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Prevalence and outcome of infections in intensive care units of a tertiary care hospital in north India.

100%
Malik S. S., Maqbool M., Rafi A., Kokab N.
Critical Care Innovations
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2022
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vol. 5
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issue 2
20-28
EN
INTRODUCTION: Infection is a major cause of morbidity and mortality in Intensive Care Units (ICUs), more so in resource limited ICUs of low and lower-middle income countries. However relatively little information is available about epidemiology and outcome of such infections in our part of the world. The point was to provide information about the prevalence and outcome of primary and secondary (nosocomial) infections in ICUs. MATERIAL AND METHODS: 257 adult patients admitted in medical and surgical ICUs over a period of 9 months were enrolled in the study. Patients fulfilling sepsis 3 criteria were categorized under “prevalence of the infections” and patients who developed infections after 48 hours of admission in ICUs were categorized under “secondary (nosocomial) infections”. Sequential Organ Failure Assessment score (SOFA score) was calculated at admission and after 72 hours of ICU stay. The patients were followed for 30 days. RESULTS: Patients were distributed in two groups: 153 (59.5%) medical ICU and 104 surgical ICU patients. Prevalence of primary infection was significantly higher in medical ICU patients (p value < 0.05). A total of 93(60.8%) patients in medical ICU and 50(48.1%) patients in surgical ICU were admitted as primary infections (p value < 0.001). Secondary (nosocomial) infections occurred in 30 (19.6%) patients in medical ICU and 15 (14.4%) patients in surgical ICU (p-value 0.283). The average length of stay was 14 days in patients with nosocomial infections and 3.5 days for patients without secondary infections (p-value < 0.001). Out of total of 188 infected patients, 80 (42.5%) died whereas 17 (24.6%) of the 69 patients without infection expired (p-value 0.008). 112 patients with mean SOFA score of 11.35 ± 2.71 expired while as 145 patients with mean SOFA score of 5.84 ± 1.92 survived (p value < 0.001). CONCLUSIONS: The prevalence of infections was more in medical ICU than in surgical ICU. The nosocomial infections significantly increase the average length of stay in ICUs. Mortality was significantly more in patients admitted with infection in Intensive Care Units. The higher the SOFA score, greater the mortality.
PL
WSTĘP: Zakażenie jest główną przyczyną zachorowalności i śmiertelności na oddziałach intensywnej opieki medycznej (OIOM), zwłaszcza na oddziałach intensywnej opieki medycznej o ograniczonych zasobach w krajach o niskich i średnich dochodach. Jednak stosunkowo niewiele informacji jest dostępnych na temat epidemiologii i skutków takich zakażeń w naszej części świata. Chodziło o dostarczenie informacji na temat częstości występowania i wyników pierwotnych i wtórnych (szpitalnych) zakażeń na OIT. MATERIAŁ I METODY: Do badania włączono 257 dorosłych pacjentów przyjmowanych na OAiIT zachowawcze i chirurgiczne w okresie 9 miesięcy. Pacjentów spełniających kryteria sepsy 3 zakwalifikowano do kategorii „występowanie zakażeń”, a pacjentów, u których doszło do zakażenia po 48 godzinach przyjęcia na OIT, do kategorii „zakażenia wtórne (szpitalne)”. Punktację Sekwencyjnej Oceny Niewydolności Narządów (SOFA) obliczono przy przyjęciu i po 72 godzinach pobytu na OIT. Pacjenci byli obserwowani przez 30 dni. WYNIKI: Pacjenci zostali podzieleni na dwie grupy: 153 (59,5%) na OIT i 104 na OIT chirurgicznie. Częstość występowania pierwotnej infekcji była istotnie wyższa u pacjentów na OIT (wartość p < 0,05). Łącznie 93 (60,8%) pacjentów na OIT i 50 (48,1%) pacjentów na OIOM chirurgicznym zostało przyjętych jako infekcje pierwotne (wartość p < 0,001). Zakażenia wtórne (szpitalne) wystąpiły u 30 (19,6%) pacjentów na OIOM-ie medycznym i 15 (14,4%) pacjentów na OIOM-ie chirurgicznym (wartość p 0,283). Średnia długość pobytu wyniosła 14 dni u pacjentów z zakażeniami szpitalnymi i 3,5 dnia u pacjentów bez zakażeń wtórnych (wartość p < 0,001). Spośród 188 zakażonych pacjentów 80 (42,5%) zmarło, podczas gdy 17 (24,6%) z 69 pacjentów zmarło bez infekcji (wartość p 0,008). 112 pacjentów ze średnią punktacją SOFA 11,35 ± 2,71 zmarło, a przeżyło 145 pacjentów ze średnim wynikiem SOFA 5,84 ± 1,92 (wartość p < 0,001). WNIOSKI: Częstość występowania zakażeń była większa na OIOM-ie medycznym niż na OIOM-ie chirurgicznym. Zakażenia szpitalne istotnie wydłużają przeciętną długość pobytu na OIT. Śmiertelność była istotnie wyższa u pacjentów przyjętych z infekcją na Oddziałach Intensywnej Terapii. Im wyższy wynik SOFA, tym większa śmiertelność.
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Acinetobacter Baumannii Nosocomial Infections

100%
Sieniawski K., Kaczka K., Rucińska M., Gagis L., Pomorski L.
Polish Journal of Surgery
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2013
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vol. 85
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issue 9
483-490
EN
Nosocomial infections caused by strains Acinetobacter baumannii strands are a growing clinical problem. The occurrence of multidrug-resistant strands is observed and that limits the ways of therapy considerably. The aim of the study was to determine the rate of infection and susceptibility spectrum of the species Acinetobacter baumannii isolated from patients treated at Maria Skłodowska-Curie Memorial Hospital in Zgierz with particular emphasis on surgical wards. Materials and methods. The material consisted of Acinetobacter baumannii isolates were obtained from samples of materials from patients treated at Maria Skłodowska-Curie Memorial Hospital in Zgierz from January to December 2011. Isolated bacterial strains were cultured at microbiological substrates. Isolates were identified to species using the VITEK 2 GN card (bioMérieux) and Vitek 2 automated system (bioMérieux). Susceptibility towards antibiotics of particular strains was determined by the means of AST NO 93 card. In the case of resistance towards carbapenem, the MIC was marked by E-test with Mueller Hinton substrate. The occurrence of MBL was verified by the means of disc system with Mueller Hinton substrate. Results. We have shown that total number of Acinetobacter baumannii infections at hospital was 140 (10,31% of total results of cultures). Percentage of Acinetobacter baumannii infections at wards: Intensive Care Unit 48%, Surgical Departments 20%, Internal Diseases Department 16%, Neurology 13%, other wards - 3%. The susceptibility percentage of Acinetobacter Baumannii against antibiotics: colistin 90%, imipenem 64%, meropenem 43%, ampicillin-sulbactam 28%, amikacin 27%, gentamicin 24%, cefepime 9%, ceftazidime 7%, ciprofloxacin 7% Conclusions. Acinetobacter baumannii infections are a significant proportion of nosocomial infections. Most relate to surgical wards and ICUs. Acinetobacter baumannii is resistant against most antibiotics. The highest percentage of sensitivity demonstrated for colistin and carbapenems
3
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Personal Experiences in Treatment of Diabetic Foot Syndrome

88%
Lewandowski A., Paszta W., Nowatorski W.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
609-614
EN
Changes like deformities, ulcerations, infection and destruction of deep tissues of foot caused by diabetes mellitus are called diabetic foot syndrome. About 2.5 million people (6% of population) suffer from diabetes mellitus in Poland. About 100 000 of them suffer from diabetic foot syndrome.The aim of the study was to retrospectively analyze patients with diabetic foot syndrome and present results of the surgical treatment of these patients.Material and methods. The study group comprised 112 patients of both sexes aged between 34 and 90 years treated in our Department of Surgery from January 2003 to December 2007. The mean age for men was 61 years and for women - 72 years. Most patients in the study group were diagnosed with type 2 diabetes mellitus (89.2% in men and 95.7% in women). Symptomatic atherosclerosis occurred in 25% of treated patients.Results. 112 patients with diabetic foot syndrome needed 144 hospitalizations (65 male patients needed 86 hospitalizations and 47 female patients needed 58 hospitalizations). The average hospitalization duration for male patients was 24 days and for female patients was 22 days. 8 patients (7,1%) died - 3 men and 5 women. 82 (73%) patients were operated. Operative methods consisted of phlegmon incision, amputation of toes, metacarpal amputation and amputation of limb under and above the knee. 38 different bacterial species were cultured as the results of microbiological evaluations in 71 patients.Conclusions. Patients with diabetic foot syndrome are hospitalized in department of surgery many times, they need multidisciplinary treatment and can be a source of nosocomial infections.
4
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Multidrug-resistant strains of coagulase-negative staphylococci isolated from patients with chronic sinusitis – MDR, XDR, PDR strains

75%
Michalik M., Podbielska-Kubera A., Samet A., Konopka W.
Polish Journal of Otolaryngology
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2020
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vol. 74
|
issue 2
36-41
EN
Introduction: The development of resistance to multiple antimicrobial agents in pathogenic bacteria has become a threat to public health. Multidrug-resistant strains that are particularly dangerous include MDR, XDR and PDR strains. Material and methods: Aspirate material from paranasal sinuses, obtained from patients with chronic sinusitis undergoing functional endoscopic sinus surgery (FESS) in Medical Center MML in Warsaw, was subjected to bacteriologic analysis. The isolated strains were identified to the species level and tested for antibiotic resistance. Then, minimal inhibitory concentration (MIC) was determined. R esults: The isolated strains of coagulase-negative staphylococci were resistant mainly to macrolides, aminoglycosides and tetracycline. Nine of the isolated strains exhibited multidrug-resistance. Discussion: Bacteria causing chronic sinusitis are becoming increasingly resistant to antimicrobial agents. The diagnostic process for coagulase-negative staphylococci (CNS) is often limited to the identification of species, or even genus of the bacteria. The CNS strains are considered to be non-pathogenic and they are not subject to eradication. This may lead to erroneous therapeutic decisions and, consequently, to the development of antibiotic resistance. CNS infections are classified as nosocomial and therefore, appropriate epidemiological procedures have to be followed. The authors highlight the necessity to determine MIC values for antibiotics and to introduce personalized treatment.
5
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Wiedza pielęgniarek na temat profilaktyki rozprzestrzeniania zakażenia bakterią Clostridium difficile

75%
Grączewska N.
Innowacje w Pielęgniarstwie i Naukach o Zdrowiu
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2022
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vol. 7
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issue 4
68-89
EN
Introduction. Nosocomial infections affect all healthcare facilities around the world. Despite the development of medicine, they pose a great threat not only to hospitalized patients, but also to healthcare professionals and people visiting the facility. Healthcare-associated infections worsen the course of the underlying disease, prolong the length of the patient's stay, increase the cost of treatment and increase patient mortality. The wide spread of the infection can lead to the closure of the ward or hospital. Aim. The aim of the study is to assess the level of knowledge of nurses about the spread of Clostridium difficile infection. Material and methods. The subject of the research is the knowledge of nurses about the spread of Clostridium difficile infection. For the purposes of the study, the diagnostic survey method was used, and the research tool was the author's questionnaire. Results. The level of knowledge was the highest in the group of people aged 41-50, and the lowest in the group of people aged up to 30. The relationship between the level of knowledge on the spread of infection with the Clostridium difficile bacterium and work experience was demonstrated. It was observed that the level of knowledge was the highest in the group of people working for over 20 years, the lowest in the group of people working for up to 5 years. The relationship between the state of knowledge about the spread of Clostridium difficile infection and the assessment of one's own knowledge deficit was demonstrated. It was observed that the level of knowledge was the highest in the group of people assessing the deficit of their knowledge in the field of Clostridium difficile infection itself, and the lowest in the group of people assessing the deficit of their knowledge in the field of hygiene. Conclusions. The analysis of the results of the conducted research confirmed that seniority and professional title have a positive impact on the knowledge of procedures among the staff. The surveyed nurses are well prepared to work with patients infected with Clostridium difficile.
PL
Wstęp. Zakażenia szpitalne dotyczą wszystkich placówek ochrony zdrowia na całym świecie. Pomimo rozwoju medycyny, stanowią duże zagrożenie nie tylko dla pacjentów hospitalizowanych, lecz także dla pracowników ochrony zdrowia oraz osób odwiedzających placówkę. Zakażenia związane z opieką zdrowotną wpływają na pogorszenie przebiegu choroby podstawowej, wydłużają czas pobytu pacjenta, zwiększają koszty leczenia oraz wpływają na wzrost śmiertelności pacjentów. Szerokie rozprzestrzenienie się zakażenia może doprowadzić do zamknięcia oddziału czy szpitala. Cel. Celem pracy jest ocena poziomu wiedzy pielęgniarek na temat rozprzestrzeniania zakażenia bakterią Clostridium difficile. Materiał i metody. Przedmiotem badań jest wiedza pielęgniarek na temat rozprzestrzeniania zakażenia bakterią Clostridium difficile. Dla potrzeb pracy skorzystano z metody sondażu diagnostycznego a narzędziem badawczym był autorski kwestionariusz ankiety. Wyniki. Poziom wiedzy najwyższy był w grupie osób w wieku 41 –50 lat, najniższy w grupie osób w wieku do 30 lat. Wykazano zależność między stanem posiadanej wiedzy na temat rozprzestrzeniania się zakażenia bakterią Clostridium difficile a stażem pracy. Zaobserwowano, że poziom wiedzy najwyższy był w grupie osób pracujących ponad 20 lat, najniższy w grupie osób pracujących do 5 lat. Wykazano zależność między stanem posiadanej wiedzy na temat rozprzestrzeniania się zakażenia bakterią Clostridium difficile a oceną własnego deficytu wiedzy. Zaobserwowano, że poziom wiedzy najwyższy był w grupie osób oceniających deficyt swojej wiedzy w zakresie samego zakażenia bakterią Clostridium difficile, najniższy w grupie osób oceniających deficyt swojej wiedzy w zakresie higieny. Wnioski. Analiza wyników przeprowadzonych badań potwierdziła, że staż pracy oraz tytuł zawodowy pozytywnie kształtuje znajomość procedur wśród personelu. Ankietowane pielęgniarki są dobrze przygotowane do pracy z pacjentem zarażonym CD.
6
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Content available

Multidrug-resistant strains of coagulase-negative staphylococci isolated from patients with chronic sinusitis – MDR, XDR, PDR strains

75%
Michalik M., Podbielska-Kubera A., Samet A., Konopka W.
Otolaryngologia Polska
|
2020
|
vol. 74(2)
36-41
EN
Introduction: The development of resistance to multiple antimicrobial agents in pathogenic bacteria has become a threat to public health. Multidrug-resistant strains that are particularly dangerous include MDR, XDR and PDR strains. Material and methods: Aspirate material from paranasal sinuses, obtained from patients with chronic sinusitis undergoing functional endoscopic sinus surgery (FESS) in Medical Center MML in Warsaw, was subjected to bacteriologic analysis. The isolated strains were identified to the species level and tested for antibiotic resistance. Then, minimal inhibitory concentration (MIC) was determined. R esults: The isolated strains of coagulase-negative staphylococci were resistant mainly to macrolides, aminoglycosides and tetracycline. Nine of the isolated strains exhibited multidrug-resistance. Discussion: Bacteria causing chronic sinusitis are becoming increasingly resistant to antimicrobial agents. The diagnostic process for coagulase-negative staphylococci (CNS) is often limited to the identification of species, or even genus of the bacteria. The CNS strains are considered to be non-pathogenic and they are not subject to eradication. This may lead to erroneous therapeutic decisions and, consequently, to the development of antibiotic resistance. CNS infections are classified as nosocomial and therefore, appropriate epidemiological procedures have to be followed. The authors highlight the necessity to determine MIC values for antibiotics and to introduce personalized treatment.
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