Implementing an infection control and prevention program decreases the incidence of healthcare-associated infections and antibiotic resistance in a Russian neuro-ICU

Abstract

BackgroundThe impact of infection prevention and control (IPC) programs in limited resource countries such as Russia are largely unknown due to a lack of reliable data. The aim of this study is to evaluate the effect of an IPC program with respect to healthcare associated infection (HAI) prevention and to define the incidence of HAIs in a Russian ICU.MethodsA pioneering IPC program was implemented in a neuro-ICU at Burdenko Neurosurgery Institute in 2010 and included hand hygiene, surveillance, contact precautions, patient isolation, and environmental cleaning measures. This prospective observational cohort study lasted from 2011 to 2016, included high-risk ICU patients, and evaluated the dynamics of incidence, etiological spectrum, and resistance profile of four types of HAIs, including subgroup analysis of device-associated infections. Survival analysis compared patients with and without HAIs.ResultsWe included 2038 high-risk patients. By 2016, HAI cumulative incidence decreased significantly for respiratory HAIs (36.1% vs. 24.5%, p-value = 0.0003), urinary-tract HAIs (29.1% vs. 21.3%, p-value = 0.0006), and healthcare-associated ventriculitis and meningitis (HAVM) (16% vs. 7.8%, p-value = 0.004). The incidence rate of EVD-related HAVM dropped from 22.2 to 13.5 cases per 1000 EVD-days. The proportion of invasive isolates of Klebsiella pneumoniae and Acinetobacter baumannii resistant to carbapenems decreased 1.7 and 2 fold, respectively. HAVM significantly impaired survival and independently increasing the probability of death by 1.43.ConclusionsThe implementation of an evidence-based IPC program in a middle-income country (Russia) was highly effective in HAI prevention with meaningful reductions in antibiotic resistance.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0383-4) contains supplementary material, which is available to authorized users.

The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran

“…In addition, in a study on the ICU neuroprotection after an infection control program that included hand hygiene, contact precautions, isolation of infected patients, and disinfection of the environment, all nosocomial infections and antibiotic resistance reduced and patient's survival increased. However, at the beginning of the program, the rate of respiratory infections and UTIs increased, which was due to the identification and reporting of all cases of nosocomial infections following the initiation of the program [ 21 ].…”

Genomic and Phenotypic Analysis of Multidrug-Resistant Acinetobacter baumannii Clinical Isolates Carrying Different Types of CRISPR/Cas Systems

“…It was also interesting that two isolates, CriePir306 and CriePir308, were obtained from the same patient (A9), but had different STs, thus indicating simultaneous infection by multiple strains. The isolate CriePir307 possessed novel ST, which allelic profile was cpn60 (8), fusA (1), gltA (16), pyrG (3), recA (6), rplB (2), rpoB (3). We have submitted this isolate to the Institut Pasteur MLST system (http://bigsdb.pasteur.fr), and new profile ST1487 was assigned to this allele combination.…”

“…A. baumannii is one of the most common causative agents of HAI infections in Russia [16]. In the present study, we provide the comprehensive data based on second-and thirdgeneration (long-read) sequencing for 12 clinical isolates of A. baumannii obtained from Moscow multidisciplinary medical center.…”

Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU

“…Today, according to the BIGSDB Institute Pasteur database ( access date 8 August 2021), 5797 K. pneumoniae sequence types and 711 capsular types have been discovered. K. pneumoniae causes different infections in ICU patients associated with high mortality rates, including bloodstream infection, pulmonary infection, and healthcare-associated ventriculitis, meningitis, and urinary tract infection [ 2 , 3 ]. It was reported from China, Spain, and Taiwan that K. pneumoniae was associated with leukocytoclastic vasculitis and microcirculation disorders, but there is no data on the relationship of such a clinical manifestation with any K. pneumoniae genetic lineages [ 4 , 5 , 6 ].…”