Impact of an Infection Control Program in an Intensive Care Unit in France •
To evaluate the impact of an infection control program in an intensive care unit (ICU).
Prospective before-after study. Two 6-month study periods were compared; between these periods, an infection control program based on isolation was implemented.
Polyvalent ICU of Montpellier Teaching Hospital.Patients. Any patient who was hospitalized in the ICU for >48 hours and was discharged during 1 of the 2 periods.
The main patient-related variables were sex, age at admission, type of patient (surgical, medical, or trauma), Simplified Acute Physiology Score II, length of ICU stay, need for intubation, duration of exposure to invasive devices, onset of nosocomial infection and pathogens responsible, and death. We compared the 2 study periods with respect to the incidence of 4 nosocomial infections (pneumonia, urinary tract infection, bacteremia, and catheter-associated infection), the frequency of infection with the main multidrug-resistant pathogens, and patient survival.
Patients in periods 1 and 2 were similar with regard to sex, age, physiology score, and exposure to invasive devices. The rates of infection with multidrug-resistant pathogens were significantly lower during period 2 than during period 1 (infection rate: 28.1% of patients in period 1 and 9.6% of patients in period 2 [P = .01]; pneumonia rate: 32.6% of patients in period 1 and 4.2% of patients in period 2 [P = .008]). The mortality rate among patients with nosocomial pneumonia was 38.2% in period 1 and 4.3% in period 2 (P = .009).
After implementation of an infection control program, the rate of infection with multidrug-resistant pathogens decreased, as did the mortality rate among patients with nosocomial pneumonia.
Available from: Craig Maclean
- "In recent years, the incidence of infections attributable to multiple drug-resistant (MDR) strains of many bacterial species, including Mycobacterium tuberculosis, Staphylococcus aureus, Pseudomonas aeruginosa and several Enterococcus spp. has increased, and it is currently estimated that, depending on the species in question, between 20% and 80% of bacterial infections worldwide are caused by MDR strains (McCormick et al., 2003; Verdier et al., 2006; Wright et al., 2006). Given the elevated costs and difficulties associated with treating MDR bacterial infections (Levy, 1998), it is important to understand the evolutionary mechanisms that constrain and promote MDR. "
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ABSTRACT: The spread of bacterial antibiotic resistance mutations is thought to be constrained by their pleiotropic fitness costs. Here we investigate the fitness costs of resistance in the context of the evolution of multiple drug resistance (MDR), by measuring the cost of acquiring streptomycin resistance mutations (StrepR) in independent strains of the bacterium Pseudomonas aeruginosa carrying different rifampicin resistance (RifR) mutations. In the absence of antibiotics, StrepR mutations are associated with similar fitness costs in different RifR genetic backgrounds. The cost of StrepR mutations is greater in a rifampicin-sensitive (RifS) background, directly demonstrating antagonistic epistasis between resistance mutations. In the presence of rifampicin, StrepR mutations have contrasting effects in different RifR backgrounds: StrepR mutations have no detectable costs in some RifR backgrounds and massive fitness costs in others. Our results clearly demonstrate the importance of epistasis and genotype-by-environment interactions for the evolution of MDR.
Available from: Rivaldo Venâncio da Cunha
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ABSTRACT: Hospital infection is a serious public health problem in the world and the critical patients, admitted to the ICU, have a great chance of getting it due to the seriousness of their clinical case and to the frequent use of invasive procedures. Objective: To know the epidemiology of hospital infections in the Intensive Care Unit of a Teaching Hospital. Method: Descriptive prospective study made in the ICU at the University Hospital of the Universidade Federal de Mato Grosso do Sul in Brazil, from Februa- ry to July of 2006. Through active daily search, the cases of hospital infection were identifi ed and also the main risk factors associated to it. Results: A total of 118 patients were observed: 59.3% (70/118) were male, 40.7% (48/118) were female; average age of 58. The global rate of hospital infection was 53.4% (63/118) and the density of occurren- ce was 52.0 for every 1000 patients/day. Hypoalbuminemia, a longer
Available from: Gadi Borkow
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ABSTRACT: Nosocomial infections, especially those caused by antibiotic resistant bacteria, are increasing at an alarming rate over the globe. Unfortunately, standard infection control practices, such as pre-emptive isolation of high-risk patients, wide and targeted surveillance cultures, and proper ventilation systems are lacking in developing countries mainly due to insufficient resources. Patients shed bacteria and contaminate their pyjamas and sheets. The temperature and humidity between the patients and the bed are appropriate conditions allowing for effective bacterial proliferation. Bed making releases large quantities of micro-organisms into the air, which contaminate the immediate and non-immediate surroundings. Personnel in contact with contaminated textiles can also cross-contaminate other surfaces or patients. Thus textiles in hospitals can be an important source of microbes contributing to endogenous, indirect-contact, and aerosol transmission of nosocomial related pathogens. The use of safe wide-spectrum antimicrobial textiles, especially in those textiles that are in close contact with the patients, may significantly reduce bioburden in clinical settings and consequently reduce the risk of nosocomial infections. This is of special significance in resource poor developing countries, where wards are overcrowded and population infection burdens are very high. The use of biocidal textiles is a simple, cost-affordable and feasible measure that may be especially important in developing countries where essential infection control measures are not implemented.
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