Prospective multicentre study in intensive care units in five cities from the Kingdom of Saudi Arabia: Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of central line-associated bloodstream infection

Al-Abdely, Hail M.; Alshehri, Areej Dhafer; Rosenthal, Víctor D.; Mohammed, Yassir Khidir; Banjar, Weam; Orellano, Pablo Wenceslao; Assiri, Abdullah M.; Kader, Nahla Moustafa Abedel; Enizy, Hessa Abdullah Al; Mohammed, Diaa Abdullah; Al-Awadi, Duaa Khalil; Cabato, Analen Fabros; Wasbourne, Maria; Saliya, Randa; Aromin, Rosita Gasmin; Ubalde, Evangelina Balon; Diab, Hanan Hanafy; Alkamaly, Modhi A.; Alanazi, Nawal; Assiry, Ibtesam Y. Hassan; Molano, Apsia Musa; Baldonado, Celia Flores; Al-Azhary, Mohamed; Atawi, Sharifa Al; Adwani, Fatima Mohammad Al; Pahilanga, Arlu Marie Casuyon; Nakhla, Raslan; Adwani, Fatma M. Al; Nair, Deepa Sasithran; Sindayen, Grace; Malificio, Annalyn Amor; Helali, Najla J.; Dossari, Haya B. Al; Kelany, Ashraf; Algethami, Abdulmajid Ghowaizi; Yanne, Leigh; Tan, Avigail; Babu, Sheema; Abduljabbar, Shatha Mohammad; Bukhari, Syed Z.; Basri, Roaa Hasan; Mushtaq, Jeyashri Jaji; Rushdi, Hala; Turkistani, Abdullah; Celiz, Jerlie Mae Gonzales; Raey, Mohammed Abdullah Al; Asiri, Ibrahim AM Al-Zaydani; Aldarani, Saeed Ali; Cortez, Elizabeth Laungayan; Demaisip, Nadia Lynette; Aziz, Misbah Rehman; Aziz, Ali Omer Abdul; Manea, Batool Al; Samy, Eslam; AlDalaton, M.; Alaliany, M.J.

doi:10.1177/1757177416669424

Cited by 27 publications

(22 citation statements)

References 26 publications

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“…Effective interventions with the INICC multidimensional approach and ISOS were reported in ICUs from Argentina (46.63 vs. 11.10 CLABSIs per 1000 CL-days), showing a 76% reduction, and 57% reduction (incidence density rate: 0.43; 95% confidence interval, 0.34-0.6; P < .001) (Rosenthal et al, 2003); Colombia, showing a 73% CLABSI rate reduction (relative risk, 0.27; 95% confidence interval, 0.14-0.52; P = .002) (Alvarez-Moreno et al, 2016); Mexico (46.3 vs. 19.5 BSIs per 1000 IVD days) showing a 58% reduction (Higuera et al, 2005); Turkey (22.7 to 12.0 CLABSIs per 1000 CL-days), showing a 47% reduction (Leblebicioglu et al, 2013); India (6.4 CLABSIs to 3.9 CLABSIs per 1000 CL-days), showing a 39% reduction (Jaggi et al, 2013); and Saudi Arabia (6.9 to 3.1 per 1000 CL-days) (Al-Abdely et al, 2017). In multicentric studies conducted in adult ICUs (14.5 vs. 9.7 CLABSIs per 1000 CLdays) from 15 countries (Argentina, Turkey, Colombia, India, Mexico, Philippines, Brazil, Peru, El Salvador, Costa Rica, Cuba, Lebanon, Macedonia, Morocco, and Panama), showed a 33% reduction ; in pediatric ICUs from 5 countries (Colombia, India, Mexico, Philippines, and Turkey)(10.7 vs. 5.2 CLABSIs per 1000 CL-days), showed a 51% reduction (Rosenthal et al, 2012), and in NICUs from 4 countries (El Salvador, Mexico, Philippines, and Tunisia) showed a CLABSI rate decrease by 55%, from 21.4 per 1000 CL-days during phase 1 to 9.7 per 1000 CLdays during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33-0.63]) .…”

Section: Limited-resource Settingsmentioning

confidence: 97%

“…Central lineassociated bloodstream infections (CLABSIs) are common complications encountered with their use, with up to 60% of all hospital-acquired bacteremias/fungemias occurring with a vascular access device (Crnich and Maki, 2001). CLABSIs substantially increase morbidity, mortality, length of hospital stay, and increased hospital costs, both in developed and resource-limited countries (Al-Abdely et al, 2017;Devrim et al, 2016;Ziegler et al, 2014;Tarricone et al, 2010;Higuera et al, 2007;Rosenthal et al, 2003). The CLABSI rates in resource-limited countries are 3-5 times higher than that encountered in high-income settings (Al-Abdely et al, 2017) and 75% of the world's population live in lowto-middle income countries (LMICs) .…”

Section: Introductionmentioning

confidence: 99%

“…CLABSIs substantially increase morbidity, mortality, length of hospital stay, and increased hospital costs, both in developed and resource-limited countries (Al-Abdely et al, 2017;Devrim et al, 2016;Ziegler et al, 2014;Tarricone et al, 2010;Higuera et al, 2007;Rosenthal et al, 2003). The CLABSI rates in resource-limited countries are 3-5 times higher than that encountered in high-income settings (Al-Abdely et al, 2017) and 75% of the world's population live in lowto-middle income countries (LMICs) . Established in 1998, the International Nosocomial Infection Control Consortium (INICC) is one group which has used surveillance and applied research to promote appropriate practices to decrease this rate (Rosenthal, 2016).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Lutwick

Al-Maani

Mehtar

et al. 2019

International Journal of Infectious Diseases

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Section: Limited-resource Settingsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Lutwick

Al-Maani

Mehtar

et al. 2019

International Journal of Infectious Diseases

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“…The lack of published literature on BSIs in Saudi Arabia was highlighted in a recent review [16]. Most recent articles of BSIs in Saudi Arabia focused on device-and central line-associated bloodstream infections [17,18].…”

Section: Introductionmentioning

confidence: 99%

Pathogenic spectrum of blood stream infections and resistance pattern in Gram-negative bacteria from Aljouf region of Saudi Arabia

Bandy

Almaeen

2020

PLoS ONE

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Background The pathogenic spectrum of bloodstream infections (BSIs) varies across regions. Monitoring the pathogenic profile and antimicrobial resistance is a prerequisite for effective therapy, infection control and for strategies aimed to counter antimicrobial resistance. The pathogenic spectrum of BSIs in blood cultures was analysed, focusing on the resistance patterns of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, in Aljouf region. Methods This descriptive cross-sectional study analysed the culture reports of all non-duplicate blood samples collected from January 1 to December 31, 2019. Antibiograms of A. baumannii, E. coli, and K. pneumoniae were analysed for antibiotic resistance. The frequency and percentages of multi-drug, extensively-drug, pan-drug and carbapenem resistance were calculated. Results Of the 222 bloodstream infections, 62.2% and 36.4% were caused by gram-negative and gram-positive bacteria, respectively. Most BSIs occurred in patients aged �60 years (59.5%). Among the 103 isolates of the studied Gram-negative bacteria (GNB), 47.6%, 38.8%, and 2.9% were multi-drug, extensively drug and pan-drug resistant respectively. 46% of K. pneumoniae isolates were carbapenemase producers. Resistance to gentamycin, 1 st-4 th generation cephalosporins, and carbapenems was observed for A. baumannii. More than 70% of E. coli isolates were resistant to 3 rd-and 4 th-generation cephalosporins. Klebsiella pneumoniae presented a resistance rate of >60% to imipenems.

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“…The DAI rates were as follow: for CLABSI (16.3 versus 6.06), CAUTI (6.75 versus 3.41), and VAP (9.8 versus 1.3) (p < 0.05) (Al-Tawfiq and Abed, 2009). In 2017, a recent prospective multicenter study in five ICUs from five cities of Saudi Arabia revealed a substantial decline (56%) in the rate of CLA-BSI under the impact of the International Nosocomial Infection Control Consortium (INICC) (Al-Abdely et al, 2017b). The same group conducted another prospective surveillance study in 2017 at seven ICUs of five hospitals in five cities of Saudi Arabia, through the implementation of the INICC Multidimensional Approach (IMA), and found a slight drop in the deviceassociated HAI (Al-Abdely et al, 2017a).…”

Section: Most Common Pathogens Isolatedmentioning

confidence: 99%

Epidemiology of bloodstream infection in Saudi Arabia

Ozbak¹

2018

Afr. J. Microbiol. Res.

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Bloodstream infections are a challenge to clinicians due to high rates of morbidity and mortality. Moreover, rational antimicrobial therapy, if promptly started, can improve the prognosis of sepsis. The gold-standard blood culture has some limitations and it takes time to complete (about 2-5 days). This leaves the clinicians to start immediately broad-range antimicrobial therapy until microbiology culture's results available that may lead to complicate situation of patient further. Therefore, there is an urgent need for the development of more advanced diagnostic approaches that can overcome limitations of culture-based methods. This review gives an overview of the BSIs and its epidemiology over several cities and hospitals in Saudi Arabia. It also encompasses the diverse molecular diagnostic modalities developed for the rapid detection and identification of BSIs. Furthermore, the growing understanding of the host's inflammatory responses to infections has led to the discovery of immunological biomarkers as diagnostic tools for sepsis-related BSI. The rational use of immunological and molecular diagnostic markers in clinical settings may speed up diagnosis and prognosis of septic patients. This review shows that the percentage of BSIs in Saudi Arabia, from 1983 to 2015, ranges from 1% to 11% among patients with confirmed infection. It also indicated that Staphylococcus aureus and coagulase negative staphylococci (CoNS) were the most common Gram-positive pathogens; while Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most Gram-negative ones from patients with BSI. The recommendation of this review is to initiate new surveillance systems of BSI in different regions and hospitals in Saudi Arabia and determining the antibiotic susceptibility profile to design antibiograms that may improve the antibiotic stewardship program for treating BSIs. A comparative study should be conducted for patients suspected to have sepsis, using the standard blood cultures, immunological markers and rapid molecular assays to set up a panel to help diagnose BSIs rapidly. This will allow early and optimal patient management and treatment in Saudi Arabia and therefore decrease overall healthcare costs.

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Prospective multicentre study in intensive care units in five cities from the Kingdom of Saudi Arabia: Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of central line-associated bloodstream infection

Abstract: Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in the ICUs of Saudi Arabia.

Cited by 27 publications

References 26 publications

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

Pathogenic spectrum of blood stream infections and resistance pattern in Gram-negative bacteria from Aljouf region of Saudi Arabia

Epidemiology of bloodstream infection in Saudi Arabia

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