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Khavandegar A, Siami Z, Rasouli A, Nazemi P, Gull A. Impact of healthcare-associated infections on in-hospital outcomes during the COVID-19 era: a multicenter comparative study of 20,942 isolated microorganisms from ICU patients. Front Public Health 2025; 13:1475221. [PMID: 39991697 PMCID: PMC11842308 DOI: 10.3389/fpubh.2025.1475221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 01/27/2025] [Indexed: 02/25/2025] Open
Abstract
Background Healthcare-associate infection (HAI) has been one of the health care issues worldwide. During the COVID-19 pandemic, HAI prevention was considered a vital aspect of the clinical management of COVID-19. In the present study, we aimed to compare the frequency of HAIs in ICU-admitted cases within and before the COVID-19 era. Methods This multicenter retrospective study applied a descriptive-analytical approach to investigate the frequency of HAIs in the ICU departments of hospitals affiliated with Tehran University of Medical Sciences from 2017 to 2022. Results Overall, 14,268 cases with 20,942 isolated microorganisms were recruited for this study, with 8,289 (58.1%) of them being male and 5,975 (41.9%) being female. A total of 6,722 (47.1%) cases with 9,917 (47.4%) isolated microorganisms were documented in the pre-COVID-19 era, while 7,546 (52.9%) patients with 11,025 (52.64%) were reported in COVID-19 era. Of 14,268 patients admitted to the ICU during the study period, 9,197 (64.8%) were discharged and 5,071 died (35.5%), of which 1,970 (29.3%) occurred in pre-COVID and 4,752 (70.7%) in the COVID-19 era (p-value < 0.001). Klebsiella species, Acinetobacter species, Escherichia coli, Staphylococcus species, and Pseudomonas aeruginosa were the five most frequent isolated microorganisms, reported in 5,542 (26.50%), 4,171 (19.90%), 2,651 (12.70%), 2,537 (12.10%), and 1,851 (8.80%) cultures, respectively. VAEs were the most common infection types as reported in 3,562 (25%) patients. There was a statistically significant difference in UTI, PMEU, BSI, and others, with an increase in PMEUs (13.5% vs. 17.1%) and BSI (22.7% vs. 24.5%) and a decrease in UTIs (24.5% vs. 22.2%) and others (4.2% vs. 2.6%) in COVID-19 era compared to pre-COVID-19. The odds of in-hospital mortality in all six main infection categories have significantly increased in the COVID-19 era when compared to the pre-COVID-19 era. The odds of death were increased in the SSI group more than the rest (OR:2.65, CI 95%: 2.13-3.29). Conclusion COVID-19 changed the pattern of HAIs and also increased their mortality. Overall, the findings of this study emphasize the importance of continuous monitoring and improvement of infection control measures in ICUs to reduce the incidence of HAIs and improve patient outcomes.
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Affiliation(s)
- Armin Khavandegar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Siami
- Department of Infectious Disease and Tropical Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aziz Rasouli
- Department of Emergency Medicine, School of Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pershang Nazemi
- Infectious Diseases Department, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoosha Gull
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Shmoury AH, Hanna W, Zakhour J, Zahreddine NK, Kanj SS. Epidemiology and microbiology of catheter-associated urinary tract infections: A 14-year surveillance study at a tertiary care center in Lebanon. J Infect Public Health 2024; 17:825-832. [PMID: 38537577 DOI: 10.1016/j.jiph.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the most common device-associated healthcare-acquired infections and pose a significant burden on patients and healthcare systems worldwide. However, there is a paucity of data on CAUTI epidemiology and microbiology in the Middle East and North Africa (MENA) region, including Lebanon. METHODS This 14-year retrospective cohort study was conducted at a tertiary care center in Lebanon. It analyzed data on all adult patients diagnosed with CAUTI between January 2009 and December 2022 in intensive care units (ICUs) and between June 2011 and December 2022 in regular units. Incidence rates, urinary catheter utilization ratios, and microbiological profiles were collected and analyzed. RESULTS A total of 620 CAUTI cases were identified during the study period. The overall CAUTI rate was 2.4 per 1000 catheter-days, with higher rates in ICUs (3.2 per 1000 catheter-days) compared to regular units (1.4 per 1000 catheter-days). No significant changes in the rates were noted despite implementing many interventions. The most common pathogens were Gram-negative bacteria, with Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae being predominant. Multidrug-resistant organisms represented 48% of all isolates. Enterobacterales were largely extended-spectrum β-lactamase (ESBL) producing, and most Acinetobacter baumannii isolates showed multidrug resistance. CONCLUSIONS This study provides important insights into CAUTI epidemiology and microbiology in a tertiary care center in Lebanon, addressing the knowledge gap in this area in the MENA region. Despite implementing prevention measures, CAUTI rates remained stable over the 14-year period. The findings highlight the need for continuous improvement in infection prevention practices, diagnostic stewardship, and antimicrobial stewardship, especially given the rising threat of antimicrobial resistance. These results can serve as a guide for the development of targeted preventive strategies to reduce the burden of CAUTIs, particularly in low- and middle-income countries where antimicrobial resistance is a major issue.
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Affiliation(s)
- Abdel Hadi Shmoury
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael Hanna
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Zakhour
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Kara Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon; Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
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Takashima M, Hyun A, Xu G, Lions A, Gibson V, Cruickshank M, Ullman A. Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e42-e56. [PMID: 38161188 DOI: 10.1542/hpeds.2023-007194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT Indwelling invasive devices inserted into the body for extended are associated with infections. OBJECTIVE This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) postinsertion infection complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device local, organ, and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per-1000-device-days per device type were reported. RESULTS A total of 116 studies (61 554 devices and 3 632 364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95% confidence interval [CI], 6-11; 50 studies) and IR of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58). CONCLUSIONS Although CVAD-BSI and ventilator associated pneumonia are well-documented, there is a scarcity of reporting on tissue and local organ infections. Standard guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.
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Affiliation(s)
- Mari Takashima
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Areum Hyun
- The University of Queensland, Queensland, Australia
| | - Grace Xu
- The University of Queensland, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | | | - Victoria Gibson
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Marilyn Cruickshank
- Sydney Children's Hospitals Network, New South Wales, Australia
- The University of Technology Sydney, New South Wales, Australia
| | - Amanda Ullman
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
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Wang F, Wang X, Shi Y, Li L, Zheng Y, Liu H, Zeng M, Jiang F, Wu Z. Development of a risk nomogram predicting urinary tract infection in patients with indwelling urinary catheter after radical surgery for cervical cancer. Prog Urol 2023; 33:492-502. [PMID: 37634960 DOI: 10.1016/j.purol.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cervical cancer (CC) patients receiving indwelling catheterization after radical hysterectomy (RH) are vulnerable to urinary tract infection (UTI). However, no model or method is available to predict the risk of UTIs. Therefore, our aim was to develop and verify a risk model to predict UTI for patients receiving indwelling catheterization after radical cervical cancer surgery (ICa-RCCS). METHODS We first collected clinical information of 380 patients receiving ICa-RCCS from January 2020 to December 2021 as a training cohort to develop the risk nomogram. UTI was then evaluated using 19 UTI predictor factors. The least absolute shrinkage and selection operator (LASSO) method was utilized for the extraction characteristics. Multivariable logistic regression analysis was then conducted to create the risk model for UTI prediction. The consistency coefficient and calibration curve were utilized to assess the model's fit accuracy. We performed bootstrapping with 1000 random samples for internal validation of the model, and decision curve analysis (DCA) for clinical application. RESULTS Predictors in the risk nomogram included indwelling catheterization duration, whether it is secondary indwelling catheterization, history of UTIs, age, and history of chemotherapy before surgery. The risk nomogram presented good discrimination and calibration (C-index: 0.810, 95% CI: 0.759-0.861). During interval validation, the model reached a high C-index up to 0.7930. DCA revealed the clinical utility of predictive model for UTI. Clinical benefit was initiated at the decision threshold≥3%. CONCLUSION We developed a novel UTI nomogram incorporating the age, history of chemotherapy before surgery, indwelling catheterization duration, whether it is secondary indwelling catheterization, and history of UTI to predict UTI risk for patients receiving ICa-RCCS. LEVEL OF EVIDENCE B: 3a.
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Affiliation(s)
- Fang Wang
- Chong Qing Three Gorges Medical College, Chongqing, China
| | - Xiaoli Wang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YuanXiang Shi
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Ling Li
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Yu Zheng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Huaying Liu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Min Zeng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fu dan University, Shanghai, China.
| | - Zhimin Wu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China.
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Hassan ME, Al-Khawaja SA, Saeed NK, Al-Khawaja SA, Al-Awainati M, Radhi SSY, Alsaffar MH, Al-Beltagi M. Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics susceptibility pattern. World J Crit Care Med 2023; 12:165-175. [PMID: 37397586 PMCID: PMC10308340 DOI: 10.5492/wjccm.v12.i3.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/03/2023] [Accepted: 03/24/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries.
AIM To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.
METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence.
RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen.
CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.
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Affiliation(s)
- Mohamed Eliwa Hassan
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Safaa Abdulaziz Al-Khawaja
- Infectious Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Medical Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busiateen 15503, Muharraq, Bahrain
| | - Sana Abdulaziz Al-Khawaja
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mahmood Al-Awainati
- Department of Family Medicine, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Sara Salah Yusuf Radhi
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mohamed Hameed Alsaffar
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
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Zand F, Vakili H, Asmarian N, Masjedi M, Sabetian G, Nikandish R, Shafiee E, Tabatabaei Esfehani A, Azadi F, Sanaei Dashti A. Unintended impact of COVID-19 pandemic on the rate of catheter related nosocomial infections and incidence of multiple drug resistance pathogens in three intensive care units not allocated to COVID-19 patients in a large teaching hospital. BMC Infect Dis 2023; 23:11. [PMID: 36609225 PMCID: PMC9821351 DOI: 10.1186/s12879-022-07962-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prevalence of resistant hospital infections in the intensive care unit (ICU) increases mortality and antibiotic resistance. COVID-19 pandemic may have unintended impact on nosocomial infections (NI) and the prevalence of resistant microorganism. METHODOLOGY The present non-interventional study was performed by a pre and a post survey each lasting 8 months before (March-October 2019) and after (March-October 2020) the onset of COVID-19 pandemic in three ICU's, not allocated to COVID-19 patients, in Nemazee Hospital, Shiraz, Iran. The rates of the following nosocomial infections were compared at pre- and post-pandemic period: ventilator associated pneumonia (VAP), central line associated blood stream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and incidence of multiple drug resistance (MDR) pathogens. RESULTS Pre-pandemic and pandemic incidence of VAP was 23.5 and 17.2 cases per 1000 device-days, respectively; an absolute decrease of 27%. The main reason for the decrease in the rate of VAP during the pandemic was a significant decrease in the rate of VAP caused by Acinetobacter baumannii; from 39 to 17% in total VAP episodes. The rate of VAP associated with other microorganisms remained relatively unchanged from 14.2 cases in pre-pandemic period to 14.3 cases per 1000 MV-days during the pandemic (P = 0.801). Pre-pandemic incidence of CLABSI was 7.3 cases and, in pandemic period, was 6.5 cases per 1000 device-days (IRR = 0.88, 95% CI 0.43-1.73, P = 0.703). Pre-pandemic incidence of CAUTI was 2 and in pandemic period, was 1.4 cases per 1000 device-days (IRR = 0.70, 95% CI 0.22-1.98, P = 0.469). CONCLUSION The results of the present study showed a decrease in the incidence of VAP in critically ill non-COVID-19 patients during the pandemic compared to before the pandemic, especially regarding Acinetobacter baumannii.
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Affiliation(s)
- Farid Zand
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hedayatollah Vakili
- grid.412571.40000 0000 8819 4698Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoor Masjedi
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golnar Sabetian
- grid.412571.40000 0000 8819 4698Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Nikandish
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Shafiee
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Tabatabaei Esfehani
- grid.412571.40000 0000 8819 4698Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Azadi
- grid.412571.40000 0000 8819 4698Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Sanaei Dashti
- grid.412571.40000 0000 8819 4698Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Rosenthal VD, Jin Z, Memish ZA, Daboor MA, Al-Ruzzieh MA, Hussien NH, Guclu E, Olmez-Gazioglu E, Ogutlu A, Agha HM, El-Sisi A, Fathalla AA, Yildizdas D, Yildizdas HY, Ozlu F, Horoz OO, Omar AA, Belkebir S, Kanaa A, Jeetawi R, El-Kholy AA, Bayani V, Alwakil W, Abdulaziz-Alkhawaja S, Swar SF, Magray TA, Alsayegh AA, Yin R. Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections. J Crit Care 2022; 72:154149. [PMID: 36108349 DOI: 10.1016/j.jcrc.2022.154149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/03/2022] [Accepted: 09/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME. MATERIALS From 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression. RESULTS 66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died. We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001). CONCLUSION Some identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; International Nosocomial Infection Control Consortium, Miami, FL, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | | | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | | | - Aziz Ogutlu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | | | - Amal El-Sisi
- Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | | | | | | | - Ferda Ozlu
- Cukurova University, Balcali Hospital, Adana, Turkey
| | | | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | | | - Alaa Kanaa
- An Najah National University, Nablus, Palestine
| | | | | | - Victor Bayani
- Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt
| | - Wafaa Alwakil
- Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt
| | - Safaa Abdulaziz-Alkhawaja
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt
| | | | | | | | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Copur B, Dosler S, Aktas Z, Basaran S, Simsek-Yavuz S, Cagatay A, Oncul O, Ozsut H, Eraksoy H. In vitro activities of antibiotic combinations against mature biofilms of ventilator-associated pneumonia isolates. Future Microbiol 2022; 17:1027-1042. [PMID: 35796076 DOI: 10.2217/fmb-2021-0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The authors aimed to determine the efficacy of frequently used antibiotics, alone or in combination, against biofilms of ventilator-associated pneumonia isolates. Materials & methods: The authors determined the MICs, minimum biofilm inhibitory concentrations and minimum biofilm eradication concentrations of meropenem, ciprofloxacin and colistin as well as their combinations against planktonic forms and biofilms of Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii clinical isolates. Results: Generally, the minimum biofilm inhibitory concentrations and minimum biofilm eradication concentrations of the antibiotics were 1000-fold higher than their MICs, and synergy was provided by different concentrations of meropenem-colistin and meropenem-ciprofloxacin combinations with checkerboard and time-kill curve methods. Conclusion: The combination of meropenem and ciprofloxacin seems to be a good candidate for the treatment of biofilm-associated infections; none of the concentrations obtained as a result of the synergy test were clinically significant.
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Affiliation(s)
- Betul Copur
- Departmant of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
| | - Sibel Dosler
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul, 34116, Turkey
| | - Zerrin Aktas
- Department of Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
| | - Seniha Basaran
- Departmant of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
| | - Serap Simsek-Yavuz
- Departmant of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
| | - Atahan Cagatay
- Departmant of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
| | - Oral Oncul
- Departmant of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
| | - Halit Ozsut
- Departmant of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
| | - Haluk Eraksoy
- Departmant of Infectious Diseases & Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34093, Turkey
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Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist 2022; 12:484-497. [PMID: 35755214 PMCID: PMC9214946 DOI: 10.1177/19418744221075888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.
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Affiliation(s)
- Negar Firoozeh
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Agah
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaith Anthony Bauer
- Department of Pulmonary Critical Care, Brooke Army Medical Center, San Antonio, TX, USA
| | - Adedeji Olusanya
- Department of Physical Medicine and Rehabilitation, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health, San Antonio, TX, USA
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Retrospective Assessment of Ventilator-Associated Pneumonias due to Acinetobacter baumannii in an Oncology Hospital. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:193-196. [PMID: 34349595 PMCID: PMC8298077 DOI: 10.14744/semb.2021.01700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 12/04/2022]
Abstract
Objectives: Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality in critically ill patients and leads to increases in health-care costs. However, it is preventable, and hospitals can decrease VAP rates. This study aims to retrospectively assess VAP rates in the intensive care unit of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of the University of Health Sciences, with reference to Acinetobacter baumannii, one of the causative organisms. Methods: This study enrolled a total of 2277 patients hospitalized between the years of 2011 and 2015. The required data were collected by reviewing medical files of the patients through computerized hospital databases. VAP rate and ventilator utilization (VU) ratio were calculated using the United States Center for Disease Control National Healthcare Safety Network methodology. Results: Of the study patients, 302 (13.26%) were seen to have developed VAP. Among these patients, 191 (63.25%) were microbiologically diagnosed VAP caused by A. baumannii. Pooled means of VU ratio and VAP rate were 0.70 and 22.91, respectively. Conclusion: The results of this study will motivate the infection control committee of the study hospital to assess current infection control program and strategies so that high VAP rate in the study intensive care unit can be reduced to the minimum possible level.
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Iordanou S, Papathanassoglou E, Middleton N, Palazis L, Timiliotou-Matsentidou C, Raftopoulos V. Device-associated health care-associated infections: The effectiveness of a 3-year prevention and control program in the Republic of Cyprus. Nurs Crit Care 2020; 27:602-611. [PMID: 33314424 DOI: 10.1111/nicc.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Device-associated health care-associated infections (DA-HAIs) are a major threat to patient safety, particularly in the Intensive Care Unit (ICU). This study aimed to evaluate the effectiveness of a bundle of infection control measures to reduce DA-HAIs in the ICU of a General Hospital in the Republic of Cyprus, over a 3-year period. METHODS We studied 599 ICU patients with a length of stay (LOS) for at least 48 hours. Our prospective cohort study was divided into three surveillance phases. Ventilator-associated pneumonia (VAP), central line-associated blood-stream infections (CLABSI), and catheter-associated blood-stream infections (CAUTI) incidence rates, LOS, and mortality were calculated before, during, and after the infection prevention and control programme. RESULTS There was a statistically significant reduction in the number of DA-HAI events during the surveillance periods, associated with DA-HAIs prevention efforts. In 2015 (prior to programme implementation), the baseline DA-HAIs instances were 43: 16 VAP (10.1/1000 Device Days), 21 (15.9/1000DD) CLABSIs, and 6 (2.66/1000DD) CAUTIs, (n = 198). During the second phase (2016), CLABSIs prevention measures were implemented and the number of infections were 24: 14 VAP (12.21/1000DD), 4 (4.2/1000DD) CLABSIs, and 6 (3.22/1000DD) CAUTIs, (n = 184). During the third phase (2017), VAP and CAUTI prevention measures were again implemented and the rates were 6: (3 VAP: 12.21/1000DD), 2 (1.95/1000DD) CLABSIs, and 1 (0.41/1000DD) CAUTIs, (n = 217). There was an overall reduction of 87% in the total number of DA-HAIs instances for the period 1 January 2015 to 31 December 2017. CONCLUSIONS The significant overall reduction in DA-HAI rates indicates that a comprehensive infection control programme can affect DA-HAI rates.
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Affiliation(s)
- Stelios Iordanou
- Intensive Care Unit, Limassol General Hospital, Limassol, Cyprus
| | | | - Nicos Middleton
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Lakis Palazis
- Nicosia General Hospital, Intensive Care Unit, Nicosia, Cyprus
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Length of stay, cost, and mortality of healthcare-acquired bloodstream infections in children and neonates: A systematic review and meta-analysis. Infect Control Hosp Epidemiol 2020; 41:342-354. [PMID: 31898557 DOI: 10.1017/ice.2019.353] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs). DESIGN A systematic review and meta-analysis. METHODS A systematic search (January 2000-September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case-control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated. RESULTS In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70-20.11) and the pooled attributable mortality rate was 8% (95% CI, 6-9). A meta-analysis was not conducted for cost due to lack of eligible studies. CONCLUSIONS Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.
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Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care center. Turk Arch Pediatr 2019; 54:105-112. [PMID: 31384145 PMCID: PMC6666360 DOI: 10.14744/turkpediatriars.2019.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 03/21/2019] [Indexed: 12/11/2022]
Abstract
Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital. Material and Methods: In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively. Results: One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1–205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance. Conclusion: Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.
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Dehghanrad F, Nobakht-e-Ghalati Z, Zand F, Gholamzadeh S, Ghorbani M, Rosenthal V. Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/94099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dang FP, Li HJ, Tian JH. Comparative efficacy of 13 antimicrobial dressings and different securement devices in reducing catheter-related bloodstream infections: A Bayesian network meta-analysis. Medicine (Baltimore) 2019; 98:e14940. [PMID: 30946317 PMCID: PMC6455863 DOI: 10.1097/md.0000000000014940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration. METHODS We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0). RESULTS Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure. CONCLUSIONS This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.
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Affiliation(s)
| | - Hui-Ju Li
- School of Nursing of Lanzhou University
| | - Jin-Hui Tian
- School of Nursing of Lanzhou University
- Key Laboratory of Clinical Translational Research and Evidence-based Medicine of Gansu Province, Lanzhou, Gansu, China
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Karagiannidou S, Zaoutis T, Maniadakis N, Papaevangelou V, Kourlaba G. Attributable length of stay and cost for pediatric and neonatal central line-associated bloodstream infections in Greece. J Infect Public Health 2019; 12:372-379. [PMID: 30616938 DOI: 10.1016/j.jiph.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and are associated with significant morbidity and healthcare costs. The aim of our study was to determine the attributable length of stay (LOS) and cost for CLABSIs in pediatric patients in Greece, for which there is currently a paucity of data. METHODS A retrospective matched-cohort study was performed in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units, hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to patients without CLABSI (non-CLABSIs) by hospital, unit, and LOS prior to study enrollment (188 children enrolled, 94 CLABSIs). The primary outcome measure was the attributable LOS and cost. Baseline demographic and clinical characteristics were recorded. Attributable outcomes were calculated as the differences in estimates of outcomes between CLABSIs and non-CLABSIs, after adjustment for propensity score and potential confounders. RESULTS There were no differences between the two groups regarding their baseline characteristics. After adjustment for age, gender, matching characteristics, central line management after study enrollment, and propensity score, the mean LOS and cost were 57.5days and €31,302 in CLABSIs versus 36.6days and €17,788 in non-CLABSIs. Overall, a CLABSI was associated with a mean (95% CI) adjusted attributable LOS and cost of 21days (7.3-34.8) and €13,727 (5,758-21,695), respectively. No significant difference was detected in LOS and cost by hospitalization unit. CONCLUSIONS CLABSIs were found to impose a significant economic burden in Greece, a finding that highlights the importance of implementing CLABSI prevention strategies.
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Affiliation(s)
- Sofia Karagiannidou
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece.
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece; Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece
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Abstract
Securing stable vascular access is an important clinical skill for the anaesthesiologist. Sick children, complex surgeries, chronic illnesses, multiple hospitalisations, and prolonged treatments can make vascular access challenging. A search was done in the English language literature using the keywords "paediatric," "vascular access," "venous access," and "techniques" or "complications" in Pubmed, Embase, and Google scholar databases. Articles were screened and appropriate content was included. Intraosseous access is a lifesaving technique that can be performed even in hypovolaemic patients rapidly. Transillumination and near-infrared light improve visualisation of superficial veins in difficult access. Ultrasonography has become the standard of care in selecting the vessel, size of catheter, guide placement, and prevent complications. Fluoroscopy is used during insertion of long-term vascular access devices. This article reviews the various routes of access, their indications, most appropriate site, securing techniques, advantages, disadvantages, and complications associated with vascular access in children.
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Affiliation(s)
- Vibhavari M Naik
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - S Shyam Prasad Mantha
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Basanth Kumar Rayani
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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Muramatsu K, Fujino Y, Kubo T, Otani M, Fushimi K, Matsuda S. Efficacy of Antimicrobial Catheters for Prevention of Catheter-Associated Urinary Tract Infection in Acute Cerebral Infarction. J Epidemiol 2017; 28:54-58. [PMID: 29093305 PMCID: PMC5742380 DOI: 10.2188/jea.je20170022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Catheter-associated urinary tract infection (CAUTI) is a common nosocomial infection. However, the effectiveness of antimicrobial catheters in reducing CAUTI in cerebral infarction patients is unknown. The purpose of this study was to determine whether antimicrobial catheters protect against CAUTI in cerebral infarction patients. Methods We identified 27,548 patients from the Japanese Diagnosis Procedure Combination Database who had been admitted from April 1, 2012 through March 31, 2014 for acute management of cerebral infarction and had used at least an indwelling urethral catheter. We extracted data on patient sex, age, comorbidity, length of stay, activities of daily living (ADL), surgery, hospital case volume, and catheter type. We defined CAUTI as a urinary tract infection arising during admission. We performed multi-level logistic regression analysis to analyze the reduction in CAUTI using antimicrobial catheters. Results The rate of CAUTI was 8.8% and 8.3% in the control and antimicrobial catheter groups, respectively. Significant risk factors for CAUTI were age, diabetes requiring insulin therapy, low ADL score, and long hospitalization. Incidence rate was significantly lower in operated cases and those treated with tissue plasminogen activator. For all cases overall, the use of an antimicrobial catheter was not associated with a lower CAUTI rate. However, use was associated with a lower rate of CAUTI in diabetic patients on insulin. Conclusions Antimicrobial catheter use was not associated with a lower incidence rate of CAUTI in acute cerebral infarction patients. However, stratified analysis suggested that use was associated with a lower incidence in diabetic patients on insulin.
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Affiliation(s)
- Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
| | - Yoshihisa Fujino
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health.,Data Science Center of Occupational Health, University of Occupational and Environmental Health
| | - Tatsuhiko Kubo
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
| | - Makoto Otani
- Data Science Center of Occupational Health, University of Occupational and Environmental Health
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health.,Data Science Center of Occupational Health, University of Occupational and Environmental Health
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Lai CC, Lee CM, Chiang HT, Hung CT, Chen YC, Su LH, Shi ZY, Liu JW, Liu CP, Lu MC, Chuang YC, Ko WC, Tseng SH, Chen YH, Hsueh PR. Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:464-470. [PMID: 28711430 DOI: 10.1016/j.jmii.2017.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units. METHODS Thirteen high-risk units, including medical (n = 5), surgical (n = 3), cardiac intensive care units (n = 2), respiratory care centers (n = 2), and respiratory care ward (n = 1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013. RESULTS The incidence of CA-UTI decreased by 22.7%, from 3.86 to 2.98 per 1000 catheter-days (95% confidence interval, 0.65-0.82; p < 0.0001) before and after the introduction of the CA-UTI bundle. Among 66 episodes of culture-proven CA-UTIs, Candida spp. were the most common pathogens (n = 17, 25.8%), followed by Escherichia coli (n = 10, 15.2%). For the seven elements of the insertion bundle, the compliance was the lowest for cleaning of the perineum, followed by hand hygiene. The overall compliance rates of the insertion bundle were 93.4%, 99.5%, and 96.3% in medical centers, regional hospitals, and district hospital, respectively. For the six elements of the maintenance bundle, the compliance was the lowest for daily review of the need of a Foley catheter. The overall compliance rates of the maintenance bundle were 95.7%, 99.9%, and 99.9% in medical centers, regional hospitals, and district hospital, respectively. CONCLUSIONS The implementation of CA-UTI bundle care successfully reduced CA-UTI in Taiwanese high-risk units. A process surveillance checklist can be helpful for understanding which parts of the bundle care require improvements.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chun-Ming Lee
- Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; Division of Infectious Disease, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiu-Tzy Chiang
- Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Tzu Hung
- Center of Infection Control, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ying-Chun Chen
- Center of Infection Control, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Hsiang Su
- Center of Infection Control, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Zhi-Yuan Shi
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jein-Wei Liu
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Disease, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Min-Chi Lu
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yin-Ching Chuang
- Department of Internal Medicine, Chi Mei Hospital, Liouying, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Shu-Hui Tseng
- Center for Disease Control, Ministry of Health and Welfare, Taiwan
| | - Yen-Hsu Chen
- Center of Infection Control, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Yamaguchi RS, Noritomi DT, Degaspare NV, Muñoz GOC, Porto APM, Costa SF, Ranzani OT. Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis. Intensive Care Med 2017; 43:1097-1104. [PMID: 28584925 DOI: 10.1007/s00134-017-4852-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/22/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children. METHODS We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil. We included patients aged 0-14 years, who needed a CVC or PICC during a PICU stay from January 2013 to December 2015. Our primary endpoint was CLABSI up to 30 days after catheter placement. We defined CLABSI based on the Center for Disease Control and Prevention's National Healthcare Safety Networks (NHSN) 2015 surveillance definitions. To account for potential confounders, we used propensity scores with inverse probability weighting. RESULTS A total of 1660 devices (922 PICCs and 738 CVCs) in 1255 children were included. The overall CLABSI incidence was 2.28 (95% CI 1.70-3.07)/1000 catheter-days. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR 2.20, 95% CI 1.05-4.61; p = 0.037) compared with PICCs. In a sensitivity analysis, CVCs remained associated with higher risk of CLABSI (adjHR 2.18, 95% CI 1.02-4.64; p = 0.044) after adding place of insertion and use of parenteral nutrition to the model as a time-dependent variable. CONCLUSIONS PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention.
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Affiliation(s)
- Ricardo Silveira Yamaguchi
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil. .,Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil. .,Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
| | - Danilo Teixeira Noritomi
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil
| | - Natalia Viu Degaspare
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.,Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil.,Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Gabriela Ortega Cisternas Muñoz
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.,Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil.,Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Ana Paula Matos Porto
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil
| | - Silvia Figueiredo Costa
- Laboratory of Bacteriology (LIM 54), Department of Infectious Diseases, Medical School, University of São Paulo, São Paulo, Brazil
| | - Otavio T Ranzani
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.,Pulmonary Division, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.,Department of Pulmonology, Hospital Clinic of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
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Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care. J Wound Ostomy Continence Nurs 2017; 44:84-88. [DOI: 10.1097/won.0000000000000280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Durdu B, Hakyemez IN, Bolukcu S, Okay G, Gultepe B, Aslan T. Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection. SPRINGERPLUS 2016; 5:1892. [PMID: 27843749 PMCID: PMC5084144 DOI: 10.1186/s40064-016-3580-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 10/19/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE Klebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI). METHODS The characteristics of patients >16 years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors. RESULTS One hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower. CONCLUSIONS Sepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.
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Affiliation(s)
- Bulent Durdu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Ismail Necati Hakyemez
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Gulay Okay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Bilge Gultepe
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Turan Aslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
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Rizwan M, Ikram A, Zaman G, Satti L, Ahmed P. Surveillance of device-associated infections in intensive care units of a tertiary care hospital. J Hosp Infect 2016; 95:101-102. [PMID: 27837929 DOI: 10.1016/j.jhin.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/13/2016] [Indexed: 11/19/2022]
Affiliation(s)
- M Rizwan
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - A Ikram
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - G Zaman
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - L Satti
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan.
| | - P Ahmed
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
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Yilmaz G, Aydin H, Aydin M, Saylan S, Ulusoy H, Koksal I. Staff education aimed at reducing ventilator-associated pneumonia. J Med Microbiol 2016; 65:1378-1384. [PMID: 27902412 DOI: 10.1099/jmm.0.000368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mechanical ventilation is a life-saving invasive procedure performed in intensive care units (ICUs) where critical patients are given advanced support. The purpose of this study was to assess the effect of personnel training on the incidence of ventilator-associated pneumonia (VAP). The study, performed prospectively in the ICU, was planned in two periods. In both periods, patient characteristics were recorded on patient data forms. In the second period, ICU physicians and assistant health personnel were given regular theoretical and practical training. Twenty-two cases of VAP developed in the pre-training period, an incidence of 31.2. Nineteen cases of VAP developed in the post-training period, an incidence of 21.0 (P<0.001). Training reduced development of VAP by 31.7 %. Crude VAP mortality was 69 % in the first period and 26 % in the second (P<0.001). Statistically significant risk factors for VAP in both periods were prolonged hospitalization, increased number of days on mechanical ventilation, and enteral nutrition; risk factors determined in the first period were re-intubation, central venous catheter use and heart failure and, in the second period, erythrocyte transfusion >5 units (P<0.05). Prior to training, compliance with hand washing (before and after procedure), appropriate aseptic endotracheal aspiration and adequate oral hygiene in particular were very low. An improvement was observed after training (P<0.001). The training of personnel who will apply infection control procedures for the prevention of healthcare-associated infections is highly important. Hand hygiene and other infection control measures must be emphasized in training programmes, and standard procedures in patient interventions must be revised.
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Affiliation(s)
- Gurdal Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Hava Aydin
- Department of Infectious Diseases and Clinical Microbiology, Akçaabat Haçkalı Baba State Hospital, Trabzon, Turkey
| | - Mustafa Aydin
- Department of Norology, Akçaabat Haçkalı Baba State Hospital, Trabzon, Turkey
| | - Sedat Saylan
- Department of Anesthesiology and Reanimation, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Hulya Ulusoy
- Department of Anesthesiology and Reanimation, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Iftihar Koksal
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
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Rosenthal VD. International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system. Am J Infect Control 2016; 44:e81-90. [PMID: 26975716 DOI: 10.1016/j.ajic.2016.01.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) is an international, nonprofit, multicentric health care-associated infection (HAI) cohort surveillance network with a methodology based on the U.S. Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN). The INICC was founded in 1998 to promote evidence-based infection control in limited-resource countries through the analysis of surveillance data collected by their affiliated hospitals. The INICC is comprised of >3,000-affiliated infection control professionals from 1,000 hospitals in 67 countries and is the only source of aggregate standardized international data on HAI epidemiology. Having published reports on device-associated (DA) HAI (HAI) and surgical site infections (SSIs) from 43 countries and several reports per individual country, the INICC showed DA HAI and SSI rates in limited-resources countries are 3-5 times higher than in high-income countries. METHODS The INICC developed the INICC Multidimensional Approach (IMA) for HAI prevention with 6 components, bundles with 7-13 elements, and the INICC Surveillance Online System (ISOS) with 15 modules. RESOURCES In this article the IMA, the ISOS for outcome surveillance of HAIs and process surveillance of bundles to prevent HAIs, and the use of surveillance data feedback are described. COMMENTS Remarkable features of the IMA and ISOS are INICC's applying of the latest published CDC-NHSN HAI definitions, including their updates and revisions in 2008, 2013, 2015 and 2016; INICC's informatics system to check accuracy of fulfillment of CDC-NHSN HAI criteria; and INICC's system to check compliance with each bundle element.
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Epidemiology of central line-associated bloodstream infections at a tertiary care centre in northern India. J Hosp Infect 2015; 92:299-301. [PMID: 26810612 DOI: 10.1016/j.jhin.2015.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 11/22/2015] [Indexed: 11/20/2022]
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Rodriguez V, Giuffre C, Villa S, Almada G, Prasopa-Plaizier N, Gogna M, Gibbons L, García Elorrio E. A multimodal intervention to improve hand hygiene in ICUs in Buenos Aires, Argentina: a stepped wedge trial. Int J Qual Health Care 2015; 27:405-11. [PMID: 26346932 DOI: 10.1093/intqhc/mzv065] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 11/14/2022] Open
Abstract
ISSUE Hand hygiene is a cost-effective measure to reduce microbial transmission (Teare EL, Cookson B, French GL, et al. UK handwashing initiative. J Hosp Infect. 1999;43:1-3.) and is considered to be the most important measure to prevent healthcare-associated infections (Pittet D, Allegranzi B, Sax H, Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641-52). Unfortunately, the compliance rate of healthcare workers (HCWs) with recommended hand hygiene procedures is less than expected. INITIAL ASSESSMENT In order to estimate the effect of a multimodal intervention on improving healthcare workers' compliance with hand hygiene in eleven intensive care units (ICUs) from 11 hospitals of Buenos Aires, a randomized cluster-stepped wedge trial was designed. CHOICE OF SOLUTION AND IMPLEMENTATION A multimodal intervention was designed based on practices characterized by being evidence-based, low cost and suggested by qualitative research: (i) leadership commitment, (ii) surveillance of materials needed to comply with hand hygiene and alcohol consumption, (iii) utilization of reminders, (iv) a storyboard of the project and (v) feedback (hand hygiene compliance rate). EVALUATION The study enrolled 705 participants, comprising nurses (66.4%), physicians (25.8%) and other HCW (7.8%) along 9 months of observation. Compliance with hand hygiene in the control group was 66.0% (2354/3565) vs. 75.6% (5190/6864) in the intervention group. Univariate analysis showed an association between the intervention and hand hygiene compliance (odds ratio, OR 1.17; 95% confidence interval (CI), 1.13-1.22). The effect was still present after adjustment by calendar's time and providers' characteristics-age, gender and profession (OR 1.08; 95% CI, 1.03-1.14). LESSONS LEARNED His study supports that a multimodal intervention was effective to improve compliance with hand hygiene in ICUs.
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Affiliation(s)
- Viviana Rodriguez
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carolina Giuffre
- Association of Nurses for Infection Control (ADECI), Buenos Aires, Argentina
| | - Silvia Villa
- Association of Nurses for Infection Control (ADECI), Buenos Aires, Argentina
| | - Griselda Almada
- Association of Nurses for Infection Control (ADECI), Buenos Aires, Argentina
| | | | - Monica Gogna
- Study Center for State and Society (CEDES), Buenos Aires, Argentina
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Sun Z, Zhu Y, Xu G, Aminbuhe, Zhang N. Regression analysis of the risk factors for postoperative nosocomial infection in patients with abdominal tumors: experience from a large cancer centre in China. Drug Discov Ther 2015; 9:411-6. [DOI: 10.5582/ddt.2015.01172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Zhipeng Sun
- Oncology Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University)
| | - Yubing Zhu
- Oncology Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University)
| | - Guangzhong Xu
- Oncology Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University)
| | - Aminbuhe
- Oncology Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University)
| | - Nengwei Zhang
- Oncology Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University)
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