Systemic Antibiotics Fail to Clear Multidrug-Resistant Klebsiella from a Pediatric ICU

Outbreak of Extended Spectrum Beta Lactamase Producing Klebsiella Species Causing Neonatal Sepsis at Patan Hospital in Nepal

“…15 Low birth weight, mechanical ventilation, prolonged hospitalization, use of third-generation cephalosporins, and invasive procedures are important risk factors for the emergence of nosocomial infections in intensive care units and for high mortality. 16,17 More than 50% of the neonates affected in this study had low birth weights and were premature. Out of twenty-three, 18 required mechanical ventilation and eight had central (umbilical) venous or arterial catheters.…”

All great truths are iconoclastic: selective decontamination of the digestive tract moves from heresy to level 1 truth

“…Recent studies using surveillance cultures from throat and rectum to detect carrier status revealed that only infections occurring after 1 week of ICU stay are due to microbes transmitted via the hands of health care workers [7,8,9,10], and that the incidence of this infection varies between 15 and 40%. Micro-organisms that are not present in the patient's admission flora but are within the ICU environment are first acquired in the oropharynx.…”

“…However, from a carriage perspective the major problem is primary endogenous infection, which is due to microorganisms that the patient imports into the ICU in their admission flora. The proportion of primary endogenous infections varies between 60 and 85%, typically occurring within the first week of ICU stay, and the micro-organisms involved do not bear any relation to the ICU ecology [7,8,9,10].…”

“…Evidence: there is no evidence that infections occurring Evidence: secondary endogenous and exogenous infection specifically on or after day 3 are attributable solely rates vary between 15 and 40%, depending on the severity to micro-organisms transmitted via the hands of carers of illness of the patient population using carriage as the gold standard [7,8,9,10] Classification of micro-organisms Gram-negative micro-organisms are associated High-level and potential pathogens can cause mortality, with a higher mortality than Gram-positive microbes low-level pathogens can only result in morbidity Evidence: where is the evidence that the affinity Evidence: septicaemia due to high-level and potential for the Gram stain correlates with pathogenicity pathogens [6] has a high mortality rate irrespective of staining with regard to outcome? characteristics.…”

“…The 'heretics' argue that hand disinfection only affects nosocomial infections that develop in patients who require intensive care for more than 1 week. They represent 15-40% of all infections, depending on the patient population [7,8,9,10]. Long-stay patients invariably have overgrowth in their throat and gut of >10 9 potential pathogens/ml of saliva or gram of faeces [19].…”