ABSTRACT
Device-associated health care-acquired infections [DA-HAIs] pose a threat to patient safety, particularly in the intensive care unit [ICU]. However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections [CLABs] per 1000 central line-days, 7.88 ventilator-associated pneumonias [VAPs] per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections [CAUTIs] per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii,Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae andEnterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates. Resistance to oxacillin and imipenem was higher as well. Comparing device use, DA-HAI rates, and bacterial resistance for the primary isolated bacteria indicated a direct association between urinary catheter use and the rates of CAUTI
ABSTRACT
Community acquired pneumonia [CAP] is the main cause of mortality and morbidity world wide. Legionella pneumophila is identified as the fourth agent that causes CAP. The aim of this study was to define the prevalence of L. pneumophila among hospitalized children by culture, direct immune-fluorescence, [DFA] and PCR. In this study 210 sputum samples were collected from hospitalized children diagnosed with CAP. Samples were cultured on selective buffered charcoal-yeast extract agar [BCYE]. Existence of L. pneumophila among sputum samples was confirmed by culture, direct immunefluorescence and PCR. Our results for 210 hospitalized children showed that the sputum of 12 children, [5.7%] with acute respiratory infections was positive for L. pneumophila. Of the 12 positive samples 3, [25%] were detected by culture; 5 by DFA, [41.6%]; and 9 by PCR, [75%]. PCR is more sensitive than culture and DFA for detection of Legionella pneumonia in sputum samples