MICROBIOLOGICAL PROFILE OF NOSOCOMIAL INFECTIONS
Abstract
Nosocomial infections, also known as health care-associated infections (HAIs) are infections that appear in patients under medical care in hospitals or other health care facilities and were absent at the time of admission. From 5 to 7 thousand cases of HAIs are registered in Ukraine every year, but according to experts, the actual number is 900 thousand cases per year. Intensive care unit (ICU) represents a prominent tool in HAIs control and quality assurance in many developed countries. In this respect, the US Center for Disease Control and Prevention (CDC) recommends monitoring HAI as a leading tool for the reduction of HAIs. Therefore, the aim of this research was to investigate microbiological profile of nosocomial infections in ICU of public hospitals in Lviv, Ukraine.
Material and methods. 105 clinical materials from 50 patients in two public hospitals in Lviv (Lviv Regional clinical hospital and Military Medical Clinical Center of the Western Region) were analyzed during July-December 2018. 114 strains of pathogens were isolated. HAIs was defined as an infection that appeared in patients later than 48 hours after admission to the hospital. Urinary tract infections (UTI), blood stream infection (BI), respiratory tract infection (RTI) and surgical site infections (SSI) were diagnosed using the criteria defined by the CDC and clinical protocols. Causative bacterial strains were isolated and identified using standard methods and chromogenic media CHROMID*S.aureusElite, CHROMID*VRE, CHROMID*MRSASMART, CHROMID*CARBASMART, CHROMID* ESBL, CHROMID*OXA-48, CHROMID*Candida (Biomerieux) and biochemical identification kitsMIKRO-LA-TESTNEFERMtest24, ENTEROtest24, CANDIDAtest21, STAPHYtest24, STREPTOtest24 (ErbaLacema, Czech Republic). Antibiotic sensitivity test was done using Kirby-Bauer disc diffusion technique. (Ethical Committee or Institutional Animal Care and Use Committee Approval Danylo Halytsky Lviv National Medical University: 25/06/2018 № 6). HAIs structure was as follows: Staphylococcus lentus (22%), Eschrichia coli (22%), Klebsiella pneumoniae subsp.ozaenae (9.8%), Pseudomonas aeruginosa (43.9%), Klebsiella pneumoniae subsp.pneumonia (8.8%), Srreptococcus spp. (7.0%), Burkholderia pseudomallei (5.3%), Staphylococcus haemolyticus (3.5), Staphylococcus aureus (3.5%). There were several types of HAIs which are rarely found, such as Staphylococcus lentus, Staphylococcus simulans, Staphylococcus lugdunensis, Aerococcus viridans, Pragia fontium, Aeromonasichthiosmia, Raoultella terrigena, Macrococcus caseolyticus.
Conclusions. In the era of antibiotics, HAIs are still uncontrollable. It is assessed that over 90.0% of HAIs are not recognized as epidemics. It is important to remember this fact when attempting to design prevention or control strategy to reduce HAIs either at WHO level, or at the level of local health care unit.
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Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine. 2017 May 1;7(5):478-82. https://doi.org/10.1016/j.apjtb.2017.01.019
Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt CE. Hospital-acquired pneumonia in ICU. Anaesthesia Critical Care & Pain Medicine. 2018 Feb 1;37(1):83-98. https://doi.org/10.1016/j.accpm.2017.11.006
Custovic A, Smajlovic J, Hadzic S, Ahmetagic S, Tihic N, Hadzagic H. Epidemiological surveillance of bacterial nosocomial infections in the surgical intensive care unit. Materia socio-medica. 2014 Feb;26(1):7. https://doi.org/10.5455/msm.2014.26.7-11
Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015 Jan;19(1):14. https://doi.org/10.4103/0972-5229.148633
Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM. Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine. 2014 Mar 27;370(13):1198-208. https://doi.org/10.1056/NEJMoa1306801
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson‐Liljequist B, Paterson DL. Multidrug‐resistant, extensively drug‐resistant and pandrug‐resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection. 2012 Mar;18(3):268-81. https://doi.org/10.1111/j.1469-0691.2011.03570.x
Hassan KA, Aftab A, Riffat M. Nosocomial infections and their control strategies. Asian Pacific Journal of Tropical Biomedicine. 2015 Jan 1(7):505-9. https://doi.org/10.1016/j.apjtb.2015.05.001
Malacarne P, Boccalatte D, Acquarolo A, Agostini F, Anghileri A, Giardino M, Giudici D, Langer M, Livigni S, Nascimben E, Rossi C. Epidemiology of nosocomial infection in 125 Italian intensive care units. Minerva anestesiologica. 2010 Jan 1;76(1):13.
Tao L, Hu B, Rosenthal VD, Gao X, He L. Device-associated infection rates in 398 intensive care units in Shanghai, China: International Nosocomial Infection Control Consortium (INICC) findings. International Journal of Infectious Diseases. 2011 Nov 1;15(11):e774-80. https://doi.org/10.1016/j.ijid.2011.06.009
Sabra SM, Abdel-Fattah MM. Epidemiological and microbiological profile of nosocomial infection in Taif hospitals, KSA (2010-2011). World journal of medical sciences. 2012;7(1):1-9.
Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine. 2017 May 1;7(5):478-82. https://doi.org/10.1016/j.apjtb.2017.01.019
Xia J, Gao J, Tang W. Nosocomial infection and its molecular mechanisms of antibiotic resistance. Bioscience trends. 2016;10(1):14-21. https://doi.org/10.5582/bst.2016.01020
Talbot TR, Bratzler DW, Carrico RM, Diekema DJ, Hayden MK, Huang SS, Yokoe DS, Fishman NO. Public reporting of health care–associated surveillance data: recommendations from the Healthcare Infection Control Practices Advisory Committee. Annals of internal medicine. 2013 Nov 5;159(9):631-5. https://doi.org/10.7326/0003-4819-159-9-201311050-00011
Alangaden GJ. Nosocomial fungal infections: epidemiology, infection control, and prevention. Infectious Disease Clinics. 2011 Mar 1;25(1):201-25. https://doi.org/10.1016/j.idc.2010.11.003
Hawkey PM, Warren RE, Livermore DM, McNulty CA, Enoch DA, Otter JA, Wilson AP. Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/healthcare Infection Society/british Infection Association Joint Working Party. Journal of Antimicrobial Chemotherapy. 2018 Mar 1;73(suppl_3):iii2-78. https://doi.org/10.1093/jac/dky027
Cornejo-Juárez P, Vilar-Compte D, Pérez-Jiménez C, Namendys-Silva SA, Sandoval-Hernández S, Volkow-Fernández P. The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit. International Journal of Infectious Diseases. 2015 Feb 1;31:31-4. https://doi.org/10.1016/j.ijid.2014.12.022
van Vught LA, Klouwenberg PM, Spitoni C, Scicluna BP, Wiewel MA, Horn J, Schultz MJ, Nürnberg P, Bonten MJ, Cremer OL, van der Poll T. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis. Jama. 2016 Apr 12;315(14):1469-79. https://doi.org/10.1001/jama.2016.2691
Tajeddin E, Rashidan M, Razaghi M, Javadi SS, Sherafat SJ, Alebouyeh M, Sarbazi MR, Mansouri N, Zali MR. The role of the intensive care unit environment and health-care workers in the transmission of bacteria associated with hospital acquired infections. Journal of infection and public health. 2016 Jan 1;9(1):13-23. https://doi.org/10.1016/j.jiph.2015.05.010
Chacko B, Thomas K, David T, Paul H, Jeyaseelan L, Peter JV. Attributable cost of a nosocomial infection in the intensive care unit: a prospective cohort study. World journal of critical care medicine. 2017 Feb 4;6(1):79. https://doi.org/10.1016/j.jiph.2015.05.010
Ustinov O.V. Standarty i protokoly[Internet].Ukrainskyi medychnyi chasopys: Pokaznyk kilkosti vnutrishnolikarnianykh infektsii v Ukraini zanyzhenyi;2016 [updated 2016April 05].Available from:https://www.umj.com.ua/article/94849/pokaznik-kilkosti-vnutrishnolikarnyanix-infekcij-v-ukraini-zanizhenij.
Kotsiuba KR, Voronkova OS, Vinnikov AI, Shevchenko TM. Mekhanizmy stiikosti do antybiotykiv predstavnykiv rodyny Enterobacteriaceae. Visnyk Dnipropetrovskoho universytetu. Seriia: Biolohiia. Medytsyna. 2014(5 (1)):33-8. https://doi.org/10.15421/021407
Salmanov AH. Profilaktyka vnutrishno-likarnianykh infektsii u viddilenniakh khirurhichnoho profiliu.
BakteriolohiiaIvirusolohiia: «Normatyvnevyrobnycho-praktychnevydannia. – K.: MNIATsmedychnoistatystyky; MVTs «Medinform», 2014, 2014. – 460s.
O’Neill J. Tackling drug-resistant infections globally: Final report and recommendations. 2016. HM Government and Welcome Trust: UK. 2018.
Pylypenko MM, Ovsiienko TV, Bondar MV. The combination of carbapenem resistance and colistin resistance of pathogens of severe Gram-negative nosocomial infections: the first signs of the start of the postantibiotic era. Emergency Medicine. 2019(2.97):54-62. https://doi.org/10.22141/2224-0586.2.97.2019.161643
Vincent JL, de Souza Barros D, Cianferoni S. Diagnosis, management and prevention of ventilator-associated pneumonia. Drugs. 2010 Oct 1;70(15):1927-44. https://doi.org/10.2165/11538080-000000000-00000
Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, Kollef M, Bassi GL, Luna CM, Martin-Loeches I, Paiva JA. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). European Respiratory Journal. 2017 Sep 1;50(3):1700582. https://doi.org/10.1183/13993003.00582-2017
Rymsha OV. Antymikrobna diia antybiotykiv ta antyseptykiv u urolohichnykh khvorykh. Annaly Mechnykovskoho instytutu. 2012(2):17-26.
Volkov AO, Bolshakova HM. Mikroflora hniinykh ran ta suchasni pidstupy shchodo zastosuvannia antyseptykiv v khirurhichnii praktytsi. Ohliad literatury. Annaly Mechnykovskoho instytutu. 2009(2):19-23.
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