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Medicine › Critical Care and Intensive Care Medicine

Nosocomial Infections in ICU

Works Count: 28415

Description

This cluster of papers focuses on the management, diagnosis, treatment, and prevention of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. It covers topics such as antibiotic therapy, healthcare-associated infections, respiratory tract decontamination, nosocomial infections, and microbial investigation. The papers also discuss the impact of VAP on patient outcomes and the implementation of evidence-based guidelines for preventing VAP.

Keywords

Ventilator-associated Pneumonia; ICU; Antibiotic Therapy; Healthcare-associated Infections; Prevention Guidelines; Nosocomial Infections; Respiratory Tract Decontamination; Microbial Investigation; Pulmonary Infections; Endotracheal Tubes

Incidence of and Risk Factors for Ventilator-Associated Pneumonia in Critically Ill Patients

1998-09-15
Richard J. Cook
Background: Understanding the risk factors for ventilator-associated pneumonia can help to assess prognosis and devise and test preventive strategies. Objective: To examine the baseline and time-dependent risk factors for ventilator-associated … Background: Understanding the risk factors for ventilator-associated pneumonia can help to assess prognosis and devise and test preventive strategies. Objective: To examine the baseline and time-dependent risk factors for ventilator-associated pneumonia and to determine the conditional probability and cumulative risk over the duration of stay in the intensive care unit. Design: Prospective cohort study. Setting: 16 intensive care units in Canada. Patients: 1014 mechanically ventilated patients. Measurements: Demographic and time-dependent variables reflecting illness severity, ventilation, nutrition, and drug exposure. Pneumonia was classified by using five methods: adjudication committee, bedside clinician's diagnosis, Centers for Disease Control and Prevention definition, Clinical Pulmonary Infection score, and positive culture from bronchoalveolar lavage or protected specimen brush. Results: 177 of 1014 patients (17.5%) developed ventilator-associated pneumonia 9.0 ± 5.9 days (median, 7 days [interquartile range, 5 to 10 days]) after admission to the intensive care unit. Although the cumulative risk increased over time, the daily hazard rate decreased after day 5 (3.3% at day 5, 2.3% at day 10, and 1.3% at day 15). Independent predictors of ventilator-associated pneumonia in multivariable analysis were a primary admitting diagnosis of burns (risk ratio, 5.09 [95% CI, 1.52 to 17.03]), trauma (risk ratio, 5.00 [CI, 1.91 to 13.11]), central nervous system disease (risk ratio, 3.40 [CI, 1.31 to 8.81]), respiratory disease (risk ratio, 2.79 [CI, 1.04 to 7.51]), cardiac disease (risk ratio, 2.72 [CI, 1.05 to 7.01]), mechanical ventilation in the previous 24 hours (risk ratio, 2.28 [CI, 1.11 to 4.68]), witnessed aspiration (risk ratio, 3.25 [CI, 1.62 to 6.50]), and paralytic agents (risk ratio, 1.57 [CI, 1.03 to 2.39]). Exposure to antibiotics conferred protection (risk ratio, 0.37 [CI, 0.27 to 0.51]). Independent risk factors were the same regardless of the pneumonia definition used. Conclusions: The daily risk for pneumonia decreases with increasing duration of stay in the intensive care unit. Witnessed aspiration and exposure to paralytic agents are potentially modifiable independent risk factors. Exposure to antibiotics was associated with low rates of early ventilator-associated pneumonia, but this effect attenuates over time.

Hospital-Acquired Infections Due to Gram-Negative Bacteria

2010-05-12
Anton Y. Peleg , David C. Hooper
Hospital-acquired infections are most commonly associated with mechanical ventilation, invasive medical devices, or surgical procedures. Gram-negative bacteria are responsible for more than 30% of hospital-acquired infections and predominate in hospital-acquired … Hospital-acquired infections are most commonly associated with mechanical ventilation, invasive medical devices, or surgical procedures. Gram-negative bacteria are responsible for more than 30% of hospital-acquired infections and predominate in hospital-acquired pneumonia. They are highly efficient at up-regulating or acquiring mechanisms of antibiotic drug resistance, especially in the presence of antibiotic selection pressure. This review updates what clinicians should know about these often life-threatening infections.
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Clinical and economic consequences of ventilator-associated pneumonia: A systematic review

2005-10-01
Nasia Safdar , Cameron Dezfulian , Harold R. Collard +1 more
Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in critically ill patients. The clinical and economic consequences of VAP are unclear, with a broad range of values reported … Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in critically ill patients. The clinical and economic consequences of VAP are unclear, with a broad range of values reported in the literature Objective: To perform a systematic review to determine the incidence of VAP and its attributable mortality rate, length of stay, and costs. Data Source: Computerized PUBMED and MEDLINE search supplemented by manual searches for relevant articles, limited to articles published after 1990. Study Selection: English-language observational studies and randomized trials that provided data on the incidence of VAP were included. Matched cohort studies were included for calculation of attributable mortality rate and length of stay. Data Extraction: Data were extracted on patient population, diagnostic criteria for VAP, incidence, outcome, type of intensive care unit, and study design. Data Synthesis: The cumulative incidence of VAP was calculated by combining the results of several studies using standard formulas for combining proportions, in which the weighted average and variance are calculated. Results from studies comparing intensive care unit and hospital mortality due to VAP, additional length of stay, and additional days of mechanical ventilation were pooled using a random effects model, with assessment of heterogeneity. Results: Our findings indicate a) between 10% and 20% of patients receiving >48 hrs of mechanical ventilation will develop VAP; b) critically ill patients who develop VAP appear to be twice as likely to die compared with similar patients without VAP (pooled odds ratio, 2.03; 95% confidence interval, 1.16–3.56); c) patients with VAP have significantly longer intensive care unit lengths of stay (mean = 6.10 days; 95% confidence interval, 5.32–6.87 days); and d) patients who develop VAP incur ≥$10,019 in additional hospital costs. Conclusions: Ventilator-associated pneumonia occurs in a considerable proportion of patients undergoing mechanical ventilation and is associated with substantial morbidity, a two-fold mortality rate, and excess cost. Given these findings, strategies that effectively prevent VAP are urgently needed. LEARNING OBJECTIVES On completion of this article, the reader should be able to: Define the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Explain the economic consequences of VAP. Use this information in a clinical setting. All authors have disclosed that they have no financial relationships or interests in any commercial companies pertaining to this educational activity. Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.

Pulmonary Aspiration of Gastric Contents in Patients Receiving Mechanical Ventilation: The Effect of Body Position

1992-04-01
Antoni Torres , Joan Serra-Batllés , Emilio Ros +5 more
Objective: To determine if the semirecumbent position (45-degree angle) decreases aspiration of gastric contents to the airways in intubated and mechanically ventilated patients. Design: A randomized, two-period crossover trial. Setting: … Objective: To determine if the semirecumbent position (45-degree angle) decreases aspiration of gastric contents to the airways in intubated and mechanically ventilated patients. Design: A randomized, two-period crossover trial. Setting: Respiratory intensive care unit. Patients: Nineteen patients requiring intubation and mechanical ventilation. Interventions: Patients were studied in the supine and semirecumbent positions on two separate days. Measurements: After technetium (Tc)-99m sulphur colloid labeling of gastric contents, sequential radioactive counts in endobronchial secretions were measured at 30-minute intervals over a 5-hour period. Samples of endobronchial secretions, gastric juice, and pharyngeal contents were obtained for qualitative bacterial cultures. Results: Mean radioactive counts in endobronchial secretions were higher in samples obtained while patients were in the supine position than in those obtained while patients were in the semirecumbent position (4154 cpm compared with 954 cpm; P = 0.036). Moreover, the aspiration pattern was time-dependent for each position: For the supine position, radioactivity was 298 cpm at 30 min and 2592 cpm at 300 min (P = 0.013); for the semirecumbent position, radioactivity was 103 cpm at 30 min and 216 cpm at 300 min (P = 0.04). The same microorganisms were isolated from stomach, pharynx, and endobronchial samples in 32% of studies done while patients were semirecumbent and in 68% of studies done while patients were in the supine position. Conclusions: We conclude that the supine position and length of time the patient is kept in this position are potential risk factors for aspiration of gastric contents. Elevating the head of the bed for patients who can tolerate the semirecumbent position may be a simple, no-cost prophylactic measure.

CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting

2008-06-01
Teresa Horan , Mary Andrus , Margaret A. Dudeck

Nosocomial Respiratory Infections with Gram-Negative Bacilli

1972-11-01
W. G. Johanson
A prospective study of 213 patients admitted to a medical intensive care unit was done to determine the frequency of colonization of the respiratory tract with Gram-negative bacilli and the … A prospective study of 213 patients admitted to a medical intensive care unit was done to determine the frequency of colonization of the respiratory tract with Gram-negative bacilli and the relation of such colonization to nosocomial infection. Ninety-five patients (45%) became colonized, 22% on the first hospital day. Associated with colonization were respiratory tract disease, coma, hypotension, tracheal intubation, acidosis, azotemia, and either leukocytosis or leukopenia. Antimicrobial therapy may have promoted colonization in some patients. Nosocomial infections developed in 26 patients (12.2%), 22 of whom were colonized with Gram-negative bacilli. Nosocomial respiratory infections occurred in 23% of colonized patients but in only 3.3% of noncolonized patients. The control of nosocomial pneumonia may require the development of methods for preventing or interrupting the colonization of hospitalized patients with Gram-negative bacilli.

Medical Section pf the American Lung Association: Guidelines for the Initial Management of Adults with Community-acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy

1993-11-01
Michael S. Niederman , John B. Bass , G. Douglas Campbell +7 more
"Medical Section pf the American Lung Association: Guidelines for the Initial Management of Adults with Community-acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy." American Review of Respiratory Disease, … "Medical Section pf the American Lung Association: Guidelines for the Initial Management of Adults with Community-acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy." American Review of Respiratory Disease, 148(5), pp. 1418–1426

Nosocomial Pneumonia in Patients Receiving Continuous Mechanical Ventilation: Prospective Analysis of 52 Episodes with Use of a Protected Specimen Brush and Quantitative Culture Techniques

1989-04-01
Jean-Yves Fagon , Jean Chastre , Y Domart +4 more
Epidemiologic studies of nosocomial bacterial pneumonia in patients requiring mechanical ventilation have been limited because of the poor reliability of diagnosis procedures in this setting. To determine prognostic and descriptive … Epidemiologic studies of nosocomial bacterial pneumonia in patients requiring mechanical ventilation have been limited because of the poor reliability of diagnosis procedures in this setting. To determine prognostic and descriptive factors of ventilator-associated (V-A) pneumonia, we prospectively studied 567 patients who had been receiving mechanical ventilation for more than 3 days in our unit. Fiberoptic bronchoscopy using a protected specimen brush (PSB) was performed on each patient suspected of having pneumonia because of the presence of a new pulmonary infiltrate and purulent tracheal secretions. The diagnosis of V-A pneumonia was retained only if PSB specimens yielded > 103 cfu/ml of at least one microorganism, unless this result was established to be a false positive result on follow-up. V-A pneumonia developed in 49 patients for a total of 52 episodes (9%). The actuarial risk of V-A pneumonia was 6.5% at 10 days, 19% at 20 days, and 28% at 30 days of ventilation. Patients with pneumonia were significantly older (65 versus 57 yr of age, p < 0.01) and more frequently had severe underlying illnesses (24 versus 10%, p < 0.01) than did patients without pneumonia. A total of 84 microorganisms (51 gram-negative and 33 gram-positive) were isolated in significant concentrations from PSB specimens. Pseudomonas aeruginosa and Staphylococcus aureus were involved in 31 and 33% of these pneumonias, respectively. Forty percent of all specimens yielded a polymicrobial flora with more than one potential pathogen. Prior antimicrobial therapy increased the rate of pneumonia caused by P. aeruginosa or Acinetobacter spp. (65 versus 19%, p < 0.01) and the frequency of methicillin resistance in staphylococcal infections (100 versus 33%, p < 0.05). Overall mortality in patients with V-A pneumonia was 71% compared with 29% in patients without pneumonia (p < 0.01). Only 13% of patients with pneumonia caused by P. aeruginosa or Acinetobacter spp. survived, whereas 31% of patients with pneumonia caused by other bacteria survived (p < 0.01).

Ventilator-associated Pneumonia Caused by Potentially Drug-resistant Bacteria

1998-02-01
Jean‐Louis Trouillet , Jean Chastre , Albert Vuagnat +4 more
To determine risk factors for ventilator-associated pneumonia (VAP) caused by potentially drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and/or Stenotrophomonas maltophilia, 135 consecutive episodes of VAP … To determine risk factors for ventilator-associated pneumonia (VAP) caused by potentially drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and/or Stenotrophomonas maltophilia, 135 consecutive episodes of VAP observed in a single ICU over a 25-mo period were prospectively studied. For all patients, VAP was diagnosed based on results of bronchoscopic protected specimen brush (> or = 10(3) cfu/ml) and bronchoalveolar lavage (> or = 10(4) cfu/ml) specimens. Seventy-seven episodes were caused by "potentially resistant" bacteria and 58 episodes were caused by "other" organisms. According to logistic regression analysis, three variables among potential factors remained significant: duration of mechanical ventilation (MV) > or = 7 d (odds ratio [OR] = 6.0), prior antibiotic use (OR = 13.5), and prior use of broad-spectrum drugs (third-generation cephalosporin, fluoroquinolone, and/or imipenem) (OR = 4.1). Distribution of the 245 causative bacteria was analyzed according to four groups defined by prior duration of MV (< 7 or > or = 7 d) and prior use or lack of use (within 15 d) of antibiotics. Although 22 episodes of early-onset VAP in patients receiving no prior antibiotics were caused by antibiotic-susceptible bacteria, 84 episodes of late-onset VAP in patients receiving prior antibiotics were mainly caused by potentially resistant bacteria. Differences in the potential efficacies (ranging from 100% to 11%) against microorganisms of 15 antimicrobial regimens were studied according to classification into these four groups. These findings may provide a more rational basis for selecting the initial therapy of patients suspected of having VAP.

National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009

2009-12-01
Jonathan R. Edwards , Kelly Peterson , Yi Mu +6 more

Incidence, Risk, and Prognosis Factors of Nosocomial Pneumonia in Mechanically Ventilated Patients

1990-09-01
Antoní Torres , Roberto Aznar , Josep M. Gatell +5 more
Seventy-eight (24%) episodes of nosocomial pneumonia (NP) were detected in 322 consecutive mechanically ventilated patients admitted to a 1,000-bed teaching hospital from April 1987 through May 1988 to assess the … Seventy-eight (24%) episodes of nosocomial pneumonia (NP) were detected in 322 consecutive mechanically ventilated patients admitted to a 1,000-bed teaching hospital from April 1987 through May 1988 to assess the incidence, risk, and prognosis factors of NP acquired during mechanical ventilation (MV). The risk and prognosis factors for developing NP during MV were studied using both univariate and multivariate statistical techniques. Multivariate analysis selected the following variables significantly associated with a higher risk for developing ventilator-associated pneumonia: more than one intubation during MV (p = 0.000012), a prior episode of aspiration of gastric content (p = 0.00018), a MV period longer than 3 days (p = 0.015), the presence of chronic obstructive pulmonary disease (COPD) (p = 0.048), and the use of positive end-expiratory pressure (PEEP) during MV (p = 0.092). The presence of an ultimately or rapidly fatal underlying disease (p = 0.0018), worsening of acute respiratory failure caused by pneumonia (p = 0.0096), the presence of septic shock (p = 0.016), an inappropriate antibiotic treatment (p = 0.02), and the type of intensive care unit (ICU) hospitalization (noncardiac surgery and nonsurgical ICU compared with post-cardiac surgery ICU) (p = 0.08) were those factors selected by a stepwise logistic regression analysis as independently worsening the prognosis. The overall fatality rate was 23% (73 of 322). The mortality of patients with NP was higher (33%; 26 of 78; p less than 0.01) when compared with fatality rates of patients without NP (19%; 47 of 244).(ABSTRACT TRUNCATED AT 250 WORDS)

Ventilator-Associated Pneumonia

1993-10-27
Marin H. Kollef
To identify factors associated with the development of ventilator-associated pneumonia (VAP) and to examine the incidence of VAP in different intensive care unit (ICU) populations.An inception cohort study.Barnes Hospital, St … To identify factors associated with the development of ventilator-associated pneumonia (VAP) and to examine the incidence of VAP in different intensive care unit (ICU) populations.An inception cohort study.Barnes Hospital, St Louis, Mo, an academic tertiary care center.A total of 277 consecutive patients required mechanical ventilation for longer than 24 hours from a medical ICU (75 patients), surgical ICU (100 patients), or cardiothoracic ICU (102 patients).Prospective patient surveillance and data collection.Ventilator-associated pneumonia and ICU mortality.Ventilator-associated pneumonia occurred in 43 patients (15.5%). Stepwise logistic regression analysis identified four factors to be independently associated with VAP (P < .05): an organ system failure index of 3 or greater (adjusted odds ratio [AOR] = 10.2; 95% confidence interval [CI], 4.5 to 23; P < .001); patient age of 60 years or older (AOR = 5.1; 95% CI, 1.9 to 14.1; P = .002); prior administration of antibiotics (AOR = 3.1; 95% CI, 1.4 to 6.9; P = .004); and supine head positioning during the first 24 hours of mechanical ventilation (AOR = 2.9; 95% CI, 1.3 to 6.8; P = .013). Ventilator-associated pneumonia occurred more often in cardiothoracic patients (21.6%) compared with medical patients (9.3%) (P = .03). Patients with VAP also had a higher mortality (37.2%) than those without VAP (8.5%) (P < .001). An organ system failure index of 3 or greater (AOR = 16.1; 95% CI, 6.1 to 42; P < .001), a premorbid lifestyle score of 2 or greater (AOR = 3.1; 95% CI, 1.3 to 7.3; P = .012), and supine head positioning during the first 24 hours of mechanical ventilation (AOR = 3.1; 95% CI, 1.2 to 7.8; P = .016) were independently associated with mortality.These data suggest potential interventions that might affect the incidence of VAP or outcome associated with VAP. Additionally, they indicate that different ICU populations may have different incidences of VAP.

Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study

2001-12-04
Corinne Alberti , Christian Brun‐Buisson , H. Burchardi +7 more
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Decontamination of the Digestive Tract and Oropharynx in ICU Patients

2008-12-31
Anne Marie G. A. de Smet , Jan Kluytmans , Ben S. Cooper +7 more
Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are … Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting.
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Major trends in the microbial etiology of nosocomial infection

1991-09-01
Dennis R. Schaberg , David H. Culver , Robert P. Gaynes
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Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States

2000-08-01
Michael J. Richards , Jonathan R. Edwards , David H. Culver +1 more
To describe the epidemiology of nosocomial infections in combined medical-surgical (MS) intensive care units (ICUs) participating in the National Nosocomial Infection Surveillance (NNIS) System.Analysis of surveillance data on 498,998 patients … To describe the epidemiology of nosocomial infections in combined medical-surgical (MS) intensive care units (ICUs) participating in the National Nosocomial Infection Surveillance (NNIS) System.Analysis of surveillance data on 498,998 patients with 1,554,070 patient-days, collected between 1992 and 1998 from 205 MS ICUs following the NNIS Intensive Care Unit protocol, representing 152 participating NNIS hospitals in the United States.Infections at three major sites represented 68% of all reported infections (nosocomial pneumonia, 31%; urinary tract infections (UTIs), 23%; and primary bloodstream infections (BSIs), 14%: 83% of episodes of nosocomial pneumonia were associated with mechanical ventilation, 97% of UTIs occurred in catheterized patients, and 87% of primary BSIs in patients with a central line. In patients with primary BSIs, coagulase-negative staphylococci (39%) were the most common pathogens reported; Staphylococcus aureus (12%) was as frequently reported as enterococci (11%). Coagulase-negative staphylococcal BSIs were increasingly reported over the 6 years, but no increase was seen in candidemia or enterococcal bacteremia. In patients with pneumonia, S. aureus (17%) was the most frequently reported isolate. Of reported isolates, 59% were gram-negative bacilli. In patients with UTIs, Escherichia coli (19%) was the most frequently reported isolate. Of reported isolates, 31% were fungi. In patients with surgical-site infections, Enterococcus (17%) was the single most frequently reported pathogen. Device-associated nosocomial infection rates for BSIs, pneumonia, and UTIs did not correlate with length of ICU stay, hospital bed size, number of beds in the ICU, or season. Combined MS ICUs in major teaching hospitals had higher device-associated infection rates compared to all other hospitals with combined medical-surgical units.Nosocomial infections in MS ICUs at the most frequent infection sites (bloodstream, urinary, and respiratory tract) almost always were associated with use of an invasive device. Device-associated infection rates were the best available comparative rates between combined MS ICUs, but the distribution of device-associated rates should be stratified by a hospital's major teaching affiliation status.

Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007

2008-10-23
Alicia Hidrón , Jonathan R. Edwards , Jean B. Patel +4 more
Objective. To describe the frequency of selected antimicrobial resistance patterns among pathogens causing device-associated and procedure-associated healthcare-associated infections (HAIs) reported by hospitals in the National Healthcare Safety Network (NHSN). Methods. … Objective. To describe the frequency of selected antimicrobial resistance patterns among pathogens causing device-associated and procedure-associated healthcare-associated infections (HAIs) reported by hospitals in the National Healthcare Safety Network (NHSN). Methods. Data are included on HAIs (ie, central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections) reported to the Patient Safety Component of the NHSN between January 2006 and October 2007. The results of antimicrobial susceptibility testing of up to 3 pathogenic isolates per HAI by a hospital were evaluated to define antimicrobial-resistance in the pathogenic isolates. The pooled mean proportions of pathogenic isolates interpreted as resistant to selected antimicrobial agents were calculated by type of HAI and overall. The incidence rates of specific device-associated infections were calculated for selected antimicrobial-resistant pathogens according to type of patient care area; the variability in the reported rates is described. Results. Overall, 463 hospitals reported 1 or more HAIs: 412 (89%) were general acute care hospitals, and 309 (67%) had 200-1,000 beds. There were 28,502 HAIs reported among 25,384 patients. The 10 most common pathogens (accounting for 84% of any HAIs) were coagulase-negative staphylococci (15%), Staphylococcus aureus (15%), Enterococcus species (12%), Candida species (11%), Escherichia coli (10%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (6%), Enterobacter species (5%), Acinetobacter baumannii (3%), and Klebsiella oxytoca (2%). The pooled mean proportion of pathogenic isolates resistant to antimicrobial agents varied significantly across types of HAI for some pathogen-antimicrobial combinations. As many as 16% of all HAIs were associated with the following multidrug-resistant pathogens: methicillin-resistant S. aureus (8% of HAIs), vancomycin-resistant Enterococcus faecium (4%), carbapenem-resistant P. aeruginosa (2%), extended-spectrum cephalosporin-resistant K. pneumoniae (1%), extended-spectrum cephalosporin-resistant E. coli (0.5%), and carbapenem-resistant A. baumannii, K. pneumoniae, K. oxytoca, and E. coli (0.5%). Nationwide, the majority of units reported no HAIs due to these antimicrobial-resistant pathogens.

The Gastrointestinal Tract The “Undrained Abscess” of Multiple Organ Failure

1993-08-01
John C. Marshall , Nicolas V. Christou , Jonathan L. Meakins
Objective This study determined the association between proximal gastrointestinal (GI) colonization and the development of intensive care unit (ICU)-acquired infection and multiple organ failure (MOF) in a population of critically … Objective This study determined the association between proximal gastrointestinal (GI) colonization and the development of intensive care unit (ICU)-acquired infection and multiple organ failure (MOF) in a population of critically ill surgical patients. Summary Background Data ICU-acquired infection in association with progressive organ system dysfunction is an important cause of morbidity and mortality in critical surgical illness. Oropharyngeal and gastric colonization with the characteristic infecting species is common, but its association with ICU morbidity is poorly defined. Methods A prospective cohort study of 41 surgical ICU patients was undertaken. Specimens of gastric and upper small bowel fluid were obtained for quantitative culture; the severity of organ dysfunction was quantitated by a numeric score. Results One or more episodes of ICU-acquired infection developed in 33 patients and involved at least one organism concomitantly cultured from the upper GI tract in all but 3. The most common organisms causing ICU-acquired infection—Candida, Streptococcus faecalis, Pseudomonas, and coagulase-negative Staphylococci–were also the most common species colonizing the proximal GI tract. Gut colonization correlated with the development of invasive infection within 1 week of culture for Pseudomonas (90% vs. 13% in noncolonized patients, p < 0.0001) or Staphylococcus epidermidis (80% vs. 6%, p < 0.0001); a weaker association was seen for colonization with Candida. Infections associated with GI colonization Included pneumonia (16 patients); wound infection (12 patients), urinary tract infection (11 patients), recurrent (tertiary) peritonitis (11 patients), and bacteremia (10 patients). ICU mortality was greater for patients colonized with Pseudomonas (70% vs. 26%, p = 0.03); organ dysfunction was most marked in patients colonized with one or more of the following: Candida, Pseudomonas, or S. epidermidis. Conclusions The upper GI tract is an Important reservoir of the organisms causing ICU-acquired infection. Pathologic GI colonization is associated with the development of MOF in the critically ill surgical patient.

Impact of BAL Data on the Therapy and Outcome of Ventilator-Associated Pneumonia

1997-03-01
Carlos M. Luna , Patrícia Vujacich , Michael S. Niederman +4 more

Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults

2003-11-18
Jean Chastre , Michel Wolff , Jean-Yves Fagon +7 more
The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown. Shortening the length of treatment may help to contain the emergence of multiresistant bacteria in the intensive care … The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown. Shortening the length of treatment may help to contain the emergence of multiresistant bacteria in the intensive care unit (ICU).To determine whether 8 days is as effective as 15 days of antibiotic treatment of patients with microbiologically proven VAP.Prospective, randomized, double-blind (until day 8) clinical trial conducted in 51 French ICUs. A total of 401 patients diagnosed as having developed VAP by quantitative culture results of bronchoscopic specimens and who had received initial appropriate empirical antimicrobial therapy were enrolled between May 1999 and June 2002.A total of 197 patients were randomly assigned to receive 8 days and 204 to receive 15 days of therapy with an antibiotic regimen selected by the treating physician.Primary outcome measures-death from any cause, microbiologically documented pulmonary infection recurrence, and antibiotic-free days-were assessed 28 days after VAP onset and analyzed on an intent-to-treat basis.Compared with patients treated for 15 days, those treated for 8 days had neither excess mortality (18.8% vs 17.2%; difference, 1.6%; 90% confidence interval [CI], -3.7% to 6.9%) nor more recurrent infections (28.9% vs 26.0%; difference, 2.9%; 90% CI, -3.2% to 9.1%), but they had more mean (SD) antibiotic-free days (13.1 [7.4] vs 8.7 [5.2] days, P<.001). The number of mechanical ventilation-free days, the number of organ failure-free days, the length of ICU stay, and mortality rates on day 60 for the 2 groups did not differ. Although patients with VAP caused by nonfermenting gram-negative bacilli, including Pseudomonas aeruginosa, did not have more unfavorable outcomes when antimicrobial therapy lasted only 8 days, they did have a higher pulmonary infection-recurrence rate compared with those receiving 15 days of treatment (40.6% vs 25.4%; difference, 15.2%, 90% CI, 3.9%-26.6%). Among patients who developed recurrent infections, multiresistant pathogens emerged less frequently in those who had received 8 days of antibiotics (42.1% vs 62.0% of pulmonary recurrences, P =.04).Among patients who had received appropriate initial empirical therapy, with the possible exception of those developing nonfermenting gram-negative bacillus infections, comparable clinical effectiveness against VAP was obtained with the 8- and 15-day treatment regimens. The 8-day group had less antibiotic use.

Diagnosis of Ventilator-associated Pneumonia by Bacteriologic Analysis of Bronchoscopic and Nonbronchoscopic “Blind” Bronchoalveolar Lavage Fluid

1991-05-01
Jérôme Pugin , R Auckenthaler , Nabil Mili +3 more
Substantial efforts have been devoted to improving the means for early and accurate diagnosis of ventilator-associated (VA) pneumonia in intensive care unit (ICU) patients because of its high incidence and … Substantial efforts have been devoted to improving the means for early and accurate diagnosis of ventilator-associated (VA) pneumonia in intensive care unit (ICU) patients because of its high incidence and mortality. A good diagnostic yield has been reported from quantitative cultures of bronchoalveolar lavage (BAL) fluid or a protected specimen brush, both obtained by fiberoptic bronchoscopy. As bronchoscopy requires specific skills and is costly, we evaluated a simpler method to obtain BAL fluid, that is, by a catheter introduced blindly into the bronchial tree. Quantitative cultures from bronchoscopically sampled BAL (B-BAL) and blindly nonbronchoscopically collected BAL (NB-BAL) were assessed for sensitivity, specificity, and predictive value for the diagnosis of VA pneumonia. A total of 40 pairs of samples were examined in 28 patients requiring prolonged mechanical ventilation and presenting a high risk of developing pneumonia. For comparison with bacteriologic data we defined a clinical score for pneumonia ranging from zero to 12 using the following variables: body temperature, leukocyte count, volume and character of tracheal secretions, arterial oxygenation, chest X-ray, Gram stain, and culture of tracheal aspirate. To quantify the bacteria in BAL the bacterial index (BI) was used, defined as the sum of the logarithm of the number of bacteria cultured per milliliter of BAL fluid. A good correlation between clinical score and quantitative bacteriology was observed (r = 0.84 for B-BAL and 0.76 for NB-BAL; p < 0.0001). Similar to studies in baboons, patients with pulmonary infection could be distinguished by a BI ⩾ 5 with a sensitivity of 93% and a specificity of 100% (B-BAL). Quantitative culture of blind sampling of BAL resulted in a slightly lower sensitivity (73%) and a specificity of 96% for the diagnosis of pneumonia. When analyzing pairs of B-BAL and NB-BAL samples we found similar results for both qualitative and quantitative bacteriology even if BAL fluids came from different lobes or the contralateral lung. These results suggest that “blind” sampling of BAL can be of value in clinical practice. Microscopic examination of BAL provided rapid (the day of BAL), sensitive (100%), and specific (88%) results, allowing us to introduce early and specific antibiotic therapy.

Short-course Empiric Antibiotic Therapy for Patients with Pulmonary Infiltrates in the Intensive Care Unit

2000-08-01
Nina Singh , Paul Rogers , Charles W. Atwood +2 more
Inappropriate antibiotic use for pulmonary infiltrates is common in the intensive care unit (ICU). We sought to devise an approach that would minimize unnecessary antibiotic use, recognizing that a gold … Inappropriate antibiotic use for pulmonary infiltrates is common in the intensive care unit (ICU). We sought to devise an approach that would minimize unnecessary antibiotic use, recognizing that a gold standard for the diagnosis of nosocomial pneumonia does not exist. In a randomized trial, clinical pulmonary infection score (CPIS) (Pugin, J., R. Auckenthaler, N. Mili, J. P. Janssens, R. D. Lew, and P. M. Suter. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am. Rev. Respir. Dis. 1991;143: 1121–1129) was used as operational criteria for decision-making regarding antibiotic therapy. Patients with CPIS ⩽ 6 (implying low likelihood of pneumonia) were randomized to receive either standard therapy (choice and duration of antibiotics at the discretion of physicians) or ciprofloxacin monotherapy with reevaluation at 3 d; ciprofloxacin was discontinued if CPIS remained ⩽ 6 at 3 d. Antibiotics were continued beyond 3 d in 90% (38 of 42) of the patients in the standard as therapy compared with 28% (11 of 39) in the experimental therapy group (p = 0.0001). In patients in whom CPIS remained ⩽ 6 at the 3 d evaluation point, antibiotics were still continued in 96% (24 of 25) in the standard therapy group but in 0% (0 of 25) of the patients in the experimental therapy group (p = 0.0001). Mortality and length of ICU stay did not differ despite a shorter duration (p = 0.0001) and lower cost (p = 0.003) of antimicrobial therapy in the experimental as compared with the standard therapy arm. Antimicrobial resistance, or superinfections, or both, developed in 15% (5 of 37) of the patients in the experimental versus 35% (14 of 37) of the patients in the standard therapy group (p = 0.017). Thus, overtreatment with antibiotics is widely prevalent, but unnecessary in most patients with pulmonary infiltrates in the ICU. The operational criteria used, regardless of the precise definition of pneumonia, accurately identified patients with pulmonary infiltrates for whom monotherapy with a short course of antibiotics was appropriate. Such an approach led to significantly lower antimicrobial therapy costs, antimicrobial resistance, and superinfections without adversely affecting the length of stay or mortality.

CDC definitions for nosocomial infections

1989-02-01
B. Yangco

Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis

2010-12-10
Benedetta Allegranzi , S Bagheri Nejad , Christophe Combescure +4 more

Clinical Importance of Delays in the Initiation of Appropriate Antibiotic Treatment for Ventilator-Associated Pneumonia

2002-07-01
Manuel Iregui , Suzanne M. Ward , Glenda Sherman +2 more

Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial

1999-11-01
Mitra B. Drakulović , Antoní Torres , Torsten Bauer +3 more

Inadequate Antimicrobial Treatment of Infections

1999-02-01
Marin H. Kollef , Glenda Sherman , Suzanne M. Ward +1 more

Epidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database

2002-12-01
Jordi Rello , Daniel A. Ollendorf , Gerry Oster +4 more

Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay

1993-03-01
Jean-Yves Fagon , Jean Chastre , Allan J. Hance +3 more

Overview of Nosocomial Infections Caused by Gram-Negative Bacilli

2005-08-19
Robert P. Gaynes , Jonathan R. Edwards
We analyzed data from the National Nosocomial Infections Surveillance (NNIS) System from 1986-2003 to determine the epidemiology of gram-negative bacilli in intensive care units (ICUs) for the most frequent types … We analyzed data from the National Nosocomial Infections Surveillance (NNIS) System from 1986-2003 to determine the epidemiology of gram-negative bacilli in intensive care units (ICUs) for the most frequent types of hospital-acquired infection: pneumonia, surgical site infection (SSI), urinary tract infection (UTI), and bloodstream infection (BSI). We analyzed >410,000 bacterial isolates associated with hospital-acquired infections in ICUs during 1986-2003. In 2003, gram-negative bacilli were associated with 23.8% of BSIs, 65.2% of pneumonia episodes, 33.8% of SSIs, and 71.1% of UTIs. The percentage of BSIs associated with gram-negative bacilli decreased from 33.2% in 1986 to 23.8% in 2003. The percentage of SSIs associated with gram-negative bacilli decreased from 56.5% in 1986 to 33.8% in 2003. The percentages pneumonia episodes and UTIs associated with gram-negative bacilli remained constant during the study period. The proportion of ICU pneumonia episodes associated with Acinetobacter species increased from 4% in 1986 to 7.0% in 2003 (P<.001, by the Cochran-Armitage chi2 test for trend). Significant increases in resistance rates were uniformly seen for selected antimicrobial-pathogen combinations. Gram-negative bacilli are commonly associated with hospital-acquired infections in ICUs. The proportion of Acinetobacter species associated with ICU pneumonia increased from 4% in 1986 to 7.0% in 2003.

Ventilator-associated Pneumonia

2002-04-01
Jean Chastre , Jean-Yves Fagon
Section:ChooseTop of pageAbstract <<CONTENTSEPIDEMIOLOGYDIAGNOSISTREATMENTReferencesCITING ARTICLES Section:ChooseTop of pageAbstract <<CONTENTSEPIDEMIOLOGYDIAGNOSISTREATMENTReferencesCITING ARTICLES

Multistate Point-Prevalence Survey of Health Care–Associated Infections

2014-03-26
Shelley S. Magill , Jonathan R. Edwards , Wendy Bamberg +7 more
Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in … Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate updated estimates of the national burden of such infections.
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Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies

2013-04-25
Wilhelmina G. Melsen , Maroeska M. Rovers , Rolf H. H. Groenwold +7 more

The Attributable Morbidity and Mortality of Ventilator-Associated Pneumonia in the Critically Ill Patient

1999-04-01
Daren K. Heyland , Deborah J. Cook , Lauren E. Griffith +2 more
To evaluate the attributable morbidity and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, we conducted a prospective, matched cohort study. Patients expected to be ventilated for … To evaluate the attributable morbidity and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, we conducted a prospective, matched cohort study. Patients expected to be ventilated for > 48 h were prospectively followed for the development of VAP. To determine the excess ICU stay and mortality attributable to VAP, we matched patients with VAP to patients who did not develop clinically suspected pneumonia. We also conducted sensitivity analyses to examine the effect of different populations, onset of pneumonia, diagnostic criteria, causative organisms, and adequacy of empiric treatment on the outcome of VAP. One hundred and seventy-seven patients developed VAP. As compared with matched patients who did not develop VAP, patients with VAP stayed in the ICU for 4.3 d (95% confidence interval [CI]: 1.5 to 7. 0 d) longer and had a trend toward an increase in risk of death (absolute risk increase: 5.8%; 95% CI: -2.4 to 14.0 d; relative risk (RR) increase: 32.3%; 95% CI: -20.6 to 85.1%). The attributable ICU length of stay was longer for medical than for surgical patients (6. 5 versus 0.7 d, p < 0.004), and for patients infected with "high risk" organisms as compared with "low risk" organisms (9.1 d versus 2.9 d). The attributable mortality was higher for medical patients than for surgical patients (RR increase of 65% versus -27.3%, p = 0. 04). Results were similar for three different VAP diagnostic criteria. We conclude that VAP prolongs ICU length of stay and may increase the risk of death in critically ill patients. The attributable risk of VAP appears to vary with patient population and infecting organism.

Invasive and Noninvasive Strategies for Management of Suspected Ventilator-Associated Pneumonia

2000-04-18
Jean-Yves Fagon , Jean Chastre , Michel Wolff +7 more
Background: Optimal management of patients who are clinically suspected of having ventilator-associated pneumonia remains open to debate. Objective: To evaluate the effect on clinical outcome and antibiotic use of two … Background: Optimal management of patients who are clinically suspected of having ventilator-associated pneumonia remains open to debate. Objective: To evaluate the effect on clinical outcome and antibiotic use of two strategies to diagnose ventilator-associated pneumonia and select initial treatment for this condition. Design: Multicenter, randomized, uncontrolled trial. Setting: 31 intensive care units in France. Patients: 413 patients suspected of having ventilator-associated pneumonia. Intervention: The invasive management strategy was based on direct examination of bronchoscopic protected specimen brush samples or bronchoalveolar lavage samples and their quantitative cultures. The noninvasive ("clinical") management strategy was based on clinical criteria, isolation of microorganisms by nonquantitative analysis of endotracheal aspirates, and clinical practice guidelines. Measurements: Death from any cause, quantification of organ failure, and antibiotic use at 14 and 28 days. Results: Compared with patients who received clinical management, patients who received invasive management had reduced mortality at day 14 (16.2% and 25.8%; difference, −9.6 percentage points [95% CI, −17.4 to −1.8 percentage points]; P = 0.022), decreased mean Sepsis-related Organ Failure Assessment scores at day 3 (6.1 ± 4.0 and 7.0 ± 4.3; P = 0.033) and day 7 (4.9 ± 4.0 and 5.8 ± 4.4; P = 0.043), and decreased antibiotic use (mean number of antibiotic-free days, 5.0 ± 5.1 and 2.2 ± 3.5; P < 0.001). At 28 days, the invasive management group had significantly more antibiotic-free days (11.5 ± 9.0 compared with 7.5 ± 7.6; P < 0.001), and only multivariate analysis showed a significant difference in mortality (hazard ratio, 1.54 [CI, 1.10 to 2.16]; P = 0.01). Conclusions: Compared with a noninvasive management strategy, an invasive management strategy was significantly associated with fewer deaths at 14 days, earlier attenuation of organ dysfunction, and less antibiotic use in patients suspected of having ventilator-associated pneumonia. *For members of the VAP Trial Group, see the Appendix.

International Study of the Prevalence and Outcomes of Infection in Intensive Care Units

2009-12-01
Jean‐Louis Vincent
Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections.To provide an … Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections.To provide an up-to-date, international picture of the extent and patterns of infection in ICUs.The Extended Prevalence of Infection in Intensive Care (EPIC II) study, a 1-day, prospective, point prevalence study with follow-up conducted on May 8, 2007. Demographic, physiological, bacteriological, therapeutic, and outcome data were collected for 14,414 patients in 1265 participating ICUs from 75 countries on the study day. Analyses focused on the data from the 13,796 adult (>18 years) patients.On the day of the study, 7087 of 13,796 patients (51%) were considered infected; 9084 (71%) were receiving antibiotics. The infection was of respiratory origin in 4503 (64%), and microbiological culture results were positive in 4947 (70%) of the infected patients; 62% of the positive isolates were gram-negative organisms, 47% were gram-positive, and 19% were fungi. Patients who had longer ICU stays prior to the study day had higher rates of infection, especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species. The ICU mortality rate of infected patients was more than twice that of noninfected patients (25% [1688/6659] vs 11% [ 682/6352], respectively; P < .001), as was the hospital mortality rate (33% [2201/6659] vs 15% [ 942/6352], respectively; P < .001) (adjusted odds ratio for risk of hospital mortality, 1.51; 95% confidence interval, 1.36-1.68; P < .001).Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.
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Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002

2007-03-01
R. Monina Klevens , Jonathan R. Edwards , Chesley Richards +4 more
The purpose of this study was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals.No single source of nationally representative data … The purpose of this study was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals.No single source of nationally representative data on HAIs is currently available. The authors used a multi-step approach and three data sources. The main source of data was the National Nosocomial Infections Surveillance (NNIS) system, data from 1990-2002, conducted by the Centers for Disease Control and Prevention. Data from the National Hospital Discharge Survey (for 2002) and the American Hospital Association Survey (for 2000) were used to supplement NNIS data. The percentage of patients with an HAI whose death was determined to be caused or associated with the HAI from NNIS data was used to estimate the number of deaths.In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, was approximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among newborns in well-baby nurseries, 417,946 among adults and children in ICUs, and 1,266,851 among adults and children outside of ICUs. The estimated deaths associated with HAIs in U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites.HAIs in hospitals are a significant cause of morbidity and mortality in the United States. The method described for estimating the number of HAIs makes the best use of existing data at the national level.
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Nosocomial infections in medical intensive care units in the United States

1999-05-01
Michael J. Richards , Jonathan R. Edwards , David H. Culver +1 more
To describe the epidemiology of nosocomial infections in medical intensive care units (ICUs) in the United States.Analysis of ICU surveillance data collected through the National Nosocomial Infections Surveillance (NNIS) System … To describe the epidemiology of nosocomial infections in medical intensive care units (ICUs) in the United States.Analysis of ICU surveillance data collected through the National Nosocomial Infections Surveillance (NNIS) System between 1992 and 1997.Medical ICUs in the United States.A total of 181,993 patients.Nosocomial infections were analyzed by infection site and pathogen distribution. Urinary tract infections were most frequent (31%), followed by pneumonia (27%) and primary bloodstream infections (19%). Eighty-seven percent of primary bloodstream infections were associated with central lines, 86% of nosocomial pneumonia was associated with mechanical ventilation, and 95% of urinary tract infections were associated with urinary catheters. Coagulase-negative staphylococci (36%) were the most common bloodstream infection isolates, followed by enterococci (16%) and Staphylococcus aureus (13%). Twelve percent of bloodstream isolates were fungi. The most frequent isolates from pneumonia were Gram-negative aerobic organisms (64%). Pseudomonas aeruginosa (21%) was the most frequently isolated of these. S. aureus (20%) was isolated with similar frequency. Candida albicans was the most common single pathogen isolated from urine and made up just over half of the fungal isolates. Fungal urinary infections were associated with asymptomatic funguria rather than symptomatic urinary tract infections (p < .0001). Certain pathogens were associated with device use: coagulase-negative staphylococci with central lines, P. aeruginosa and Acinetobacter species with ventilators, and fungal infections with urinary catheters. Patient nosocomial infection rates for the major sites correlated strongly with device use. Device exposure was controlled for by calculating device-associated infection rates for bloodstream infections, pneumonia, and urinary tract infections by dividing the number of device-associated infections by the number of days of device use. There was no association between these device-associated infection rates and number of hospital beds, number of ICU beds, or length of stay. There is a considerable variation within the distribution of each of these infection rates.The distribution of sites of infection in medical ICUs differed from that previously reported in NNIS ICU surveillance studies, largely as a result of anticipated low rates of surgical site infections. Primary bloodstream infections, pneumonia, and urinary tract infections associated with invasive devices made up the great majority of nosocomial infections. Coagulase-negative staphylococci were more frequently associated with primary bloodstream infections than reported from NNIS ICUs of all types in the 1980s, and enterococci were a more frequent isolate from bloodstream infections than S. aureus. Fungal urinary tract infections, often asymptomatic and associated with catheter use, were considerably more frequent than previously reported. Invasive device-associated infections were associated with specific pathogens. Although device-associated site-specific infection rates are currently our most useful rates for performing comparisons between ICUs, the considerable variation in these rates between ICUs indicates the need for further risk adjustment.

Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients

1994-02-10
Deborah J. Cook , Hugh D. Fuller , Gordon Guyatt +7 more
The efficacy of prophylaxis against stress ulcers in preventing gastrointestinal bleeding in critically ill patients has led to its widespread use. The side effects and cost of prophylaxis, however, necessitate … The efficacy of prophylaxis against stress ulcers in preventing gastrointestinal bleeding in critically ill patients has led to its widespread use. The side effects and cost of prophylaxis, however, necessitate targeting preventive therapy to those patients most likely to benefit.
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A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation

1998-03-19
Deborah J. Cook , Gordon Guyatt , John Marshall +7 more
Critically ill patients who require mechanical ventilation are at increased risk for gastrointestinal bleeding from stress ulcers. There are conflicting data on the effect of histamine H2-receptor antagonists and the … Critically ill patients who require mechanical ventilation are at increased risk for gastrointestinal bleeding from stress ulcers. There are conflicting data on the effect of histamine H2-receptor antagonists and the cytoprotective agent sucralfate on rates of gastrointestinal bleeding, ventilator-associated pneumonia, and mortality.
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National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1990-May 1999, Issued June 1999

1999-12-01

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

2016-07-14
André C. Kalil , Mark L. Metersky , Michael Klompas +7 more
Abstract It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or … Abstract It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.
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Nosocomial infections: Epidemiology, prevention, control and surveillance

2017-01-07
Hassan Ahmed Khan , Fatima Kanwal Baig , Riffat Mehboob
Nosocomial infections or healthcare associated infections occur in patients under medical care. These infections occur worldwide both in developed and developing countries. Nosocomial infections accounts for 7% in developed and … Nosocomial infections or healthcare associated infections occur in patients under medical care. These infections occur worldwide both in developed and developing countries. Nosocomial infections accounts for 7% in developed and 10% in developing countries. As these infections occur during hospital stay, they cause prolonged stay, disability, and economic burden. Frequently prevalent infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections and ventilator-associated pneumonia. Nosocomial pathogens include bacteria, viruses and fungal parasites. According to WHO estimates, approximately 15% of all hospitalized patients suffer from these infections. During hospitalization, patient is exposed to pathogens through different sources environment, healthcare staff, and other infected patients. Transmission of these infections should be restricted for prevention. Hospital waste serves as potential source of pathogens and about 20%–25% of hospital waste is termed as hazardous. Nosocomial infections can be controlled by practicing infection control programs, keep check on antimicrobial use and its resistance, adopting antibiotic control policy. Efficient surveillance system can play its part at national and international level. Efforts are required by all stakeholders to prevent and control nosocomial infections.

Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995.

1996-05-01

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

2017-09-01
Antoní Torres , Michael S. Niederman , Jean Chastre +7 more
The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of … The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent. The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited. A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink). Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population–intervention–comparison–outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.
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Ventilator-associated pneumonia in adults: a narrative review

2020-03-10
Laurent Papazian , Michael Klompas , Charles‐Édouard Luyt
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Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia

2005-02-07

The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee

1995-08-23
Jean‐Louis Vincent
<h3>Objective.</h3> —To determine the prevalence of intensive care unit (ICU)—acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection … <h3>Objective.</h3> —To determine the prevalence of intensive care unit (ICU)—acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality. <h3>Design.</h3> —A 1-day point-prevalence study. <h3>Setting.</h3> —Intensive care units in 17 countries in Western Europe, excluding coronary care units and pediatric and special care infant units. <h3>Patients.</h3> —All patients (&gt;10 years of age) occupying an ICU bed over a 24-hour period. A total of 1417 ICUs provided 10 038 patient case reports. <h3>Main Outcome Measures.</h3> —Rates of ICU-acquired infection, prescription of antimicrobials, resistance patterns of microbiological isolates, and potential risk factors for ICU-acquired infection and death. <h3>Results.</h3> —A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower respiratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infection reported. Most frequently reported microorganisms were Enterobacteriaceae (34.4%),<i>Staphylococcus aureus</i>(30.1%; [60% resistant to methicillin]),<i>Pseudomonas aeruginosa</i>(28.7%), coagulase-negative staphylococci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (&gt;48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. ICU-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% CI, 1.71 to 7.18), and bloodstream infection (OR, 1.73; 95% CI, 1.25 to 2.41) increased the risk of ICU death. <h3>Conclusions.</h3> —ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients. (<i>JAMA</i>. 1995;274:639-644)

The Prevalence of Nosocomial Infection in Intensive Care Units in Europe

1995-08-23
Jean‐Louis Vincent
<h3>Objective.</h3> —To determine the prevalence of intensive care unit (ICU)—acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection … <h3>Objective.</h3> —To determine the prevalence of intensive care unit (ICU)—acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality. <h3>Design.</h3> —A 1-day point-prevalence study. <h3>Setting.</h3> —Intensive care units in 17 countries in Western Europe, excluding coronary care units and pediatric and special care infant units. <h3>Patients.</h3> —All patients (&gt;10 years of age) occupying an ICU bed over a 24-hour period. A total of 1417 ICUs provided 10 038 patient case reports. <h3>Main Outcome Measures.</h3> —Rates of ICU-acquired infection, prescription of antimicrobials, resistance patterns of microbiological isolates, and potential risk factors for ICU-acquired infection and death. <h3>Results.</h3> —A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower respiratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infection reported. Most frequently reported microorganisms were Enterobacteriaceae (34.4%),<i>Staphylococcus aureus</i>(30.1%; [60% resistant to methicillin]),<i>Pseudomonas aeruginosa</i>(28.7%), coagulase-negative staphylococci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (&gt;48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. ICU-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% CI, 1.71 to 7.18), and bloodstream infection (OR, 1.73; 95% CI, 1.25 to 2.41) increased the risk of ICU death. <h3>Conclusions.</h3> —ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients. (<i>JAMA</i>. 1995;274:639-644)

Prevalence, Diagnosis, and Microbiology of Ventilator-Associated Pneumonia in Traumatically Injured Patients

2025-06-23
Christopher B. Horn , Qiao Zhang , Daniel M. Kaufman +4 more | Surgical Infections
Background: Hospital-acquired infections (HAIs) are important risk factors for mortality in trauma patients and are increasingly under scrutiny as markers of healthcare quality. We sought to define the effect of … Background: Hospital-acquired infections (HAIs) are important risk factors for mortality in trauma patients and are increasingly under scrutiny as markers of healthcare quality. We sought to define the effect of trauma on the prevalence, diagnosis, microbiology, and outcomes of ventilator-associated pneumonia (VAP). Patients and Methods: We performed retrospective national case-control and single-center cohort studies. Injured and non-injured patients from a representative cohort of inpatient hospital visits in the United States from 2010 to 2014 were case-matched, and the prevalence and outcomes of patients with VAP were compared. Patients with a diagnosis of VAP at our institution from 2002 to 2015 were then identified. We compared the effect of trauma on the prevalence, demographics, microbiologic testing, and recovered microorganisms of patients. Results: Overall, 1.7 million trauma visits were identified in the 2010-2014 National Inpatient Sample. In total, 94% of these visits were case-matched with non-injured controls. Trauma visits had a three-fold increased prevalence of a diagnosis of VAP. Cases of VAP (n = 635) were then extracted from our institutional database. We found an increased prevalence of VAP in injured inpatients. Microbiologic cultures were more frequently assessed in injured patients. Injury was associated with an increased frequency of gram-positive VAP and a decreased frequency of gram-negative pneumonia. Discussion: Injured inpatients are three-fold more likely to receive a diagnosis of VAP as compared with uninjured inpatient controls and are more likely to have a microbiologic diagnosis.

Anaerobic microbiota facilitate pathogen access to the airway epithelium in a novel co-culture model of colonization

2025-06-19
Peter J. A. Moore , Leslie A. Kent , Ryan C. Hunter | bioRxiv (Cold Spring Harbor Laboratory)
ABSTRACT Chronic rhinosinusitis (CRS) is a prevalent condition characterized by mucus stasis, persistent inflammation, and infection of the paranasal sinuses. It often involves the bacterium Pseudomonas aeruginosa, especially in individuals … ABSTRACT Chronic rhinosinusitis (CRS) is a prevalent condition characterized by mucus stasis, persistent inflammation, and infection of the paranasal sinuses. It often involves the bacterium Pseudomonas aeruginosa, especially in individuals with cystic fibrosis or a history of antibiotic use. While P. aeruginosa is a known opportunistic pathogen that employs a diverse array of virulence factors to cause airway infections, its ability to thrive in the sinonasal environment is also likely influenced by its local microbial ecology. For instance, anaerobic bacterial genera, such as Streptococcus, Veillonella, and Prevotella, are also commonly found in CRS and may contribute to P. aeruginosa persistence. Here we sought to test the hypothesis that anaerobes promote P. aeruginosa colonization of the upper airways, specifically through degradation of mucin glycoproteins that decorate the epithelial surface. Using a novel dual oxic-anoxic culture platform termed DOAC, we co-cultured Calu-3 epithelial cells with a CRS-derived anaerobic microbial community. We observed increased expression of inflammatory marker genes and degradation of mucin glycoproteins, along with enhanced P. aeruginosa colonization of the epithelial surface after anaerobe pre-treatment. Furthermore, mucins isolated from anaerobe-treated Calu-3 cells promoted greater P. aeruginosa attachment to microtiter plates in vitro compared to intact mucins. These results suggest that anaerobic microbiota may shape the sinonasal environment in a way that favors P. aeruginosa persistence, offering new insights into CRS pathogenesis and potential therapeutic targets to disrupt detrimental bacterial interactions in chronic airway disease. IMPORTANCE The prevalence and abundance of strict and facultative anaerobic bacteria in chronic sinusitis as detected by culture-independent sequencing has renewed interest in their potential role(s) in disease onset, progression, and treatment. However, reductionist study of interactions between anaerobic microbiota and the host has been limited by the lack of laboratory models compatible with their conflicting oxygen demands. The significance of this work lies in the use of a novel co-culture platform, termed DOAC, to interrogate anaerobe interactions with the airway epithelium. We use this platform to show that anaerobic CRS microbiota elicit a pro-inflammatory response, degrade mucin glycoproteins, and promote mucosal colonization by the canonical CRS pathogen, Pseudomonas aeruginosa . This work highlights highlight a potential role of anaerobic microbiota in conditioning the sinonasal environment to favor pathogen colonization.

Etiological structure of pathogens of lower respiratory tract infections in chronically critically ill patients undergoing treatment and rehabilitation in intensive care units

2025-06-19
Tatiana Kameneva , S. A. Bazanovich , M. Yu. Yuriev +4 more | Physical and rehabilitation medicine medical rehabilitation
Background: Chronic critical condition (CCI) is a syndrome that includes dependence on artificial ventilation, systemic inflammatory response, multiple organ failure, secondary sarcopenia, hypermetabolism-hypercatabolism syndrome, protein-energy deficiency. Infections of the lower … Background: Chronic critical condition (CCI) is a syndrome that includes dependence on artificial ventilation, systemic inflammatory response, multiple organ failure, secondary sarcopenia, hypermetabolism-hypercatabolism syndrome, protein-energy deficiency. Infections of the lower respiratory tract (LRT) in this category of patients in intensive care units (ICU) remain one of the significant causes of adverse outcomes, lengthening hospital admission and increasing financial costs for treatment. Aims: To determine the etiological structure of LRT infections in CCI patients in the ICU for the period from 2020 to 2023 and their sensitivity to antibiotics, identify the most common mechanisms of resistance of the leading pathogens and formulate recommendations for optimizing antimicrobial therapy for these patients. Materials and methods: The study included patients with confirmed LRT infection in a predominantly prolonged and chronic critical condition for the period from 2020 to 2023. The identification of microorganisms was carried out using an automatic BD Phoenix 100 analyzer. The EUCAST criteria were used to interpret the sensitivity. Results: for the period from 2020 to 2023, the top 10 leading pathogens of LRP infections in 1007 patients included mainly gram-negative microorganisms in this category. At the same time, Acinetobacter baumannii increased from 13,22% to 21,40% (p0,001) and Escherichia coli decreased from 7,90% to 2,98% (p0,001) over the specified period. The resistance of Klebsiella pneumoniae and Acinetobacter baumannii to carbapenems from 2020 to 2023 increased significantly from 80,50% to 91,64% (p0,001) and from 89,89% to 98,14% (p0,001), respectively. Carbapenemase producers of Klebsiella pneumoniae increased their resistance to colistin from 4,95% to 9,00% (p0,001) and tigecycline from 48,76% to 71,28% (p0,001), respectively, and to ceftazidime/avibactam from 33,06% to 47,73% (p=0,041). Conclusions: Gram-negative bacteria with a high level of antibiotic resistance, including carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosae, and Acinetobacter baumannii, were the predominant causative agents of LRT infections in CCI patients in the ICU. An analysis of the etiological structure of LRT infections and their sensitivity to antibiotics in this category of patients is necessary to create local protocols for effective empirical antimicrobial therapy. In each specific ICU of a medical organization.

Lung Microbiota in Acute Respiratory Failure and Acute Respiratory Distress Syndrome

2025-06-17
Salvatore Lucio Cutuli , Eloisa Sofia Tanzarella , Gianmarco Lombardi +6 more | Current anesthesiology reports

The pasteurized Weissella cibaria alleviates sepsis-induced acute lung injury by modulation of intestinal mucus barrier and gut microbiota

2025-06-17
Yuanzhe Li , Debin Yang , Huan Zhao +7 more | Journal of Translational Medicine
Dysbiosis of intestinal microecology caused by sepsis plays a crucial role in the onset and progression of sepsis-induced acute lung injury (SALI). As a postbiotic type, inactivated probiotic bacteria can … Dysbiosis of intestinal microecology caused by sepsis plays a crucial role in the onset and progression of sepsis-induced acute lung injury (SALI). As a postbiotic type, inactivated probiotic bacteria can regulate the gut microbiome. Pasteurized bacteria are considered safer than live bacteria in immune dysregulation disorders. Weissella cibaria (W. cibaria) is considered a candidate probiotic with certain beneficial functions. However, whether inactivated W. cibaria can alleviate SALI and the underlying mechanisms remain unclear. This study aimed to investigate whether inactivated W. cibaria can regulate intestinal mucosal barrier function and gut microbiota, thereby improving SALI. Following gavage of pasteurized W. cibaria in septic mice, lung tissue damage and inflammation levels were assessed. Circulating LPS levels and inflammatory cytokine concentrations in the blood were measured. Additionally, colonic tissue inflammation, intestinal mucosal barrier integrity, and alterations in the gut microbiota were evaluated. Pasteurized W. cibaria increases survival rates in SALI mice and improves pathological damage and cell apoptosis in lung tissue. Pasteurized W. cibaria also reduces the lung inflammatory response in septic mice by lowering pro-inflammatory cytokine levels and increasing anti-inflammatory cytokine levels. Pasteurized W. cibaria appears to exert its effects by improving the intestinal mucosal barrier and reversing gut microbiota dysbiosis caused by sepsis. Specifically, pasteurized W. cibaria alleviates intestinal barrier damage and inflammation in SALI mice, enhancing the integrity of the intestinal mucosal barrier. Additionally, pasteurized W. cibaria increases the abundance of anti-inflammatory bacteria such as Muribaculaceae. Pasteurized W. cibaria also decreases the levels of LPS-producing bacteria, including Escherichia-Shigella and Helicobacter, leading to significant attenuation in metabolic endotoxemia, which in turn alleviates excessive lung inflammation in septic mice. Pasteurized W. cibaria has the potential to act as a postbiotic agent, improving sepsis-induced gut microbiota dysbiosis and acute lung injury, and providing a novel strategy for treating SALI.

Optimizing microbiological surveillance during selective digestive decontamination in the intensive care unit: an in silico simulation study

2025-06-17
Jelle L G Haitsma Mulier , Fleur J van Dijk , Valentijn A. Schweitzer +3 more | Critical Care
Abstract Background Selective Digestive Decontamination (SDD) prevents infections and reduces mortality in the intensive care unit (ICU). Microbiological surveillance is considered essential for effective decontamination and detecting antibiotic resistance. However, … Abstract Background Selective Digestive Decontamination (SDD) prevents infections and reduces mortality in the intensive care unit (ICU). Microbiological surveillance is considered essential for effective decontamination and detecting antibiotic resistance. However, its optimal frequency is unclear. We compared microbiological yield and costs of different surveillance intervals during SDD. Methods In a computational simulation study, using data from a Dutch ICU, three surveillance scenarios were compared: (A) twice-weekly, (B) once-weekly, and (C) no surveillance. The primary outcome was the number of clinically relevant potentially pathogenic microorganisms (PPMs) detected per scenario. Secondary outcomes included detection of colonisation persistence prompting SDD intensification and surveillance costs. Results We included 8,499 ICU admissions, 52,553 clinical and 75,567 SDD cultures. Scenario A yielded 911 (95% CI 905–917) PPMs per 1,000 days, of which 90 (88–94) were clinically relevant: 9 (9–10) multidrug-resistant microorganisms, 68 (66–71) microorganisms resistant to standard therapy, and 13 (12–14) infection-related microorganisms. Scenarios B and C yielded 85 (82–88) and 77 (75–80) relevant PPMs, respectively (94% and 86% compared to scenario A). Scenario A identified 56 (55–58) cases of colonisation persistence per 1,000 days while scenarios B and C detected 43 (42–45) and 12 (11–12), respectively. Total costs of SDD surveillance were €78,774, €55,208, and €31,522 per 1,000 days for scenarios A, B and C. Conclusion Compared to twice-weekly surveillance, once-weekly microbiological surveillance reduces costs by 30% with 6% loss in clinically relevant PPM detections. No surveillance reduces costs by 60% with 14% detection loss.

Characterizing Microbiome Changes in Veno-Venous Extracorporeal Membrane Oxygenation: A Case Report of Multidrug-Resistant Bacteremia

2025-06-17
Zachary Jarrett , Hui Xia , Erika R. O’Neil +5 more | ASAIO Journal
Microbiome analysis using metagenomics next-generation sequencing (mNGS) is rarely performed in patients receiving extracorporeal membrane oxygenation (ECMO). Patient body sites were swabbed within 72 hours of ECMO cannulation and weekly … Microbiome analysis using metagenomics next-generation sequencing (mNGS) is rarely performed in patients receiving extracorporeal membrane oxygenation (ECMO). Patient body sites were swabbed within 72 hours of ECMO cannulation and weekly during ECMO course. Specimens underwent 16S sequencing to identify the microbiome along with mNGS to determine antimicrobial resistance genes. Fifty-two year old male who suffered polytraumatic injuries and developed acute respiratory syndrome was placed on veno-venous (VV) ECMO to treat severe respiratory failure. On ECMO day 1, the patient was undergoing treatment for urinary tract infection due to susceptible Pseudomonas aeruginosa (PsA). On ECMO day 22, the patient developed fulminant septic shock and tracheal aspirate and blood cultures both grew MDR PsA and Enterobacter cloacae complex (ECC) and ultimately died on day 23. There were significant microbiome and antimicrobial resistance changes that preceded sepsis on day 22, as evidenced by the increase in oral PsA colonization and expansion of resistance genes, such as KPC and OXA-50 , which suggest several possible reservoirs for infection outside of the circuit. Further application of these methods is needed to understand microbiome changes in ECMO and ultimately guide infection prevention efforts.

Endotracheal Tube‐Associated Complications in Paediatric Critical Care: A Systematic Review and Meta‐Analysis

2025-06-16
Joanne Curlis , Karina Charles , Ruth Royle +4 more | Nursing in Critical Care
ABSTRACT Background Children admitted to the paediatric intensive care unit who require mechanical ventilation are at increased risk for endotracheal tube complications. Increased endotracheal tubes complications can lead to increased … ABSTRACT Background Children admitted to the paediatric intensive care unit who require mechanical ventilation are at increased risk for endotracheal tube complications. Increased endotracheal tubes complications can lead to increased length of stay and subsequent increased health care costs. Aim To estimate the incidence of endotracheal tube‐associated infections and other complications in mechanically ventilated children. Study Design Systematic review and meta‐analysis of observational studies. The electronic databases and search machines PubMed, Embase and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched for articles published 2012 to 2023. We included cohort studies and randomized controlled trials set in paediatric intensive care that reported endotracheal tube‐associated complications (infection, accidental removal, pressure injuries and blockage). Study eligibility assessment, data extraction and critical appraisal were undertaken by pairs of reviewers. Pooled estimates of complications were generated using random effects meta‐analysis. Study quality was assessed using the Critical Appraisal Skills Programme tool for randomized controlled trials and cohort studies. Results We included data from 34 studies (12 RCTs and 22 cohort studies; n = 50 359 patients; 232 123 ventilator days). There was substantial study heterogeneity. The primary outcome was endotracheal tube‐associated infection: ventilator‐associated pneumonia, ventilator‐associated events and/or ventilator‐associated tracheobronchitis. Ventilator‐associated pneumonia was the most common endotracheal tube‐associated complication (incidence rate 13.5/1000 ventilator days; 95% confidence interval [CI] 8.2, 22.2) with higher rates in low‐ and middle‐income countries than high‐income economies (incidence rate difference 11.9%; 95% CI 10.2, 13.7). Accidental extubation was the second most common complication (7.4/1000 ventilator days; 95% CI 5.1, 10.7) followed by endotracheal tube‐associated pressure injuries (5.4/1000 ventilator days; 95% CI 1.7, 16.6) and endotracheal tube blockage (5.0/1000 ventilator days; 95% CI 1.4, 17.6). Conclusions Endotracheal tube‐associated complications remain prevalent and contribute avoidable harm. The continued high incidence of ventilator‐associated pneumonia highlights further efforts are needed to reduce burden, especially in lower‐ and middle‐ income countries. Relevance to Clinical Practice Awareness of endotracheal tube‐associated complications will promote initiatives to reduce complications and prevent patient harm. Prospero Registration: PROSPERO 2022 CRD42022339900.

Postoperative Infectious Pneumonia in Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

2025-06-16
Said Khallikane , Rachid Seddiki , Issam Serghini | F1000Research
<ns5:p>Background Postoperative infectious pneumonia (PIP) is a common and serious complication following cardiothoracic surgery, including coronary artery bypass grafting (CABG), valve interventions, and thoracic oncologic procedures. It is associated with … <ns5:p>Background Postoperative infectious pneumonia (PIP) is a common and serious complication following cardiothoracic surgery, including coronary artery bypass grafting (CABG), valve interventions, and thoracic oncologic procedures. It is associated with increased morbidity, prolonged intensive care unit (ICU) stay, and healthcare burden. Methods We performed a systematic review and meta-analysis according to PRISMA 2020 guidelines. Studies published between January 2021 and December 2023 were identified from PubMed, Embase, and Scopus. Eligible studies reported the incidence and/or perioperative risk factors for PIP with odds ratios (ORs) and 95% confidence intervals (CIs). A random-effects model was used for pooled estimates. Study quality was assessed using the Newcastle-Ottawa Scale. The review was prospectively registered in PROSPERO 2025 CRD 420251057914. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251057914. Results Six high-quality cohort studies involving 4,392 patients were included. The pooled incidence of PIP was 14.8% (95% CI, 10.6%–19.2%). Incidence was highest after thoracic oncologic surgery (17.2%), followed by valve surgery (15.8%) and CABG (13.5%). Significant risk factors included prolonged mechanical ventilation &gt;48 hours (OR: 3.46), age &gt;70 years (OR: 2.71), chronic obstructive pulmonary disease (OR: 2.95), cardiopulmonary bypass time &gt;120 minutes (OR: 2.63), and left ventricular ejection fraction &lt;40% (OR: 2.38). Heterogeneity was moderate (I<ns5:sup>2</ns5:sup> = 46%) with no publication bias. Conclusions PIP remains a major postoperative concern. Identification of key risk factors enables targeted preventive strategies—early extubation, pulmonary optimization, and standardized care pathways—to reduce PIP incidence and improve outcomes.</ns5:p>

A comparative analysis of cluster based interventions on healthcare-associated infections in a tertiary care hospital in China

2025-06-16
Ya Zou , Chunhuan Lao , Ting Fan +7 more | Frontiers in Public Health
Background Healthcare-associated infections (HAIs) are a significant concern in infection prevention. This study analyzes the trend of incidence of HAIs in a tertiary care hospital in China and assesses the … Background Healthcare-associated infections (HAIs) are a significant concern in infection prevention. This study analyzes the trend of incidence of HAIs in a tertiary care hospital in China and assesses the effectiveness of cluster based interventions. Methods A retrospective analysis was conducted on HAIs reports from 2015 to 2024, focusing on episodes involving the incidence rate of hospital infections, the catheter infection rate related to invasive procedures in the intensive care unit (ICU), healthcare workers’ compliance with hand hygiene, needlestick and sharp injuries (NSIs) among healthcare workers, the prophylactic use rate of antimicrobial agents for Class I surgical incisions, and the antimicrobial usage density (AUD). In 2019, we implemented cluster-based interventions on the incidence of HAIs, strengthening hospital infection control. Results The downward trend in HAIs is notable, with infection rates of 9.34 ± 0.25 and 7.29 ± 0.78 per 1,000 patient-days observed during the periods of 2015–2019 and 2020–2024, respectively ( p &amp;lt; 0.001). The decline in ICU infections linked to invasive ventilators and catheters is evident, with significant reductions in ventilator-associated pneumonia rates per 1,000 ventilator days (6.31 ± 1.50 vs. 2.72 ± 1.01, p = 0.002), catheter-associated urinary tract infection rates per 1,000 catheter days (1.66 ± 0.33 vs. 0.99 ± 0.28, p = 0.008), and catheter-related bloodstream infection rates per 1,000 catheter days (1.39 ± 0.35 vs. 0.43 ± 0.14, p &amp;lt; 0.001) during the periods of 2015–2019 and 2020–2024. A significant enhancement in hand hygiene compliance was observed when comparing the periods from 2015–2019 and 2020–2024, with a statistically significant difference (68.13 ± 3.55 vs. 77.39 ± 3.37, p = 0.003). Additionally, a notable decrease in NSIs per 10,000 patient days was observed during the same comparison period, with a statistically significant difference (12.17 ± 1.47 vs. 9.20 ± 1.07, p = 0.006). Conclusion Cluster-based interventions are effective in reducing healthcare-associated infections in a tertiary care hospital in China.

Coagulase-negative Staphylococcus bacteremia in ECMO: Examining key influencing factors

2025-06-13
Faraz Iqbal Khaskheli , Safa Nasir , Hina Khan +2 more | American Journal of Infection Control

Lipidomic signatures of ventilator-associated pneumonia in COVID-19 ARDS patients: a new frontier for diagnostic biomarkers

2025-06-05
Arthur Kassa-Sombo , Charles Verney , A. Pasquet +7 more | Annals of Intensive Care

Prevention of VAP Using Hypertonic Saline Nebulization in NICU: A More Nuanced Perspective is Required

2025-06-04
Shraddha Chaturvedi , Manish Kumar | Indian Pediatrics

Inhaled Antibiotics for Ventilator-Associated Pneumonia: A Turning Point

2025-06-02
Stéphan Ehrmann | Respiratory Care
Ventilator-associated pneumonia remains a major challenge in critical care because of its high incidence, prolonged ICU and hospital stays, and escalating health care costs. Conventional intravenous antibiotic therapy is limited … Ventilator-associated pneumonia remains a major challenge in critical care because of its high incidence, prolonged ICU and hospital stays, and escalating health care costs. Conventional intravenous antibiotic therapy is limited by suboptimal lung penetration and systemic toxicity. Inhaled antibiotic therapy offers a promising alternative by delivering high concentrations of drug directly to the site of infection, thereby potentially overcoming biofilm-related resistance mechanisms and improving bacterial eradication. This review examines the epidemiology and clinical burden of ventilator-associated pneumonia, its pathophysiology, and the pharmacokinetic advantages of the inhaled route. Three strategies for inhaled antibiotic therapy-substitutive, adjunctive, and preventive-are discussed. Data from key trials provide proof of concept for prophylactic inhaled therapy, whereas mixed results from adjunctive studies underscore the need for further research. Practical implementation guidelines, such as optimal nebulizer selection, circuit configuration, and essential safety measures, are discussed. Finally, future perspectives on inhaled anti-infectious therapies, including immunomodulators and biologics, are presented. Together, these data support the view that inhaled anti-infective therapy has the potential to transform the management of ventilator-associated pneumonia, although further standardized, large-scale trials are needed to fully establish its clinical efficacy in all situations.

The burden of ESKAPE pathogen-related hospital-acquired infections: clinical and financial perspective from a systematic review

2025-06-01
Pei Yee Woh , Xiangyu Zhang | Journal of Hospital Infection

The role of broncho-alveolar lavage in prevention of ventilator associated pneumonia and prediction of prognosis in mechanically ventilated trauma patients

2025-06-01
Asmaa Abdelhakim , M Mahran , Mohamed H. Fouda +4 more | Deleted Journal

The efficacy of prophylactic nebulized antibiotics for the prevention of ICU-acquired pneumonia: A meta-analysis

2025-06-01
S Tu , Yemin Shi | Asian Journal of Surgery

Ventilator Associated Pneumoniaina Medical Intensive Care Unit: Incidence, Risk factors and Mortality

2025-05-31
Shriprakash Kalantri , Ashok Meshram , Nitin Tiple | Indian Journal of Critical Care Medicine

Co-relation between Prior Airway Management and Incidence of Ventilator Associated Pneumonia in Traumatic Brain Injury Patients: A Prospective Observational Study

2025-05-31
Kajal Jain , Karan Singla | Indian Journal of Critical Care Medicine

Diagnostic Value of Bedside Lung Ultrasonography Plus Procalcitonin in Ventilator-associated Pneumonia

2025-05-31
Sudha Kansal , Shivali Sandal | Indian Journal of Critical Care Medicine

The ICU Burden: How Drug-resistant Pneumonia Shapes Shock And Mortality: A Retrospective Analysis

2025-05-31
Prakhar Sharma , Deepansh Gupta , Krishnapriya S Kumar +2 more | Indian Journal of Critical Care Medicine

Retrospective Observational Study of the Outcome in the Patients with Serious Hospital Acquired Infections Treated With Empiric Vs Definitive Antibiotic Therapy

2025-05-31
Susruta Bandyopadhyay , D. Ray | Indian Journal of Critical Care Medicine

Heat and Moisture Exchangers (HMEs) vs Heated Humidifiers (HHs) in the Management of Mechanical Ventilated Adult Patients

2025-05-31
Shweta Ram Chandankhede , Srinivas GPVN , Savitha Appana | Indian Journal of Critical Care Medicine

Possible Ventilator-Associated Pneumonia (PVAP) Prevention: The Role of Oral Care and Subglottic Endotracheal Tubes

2025-05-31
Dan Popkin , Kevin H. Smith | American Journal of Infection Control

Bacterial Etiology and Antibiotic Management of Sepsis

2025-05-31
Mahajan PM , Panchal GV , Chavan GG +1 more | Indian Journal of Critical Care Medicine

Combined pathogenic characteristics to analyze susceptibility factors of postoperative pneumonia in patients undergoing cardiac surgery

2025-05-30
Jie Li , Zhenhua Wu , Chang Xie +1 more | Journal of Cardiothoracic Surgery

Turkish Validity and Reliability Study of the Ventilator-Associated Pneumonia Preventive Behavior Measurement Tool

2025-05-30
Esin Kelağalar , Özlem Doğu , Öznur Tiryaki +1 more | Florence Nightingale Journal of Nursing

Intervenciones de Enfermería en la prevención de las infecciones asociadas a la atención sanitaria en las unidades de cuidados intensivos. Una Revisión Sistemática.

2025-05-29
Marco Joel Verdezoto Verdezoto , David Eduardo González Naranjo | Reincisol
Las infecciones relacionadas con la atención sanitaria son un desafío global en términos de salud pública, constituyendo un riesgo para la seguridad de los pacientes y un punto crítico en … Las infecciones relacionadas con la atención sanitaria son un desafío global en términos de salud pública, constituyendo un riesgo para la seguridad de los pacientes y un punto crítico en los servicios de salud. El objetivo de este estudio fué evaluar las investigaciones realizadas en la literatura científica sobre intervenciones de enfermería para evitar las Infecciones asociadas a la atención sanitaria en la Unidad de Cuidados Intensivos. En este análisis sistemático se realizó una búsqueda de artículos en las plataformas PubMed, CINAHL, Scielo y Google en búsqueda libre, utilizando operadores boleanos como “and” y “or”, se revisó documentación entre los años 2017 y 2024. Los resultados mostraron que los microorganismos más prevalentes, especialmente en unidades de cuidados intensivos fueron escherichia coli, klebsiella pneumoniae, enterococcus sp, enterococcus faecium, enterobacter, burkholderia y staphylococcus aureus, relacionados por el uso compartido de habitaciones entre pacientes. La adherencia a protocolos de lavado de manos y normas de asepsia son muy efectivas para prevenir infecciones asociadas a la atención sanitaria, particularmente aquellas adquiridas en las UCI, la implementación de estrategias de supervisión y auditoría son eficaces para mejorar la adherencia y reducir la incidencia de IAAS en los pacientes hospitalizados.

Early Sitting Improves the Accuracy of Predicting In-Hospital Mortality in Older Adult Patients With Pneumonia

2025-05-28
Hidenori Akaiwa , Yosuke Morimoto , Ryuichiro Takamura +2 more | Cureus

Antibiotics with Anti-Anaerobe Activity Promote Enteric Pathobionts in ICU Patients

2025-05-27
Steven Taylor , Sophie Miller , Alyson Richard +7 more

Stress ulcer prophylaxis practice in UK critical care units: A comparison of cross-sectional surveys between 2020 and 2024

2025-05-26
Mark Borthwick , Greg Barton , Emma Boxall +7 more
Background: Critically ill patients are at risk of bleeding from stress ulcers. Comprehensive information regarding United Kingdom stress ulcer prophylaxis (SUP) practices are not available and may change over time. … Background: Critically ill patients are at risk of bleeding from stress ulcers. Comprehensive information regarding United Kingdom stress ulcer prophylaxis (SUP) practices are not available and may change over time. We aimed to describe SUP practices in 2020 and reevaluate the position in 2024. Methods: Critical care pharmacists provided observed SUP practice data for UK adult critical care units via an electronic repository in 2020 and 2024. One response was accepted from each critical care unit at each time point. Data collected included trigger criteria for commencing SUP, primary medication class used, primary SUP cessation criteria, and level of nutritional intake (if part of cessation criteria). Results: There were high response rates of 70.3% (2020) and 66.7% (2024) of registered UK adult critical care units. Few differences in primary SUP trigger criteria between 2020 and 2024 were seen, with small differences in the categories of ‘SUP not used’ ( p = 0.002) and ‘Shock’ ( p = 0.027) driving statistical significance (χ 2 (7, 454) = 16.76, p = 0.019). There was a significant change in the primary medication class used for SUP (H2 receptor antagonist 49.4% 2020, vs 0.4% 2024, proton pump inhibitor 44.7% 2020 vs 97.8% 2024; χ 2 (2, 458) = 159.62, p &lt; 0.001). Primary SUP cessation criteria was ‘Patient fed’ (66.8% 2020, 64.6% 2024), with most describing this threshold as met when the patient receives full enteral feed (72.0% 2020, 78.8% 2024). Conclusion: The UK has moved towards proton pump inhibitors as the primary SUP medication class. SUP is most frequently discontinued on establishment of enteral nutrition.

Microbiological profile of healthcare-associated infections at a tertiary care center, New Delhi, India

2025-05-26
Ashish William , Anil Kumar , V. S. Randhawa +2 more | One Health Bulletin
Objective: To determine the incidence and microbiological profile of healthcare-associated infections (HAIs) in a Medical Intensive Care Unit (MICU) in New Delhi, India. Methods: All patients aged 18 years and … Objective: To determine the incidence and microbiological profile of healthcare-associated infections (HAIs) in a Medical Intensive Care Unit (MICU) in New Delhi, India. Methods: All patients aged 18 years and above who were admitted to the MICU and suspected of having HAIs by the treating physicians were enrolled in this study. Different samples (pus, blood, urine, and sterile fluid/aspirates) were collected from all patients according to standard protocol. Cultures and microscopy were performed on the samples, and identification of growth was done using biochemical tests and the VITEK-2 system. The antimicrobial susceptibility testing was also conducted according to Clinical and Laboratory Standard Institute guidelines. Results: Among 81 patients with central lines, urinary catheters, and mechanical ventilation, HAIs were observed in 12 (14.8%) patients. Of these 81 patients, ventilator-associated pneumonia (VAP) occurred in 9 patients (11.1%) and central line-associated bloodstream infection was observed in 3 patients (3.7%). The microorganisms isolated from patients with VAP included Klebsiella pneumoniae in 6 cases, Acinetobacter lwoffii in 1 case, Escherichia coli in 1 case and methicillin-resistant Staphylococcus aureus in 1 case. Among the Gram-negative isolates from VAP patients, high resistance was observed in Escherichia coli (83.33%) and Klebsiella pneumoniae (100%) to both imipenem and meropenem. All the isolates were susceptible to colistin. Conclusions: The study highlights the high incidence of HAIs in critically ill MICU patients and the alarming prevalence of carbapenem resistance in the HAI-causing pathogens. HAIs are largely preventable through effective infection prevention and control measures.