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Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit 被引量:2
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作者 Maria Caterina Pace Antonio Corrente +4 位作者 Maria Beatrice Passavanti Pasquale Sansone Stephen Petrou Sebastiano Leone Marco Fiore 《World Journal of Clinical Cases》 SCIE 2023年第13期2874-2889,共16页
Intensive care units(ICU)for various reasons,including the increasing age of admitted patients,comorbidities,and increasingly complex surgical procedures(e.g.,transplants),have become"the epicenter"of nosoco... Intensive care units(ICU)for various reasons,including the increasing age of admitted patients,comorbidities,and increasingly complex surgical procedures(e.g.,transplants),have become"the epicenter"of nosocomial infections,these are characterized by the presence of multidrug-resistant organisms(MDROs)as the cause of infection.Therefore,the perfect match of fragile patients and MDROs,as the cause of infection,makes ICU mortality very high.Furthermore,carbapenems were considered for years as last-resort antibiotics for the treatment of infections caused by MDROs;unfortunately,nowadays carbapenem resistance,mainly among Gram-negative pathogens,is a matter of the highest concern for worldwide public health.This comprehensive review aims to outline the problem from the intensivist's perspective,focusing on the new definition and epidemiology of the most common carbapenem-resistant MDROs(Acinetobacter baumannii,Pseudomonas aeruginosa and Enterobacterales)to emphasize the importance of the problem that must be permeating clinicians dealing with these diseases. 展开更多
关键词 Antimicrobial resistance MULTIDRUG-resistant PDR Carbapenem-resistance Multidisciplinary critical care intensive care unit
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Risk factors and antibiotic resistance of pneumonia caused by multidrug resistant Acinetobacter baumannii in pediatric intensive care unit 被引量:2
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作者 Xiao-fang Cai Ji-min Sun +1 位作者 Lian-sheng Bao Wen-bin Li 《World Journal of Emergency Medicine》 CAS 2012年第3期202-207,共6页
With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi (Ab) has become more and more serious with multidrug resistant Acinetobacter baumannfi (MDRAb) emerging an... With beta-lactam drugs and immunosuppressants widely used, the infection caused by Acinetobacter baumannfi (Ab) has become more and more serious with multidrug resistant Acinetobacter baumannfi (MDRAb) emerging and worsening rapidly. Compared with other patients, the incidence and multidrug resistance of MDRAb are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, prolonged hospitalization and invasive operations. Hence it is significant to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence of MDRAb in children. A total 115 patients with MDRAb pneumonia and 45 patients with negative MDRAb (NMDRAb) pneumonia who had been treated from January 2009 to August 2011 were studied retrospectively at the PICU of Wuhan Children's Hospital. Clinical data were analyzed with univariate and multivariate Logistic regression. In 176 clinical strains of Acinetobacter baumannfi isolated, there were 128 strains of MDRAb, accounting for 72.73%. Drug susceptibility tests showed that the resistance rates of 13-1actam antibiotics were more than 70% except for cefoperazone sulbactam. The rates to carbapenems were higher than 90%. They were significantly higher than those of NMDRAb. Amikacin, levofloxacin, ciprofloxacin and minocycline had the lowest drug-resistance rates (〈20%). Multivariate Logistic regression revealed that ICU stay, the time of mechanical ventilation, anemia, hypoproteinemia and the use of carbapenems were independent risk factors for MDRAb pneumonia. MDRAb is an important opportunistic pathogen to pneumonia in PICU, and its drug-resistance is severe. It increases significantly the mortality of patients. It is important to take the effective prevention measures for controlling it. 展开更多
关键词 PEDIATRIC intensive care unit Multidrug resistance Acinetobacter baumannii PNEUMONIA Risk factor Retrospective study
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Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern
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作者 Mohamed Eliwa Hassan Safaa Abdulaziz Al-Khawaja +5 位作者 Nermin Kamal Saeed Sana Abdulaziz Al-Khawaja Mahmood Al-Awainati Sara Salah Yusuf Radhi Mohamed Hameed Alsaffar Mohammed Al-Beltagi 《World Journal of Critical Care Medicine》 2023年第3期165-175,共11页
BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients... BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle. 展开更多
关键词 Ventilator-associated pneumonia intensive care unit Antibiotics susceptibility pattern Kingdom of Bahrain Adults Bacterial resistance ACINETOBACTER
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Comparing Resistant Microorganisms Isolated from Patients and Environment in an Intensive Care Unit 被引量:1
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作者 Quésia Souza Damaceno Robert Iquiapaza Adriana C. Oliveira 《Advances in Infectious Diseases》 2014年第1期30-35,共6页
Background: Recently, the probable involvement of surfaces from the hospital environment as a disseminating source of resistant bacteria has been highlighted. The aim of the study was to compare resistant microorganis... Background: Recently, the probable involvement of surfaces from the hospital environment as a disseminating source of resistant bacteria has been highlighted. The aim of the study was to compare resistant microorganisms isolated from inanimate surfaces, equipments and patient blood culture samples in an Intensive Care Unit from Belo Horizonte, Brazil. Methods: A cross-sectional study was performed from July to October 2009. Data sources were microbiologic samples from environment and patient blood culture. Duplicate samples were obtained by swabs from up to seven different touch sites around two different patients in four different days. Jointly with the environmental samples, bacterial isolates from an adult ICU patients’ routine blood cultures were obtained from hospital laboratory. The samples were identified, tested for sensitivity and compared by rep-PCR test to verify similarity. Results: Difference among the averages of Colony Forming Units was found within the environment samples (p < 0.004). In the environment were identified antibiotic resistant microorganisms such as Vancomycin resistant Enterococcus faecalis, imipenem and ciprofloxacin Pseudomonas aeruginosa and multidrug-resistant Acinetobacter baumannii. Similarities (60% -80%) were established among environmental and blood culture samples. Conclusion: The environmental sampling showed different averages of contamination of the surfaces and equipment. The similarity among the bacterial isolates of patients’ blood cultures and environmental samples reinforces the hypothesis of the horizontal transference of pathogens. 展开更多
关键词 Cross Infection BACTERIAL Drug resistance intensive care units ENVIRONMENT CONTAMINATION
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Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings 被引量:24
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作者 Estuardo Salgado Yepez Maria M Bovera +13 位作者 Victor D Rosenthal Hugo A González Flores Leonardo Pazmino Francisco Valencia Nelly Alquinga Vanessa Ramirez Edgar Jara Miguel Lascano Veronica Delgado Cristian Cevallos Gasdali Santacruz Cristian Pelaéz Celso Zaruma Diego Barahona Pinto 《World Journal of Biological Chemistry》 CAS 2017年第1期95-101,共7页
AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance... AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates. 展开更多
关键词 Ventilator-associated pneumonia Catheter-associated urinary tract infection Healthcare-associated infection Antibiotic resistance Developing countries intensive care unit SURVEILLANCE Central line-associated bloodstream infections Hospital infection
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Risk factors and mortality rates of carbapenem-resistant Gram-negative bacterial infections in intensive care units
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作者 Tulay Orhan Kuloglu Gamze Kalin Unuvar +2 位作者 Fatma Cevahir Aysegul Ulu Kilic Emine Alp 《Journal of Intensive Medicine》 CSCD 2024年第3期347-354,共8页
Background The prevalence of hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria(CRGNB)is increasing worldwide.Several risk factors have been associated with such infections.The present ... Background The prevalence of hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria(CRGNB)is increasing worldwide.Several risk factors have been associated with such infections.The present study aimed to identify risk factors and determine the mortality rates associated with CRGNB infections in intensive care units.Methods This retrospective case-control study was conducted at Erciyes University Hospital(Kayseri,Turkey)between January 2017 and December 2021.Demographic and laboratory data were obtained from the Infection Control Committee data and record system.Patients who had CRGNB infection 48–72 h after hospitalization were assigned to the case group,while those who were not infected with CRGNB during hospitalization formed the control group.Risk factors,comorbidity,demographic data,and mortality rates were compared between the two groups.Results Approximately 1449 patients(8.97%)were monitored during the active follow-up period;of those,1171 patients were included in this analysis.CRGNB infection developed in 14 patients(70.00%)who had CRGNB colonization at admission;in 162(78.26%)were colonized during hospitalization,whereas 515(54.56%)were not colonized.There was no significant difference in age,sex(male/female)or comorbidities.The total length of hospital stay was statistically significantly longer(P=0.001)in the case group(median:24[interquartile range:3–378]days)than the control group(median:16[interquartile range:3–135]days).The rates of colonization at admission(25.5%;vs.10.6%,P=0.001)and mortality(64.4%vs.45.8%,P=0.001)were also significantly higher in the cases than in the control group,respectively.In the univariate analysis,prolonged hospitalization,the time from intensive care unit admission to the development of infection,presence of CRGNB colonization at admission,transfer from other hospitals,previous antibiotic use,enteral nutrition,transfusion,hemodialysis,mechanical ventilation,tracheostomy,reintubation,central venous catheter,arterial catheterization,chest tube,total parenteral nutrition,nasogastric tube use,and bronchoscopy procedures were significantly associated with CRGNB infections(P<0.05).Multivariate analysis identified the total length of stay in the hospital(odds ratio[OR]=1.02;95%confidence interval[CI]:1.01 to 1.03;P=0.001),colonization(OR=2.19;95%CI:1.53 to 3.13;P=0.001),previous antibiotic use(OR=2.36;95%CI:1.53 to 3.62;P=0.001),intubation(OR=1.59;95%CI:1.14 to 2.20;P=0.006),tracheostomy(OR=1.42;95%CI:1.01 to 1.99;P=0.047),and central venous catheter use(OR=1.62;95%CI:1.20 to 2.19;P=0.002)as the most important risk factors for CRGNB infection.Conclusions Colonization,previous use of antibiotics,and invasive interventions were recognized as the most important risk factors for infections.Future research should focus on measures for the control of these parameters. 展开更多
关键词 Multidrug resistance Gram-negative bacteria INFECTION intensive care units
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Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients 被引量:1
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作者 Ravinder Kaur Megh Singh Dhakad +1 位作者 Ritu Goyal Rakesh Kumar 《Asian Pacific Journal of Tropical Biomedicine》 SCIE CAS 2016年第5期455-460,共6页
Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit(ICU) patients.Methods: The study used a qualitative descriptive... Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit(ICU) patients.Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed.Identification and speciation of the isolates was conducted by the biochemical tests.Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document.Results: Ninety Candida isolates were isolated from the different clinical samples: urine(43.3%), tracheal aspirate(31.1%), urinary catheter(12.2%), endotracheal tube(7.8%),abdominal drains(3.3%), sputum(2.2%). The incidence of candidiasis caused by nonalbicans Candida(NAC) species(63.3%) was higher than Candida albicans(36.7%).The various NAC species were isolated as: Candida tropicalis(41.1%), Candida glabrata(10%), Candida parapsilosis(6.7%), Candida krusei(3.3%) and Candida kefyr(2.2%). The overall isolation rate of Candida species from samples was 53.3%. Antifungal susceptibility indicated that 37.8% and 7.8% of the Candida isolates were resistant to fluconazole and amphotericin B, respectively.Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon. 展开更多
关键词 ANTIFUNGAL resistance CANDIDA SPECIES COLONIZATION intensive care unit PATIENTS
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Antimicrobial resistance pattern in ventilator-associated pneumonia in an intensive care unit of Babol, northern Iran
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作者 Mahmoud Sadeghi-Haddad-Zavareh Hadi Ahmadi Jouybari +6 位作者 Mostafa Javanian Mehran Shokri Masomeh Bayani Mohammad Reza Hasanjani Roushan Arefeh Babazadeh Soheil Ebrahimpour Parviz Amri Maleh 《Journal of Acute Disease》 2018年第2期74-77,共4页
Objective:To investigate antibiotic resistance pattern of ventilator-assiated pneumonia (VAP) generating microorganisms,and quantitative culture and determining antibiotic sensitivity.Methods:This cross sectional stud... Objective:To investigate antibiotic resistance pattern of ventilator-assiated pneumonia (VAP) generating microorganisms,and quantitative culture and determining antibiotic sensitivity.Methods:This cross sectional study was performed on 50 patients suffering from VAP in intensive care unit of Ayatollah Rouhani Hospital,Babol,Iran during 2014-2015.VAP was probable for them based on clinical signs and the criteria of Clinical Pulmonary Infection Score standards.Lower respiratory samples were given under bronchoalveolar lavage and quantitative culture was done on them.Afterwards by microdilution method,minimal inhibitory concentration based on respective microorganisms,considering clinical pulmonary infection score were determined.Results:From 50 investigated samples in this study,the most common microorganisms were Acinetobacter baumannii (A.baumannii) (70%) then Pseudomonas aeruginosa (12%),Staphylococcus aureus (8%) and Klebsiella pneumonia (3%).In our study A.baummannii showed approximate 100% resistance to all antibiotics,in a way that A.baumannii resistance to imipenem and meropenem and piperacillin/tazobactam each was 97.1%.The most resistance of Pseudomonas aeruginosa was 66.7% to each cefepime and ceftazidime and clavulanate/ticarcillin.Staphylococcus aureus showed 75% resistance to nafcillin,cloxacillin and resistance in case of vancomycin was not seen.Conclusion:In current study,A.baumannii had the most prevalence among VAP and this species is resistant to most of antibiotics.Using ceftazidime,cefepime and clavulanate/ticarcillin,in treatment of the patients suffering VAP is not reasonable. 展开更多
关键词 ANTIBACTERIAL resistant VENTILATOR-ASSOCIATED PNEUMONIA intensive care unit
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Epidemiological Characteristics, Resistance Patterns and Spread of Gram-Negative Bacteria Related to Colonization of Patients in Intensive Care Units
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作者 Quésia Souza Damaceno Jacques Nicoli Adriana Cristina Oliveira 《Advances in Infectious Diseases》 2015年第1期14-20,共7页
Our aim was to determine the epidemiological characteristics, the resistance patterns and the spread of Gram negative bacteria related to colonization of patients in adult Intensive Care Units. Methods: A prospective ... Our aim was to determine the epidemiological characteristics, the resistance patterns and the spread of Gram negative bacteria related to colonization of patients in adult Intensive Care Units. Methods: A prospective cohort of patients colonized and/or infected with Gram negative bacteria was conducted at two adult ICUs from hospitals in Brazil (April 2012 to February 2013). Nasal, groin and perineum swabs were performed. Samples were incubated on MacConkey and cetrimide agar (48 h at 37℃) and identification tests (Vitek-BioMérieux), antibiogram (Bauer-Kirby method), Carba NP test, Polymerase Chain Reaction (PCR) and sequencing were performed. The patterns of resistant microorganisms were compared by rep-PCR (Diversilab). Results: There were 53 cases of colonization. In these cases, we identified imipenem-resistant Acinetobacter baumannii (51%), Pseudomonas aeruginosa (32%), Klebsiella pneumoniae ESBL (38%) or imipenem resistant (5.6%). The use of antimicrobials and medical devices were related to colonization (p The resistance patterns expressed by Klebsiella pneumoniae were ESBL (CTX-M, SHV e TEM) and KPC2. A verified profile of Acinetobacter baumannii was related to OXA-23 and OXA-253 (OXA-143 variant). The profiles ESBL and KPC2 expressed by Klebsiella pneumoniae were distributed between the both ICUs. The distribution of OXA-23 and OXA-253 was verified only in one ICU. The similarity of strains ranged from 80% to 95%, highlighting the horizontal transference of these microorganisms. 展开更多
关键词 intensive care unit Bacterial DRUG-resistANCE GRAM-NEGATIVE AEROBIC Bacteria COLONIZATION
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Evaluation of rational use of antimicrobial agents in a Brazilian intensive care unit
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作者 Fabiana Xavier Cartaxo Salgado Tarquino Erastides Gavilanes Sanchez +3 位作者 Noriberto Barbosa da Silva Hildeamo Bonifacio Oliveira Mauro Karnikowski Margo Gomes de Oliveira Karnikowski 《Health》 2014年第2期188-194,共7页
The present study sought to assess the rational use of antimicrobial agents in a Brazilian intensive care unit (ICU) and its association with antimicrobial resistance in elderly patients admitted to the unit. Results:... The present study sought to assess the rational use of antimicrobial agents in a Brazilian intensive care unit (ICU) and its association with antimicrobial resistance in elderly patients admitted to the unit. Results: Choice of empiric and sensitivity-guided therapy was inadequate in > 80% and 59% of cases respectively. Inadequate antimicrobial therapy, whether empiric or sensitivity-guided, was positively correlated with bacterial resistance (r = 0.316;p = 0.001). Sensitivity testing revealed a 46.5% resistance rate to eight out of the ten most commonly used antibiotics. Multiple drug-resistant organisms were found in 40.8% of patients. A significant increase was observed in the number of multidrug-resistant samples between 2006/2007 and 2008 (r = 0.41, p = 0.006), (r = 0.598, p = 0.001), (r = 0.688, p = 0.00). Conclusion: We found a high rate of antibiotic misuse in the study sample. Inadequate therapy was correlated with resistance to antimicrobial agents. 展开更多
关键词 Rational use of Antimicrobial Agents intensive care unit Microbial resistance
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Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital,Indonesia 被引量:7
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作者 Maksum Radji Siti Fauziah Nurgani Aribinuko 《Asian Pacific Journal of Tropical Biomedicine》 SCIE CAS 2011年第1期39-42,共4页
Objective:To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit(ICU) of a tertiary care of Falmawati Hospital Jakarta Indonesia.Methods:A cross sectional retrospective study of bacteria... Objective:To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit(ICU) of a tertiary care of Falmawati Hospital Jakarta Indonesia.Methods:A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods,and(heir antibiotic susceptibility testing was performed using disk diffusion method.Results:Specimens were collected from 385 patients who were given antimicrobial treatment,of which 249(64.68%) were cultured positive and 136(35.32%) were negative.The most predominant isolate was Pseudomonas aeruginosa(P.aeruginosa)(26.5%) followed by Klebsiella pneumoniae(K.pneumoniae)(15.3%) and Staphylococcus epidermidis(14.9%).P.aeruginosa isolates showed high rate of resistance to cephalexin(95.3%),cefotaxime(64.1%),and ceftriaxone(60.9%).Amikacin was the most effective(84.4%) antibiotic against P.aeruginosa followed by imipenem(81.2%),and meropenem(75.0%).K.pneumoniae showed resistance to cephalexin(86.5%),ceftriaxone(75.7%),ceftazidime(73.0%),cefpirome(73.0%) and cefotaxime(67.9%),respectively.Conclusions:Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins,and quinolone antibiotics.Regular surveillance of antibiotic susceptibility pallerns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients. 展开更多
关键词 Antibiotic susceptibility intensive care unit BACTERIAL resistANCE BACTERIAL pathogen Sensitivity PATTERN Antimicrobial resistANCE Pseudomonas AERUGINOSA KLEBSIELLA PNEUMONIAE Isolate Specimen
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Diagnosis and management of malaria in the intensive care unit
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作者 George Akafity Nicholas Kumi Joyce Ashong 《Journal of Intensive Medicine》 CSCD 2024年第1期3-15,共13页
Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year.Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia,where the disease is endemic.I... Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year.Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia,where the disease is endemic.In non-endemic areas,malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs.Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria,respiratory distress,acute kidney injury,bleeding complications,and co-infection.Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy,recognition of complications,and appropriate supportive care.However,the lack of diagnostic capacities due to limited advances in equipment,personnel,and infrastructure presents a challenge to the effective diagnosis and management of malaria.This article reviews the clinical classification,diagnosis,and management of malaria as relevant to critical care clinicians,highlighting the role of diagnostic capacity,treatment options,and supportive care. 展开更多
关键词 MALARIA intensive care unit Severe malaria Antimicrobial resistance ANTIMALARIALS Artemisinin-based combination therapy
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Risk factors affecting nasal colonization of methicillin-resistant Staphylococcus aureus when admitted in intensive care unit 被引量:1
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作者 Li Qiang Zhuang Taifeng +2 位作者 Lin Ying Xi Jingjing Yao Gaiqi 《Chinese Medical Journal》 SCIE CAS CSCD 2014年第10期1804-1807,共4页
Background Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for subsequent invasive MRSA infection,particularly in patients admitted for critical care.The purpose of this study w... Background Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for subsequent invasive MRSA infection,particularly in patients admitted for critical care.The purpose of this study was to investigate the risk factors affecting nasal colonization of MRSA in patients admitted to intensive care units (ICU).Methods Between August 1,2011 and June 30,2012,we screened for MRSA nasal colonization in 350 patients by Real-time PCR within 24 hours of admission by means of swab samples taken from the anterior nares.According to the results of PCR,the patients were divided into 2 groups:the positive group with nasal MRSA colonization and the negative group without nasal MRSA colonization.The 31 (8.86%) patients were MRSA positive.The risk factors evaluated included thirteen variables,which were analyzed by t test for continuous variables and X2 test for discrete variables.The variables with significance (P <0.05) were analyzed with stepwise Logistic regression.Results There were differences (P <0.05) in four variables between two groups.The duration of stay in hospital prior to ICU admission in the positive group was (35.7±16.1) days,vs.(4.5±3.1) days in the negative group.The average blood albumin level was (28.4±2.9) g/L in the positive group,vs.(30.5±4.3) g/L in the negative group.Of 31 patients in the positive group,seven had been treated with antibiotics longer than seven days vs.34 of 319 patients in the negative group.In the positive group,four of 31 patients received treatment with more than two classes of antibiotics prior to admission in ICU,contrasted to 13 of 319 patients in the negative group.Furthermore,stepwise Logistic regression analysis for these four variables indicates that the duration of stay in hospital prior to ICU admission may be an independent risk factor.Conclusions MRSA colonization in ICU admission may be related to many factors.The duration of stay in hospital prior to ICU admission is an independent risk factor. 展开更多
关键词 methicillin-resistant staphylococcus aureus polymerase chain reaction intensive care unit risk factors
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Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria 被引量:2
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作者 Patricia Cornejo-Juárez Ivan González-Oros +2 位作者 Paola Mota-Castañeda Diana Vilar-Compte Patricia Volkow-Fernández 《World Journal of Critical Care Medicine》 2020年第3期43-53,共11页
BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,c... BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,creating a new burden on medical care in hospitals,particularly for patients admitted to the intensive care unit(ICU).AIM To describe risk factors for ventilator-acquired pneumonia(VAP)in patients with cancer and to evaluate the impact of MDRB.METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City,which included all patients who were admitted to the ICU and required MV≥48 h.They were classified as those who developed VAP versus those who did not;pathogens isolated,including MDRB.Clinical evolution at 60-d was assessed.Descriptive analysis was carried out;comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.RESULTS Two hundred sixty-three patients were included in the study;mean age was 51.9 years;52.1%were male;68.4%had solid tumors.There were 32 episodes of VAP with a rate of 12.2%;11.5 episodes/1000 ventilation-days.The most frequent bacteria isolated were the following:Klebsiella spp.[n=9,four were Extended-Spectrum Beta-Lactamase(ESBL)producers,one was Carbapenem-resistant(CR)];Escherichia coli(n=5,one was ESBL),and Pseudomonas aeruginosa(n=8,two were CR).One Methicillin-susceptible Staphylococcus aureus was identified.In multivariate analysis,the sole risk factor associated for VAP was length of ICU stay(OR=1.1;95%CI:1.03-1.17;P=0.003).Sixty-day mortality was 53%in VAP and 43%without VAP(P=0.342).There was not higher mortality in those patients with MDRB.CONCLUSION This study highlights the high percentage of Gram-negative bacteria,which allows the initiation of empiric antibiotic coverage for these pathogens.In this retrospective,single center,observational study,MDRB VAP was not directly linked to increased mortality at 60 days. 展开更多
关键词 Ventilator-associated pneumonia CANCER Multidrug resistance bacteria MORTALITY intensive care unit Mechanical ventilation
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Molecular Detection of Carbapenemase Genes in Extensive Drug Resistant Acinetobacter baumannii Clinical Isolates from ICU Patients, Khartoum 被引量:1
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作者 Shirehan M. Ibrahim Elamin M. Ibrahim +2 位作者 Omer A. Ibrahim Omnia M. Hamid Hassan A. Alaziz 《Open Journal of Medical Microbiology》 2022年第1期38-48,共11页
Background: The emergence of carbapenemase producing Acinetobacter baumannii is increasingly reported nowadays and constitutes a major problem to the intensive care unit (ICU) patients with notable extensive-drug resi... Background: The emergence of carbapenemase producing Acinetobacter baumannii is increasingly reported nowadays and constitutes a major problem to the intensive care unit (ICU) patients with notable extensive-drug resistance ability. The study investigates carbapenemase producing A. baumannii strains exhibiting an extensively drug-resistant (XDR) phenotype, isolated from ICU patients in Khartoum. Methods: A total of 100 nonduplicate Gram-negative coccobacilli strains were obtained from microbiology laboratory of ICU patients’ clinical isolates. Molecular identification of A. baumannii was performed by targeting 16S rRNA gene using specifically designed primers. Then, XDR strains were determined by susceptibility testing (disc diffusion). For detection of carbapenemase genes Polymerase chain reaction (PCR) was carried out. Result: Of 100 ICU clinical isolates, 38 (38.0%) was confirmed A. baumannii strains, those strains showed 100% carbapenem resistance and 60.5% extensive drug resistance to the antibiotics tested. The frequency of carbapenemase producer was 57.9% (22/38) of carbapenem resistance A. baumannii (CRAB). The most common carbapenemase associated with resistance was blaOXA gene followed by blaNDM and blaGES A. baumannii isolates. The co-occurrence of blaOXA-48-like and blaNDM, blaOXA-23-like and blaOXA-51, and blaNDM-1 and blaOXA-51 was detected in 22.7%, 18.2% strains and 4.5% respectively. A unique characteristic of our findings was the coharbouring of the genes blaNDM-1, blaOXA-23-like, blaOXA-51 and blaOXA-143 in 9.1% strains (2/22), and this was the first report in the Khartoum city, Sudan. Conclusion: We have demonstrated for the first time a high prevalence of XDR-carbapenemase producing A. baumannii clinical isolates from ICU patients in Khartoum. Also an emergent blaOXA-143 was reported as High-Risk Clones. This highlights the routine mentoring of XDR-carbapenemase producing A. baumannii to avoid clone dissemination in our region hospitals. 展开更多
关键词 Carbapenem Producing Acinetobacter baumannii (CPAB) intensive care unit (ICU) Patients Extensive Drug-resistant (XDR) COLISTIN
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重症监护病房多重耐药菌感染分布情况及影响因素分析 被引量:1
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作者 曾祥泰 张庆英 +2 位作者 逄楠 李艳操 许晓佳 《中国医药科学》 2024年第11期186-190,共5页
目的分析重症监护病房(ICU)患者多重耐药菌(MDRO)感染的分布情况及其危险因素,并提出相关的预防和控制措施。方法本研究以2021年7月至2022年12月汕头市某三级甲等医院ICU收治的1407例患者为对象,回顾性收集其住院期间是否发生MDRO感染,... 目的分析重症监护病房(ICU)患者多重耐药菌(MDRO)感染的分布情况及其危险因素,并提出相关的预防和控制措施。方法本研究以2021年7月至2022年12月汕头市某三级甲等医院ICU收治的1407例患者为对象,回顾性收集其住院期间是否发生MDRO感染,分析MDRO感染发生率和分布情况,并分为MDRO感染组和非MDRO感染组进行比较,采用多因素logistic回归筛选MDRO感染的相关危险因素。结果ICU共有1407例住院患者均接受细菌培养及耐药菌株检测,其中男性患者为880例,女性患者为527例;MDRO感染发生率为18.69%(263/1407)。ICU中MDRO感染菌株主要涉及大肠埃希菌、金黄色葡萄球菌和肺炎克雷伯菌等。多因素分析结果显示,合并心血管病(OR=1.453,95%CI 1.006~2.079)、广谱抗生素使用时长≥1周(OR=1.900,95%CI 1.377~2.620)、使用≥2联抗生素(OR=1.913,95%CI 1.378~2.655)、留置血管内导管(OR=2.456,95%CI 1.416~3.241)与MDRO感染风险增高有关(P<0.05)。结论ICU患者中MDRO的感染发生率相对其他普通病区仍处于较高水平,应针对MDRO感染的特点和相关的高危因素及时采取预防和控制措施,有效降低MDRO的感染发生率。 展开更多
关键词 重症监护病房 多重耐药菌 感染 影响因素
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湖南省细菌耐药监测网2012-2021年ICU分离细菌耐药性监测报告
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作者 陈丽华 付陈超 +12 位作者 李晨 李艳明 刘君 宁兴旺 石国民 邬靖敏 杨怀德 袁红霞 郑铭 任南 黄勋 吴安华 周建党 《中国感染控制杂志》 CAS CSCD 北大核心 2024年第8期942-953,共12页
目的了解2012—2021年湖南省细菌耐药监测网网点医院重症监护病房(ICU)患者临床分离菌株分布情况及对抗菌药物的敏感性。方法按照全国细菌耐药监测网方案,应用WHONET 2022软件对所有湖南省耐药监测网成员单位上报的ICU临床分离细菌及药... 目的了解2012—2021年湖南省细菌耐药监测网网点医院重症监护病房(ICU)患者临床分离菌株分布情况及对抗菌药物的敏感性。方法按照全国细菌耐药监测网方案,应用WHONET 2022软件对所有湖南省耐药监测网成员单位上报的ICU临床分离细菌及药敏结果数据进行分析。结果2012—2021年各年份湖南省细菌耐药监测网成员单位ICU分离细菌总数为5777~22369株,其中革兰阴性菌每年占比为76.1%~78.0%。金黄色葡萄球菌一直稳居每年分离的革兰阳性菌之首。革兰阴性菌中,居前5位的细菌分别为鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和嗜麦芽窄食单胞菌。耐甲氧西林金黄色葡萄球菌检出率呈逐年下降趋势,未发现对万古霉素、替考拉宁及利奈唑胺耐药的葡萄球菌属细菌。耐万古霉素粪肠球菌检出率为0.6~1.1%,耐万古霉素屎肠球菌检出率为0.6%~2.2%。大肠埃希菌、肺炎克雷伯菌对亚胺培南的耐药率分别为3.1%~5.7%、7.7%~20.9%。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南耐药率分别为24.6%~40.1%、76.1%~80.9%,耐碳青霉烯类铜绿假单胞菌检出率呈逐年下降趋势,鲍曼不动杆菌对多黏菌素B保持了较高的敏感性,耐药率<10%。结论ICU临床分离菌对常见抗菌药物的耐药形势较严峻,尤其是耐碳青霉烯类肠杆菌目细菌在2019年后有升高趋势,需要加强细菌耐药监测,开展多学科联动。 展开更多
关键词 病原菌 耐药性 重症监护病房 耐碳青霉烯类革兰阴性菌 湖南省细菌耐药监测网
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某三级医院鲍曼不动杆菌临床分布及耐药性变迁
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作者 王丽恒 刘婧 +1 位作者 潘舒月 林家福 《川北医学院学报》 CAS 2024年第7期941-944,共4页
目的:分析川北医学院附属医院分离的鲍曼不动杆菌(AB)的临床分布及耐药情况,了解其变化趋势。方法:分析川北医学院附属医院分离的764株AB的临床分布及药敏试验结果,并与课题组前期研究结果进行对比分析。结果:本次检出的AB在各标本中及... 目的:分析川北医学院附属医院分离的鲍曼不动杆菌(AB)的临床分布及耐药情况,了解其变化趋势。方法:分析川北医学院附属医院分离的764株AB的临床分布及药敏试验结果,并与课题组前期研究结果进行对比分析。结果:本次检出的AB在各标本中及在临床科室的占比与川北医学院附属医院2004~2008年和2011~2014年报告数据存在统计学差异(P<0.05),三个时期均以痰标本检出率最高(73.1%~84.2%),ICU和神经外科占比位列前两位;近年急诊科的AB分离率高达17.3%。三个时期12种抗菌药的合计耐药率分别为69.2%、79.6%和58.1%(P<0.05)。2020~2021年,AB对所试13/16种抗菌药的耐药率均>50%。2020~2021年神经外科和ICU分离菌株对所试12种抗菌药的合计耐药率分别为66.5%和75.4%,较2011~2014年的耐药率(分别为79.7%和84.1%)降低(P<0.05)。结论:川北医学院附属医院AB主要见于呼吸道感染,以ICU、神经外科和急诊科较为常见。AB(尤其在ICU和神经外科病房)多重耐药现象较为严重。规范抗菌药物使用和加强细菌耐药性实时监测具有重要意义。 展开更多
关键词 鲍曼不动杆菌 耐药性 分布 重症监护病房 神经外科病房
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急诊重症监护室血流感染患者临床结局的风险因子探讨
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作者 张培 邰萍 +4 位作者 林康 李薇 金铃 何帮顺 蔺昕 《临床检验杂志》 CAS 2024年第5期332-336,共5页
目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分... 目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分析患者死亡的危险因素,运用Cox回归分析上述因素与患者生存时间和临床结局的关系。结果在141例EICU血流感染患者中,两种及以上细菌混合血流感染[比值比(OR)=5.68,95%置信区间(CI):1.20~26.98,P<0.05]及多重耐药菌血流感染(OR=6.39,95%CI:2.78~14.67,P<0.01)与患者死亡具有显著相关性;是否根据药敏结果及时调整用药[风险比(HR)=0.47,95%CI:0.30~0.74]和多重耐药菌血流感染(HR=2.02,95%CI:1.28~3.20)是EICU血流感染患者死亡的风险因子(P<0.01)。结论尽早采集血培养,明确感染病原菌,精准用药控制感染,可以有效降低患者的死亡率。 展开更多
关键词 急诊重症监护室 血流感染 血培养 多重耐药菌 精准用药
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ICU感染病原菌分布情况及耐药性分析
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作者 曾凤 李强 杨健 《中外医学研究》 2024年第3期69-73,共5页
目的:分析重症监护室(ICU)感染病原菌分布情况及耐药性。方法:回顾性分析2019年12月—2022年12月阜宁县人民医院收治的120例ICU患者的病例资料。统计ICU患者院内感染发生情况及病原菌分布特征,分析ICU院内感染患者耐药情况。结果:120例... 目的:分析重症监护室(ICU)感染病原菌分布情况及耐药性。方法:回顾性分析2019年12月—2022年12月阜宁县人民医院收治的120例ICU患者的病例资料。统计ICU患者院内感染发生情况及病原菌分布特征,分析ICU院内感染患者耐药情况。结果:120例ICU患者共有30例发生院内感染,院内感染的发生率为25.00%。120例ICU院内感染患者共检出菌株35株,其中20株为革兰阴性菌,占病原菌总株数的57.14%,12株为革兰阳性菌,占病原菌总株数的34.29%,3株为真菌,占病原菌总株数的8.57%。对肺炎克雷伯菌、大肠埃希菌两种主要革兰阴性菌进行耐药性分析:肺炎克雷伯菌对头孢唑啉、左旋氧氟沙星、头孢吡肟的耐药率均>50.00%;肺炎克雷伯菌对亚胺培南、红霉素的耐药率最低,均为20.00%,对头孢唑啉的耐药率最高,为100.00%。大肠埃希菌对氨苄西林、莫西沙星的耐药率均≥50.00%;大肠埃希菌对亚胺培南的耐药率最低,为0,对氨苄西林的耐药率最高,为75.00%。对金黄色葡萄球菌、表皮葡萄球菌两种主要革兰阳性菌进行耐药性分析;金黄色葡萄球菌对氨苄西林、左旋氧氟沙星、红霉素的耐药率均>50.00%;表皮葡萄球菌对氨苄西林、红霉素的耐药率均为100.00%;金黄色葡萄球菌对莫西沙星的耐药率为0;表皮葡萄球菌对利福平的耐药率为0。结论:ICU患者检出病原菌以革兰阴性菌为主,多数病原菌存在不同程度的耐药,在临床治疗中需根据药敏结果有针对性地进行合理用药。 展开更多
关键词 重症监护室 院内感染 病原菌分布 耐药性 金黄色葡萄球菌 表皮葡萄球菌
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