Acinetobacter baumannii blood infections in intensive care patients [Bacteremia por Acinetobacter baumannii en pacientes en estado crftico]

Objective: Determine the severity and the course of Acinetobacter baumannii blood infections (AbBI). Methods: We carried out a prospective review of all Acinetobacter baumannii (A.baumannii) isolated from the Intensive Care Unit (ICU) of a medical facility. Results: During the study period, 46 patients were identified with AbBI. The rate of AbBI was 14per 1,000 admissions. A.baumannii was ICU acquired in 85% of cases studied. The median time frame between ICU admission and acquisition of AbBI was 9�7 days. 31 patients displayed blood infection (BI) by A.baumannii alone and 15 with polymicrobial BI. The clinical manifestation of the 31 patients with AbBI included the following symptoms: 42% presented with septic shock, 42% had severe sepsis and 16% had sepsis. Two or more episodes of AbBI were observed among 13% of patients. Of A. baumannii isolates, 17% were resistant to imipenem. Patient mortality with AbBI alone was 45% and 40% for polymicrobial BI. Patient mortality for septic shock was 60%, 70% died during the first 72 hrs after AbBI. Conclusions: AbBI displayed an endemic pattern during the study period. Severe sepsis and septic shock were the most common clinical presentations of AbBI. AbBI are associated with a significant increase in the death rate of patient in the ICU studied

Cerebral venous thrombosis at the Hospital Civil de Guadalajara "Fray Antonio Alcalde" [Trombosis venosa cerebral en el Hospital Civil de Guadalajara "Fray Antonio Alcalde"]

Introduction: Cerebral venous thrombosis (CVT) is the least common among all sorts of acute cerebrovascular disease, with a hospital frequency reported of 0.43 to 8% in Mexico. CVT has been studied mainly in concentration hospitals in Mexico City; however, its features in other scenarios of the rest of the country are unknown. Objective: To describe the main clinical, therapeutic and radiological features as well as the prognosis of CVT at the Hospital Civil de Guadalajara "Fray Antonio Alcalde". Material and methods: All consecutive patients with diagnosis of CVT between 1999 and 2008, complete data about clinical and radiological characteristics at hospital admittance, as well as the in-hospital evolution and outcome at discharge and during long-term follow-up were registered. Results: A total of 24 patients with mean age of 30 years were included; 20 of them (83%) were women. The course of the CVT was mainly sub-acute with a delay in diagnosis of eleven days. Headache, motor focal signs and cognitive and behavioral disturbances were the most common manifestations. Longitudinal superior sinus was the most affected. Puerperium was the most frequently associated condition to CVT (46%). Hospital stay was 22 days in average and during this lapse, one fourth of patients received anticoagulation. At discharge, mortality rate was 8% with a bad outcome in 50% of cases; however, during a follow-up (17 months in average), 70% observed a good outcome, without CVT recurrence. Conclusion: CVT in our hospital is not different to what has been previously reported in other hospitals in Mexico. The mortality observed was low and the long term prognosis was good

Cerebral venous thrombosis at the Hospital Civil de Guadalajara "Fray Antonio Alcalde" [Trombosis venosa cerebral en el Hospital Civil de Guadalajara "Fray Antonio Alcalde"]

Introduction: Cerebral venous thrombosis (CVT) is the least common among all sorts of acute cerebrovascular disease, with a hospital frequency reported of 0.43 to 8% in Mexico. CVT has been studied mainly in concentration hospitals in Mexico City; however, its features in other scenarios of the rest of the country are unknown. Objective: To describe the main clinical, therapeutic and radiological features as well as the prognosis of CVT at the Hospital Civil de Guadalajara "Fray Antonio Alcalde". Material and methods: All consecutive patients with diagnosis of CVT between 1999 and 2008, complete data about clinical and radiological characteristics at hospital admittance, as well as the in-hospital evolution and outcome at discharge and during long-term follow-up were registered. Results: A total of 24 patients with mean age of 30 years were included; 20 of them (83%) were women. The course of the CVT was mainly sub-acute with a delay in diagnosis of eleven days. Headache, motor focal signs and cognitive and behavioral disturbances were the most common manifestations. Longitudinal superior sinus was the most affected. Puerperium was the most frequently associated condition to CVT (46%). Hospital stay was 22 days in average and during this lapse, one fourth of patients received anticoagulation. At discharge, mortality rate was 8% with a bad outcome in 50% of cases; however, during a follow-up (17 months in average), 70% observed a good outcome, without CVT recurrence. Conclusion: CVT in our hospital is not different to what has been previously reported in other hospitals in Mexico. The mortality observed was low and the long term prognosis was good

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically