Catheter-associated urinary tract infections: patient characteristics, treatment, and clinical outcomes in one South Texas acute care hospital

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital. Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes. Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients ranged in age from 44 to 71 years old with a mean age of 68.8 years old; 2 were male and 3 were female; the average length of stay ranged from 19 to 59 days with an average stay of 32.2 days. All patients had severe illness on presentation and multiple comorbidities. Organisms isolated included klebsiella oxytoca, carbapenem-resistant Enterobacteriaceae, extended-spectrum beta-lactamase E. coli and klebsiella pneumoniae. Susceptibility studies were conducted on all 5 patients. Antibiotics used include piperacillin-tazobactam, ceftriaxone, levofloxacin, and meropenem. CAUTIs resolved in 4 patients; two of them were discharged to skilled nursing facilities, one was discharged home, and one died due to complications from COVID-19. Conclusions: Among these cases, factors such as local rates of COVID-19 cases (the cases happened when hospital census was unusually high), extended length of stay, use of mechanical ventilation, Foley catheter placement in the Emergency Department, severe illness, and comorbid health conditions should be considered when assessing risk of CA-UTI and treatment outcome. While antibiotics that were prescribed appropriately corresponded with sensitivity studies, sustainability of infection prevention processes for the prevention of CA-UTIs is difficult to sustain during periods of crisis as exemplified in this project

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted