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Volume 24 - December 2003

Contents

Page 10 of 13

Original Articles

  • Impact of a Program of Intensive Surveillance and Interventions Targeting Ventilated Patients in the Reduction of Ventilator-Associated Pneumonia and Its Cost-Effectiveness

  • Kwan Kew Lai, Stephen P. Baker, Sally A. Fontecchio
  • Published online by Cambridge University Press:
    02 January 2015, pp. 859-863
  • Objective:

    We hypothesized that a program of prospective intensive surveillance for ventilator-associated pneumonia (VAP) and concomitant implementations of multimodal, multidisciplinary preventive and intervention strategies would result in a reduction in the incidence of VAP and would be cost-effective.

    Setting:

    Medical and surgical intensive care units (ICUs) in a university teaching hospital.

    Interventions:

    All ventilated patients in the medical and surgical ICUs were monitored for VAP from January 1997 through December 1998. Interventions including elevation of the head of the bed, use of sterile water and replacement of stopcocks with enteral valves for nasogastric feeding tubes, and prolongation of changing of in-line suction catheters from 24 hours to as needed were implemented.

    Results:

    The rates of VAP decreased by 10.8/1,000 ventilator-days in the medical ICU (CI95, 4.65-16.91) and by 17.2/1,000 ventilator-days in the surgical ICU (CI95> 2.85-31.56) when they were compared for 1997 and 1998. With the use of the estimated cost of a VAP of $4,947 from the literature, the reduction resulted in cost savings of $178,092 and $148,410 in the medical and surgical ICUs, respectively, for a total of $326,482. In addition, $25,497 was saved due to the lengthening of the time for the change of in-line suction catheters, resulting in a cost savings of $351,979. This total cost savings of $351,979 minus the cost of enteral valves of $2,100 resulted in total net savings of $349,899.

    Conclusion:

    Intensive surveillance and interventions targeted at ventilated patients resulted in reduction of VAP and appeared to be cost-effective.

Front matter

  • ICE volume 24 issue 3 Cover and Front matter

  • Published online by Cambridge University Press:
    02 January 2015, pp. f1-f6
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Topics in Long-Term Care

Concise Communications

Concise Communication

Concise Communications

Original Articles

  • Epidemiologic Investigation of Burkholderia cepacia Acquisition in Two Pediatric Intensive Care Units

  • Chawki Loukil, Carole Saizou, Catherine Doit, Philippe Bidet, Patricia Mariani-Kurkdjian, Yannick Aujard, François Beaufils, Edouard Bingen
  • Published online by Cambridge University Press:
    02 January 2015, pp. 707-710
  • Objectives:

    To investigate and describe an outbreak of Burkholderia cepacia in a neonatal intensive care unit (NICU) and a pediatric intensive care unit (PICU), and to report the interventions leading to the cessation of the outbreak.

    Design:

    We conducted an epidemiologic investigation of an outbreak of B. cepacia colonization or infection in two clinical wards during a 35-month period (December 1998 to October 2001).

    Setting:

    A 500-bed, university hospital-affiliated, tertiary-care pediatric institution in Paris, France, with a 22-bed PICU and 31-bed NICU.

    Methods:

    Ribotyping was used to determine the genotypes of B. cepacia isolates. Procedures for the maintenance and disinfection of respiratory therapy devices were reviewed.

    Results:

    Thirty-two children were colonized (n = 14) or infected (n = 18) by B. cepacia in 2 wards (28 in the PICU and 4 in the NICU). In the PICU, a single ribotype was found among the isolates obtained from all of the patients except 1, and from the 6 isolates obtained from respiratory therapy devices (ie, heated humidifier water). In the NICU, the isolates obtained from the patients harbored a single ribotype unrelated to that of the epidemic strain isolated in the PICU; no environmental source of infection was found.

    Conclusion:

    Two different outbreaks appeared to be associated with 2 ribotypes, 1 of which was linked to patient-to-patient transmission via respiratory therapy devices. Complete elimination of the outbreak was achieved only when disposable, sterilizable, or easy-to-disinfect materials were used in the PICU. The source of infection in the NICU was not found.

  • Ventilator-Associated Pneumonia at a Tertiary-Care Center in a Developing Country: Incidence, Microbiology, and Susceptibility Patterns of Isolated Microorganisms

  • Zeina A. Kanafani, Layla Kara, Shady Hayek, Souha S. Kanj
  • Published online by Cambridge University Press:
    02 January 2015, pp. 864-869
  • Objective:

    Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country.

    Design:

    Prospective observational cohort study.

    Setting:

    The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries.

    Patients:

    All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed.

    Results:

    Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate.

    Conclusion:

    Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.

Medical News

  • Nosocomial Primary Bloodstream Infection in Patients in the Pediatric Intensive Care Unit

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 147
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  • Respiratory Viral Infections in Hospitalized Children: Implications for Infection Control

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 72
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Back matter

  • ICE volume 24 issue 3 Cover and Back matter

  • Published online by Cambridge University Press:
    02 January 2015, pp. b1-b2
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Annual Index

Original Articles

  • Resistance in Enterobacteriaceae: Results of a Multicenter Surveillance Study, 1995-2000

  • Ian Friedland, Lue Stinson, Margaretmary Ikaiddi, Sandra Harm, Gail L. Woods
  • Published online by Cambridge University Press:
    02 January 2015, pp. 607-612
  • Objectives:

    To assess changes over time in susceptibility of Enterobacteriaceae from patients in ICUs, compare susceptibility rates of isolates from patients in ICUs with those from inpatients outside ICUs, and explore phenotypic patterns of cross-resistance and co-resistance.

    Design:

    From 1995 to 2000, centers participating in the ICU Surveillance Study tested 100 to 200 consecutive nosocomial gram-negative bacilli by broth microdilution.

    Setting:

    Each year, 42 to 97 U.S. hospitals tested isolates.

    Results:

    In all years, imipenem was the most potent agent tested, followed by amikacin and ertapenem. Extended-spectrum beta-lactam and monobactam agents had good activity against Escherichia coli and Klebsiella species, but limited activity against Enterobacter species. Susceptibility to imipenem and amikacin did not fluctuate during the analysis period, whereas susceptibility to ceftazidime, ceftriaxone, and ciprofloxacin decreased 2% to 5%. The decline was most pronounced for susceptibility of Escherichia coli to ciprofloxacin: 98.7% of ICU isolates were susceptible in 1995 versus 93.2% in 2000. Susceptibility of ICU isolates was lower than that of non-ICU isolates, except for ciprofloxacin, for which the reverse was true. Cross-resistance was common among extended-spectrum cephalosporins and penicillins, but uncommon between imipenem and ertapenem. Only imipenem and ertapenem remained highly active against Enterobacteriaceae with a phenotype suggesting possible production of an extended-spectrum beta-lactamase and those with a phenotype suggesting possible Amp C hyperproduction.

    Conclusions:

    Imipenem was the most active agent against nosocomial Enterobacteriaceae. Susceptibility to ciprofloxacin decreased from 1995 to 2000, particularly in Escherichia coli, and, in contrast to other agents, was lower among non-ICU isolates.

Medical News

  • Antibiotic-Resistant Bacteria Among Residents of Long-Term-Care Facilities

  • Gina Pugliese
  • Published online by Cambridge University Press:
    02 January 2015, p. 387
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Front matter

  • ICE volume 24 issue 7 Cover and Front matter

  • Published online by Cambridge University Press:
    02 January 2015, pp. f1-f5
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Medical News

  • Risk of Tuberculin Skin Test Conversion Among Healthcare Workers

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 72
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Concise Communications

Original Articles

  • A Chryseobacterium meningosepticum Outbreak in a Neonatal Ward

  • Serdal Güngör, Metehan Özen, Aysehan Akinci, Riza Durmaz
  • Published online by Cambridge University Press:
    02 January 2015, pp. 613-617
  • Objective:

    To report epidemiologic, bacteriologic, and clinical features of a Chryseobacterium meningosepticum outbreak.

    Design:

    Outbreak investigation.

    Setting:

    A neonatal intensive care unit (NICU) of a referral teaching hospital.

    Methods:

    During 2 weeks in September 2001, four neonates in the NICU developed sepsis and underwent laboratory investigation. Multiple samples were obtained for cultures from endotracheal tubes, mechanical ventilators and humidifier boxes, infant incubators, parenteral and antiseptic solutions, feeding bottles, sinks, faucets, doors, and healthcare workers.

    Results:

    C. meningosepticum was isolated from the blood cultures of four patients. The first isolate was identified 5 days after the death of the index case. Although all isolates were ciprofloxacin susceptible in vitro, the remaining three patients did not respond to ciprofloxacin therapy given for 6 or 7 days. Therapy was switched to vancomycin and rifampin and all three patients survived, with one having a complication (hydrocephalus). Environmental surveillance revealed C. meningosepticum in the stock lipid solution as the source of the epidemic. The outbreak was controlled after discontinuation of intravenous lipid solution, restriction of further neonatal admissions, and thorough disinfection of the unit and its equipment.

    Conclusion:

    Early identification of an epidemic and its source is important in avoiding morbidity and mortality. A contaminated lipid stock bottle was the source of this outbreak associated with multiple cases and one death.

Annual Index

Concise Communications

Page 10 of 13