by soft tissue and skin infections. The CDI incidence density 1.13 cases/10,000 patient-days. Conclusion: A high frequency of infections caused by MDR bacteria was found with patients in ICUs, and respiratory tract infections dominated. Information on the types of infections and pathogens can help develop policies for prevention, diagnosis, treatment, and resource allocation.

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Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality

Cited by 96 publications

References 21 publications

Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

<p>High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant <em>Acinetobacter baumannii</em> in Intensive Care Unit</p>

Frequency and characteristics of multi-resistant bacteria in the intensive care unit

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