Healthcare-associated infections in the neurological intensive care unit: Results of a 6-year surveillance study at a major tertiary care center

Abulhasan, Yasser B.; Rachel, Susan P.; Châtillon-Angle, M.; Alabdulraheem, Najayeb; Schiller, Ian; Dendukuri, Nandini; Angle, Mark; Frenette, Charles

doi:10.1016/j.ajic.2017.12.001

Cited by 43 publications

(34 citation statements)

References 25 publications

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“…Extensive studies in the USA and Europe showed that HAI incidence density ranged from 13.0 to 20.3 episodes per 1000 patient-days [14]. Incidence rates are higher in ICUs, affecting~30% of patients [15]. However, a survey of long-term care facilities for the elderly in Japan found that the overall incidence rate of HAIs was 0.18 per 1000 resident-days [16].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and clinical characteristics of healthcare-associated infection in elderly patients in a large Chinese tertiary hospital: a 3-year surveillance study

Zhao

Wang

et al. 2020

BMC Infect Dis

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Background: We analyzed the results of a 3-year surveillance study on the epidemiological and clinical characteristics of healthcare associated-infections (HAIs) in elderly inpatients in a large tertiary hospital in China. Methods: Real-time surveillance was performed from January 1, 2015 to December 31, 2017. All HAIs were identified by infection control practitioners and doctors. Inpatient data were collected with an automatic surveillance system.Results: A total of 134,637 inpatients including 60,332 (44.8%) elderly ≥60 years were included. The overall incidence of HAI was 2.0%. The incidence of HAI in elderly patients was significantly higher than that in non-elderly patients (2.6% vs. 1.5%, χ 2 = 202.421, P < 0.01) and increased with age. The top five sites of HAIs in the elderly were the lower respiratory tract, urinary tract, blood stream, antibiotic-associated diarrhea, and surgical site. The five most common pathogens detected in elderly HAI patients were Candida albicans, Klebsiella pneumonia, Acinetobacter baumannii, Escherichia coli, and Pseudomonas aeruginosa. The incidence of ventilator-associated pneumonia in the elderly was lower than in the non-elderly, catheter-associated urinary tract infections were more common in elderly patients, and the rate of central line-associated bloodstream infection was similar between groups. The numbers of male patients and patients with comorbidities and special medical procedures (e.g., intensive care unit admission, cerebrovascular disease, brain neoplasms, hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, malignant tumor, malignant hematonosis, and osteoarthropathy) were significantly higher in the elderly group, but the number of patients who underwent surgery was lower. Conclusion:We observed a significantly higher overall incidence of HAI in elderly inpatients ≥60 compared to non-elderly inpatients < 60 years, but the trend was different for device-associated HAIs, which was attributed to the higher rates of comorbidities and special medical procedures in the elderly group. The main HAI sites in elderly inpatients were the lower respiratory tract, urinary tract, and bloodstream, and the main pathogens were gramnegative bacilli and Candida albicans.

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Section: Discussionmentioning

confidence: 99%

Epidemiological and clinical characteristics of healthcare-associated infection in elderly patients in a large Chinese tertiary hospital: a 3-year surveillance study

Zhao

Wang

et al. 2020

BMC Infect Dis

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“…Most of the microorganisms isolated were either acquired at the hospital, and often associated with intensive care treatment, or sometimes isolated from patients with a previous hospital admission [24,25]; further, there also seems to be an association with preceding travels outside the country of residence [26]. In this study, there was a consolidation of a rigid antibiotics policy, characterized by a non-treatment of colonization and the implementation of de-escalation [27][28][29].…”

Section: Resultsmentioning

confidence: 79%

Implementation of Preventive Actions to Control Carbapenem-Resistant Enterobacteriaceae and MDR Gram Negatives at a Neurological Hospital

Bricchi¹,

Asti²,

Pascale³

et al. 2020

Journal of Microbiology and Infectious Diseases

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The primary causes in our division of multidrug-resistant (MDRs) infections in 2016 were K. pneumoniae and A. baumannii; the preventive actions have ensured the reduction of their incidence in 2017 and allowed us to discover the microbiological sentinel events (SE) and start appropriate precautionary behavior and isolation. Methods: The setting is inpatient care with MDR infections and the aim of the procedure is to formalize the management mode, reporting and transmission of SE, collected at the end of study period for previous years from January 1 st , 2015 to December 31 st , 2017. Results: It should be noted that of a total of 5772 hospitalizations detected in 2016 there was an increase in rate of A. baumannii compared to the rate found in 2015 for 5679 hospitalizations and in 2017 for 5682 hospitalizations; the same trend was observed for K. pneumoniae. For as regards P. aeruginosa carbapenemase producing or MDR, the rates were lower in 2016 and in 2017. Conclusions: The main goals that we achieved in the three years considered are the decreased incidence of healthcare-associated infections (HAIs) and the decreased incidence of multidrug-resistant (MDR) microorganisms. These actions were of course associated with the control of antibiotic pressure and a careful stewardship. The strict surveillance of HAIs is fundamental to control the growing reservoir within hospital communities.

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“…We observed that CAUTI rate was 5.93, which was similar to a study by Orsi et al and Abulhasan et al in NSICUs. 10,14 The reason for relatively higher CAUTI in our study was that neurosurgical patients required prolonged and multiple urinary catheterization. Our central line-associated bloodstream infection (CLABSI) rate was 3.43, which was much lower than that reported by Orsi et al 10 In our study, CVC lines were changed whenever there was a clinical indication, but in the study by Orsi et al, CVC line days were not mentioned.…”

Section: Discussionmentioning

confidence: 78%

Infections in Neurosurgical Intensive Care Patients: A 3-Year Study in a Tertiary Health Care Center, North India

Chaturvedi

Jena

Tarai

et al. 2019

Journal of Neuroanaesthesiology and Critical Care

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Background In the neurosurgical patient community, infection rate depends on the severity of neurological injuries at the time of presentation, which is measured by the Glasgow coma score (GCS). In addition, associated comorbidities; exposure to invasive devices such as endotracheal tube, central venous catheters, and urinary catheters; and neuroscience-specific devices, such as ventricular/lumbar catheters, increase chances of infection. We share our experience from a dedicated neurosurgical intensive care unit (NSICU) of a super speciality tertiary care hospital in north India. Patients and Methods This is a 3-year retrospective and observational study from January 2014 to December 2016. Total 2,608 patients were admitted to NSICU during this period; 229 patients were included whose cultures were collected after 48 hours of admission and were positive. We have analyzed patient's risk factors, length of stay (LOS), outcome, organism details, and those health care–associated infections (HAI) that fulfilled the CDC (Centers for Disease Control and Prevention) criteria. Results Out of 2,608 patients admitted, 229 were culture positive after 48 hours of admission and 53 developed HAIs (53/2,608 [2.03%]). Male-to-female ratio was 2:1. One hundred three patients had a low GCS (5–8) and 126 had a high GCS (9–15). Average LOS in ICU was 6 days, and mortality was 17.4% (40/229). A total of 57 laboratory-confirmed positive cultures were identified in 53 patients. This included 35 from urine, 15 from blood, 2 from surgical wound, and 1 from respiratory tract. Among the HAI, the rate of ventilator-associated pneumonia (VAP) was 0.22, central line-associated bloodstream infection (CLABSI) 3.43, catheter-associated urinary tract infection (CAUTI) 5.93, and surgical site infection (SSI) 0.9%. Conclusion Neurosurgical patients are particularly vulnerable to infection because of the formidable nature of their illness, frequency of associated trauma, and presence of invasive devices. In our study, lower rate of HAIs was observed because we have a dedicated NSICU, strict infection control practices, an appropriate antimicrobial stewardship program, and early shifting of neurosurgical patients to an appropriately staffed high-dependency unit/ward.

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Healthcare-associated infections in the neurological intensive care unit: Results of a 6-year surveillance study at a major tertiary care center

Cited by 43 publications

References 25 publications

Epidemiological and clinical characteristics of healthcare-associated infection in elderly patients in a large Chinese tertiary hospital: a 3-year surveillance study

Epidemiological and clinical characteristics of healthcare-associated infection in elderly patients in a large Chinese tertiary hospital: a 3-year surveillance study

Implementation of Preventive Actions to Control Carbapenem-Resistant Enterobacteriaceae and MDR Gram Negatives at a Neurological Hospital

Infections in Neurosurgical Intensive Care Patients: A 3-Year Study in a Tertiary Health Care Center, North India

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