Catheter Associated Urinary Tract Infection Prevention bundle

Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, and potentially lead to significant morbidity and mortality. Multifaceted infection control strategies implemented as bundles can prevent nosocomial infections associated with invasive devices such as CAUTIs. The components of the CAUTI bundle proposed herein, include appropriate indications for catheterization and recommendations for the procedures of catheter insertion and catheter maintenance and care. Avoiding unnecessary urinary catheter use is the most effective measure for their prevention. To minimize the risk of CAUTI, urinary catheters should be placed only when a clinical valid indication is documented and they should be removed as soon as possible; alternatives to catheterization should also be considered. Aseptic insertion technique, maintenance of closed drainage system and strict adherence to hand hygiene are essential for preventing CAUTI. The successful implementation of the bundle requires education and training for all healthcare professionals and evaluation of surveillance data

Impact of bloodstream infections caused by carbapenem-resistant Gram-negative pathogens on ICU costs, mortality and length of stay

Background: The aim of this study was to estimate the impact of bloodstream infections (BSIs) caused by carbapenem-resistant Gram-negative (CRGN) pathogens on hospital costs, mortality and length of stay (LOS). Methods: All patients hospitalized for ≥3 days in the Intensive Care Unit (ICU) of a tertiary-care general hospital from 1/1/2015 to 31/12/2017 were included in the study. A retrospective case-control study was performed in order to examine the difference in medical, pharmaceutical and operating costs, LOS and in-hospital mortality between patients with BSI caused by CRGN/without BSI (cases/controls, respectively). The statistical analysis was performed using the SPSS software (v23.0). Results: A total of 419 patients (67.5% males, median age 60.0 years) were included in the analysis (142 cases/277 controls); 10 patients with non-CRGN BSIs were excluded. Overall mortality was 33.7% (49.3/25.6% in cases/controls). The median LOS and total cost were 30.0 vs. 12.0 days and 20 359.1 vs. 8,509.3 €, respectively, between patients with/without CRGN BSIs. After adjusting for baseline demographics, underlying disease severity and patients' specialties, CRGN BSIs remained a significant factor in mortality (odds ratio 2.9; 95% confidence interval 1.8–4.8; p <0.001). Additionally, CRGN BSIs seem to result in significantly prolonged LOS and extra cost per infected patient (p <0.001). Conclusions: ICU patients with CRGN BSI are at increased risk for mortality and prolonged hospitalization and incur higher costs, imposing a heavy burden on healthcare system. Infection control strategies, considering also the cost-efficacy of interventions, are crucial in order to control the expansion of CRGN infections. © 2019 The Author

Infection control interventions affected by resource shortages: impact on the incidence of bacteremias caused by carbapenem-resistant pathogens

We evaluated an infection control (IC) program influenced by personnel and material resource shortages on the incidence of bloodstream infections (BSI) due to carbapenem-resistant Klebsiella pneumoniae (CRKP), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA) in an endemic region. Between January 2010 and December 2015, all BSI episodes caused by CRKP, CRAB, and CRPA were recorded. An IC bundle was implemented in January 2012. We evaluated the effect of the interventions on BSI rates between the pre-intervention (2010–2011) and intervention (2012–2013) periods, using an interrupted time-series model. From 2014, when interventions were still applied, BSI incidence was gradually increased. For this reason, we evaluated with a linear mixed effects model several factors possibly contributing to this increase for the years 2012–2015, which was considered as the intervention/follow-up period. During the study period, 351 patients with BSI were recorded, with a total of 538 episodes; the majority (83.6%) occurred in the intensive care unit (ICU). The BSI incidence rate per year during 2010–2015 for ICU patients was 21.03/19.63/17.32/14.45/22.85/25.02 per 1000 patient-days, respectively, with the reduction in BSI levels after the start of intervention marginal (p = 0.054). During the follow-up period (2014–2015), the most influential factors for the increased BSI incidence were the reduced participation in educational courses and compliance with hand hygiene. The implementation of IC interventions reduced the BSI incidence rates, particularly for ICU patients. However, factors possibly related to the restrictions of human and material resources apparently contributed to the observed expansion of BSI in our endemic setting. © 2017, Springer-Verlag GmbH Germany

Five-year trends of antimicrobial drugs consumption and incidence of bloodstream infections caused by multidrug-resistant pathogens in a Greek ICU

<p>Excessive and inappropriate use of antibiotics enhances the emergence of antimicrobial resistance, resulting into a vicious cycle. Continuous surveillance of antibiotic consumption and implementation of antibiotic stewardship programs (ASP) is an important component of infection control interventions. Greece is a high endemicity area for multidrug resistant pathogens (MDR), especially carbapenem-resistant (CR) Gram-negatives (GN), and moreover antibiotic consumption is among the highest in Europe. Aim of this study was to record antibiotic consumption and the incidence of bloodstream infections (BSI) caused by MDR pathogens in our 12-bed general ICU, before initiating an ASP in the hospital. Trends over time were also evaluated.</p><p>An observational study was performed from January 2010 to December 2014. Consumption data were retrospectively collected from the hospital pharmacy records and expressed as daily defined doses (DDD) per 1000 patient-days (PD). All BSI episodes caused by CR Klebsiella pneumoniae (CRKP), CR Acinetobacter baumannii (CRAB), CR Pseudomonas aeruginosa (CRPA), vancomycin-resistant Enterococcus spp (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were prospectively recorded. Identification was performed by conventional or automated methods (Vitek 2 Compact, bioMerieux). Antimicrobial susceptibility testing and MIC values determination was performed by Vitek 2 and Etest (bioMerieux).</p><p>We recorded 395 BSI episodes caused by the study pathogens, with a mean annual incidence of 21.21/1000 PD. The incidence declined from 22.95 in 2011 to 17.90/1000 PD in 2013, however, a significant increase was observed in 2014 (25.21/1000 PD, p= 0.03). No correlations between the consumption of antimicrobial agents (AMA) and incidence data were found. The predominant pathogens were CRAB and CRKP. Antibiotic use was high in all 5 years of the study with a mean annual consumption of 3077 DDD/1000 PD. The most common AMA prescribed was ampicillin/sulbactam (17.7%), followed by meropenem (16.8%) and colistin (11.8%). Τhe total AMA consumption rose by 20.3% from 2010 to 2014 (p= 0.18). The rate of change in AMA use was more remarkable for quinolones (128.4%, p= 0.004) and colistin (66.1%, p= 0.02). A decreasing trend was observed for only few antimicrobials, such as tigecycline (-48.5 %, p= 0.12) and daptomycin (-93%, p= 0.012).</p><p>Total AMA use temporary decreased in 2011 (-21.3%, p= 0.33) and a continuous and significant increasing trend was observed thereafter (p= 0.022). In conclusion, the local epidemiology of resistance defines the antimicrobial decision-making. In our setting, the high incidence of CRGN imposes the use of broad-spectrum and last resort AMA. In the era of growing resistance and limited treatment options, judicious antibiotic use is crucial. Our surveillance data increase our awareness and necessitate the ASP launching, so as to optimize antibiotic prescribing and preserve the effectiveness of last resort antimicrobials.</p&gt

Wide dissemination of linezolid-resistant Staphylococcus epidermidis in Greece is associated with a linezolid-dependent ST22 clone

Objectives: Dependence on linezolid was recently described as significant growth acceleration of linezolidresistant Staphylococcus epidermidis (LRSE) isolates upon linezolid exposure. We investigated the possible contribution of linezolid dependence to LRSE dissemination in Greece. Methods: Linezolid resistance rates were estimated in six tertiary hospitals located throughout Greece between 2011 and 2013. Sixty-three randomly selected LRSE recovered in these hospitals during this period were studied. Growth curve analysis was conducted with and without linezolid. Clonality of the isolates was investigated by PFGE and MLST. Results: During the study period, the LRSE rate in the participating hospitals rose significantly from 6.9% to 9% (P=0.006); the increase was more prominent in ICUs (from 15.1% to 20.9%; P=0.005). Forty-seven (74.6%) of the 63 LRSE, derived from all study hospitals, clearly exhibited linezolid dependence, growing significantly faster in the presence of 16 and 32 mg/L linezolid. Of note, 61 (96.8%) LRSE exhibited a single macrorestriction pattern and belonged to ST22, which included all linezolid-dependent LRSE. The remaining two LRSE belonged to unique STs. Five of six linezolid-dependent isolates tested also exhibited linezolid dependence upon exposure to 8 mg/L linezolid. Interestingly, five of six ST22 linezolid-non-dependent isolates tested developed linezolid dependence when linezolid exposure preceded growth analysis. Conclusions: The rapid LRSE dissemination in Greek hospitals threatens linezolid activity. The observation that most LRSE belonged to ST22 and expressed dependence on linezolid clearly implies that the spread of linezolid resistance should have been driven by this trait, which provided the LRSE with a selective advantage under linezolid pressure. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved