The Journal of hospital infection
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The purpose of this study was to identify molecular and epidemiological characteristics of hospital-acquired carbapenem-resistant Acinetobacter baumannii (CRAB) from two different intensive care unit (ICU) settings in Karachi, Pakistan. A cross-sectional study was performed in the adult ICUs of a private sector tertiary care hospital (PS-ICU) and of a government sector hospital (GS-ICU) between November 2007 and August 2008. Deduplicated CRAB isolates from clinical specimens were examined for carbapenemase and class 1 integrase genes. ⋯ PFGE typing grouped the isolates into eight distinct clusters, three of which were found in both hospitals. Most of the isolates within each PFGE cluster shared identical or highly similar VNTR profiles, suggesting close epidemiological association. Irrespective of differences in risk factors and infection control policies and practices, the extent of clonality among CRAB isolates was very similar in both ICU settings.
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Despite the clinical significance of complications due to intravascular catheters, the inappropriate use of intravascular catheters in hospitalised patients has not been adequately characterised. The objective of this prospective observational study was to develop definitions for appropriate intravascular device use, to estimate the frequency of inappropriate use of intravascular devices, and to examine risk factors and outcomes associated with inappropriate use in hospitalised patients. Among 436 patients admitted between October and December 2007, a total of 2909 hospitalisation days and use of 876 intravascular devices was observed. ⋯ Use of central venous catheters was not a predictor for inappropriate device use. Inappropriate intravascular device use is a very common phenomenon in hospitalised patients and is strongly linked to adverse device-related outcomes. These results may be used to develop strategies to systematically reduce excessive intravascular device use which would be expected to reduce adverse events associated with morbidity, mortality, and excess healthcare costs.
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The Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) implemented a seek and destroy (S&D) programme in 2006 to minimise meticillin-resistant Staphylococcus aureus (MRSA) colonisation and/or infection of patients. Using a phased introduction, all patient specialties were included in the scheme by September 2008, well in advance of the mandatory Department of Health, England (DoH) requirement for all patients to be screened. NuTH screens nose, throat and perineum samples from approximately 15,000 patients per month using a chromogenic culture method, showing a mean MRSA prevalence of 2.4%. ⋯ Review of data during a typical one-month period indicated that only seven day-case patients would not have been identified as MRSA carriers using our targeted S&D approach compared with the DoH universal screening. Detection of these additional patients incurred total laboratory costs of £20,000 and generated a further 4200 associated negative screens in one month alone. Our study indicates that a screening strategy based upon clinical risk is more pragmatic and more cost-effective than the universal programme currently required in England.
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Staphylococcus aureus bacteraemia (SAB) episodes identified in a prospective multicentre study during 1999-2002 (not including MRSA) were followed up by an infectious disease specialist. The aim of this study was to compare predisposing factors, disease progression and outcome of healthcare (HA)- and community (CA)-associated SAB. Of 430 SAB episodes, 232 (54%) were HA. ⋯ The case fatality rates for HA-SAB versus CA-SAB at 28 days were 14% vs 11% (NS). Independent risk factors according to multivariate analysis for a fatal outcome were age, chronic alcoholism, immunosuppressive treatment, ultimately or rapidly fatal underlying diseases, severe sepsis on the onset of SAB, S. aureus pneumonia and endocarditis. As a result of a prospective study design, meticulous infection foci search and infectious disease specialist follow-up of each SAB episode, the case fatality remained low and 97% of the HA-SAB episodes presented infection foci within three days of onset of bacteraemia.