Nosocomial Infections and Multidrug-Resistant Bacterial Organisms in the Pediatric Intensive Care Unit

McGrath, Eric; Asmar, Basim I.

doi:10.1007/s12098-010-0253-4

Cited by 44 publications

(44 citation statements)

References 56 publications

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“…It has the ability to generate a large number of virulence factors, which are important in pathogenesis and infectious invasion [4]. The global emergence of organisms with multiple drug resistances (MDRs), such as methicillin-resistant Staphylococcus aureus (MRSA), is an important factor in acute and chronic infections that leads to increased mortality rates and increased healthcare costs [5]. Difficulty in choosing appropriate antibiotics due to antibiotic resistance has limited the treatment of burn wound infections [6,7].…”

Section: Introductionmentioning

confidence: 99%

Biofilm formation and antimicrobial resistance in methicillin-resistant Staphylococcus aureus isolated from burn patients, Iran

Moghadam

Pourmand

Aminharati

2014

J Infect Dev Ctries

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Introduction: Burns are the most serious forms of trauma and a major cause of mortality worldwide. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common pathogens of burn wound infections; treatment has faced serious problems due to antibiotic resistance in these strains. Biofilm formation, which increases antibiotic resistance capabilities and is considered to be a virulence factor, also causes treatment failure and recurrent staphylococcal infections in burn patients. Methodology: A total of 135 pus/wound swabs were collected; S. aureus was identified by confirmatory tests. The icaA/D and mecA genes were detected in DNA extracts by polymerase chain reaction assay separately. To determine the prevalence of biofilm formation, a modified Congo red agar and the microtiter plate method were used. Investigation of antibiotic resistance was performed using the disk diffusion method. Results: S. aureus (48.87%) was identified in 65 (48.87%) samples, of which 40 (61.53%) were confirmed to be MRSA. Among MRSA and methicillin-sensitive S. aureus (MSSA) isolates, 97.5% and 60% produced biofilm, respectively. Resistance of MRSA isolates to amikacin, ceftriaxone, ciprofloxacin, erythromycin, gentamicin, mupirocin, rifampin, tetracycline, and tobramycin was 64.1%, 76.92%, 51.28%, 87.18%, 71.8%, 10.26%, 5.13%, 89.74%, and 61.54%, respectively. All MRSA and MSSA isolates were susceptible to fusidic acid, linezolid, teicoplanin, tigecycline, and vancomycin. Conclusions: The high prevalence of biofilm-producing, drug-resistant S. aureus isolates in our study suggests that epidemiological studies on the characteristics of common strains found in burn centers and a definition of their antibiotic resistance pattern would be helpful for therapeutic decisions.

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Section: Introductionmentioning

confidence: 99%

Biofilm formation and antimicrobial resistance in methicillin-resistant Staphylococcus aureus isolated from burn patients, Iran

Moghadam

Pourmand

Aminharati

2014

J Infect Dev Ctries

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“…1 Outbreaks of MDR gram-negative bacteria in hospitals and long-term-care facilities are well documented, and nosocomial infections with such organisms are increasing. 1,2 Reported vehicles of transmission include environmental sources (eg, ventilators, patient beds, infusion pumps, sink drains) [3][4][5] and hands of healthcare workers. 6,7 Outbreaks have been linked to medical devices and procedures, 8,9 including catheters, 10 bronchoscopes, 11 and endoscopes 12 -particularly those used in endoscopic retrograde cholangiopancreatography (ERCP).…”

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confidence: 99%

Endoscopic Retrograde Cholangiopancreatography–Associated AmpCEscherichia coliOutbreak

Wendorf

Kay

Baliga

et al. 2015

Infect. Control Hosp. Epidemiol.

185

149

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BACKGROUNDWe identified an outbreak of AmpC–producingEscherichia coliinfections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012–August 2013. Gene sequencing revealed a shared novel mutation in ablaCMYgene and a distinctivefumC/ fimHtyping profile.OBJECTIVETo determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CRE. coliand AmpCE. colicirculating at hospital A.METHODSWe reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identicalblaCMY-2,fumC, andfimHalleles or related pulsed-field gel electrophoresis patterns.RESULTSThirty-five of 49 AmpCE. colitested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer’s recommended cleaning guidelines.CONCLUSIONRecommended reprocessing guidelines are not sufficient.Infect Control Hosp Epidemiol2015;00(0): 1–9

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“…To the Editor: Ventilator Associated Pneumonia (VAP), especially with multiresistant organisms has been increasing in the Neonatal Intensive Care Units (NICU) [1][2][3][4][5]. There are few published data from India.…”

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Ventilator Associated Pneumonia (VAP) in Neonatal Intensive Care Unit — An Emerging Problem

2014

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In this retrospective observational study, medical case records of neonates who required mechanical ventilation for >48 h were evaluated to determine the incidence, risk factors, morbidity and mortality of VAP in the NICU of Institute of Child Health, Chennai, India between January 1 and October 31, 2007. VAP was diagnosed using the Center for Disease Control and Prevention (CDC) criteria for diagnosis of clinically defined nosocomial pneumonia in infants. The criteria includes: Worsening gas exchange, increasing oxygen requirements, or increasing ventilator settings and at least three of the following: temperature instability; leukopenia or leukocytosis and left shift; increasing respiratory secretions or increasing suctioning requirements; apnea, tachypnea, nasal flaring with retraction of chest wall or grunting; wheezing, rales, or rhonchi; bradycardia or tachycardia and two or more serial chest radiographs with at least one of the following: new or progressive and persistent infiltrate; consolidation; cavitation; pneumatoceles.Of the 265 mechanically ventilated neonates enrolled in the study, 135 neonates entered the study cohort. The incidence of VAP was 22.22 cases per 100 mechanically ventilated neonates. Klebsiella (66.67%) was the predominant organism isolated from the lower respiratory tract specimen (LRT) collected through the endotracheal tube. Home delivery, respiratory distress at admission, unstable cardiopulmonary assessment at admission defined as atleast one of the following: unstable airway/abnormal breathing/abnormal circulation/altered mental status, repeated intubations (more than 1), prolonged ventilation, prolonged duration of hospitalization and level III stay were found to significant risk factors for VAP by univariate analysis. Factors that retained significance in multivariate logistic regression model were unstable initial cardio pulmonary assessment (p value=0.010, adjusted OR: 0.2, 95% CI: 0.0,0.6) and repeated intubations (p value, 0.001, adjusted OR: 34.3, 95 % CI: 8.3,142.4). The mortality rates for the neonates with VAP was 50% and for those without VAP was 69.5 % (p value=0.030).VAP is a serious nosocomial infection. Preventable risk factors should be addressed in all neonatal units. Further research is necessary to formulate the guidelines for diagnosis of VAP in neonates.

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Nosocomial Infections and Multidrug-Resistant Bacterial Organisms in the Pediatric Intensive Care Unit

Cited by 44 publications

References 56 publications

Biofilm formation and antimicrobial resistance in methicillin-resistant Staphylococcus aureus isolated from burn patients, Iran

Biofilm formation and antimicrobial resistance in methicillin-resistant Staphylococcus aureus isolated from burn patients, Iran

Endoscopic Retrograde Cholangiopancreatography–Associated AmpCEscherichia coliOutbreak

Ventilator Associated Pneumonia (VAP) in Neonatal Intensive Care Unit — An Emerging Problem

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