EPIDEMIOLOGY OF BACTERIA COLONIZATION AND ICU-ACQUIRED INFECTION IN A NIGERIAN TERTIARY HOSPITAL

Background: Health care associated infection (HCAI) or Hospital acquired infection is associated with significant morbidity, mortality and cost. The incidence is about 6% and disproportionately higher in critically ill patients who may have been immune-compromised with many invasive procedures already performed. Prevention of HCAI and appropriate management of patients in the intensive care unit (ICU) requires knowledge on the pattern of microbial colonization and infections. The aim of this preliminary study was to provide current data on the pattern of ICU acquired infections in our hospital. Patients and Methods: It was a cross sectional study of patients admitted into the ICU who were expected to stay longer than 48hrs between July 2011 and September 2012. Urine, blood, and tracheal aspirate were collected on days 1, 3 and 5 for microbiological studies. All patients involved in the study had urethral catheter in-situ and received mechanical ventilation in the ICU. Results: Fifty-nine patients were recruited into the study. The mean age of the patients was 30.08 + 19.9yr; while the reasons for admissions were respiratory failure (59.3%), cardiovascular instability, trauma and neurological diseases. About 30% of the samples taken from the study sites on arrival in the ICU had positive culture yields. Organisms cultured included Klebsiella oxytoca, Staphylococcus aureus, and Pseudomonas aeruginosa. The urinary tract had the highest number of isolated organisms- 9(60%), followed by equal number of isolated organisms-3(20%) in the blood and respiratory tract. Eleven (73.3%) of the organisms isolated were Gram-negative bacteria, and 4 (26.7%) were Gram-positive cocci. The commonest bacteria isolates were Staphylococcus aureus (4/26.7%) and Klebsiella oxytoca (4/ 26.7%). A total of 15 ICU- acquired infections were detected in 9 of 59 patients. Conclusion: The HCIA infection rate was 15%, and urinary tract infections (UTI) was the commonest hospital acquired infection in our ICU. Klebsiella oxytoca and Staphylococcus aureus were the commonest organisms

ICU utilization by cardio-thoracic patients in a Nigerian Teaching Hospital: Any role for HDU?

Background: The underlying pathological conditions in cardio-thoracic patients, anesthetic and operative interventions often lead to complex physiological interactions that necessitate ICU care. Our objectives were to determine the intensive care unit (ICU) utilization by cardio-thoracic patients in our centre, highlight the common indications for admission; and evaluate the interventions provided in the ICU and the factors that determined outcome. Materials and Methods: The intensive care unit (ICU) records of University College Hospital, Ibadan for a period of 2 years (October 2007 to September 2009) were reviewed. Data of cardio-thoracic patients were extracted and used for analysis. Information obtained included the patient demographics, indications for admission, interventions offered in the ICU and the outcome. Results: A total of 1, 207 patients were managed in the ICU and 206 cardio-thoracic procedures were carried out during the study period. However, only 96 patients were admitted into the ICU following cardio-thoracic procedures, accounting for 7.9% of ICU admissions and 46.6% of cardio-thoracic procedures done within the review period. The mean length of stay and ventilation were 5.71 ± 5.26 and 1.30 ± 2.62 days. The most significant predictor of outcome was endotracheal intubation (P = 0.001) and overall mortality was 15%. Conclusion: There is a high utilization of the ICU by cardio-thoracic patients in our review and post-operative care was the main indication for admission. Some selected cases may be managed in the HDU to reduce the burden on ICU resources. We opine that when endotracheal intubation is to continue in the ICU, a 1:1 patient ratio should be instituted

Intensive care unit admissions during the puerperium in Ibadan

Context: Intensive care unit (ICU) admissions of parturients are rare and is about 0.2% of total number of maternities per year in the United Kingdom (UK) compared to 1.1% reported from a teaching hospital in Benin, Nigeria. Objective: This study sought the indications and outcome of critically ill obstetric patients admitted into the intensive care unit (ICU) of the University College Hospital (UCH), Ibadan, Nigeria in the year 2001. Study Design, setting and subjects: Descriptive study involving 21patients admitted into the ICU, University st st College Hospital, Ibadan, between 1 January to 31 December 2001. Data was prospectively collected from each obstetric patient admitted. Results: The total number of deliveries during the year was 1,132 and 21 patients required admission into the ICU (1.86%). The median age was 26 years with a range of 20 35years. Eighteen patients (81%) were admitted postemergency caesarean section or exploratory laparatomy. Eclampsia accounted for 47.6% (10/21) of the admissions, followed by severe haemorrhage from ruptured uterus 33.3% (7/21). Ten patients died giving a mortality rate of 47.6% in this series of obstetric patients admitted into the ICU. Conclusion: The admission rate of obstetrics patient into the ICU in Ibadan is 1.86%, this may be reduced by an improvement in the management of hypertensive disease of pregnancy and reducing the incidence of ruptured uterus through health education of parturient with high risk pregnancies on the need to have monitored ante-natal care and delivery. Keywords: obstetric, ICU admissions, indications, outcome Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 56-5