Effect of seasons on delirium in postoperative critically ill patients: a retrospective analysis

Abstract Background and objectives Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations. Methods We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables. Results Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p= 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p= 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p= 0.002) than in winter. Conclusions In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.

Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital / 中华创伤杂志(英文版)

PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

Bronchopleural Fistula-The Role Of Physiotherapy Rehabilitation: A Case Report

Purpose: Bronchopleural fistula is a commonest complication developed in post-traumatic cases and the management of which is still a challenge due to lack of scientific evidence. The purpose of this case report is to investigate the effects of physiotherapy treatment in management of patients with bronchopleural fistula. Case Description: A 20-year-old man met with a road traffic accident following which he was diagnosed with hemopneumothorax and ICD was placed. Continuous removal of ICD over 3 to 4 times by patient himself in unconscious state lead to the development of bronchopleural fistula. Results: The patient was seen for 15 sessions over 3 weeks period ( 5 days per week). At discharge, his Functional status score in ICU (FSS-ICU) was 35. He was able to complete exercise tolerance test in 6-minute time interval with 540 meters of distance involving 10 laps with single rest pause during 4th minute. Discussion: Though bronchopleural fistula is considered as a relative complication of physical therapy; this case report suggests that with appropriate care physical therapy along with other medical management team can help to cure it and improve patient’s functional status as well as his quality of living.

Severity of disease scoring systems and mortality after non-cardiac surgery / Sistemas de classificação da gravidade da doença e mortalidade após cirurgia não cardíaca

Abstract Background: Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Methods: Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). Results: 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high-risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Conclusion: Some factors influenced both surgical intensive care unit and hospital mortality.

Resumo Justificativa: A mortalidade após cirurgia é frequente e os sistemas de classificação da gravidade da doença são usados para a previsão. Nosso objetivo foi avaliar os preditivos de mortalidade após cirurgia não cardíaca. Métodos: Os pacientes adultos admitidos em nossa unidade de terapia intensiva cirúrgica entre janeiro de 2006 e julho de 2013 foram incluídos. Análise univariada foi feita com o teste de Mann-Whitney, qui-quadrado ou exato de Fisher. Regressão logística foi feita para avaliar fatores independentes com cálculo de razão de chances (odds ratio - OR) e intervalo de confiança de 95% (IC 95%). Resultados: No total, 4.398 pacientes foram incluídos. A mortalidade foi de 1,4% na unidade de terapia intensiva cirúrgica e de 7,4% durante a internação hospitalar. Os preditivos independentes de mortalidade na unidade de terapia intensiva cirúrgica foram APACHE II (OR = 1,24); cirurgia de emergência (OR = 4,10), sódio sérico (OR = 1,06) e FiO2 na admissão (OR = 14,31). Bicarbonato sérico na admissão (OR = 0,89) foi considerado um fator protetor. Os preditivos independentes de mortalidade hospitalar foram idade (OR = 1,02), APACHE II (OR = 1,09), cirurgia de emergência (OR = 1,82), cirurgia de alto risco (OR = 1,61), FiO2 na admissão (OR = 1,02), insuficiência renal aguda no pós-operatório (OR = 1,96), frequência cardíaca (OR = 1,01) e sódio sérico (OR = 1,04). Os pacientes moribundos apresentaram escores mais altos de gravidade da doença nos sistemas de classificação e mais tempo de permanência em unidade de terapia intensiva cirúrgica. Conclusão: Alguns fatores tiveram influencia sobre a mortalidade tanto hospitalar quanto na unidade de terapia intensiva cirúrgica.

Risk of anticoagulation therapy in surgical intensive care unit patients predicted by thromboelastograph / 中华危重病急救医学

Objective@#To explore the correlation between thromboelastography (TEG) parameters and the risk of venous thromboembolism (VTE) and bleeding in patients receiving anticoagulant therapy in surgical intensive care unit (SICU).@*Methods@#205 patients received low molecular weight heparin (LMWH) anticoagulant therapy admitted to SICU of Tianjin Hospital from December 2016 to December 2017 were consecutively enrolled. TEG detection was performed in all patients at 1 day after anticoagulation therapy, and coagulation reaction time (R value), blood clot generation time (K value), blood clot generation rate (α angle) and maximum width value (MA value) were recorded. At the same time, the traditional coagulation function test was carried out, and prothrombin time (PT), activated partial thromboplastin time (APTT) and D-dimer levels were also recorded. The incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) and bleeding during hospitalization were observed. Multivariate Logistic regression analysis was used to analyze the risk factors for VTE and bleeding in patients receiving anticoagulant therapy.@*Results@#Of 205 patients, during the anticoagulant treatment, 14 patients developed DVT, and 4 patients with PE (2 of them were combined with DVT) with an incidence of 7.8% (16/205). There were 2 patients suffering from cerebral hemorrhage, 2 patients with gastric bleeding, and 1 patient with intra-tracheal hemorrhage with an incidence of 2.4% (5/205). Compared with the patients without VTE or bleeding, the R value of TEG in patients with VTE was significantly lowered (minutes: 4.6±2.2 vs. 7.4±1.4, P < 0.01), which was significantly increased in patients with hemorrhagic complications (minutes: 12.1±1.1 vs. 7.4±1.4, P < 0.01). There was no significant difference in the K value, α angle, MA value of TEG, or PT, APTT, D-dimer between the patients with and without VTE or bleeding. Multivariate Logistic regression analysis revealed that the R value of TEG was independent risk factor for incidence of VTE and hemorrhagic complication in SICU patients who receiving anticoagulation therapy [VTE: β = 0.386, odds ratio (OR) = 1.096, 95% confidence interval (95%CI) = 1.021-2.361, P = 0.006; hemorrhagic complication: β = -1.213, OR = 1.051, 95%CI = 1.017-3.458, P = 0.045].@*Conclusion@#The R value of TEG is associated with the occurrence of VTE and hemorrhagic complications in patients receiving anticoagulant therapy in SICU.

Risk Factors of Delirium Among the Patients at a Surgical Intensive Care Unit / 중환자간호학회지

PURPOSE: This study examined the prevalence of delirium-related factors in a surgical intensive care unit (SICU).METHODS: This retrospective study enrolled 73 patients who were admitted to an SICU from October 1, 2016 to March 20, 2017 and who had been hospitalized for more than 72 hours. Data was collected by reviewing electronic medical records.RESULTS: Delirium occurred in 46 (63.0%) patients. Its related factors were age, education, mechanical ventilator, sleep, narcotics, physical restraint, and central line catheters.CONCLUSION: The results indicate that sleep and physical restraint are significant factors related to delirium occurrence. The results of this study can help in developing guidelines for the prevention of delirium.

Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit.

Background: Nosocomial infections (NIs) in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a) evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b) identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU). Patients and Methods: After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient‑outcome were determined. Results: Three hundred and nineteen of 6864 patients (4.6%) developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs) accounted for most of the infections (44.2%) followed by surgical‑site infection (SSI, 11.6%), bloodstream infection (BSI, 7.5%), urinary tract infection (UTI, 6.9%) and infections from combined sources (29.8%). Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram‑negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. Conclusion: The incidence of NI and sepsis‑related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram‑negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

Active screening and risk factors for colonization of multidrug-resistant or-ganisms in a surgical intensive care unit / 中国感染控制杂志

Objective To investigate colonization status and risk factors of multidrug-resistant organisms (MDROs)in a surgical intensive care unit (SICU),and provide a basis for active clinical screening of MDROs. Methods From June 1,2013 to August 31,2013,patients who admitted to SICU≥24 hours were performed active screening,the colnization status of methicillin-resistant Staphylococcus aureus (MRSA)and extended-spectrumβ-lactamase-producing Escherichiacoli/Klebsiellapneumoniae (ESBL-E.coli/Kp)among patients were detected,re-lated risk factors were analyzed. Results When patients who admitted to SICU≤48 hours,the detection rate of MRSA and ESBL-E.coli/Kp was 1 1 .00% and 73 .00% respectively;when admitted to SICU>7 days,the increased detection rate of MRSA and ESBL-E.coli/Kp was 16.67% and 44.44% respectively. Patients stayed in hospital >7 days before admit-ting to SICU (OR95% CI:4.48 [1 .21-16.65 ])was an independent risk factor of carrying MRSA when admitting to SICU,APACHEⅡscore ≥16 (OR95% CI:6.36[1.47-27.54])was an independent risk factor of carrying MRSA 48 hours after admitting to SICU. Conclusion When patients admitted to SICU,the carrying rate of MDROs is high,isola-tion rate rises with prolonged length of SICU stay. Hospitals should carry out MDRO colonization screening proj ect among patients and implement effective isolation control measures to reduce the incidence of healthcare-associated infection.

Related factors analysis and prevention of ventilator-associated pneumonia in surgical intensive care unit a-mong elderly patient / 中国基层医药

Objective To understand the incidence.mortality and risk factors of ventilator -associated pneu-monia(VAP)in surgical intensive care unit among elderly patient,in order to direct the clinical prevention and treat-ment of VAP.Methods Retrospective analysis was used on 65 cases of mechanical ventilation elderly patients in our hospital nearly 3 years.Results The incidence of VAP was 66.2%.The mortality of VAP was 67.4%.The factors of long-term mechanical ventilation,high APACHE Ⅱ score,low Glasgow score and inappropriate initial antimicrobial therapy were influenced the prognosis of VAP.Conclusion The incidence of VAP can be decreased and the cure rate can be increased by some effective measures in SICU.

The clinical monitoring of invasive aspergillosis in surgical intensive care unit during 10 years / 中华危重病急救医学

Objective To investigate the invasive aspergillosis (IA) status in a surgical intensive care unit (SICU).Methods The clinical data including general state,operation,pathogenic microorganisms,infection position,clinical situation,treatment and prognosis of patients with IA admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were retrospectively analyzed.Results 8 220 patients admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were enrolled.Of 8 220 patients,there were 29 cases experienced IA,with an incidence of 0.35％,and the incidence of hospital onset of IA infection was 0.27％ (22/8 220).The incidence of hospital onset of IA infection was accounted for 6.98％ (22/315) of the incidence of hospital onset of infection in SICU in the same period.Compared with 2004-2008,in 2009-2013,the incidence of hospital onset of infection was significantly decreased [3.19％ (137/4 293) vs.4.53％ (178/3 927),x2=10.020,P=0.002],while the incidence of IA [0.56％ (24/4 293) vs.0.13％ (5/3 927),x2=10.874,P=0.001],the incidence of hospital onset of IA infection [0.40％ (17/4 293) vs.0.13％ (5/3 927),x2=5.556,P=0.019],and the percentage of incidence of hospital onset of IA infection according to the incidence of hospital onset of infection were increased by 5 years [12.40％ (17/137) vs.2.81％ (5/178),x2=10.982,P=0.001].Of 29 patients with IA,25 cases had occurred after operation,and the majority of them were from the Department of General Surgery (13 cases),and followed by post-renal transplantation (6 cases) and post-thoracic surgery (3 cases).In the total submission of 155 specimens from 29 patients with IA,there were 17 strains isolated aspergillosis,among which included 2 strains of Aspergillus fumigatus,and 15 other un-subgrouped strains.The most common infection site was lower respiratory tract (23 cases,79.31％).Sixteen patients were found with positive galactomannan (GM) test.In all the risk factors contributing to IA,the ratio of the long-term usage of broad-spectrum antibiotics over 4 days was the highest [36.25％ (29/80)],which followed by the long-term use of hormone [18.75％ (15/80)],complicated with acute kidney injury [18.75％ (15/80)],liver injury [13.75％ (11/80)],the long-term use of immunosuppressive orally [7.50％ (6/18)],and complicated with neutropenia [5.00％ (4/80)].In 29 patients with IA,there were 28 patients received anti-fungal treatment except for 1 patient without treatment,and those were single use of itraconazole in 1 case,single use of echinocandins in 3 cases,single use of liposomal amphotericin B in 5 cases,8 cases with voriconazole,single use of liposomal amphotericin B or echinocandins then replaced by voriconazole in 8 cases,and 3 cases of echinocandins therapy combined with voriconazole.Seventeen of 29 patients died,with a mortality rate of 58.62％.Conclusions IA is an uncommon but increasing postoperative complication of patients in SICU in recent 5 years.The most common sites of IA were lower respiratory tract.The mortality of IA is very high.So clinicians should pay more attention to the careful monitor for IA.

Validation of APACHE II Score and Comparison of the Performance of APACHE II and Adjusted APACHE II Models in a Surgical Intensive Care Unit / 대한구급학회지

BACKGROUND: The ability to accurately adjust for the severity of illness in outcome studies of critically ill patients is essential for clinical audits and trials. Several studies have been carried out to validate the acute physiology and chronic health evaluation (APACHE II) score in Korean ICUs. However, few reports have been presented that compare the performance of the APACHE II score and diagnostic category weighted APACHE II models in the surgical ICU population of Korea. The aim of this study was to validate APACHE II and compare the performance of the APACHE II and adjusted APACHE II models for emergency admission in a surgical intensive care unit (SICU) population. METHODS: A retrospective analysis of the prospective ICU registry was conducted in the SICU between October 2007 and February 2011. Calibration and discrimination were determined by the Hosmer-Lemeshow test and the area under the receiver operating characteristic (AUC) curve from patients. RESULTS: This study included 854 patients. SICU mortality was 9.4%. For APACHE II and adjusted APACHE II, AUCs were 0.791 and 0.757, respectively. Hosmer and Lemeshow C statistics showed good calibration for APAHCE II and for adjusted APACHE II (p > 0.05). CONCLUSIONS: The ability of the APACHE II system in predicting group outcome is validated in a surgical ICU population by a receiver operating characteristic curve and logistic regression analysis. Mortality rates predicted using APACHE II exhibited good calibration and moderate discrimination. Diagnostic category weighted adjusted APACHE II did not improve the mortality prediction.

Incidence and risk factors of supraventricular arrhythmias in postoperative cancer patients in intensive care unit / 中国综合临床

Objective To evaluate the incidence and to investigate risk factors of supraventricular arrhythmia (SVAs) in postoperative cancer patients in intensive care unit ( ICU ). Methods Data of 570 patients consecutively admitted to oncologic surgical ICU of Cancer Hospital of Chinese Academy of Medical Sciences from Nov. 2008 to Oct. 2009 were retrospectively collected. Univariate and multivariate logistic analysis were conducted for potential factors that influenced SAVs. Results Thirteen patients with a history of atrial fibrillation (AF) were excluded and 557 patients were eligible for the study. SVAs occurred in 72 patients ( 12. 93% ). Multivariate analysis showed four independent predictors of SVAs including age ( OR = 1. 066,95%CI: 1. 034 - 1. 099,P ＜0. 001 ) ,a history of coronary heart diseases ( OR = 2. 644,95% CI: 1. 459 - 4. 790,P ＜ 0. 05), sepsis ( OR = 2. 374,95% CI: 1. 098 - 5. 135, P ＜ 0. 05 ) and intra-thoracic procedure ( OR =2. 322,95 % CI: 1.061 - 5.084, P ＜ 0. 05 ) . ICU length of stay, severity ( APACHE Ⅱ scores in SVAs patients) were significantly greater in patients who were not affected by SVAs ( ICU stay: [2 ( 1 ～ 77 )]vs [3 ( 1 ～ 40 )]days,P ＜ 0. 001; APACHE Ⅱ score: [9 (0 ～ 37 )] vs [11 (3 ～ 38 )], P = 0. 001 ). Nine cases died in SVAs patients ( 12. 5% ) and 19 died in the non-SVAs patients (3.9%), with significant difference between the two groups( x2 = 9. 673, P = 0. 002). Conclusion In oncologic surgical ICU, the incidence of SVAs is high. Age,history of coronary heart diseases, sepsis and intra-thoracic procedure were independent rsik factors of SVAs. SVAs prolong ICU length of stay. SVAs is a marker of critical illness severity.

Supraventricular Arrhythmias in the Surgical Intensive Care Unit

PURPOSE: Supraventricular arrhythmia is a well-known complication of cardiothoracic surgery, and is common in patients wirth underlying cardiovascular disease. Also, it's treatment and prognosis are well known. However the incidence, the contributing factors, and the prognosis for supraventricular arrhythmias in noncardiothoracic surgical patients are less well known. This study was undertaken to investigate the incidence, the clinical presentation, the prognosis, and the factors comtributing to the prognosis for supraventricular arrhythmia in the surgical intensive care unit. METHODS: We performed a retrospective study of 34 patients with newly developed or aggravated supraventricular arrhythmias in the surgical intensive care unit between March 2004 and February 2005. The incidence, the risk factors, and the prognosis of supraventricular arrhythmias were analyzed. RESULTS: During a 12month period, the incidence of supraventricular arrhythmia was 1.79% (34/1896). Most patients had pre-existing cardiovascular disease and sepsis. The mortality rate was 29.4%, and the most common cause of death was multiple organ failure due to septic shock. The mean value of the APACHE II score was 20.9, and the surgical intensive care unit and the hospital lengths of stay were 9.9 days and 25.8 days, respectively. The APACHE II score measured when the arrhythmia developed was a significant factor in predicting mortality, CONCLUSION: Supraventricular arrhythmias result in increased mortality and increased length of stay in both the surgical intensive care unit and the hospital. The arrhythmia itself did not cause death, but a high APACHE II score incicated a poor prognosis. This may reflect the severity of the illness rather than an independent contributor to mortality.

Clinical Evaluation of Extending Administration Time of Meropenem in Treatment of Bacterial Infections in Surgical Intensive Care Unit / 中华医院感染学杂志

OBJECTIVE To evaluate the clinical efficacy and safety of extending the administration time of meropenem in the treatment of moderate and severe bacterial infections in surgical intensive care uint(SICU) patients.METHODS Fifty patients with moderate and severe bacterial infections admitted to SICU were randomized to two groups: meropenem 30 min infusion group(n=25) and meropenem 3 h infusion group(n=25),the clinical efficacy and side-effects were observed between two groups.RESULTS Twenty-five patients were enrolled in meropenem 30 min infusion group with an effective rate of 48%,bacterial clearance rate of 26.9%.On the other hand,twenty-five patients were enrolled in meropenem 3 h infusion group with an effective rate of 60%,bacterial clearance rate of 43.5%.There were no significant differences between two groups(P=0.375,P=0.224,separately).CONCLUSIONS There are no significant differences between two groups on effective rate and bacterial clearance rate.

Disposable Over-shoes Using for Nosocomial Infection Control in Intensive Care Unit / 中华医院感染学杂志

OBJECTIVE To analyze the effect of the disposable over-shoes for the control of nosocomial infection of the intensive care units(ICU). METHODS The effects of the disposable over-shoes for the environment contamination and nosocomial infection control of the surgical ICU were investigated. RESULTS The mean of air bacteria colony counts when disposable over-shoes were worn was lower than that when without their use by healthcare workers (P0.05). The rates of nosocomial infection beteen them were 21.5‰ and 17.1‰,respectively. CONCLUSIONS The use of disposable over-shoes can't improve the environment quality and is not benefit for the control of nosocomial infection of surgical ICU.

Nosocomial pneumonia in medico-surgical intensive care unit

Cases of hospital acquired pneumonia occurring during the 1st 12 months of Medico-Surgical ICU (Intensive care unit, MSICU) in operation were evaluated retrospectively to determine its incidence, common causative pathogens, outcome and radiological patterns with the new hospital setting providing a unique relatively aseptic environment. Among the 920 admitted patients, 73 episodes of nosocomial pneumonia on 63 patients were identified and the incidence rate was 7%. The most common pathogens were Pseudomonas. Staphylococcus, Serratia, and Enterobacter in the order of frequency of occurrence, and the gram-negative pathogens comprised 70%. Nosocomial pneumonia was more common after use of antibiotics due to such pathogens as Enterobacter, Acinetobacter, and Candida which caused poor outcome. Enterobacter had the greatest tendency to be related with poor outcome and Serratia the least. Overall mortality was 25%. Bronchopneumonia was the most common type of pneumonia caused by any pathogen except Acinetobacter which caused a mixed type of nosocomial pneumonia.

The monitoring of nosocomial infections and control of an outbreak in a surgical intensive care unit / 解放军医学杂志

Objective To investigate the incidence and the risk factors of nosocomial infection in a surgical ICU (SICU) where infections occurred frequently. Methods A bacteriological investigation was prospectively done in all the inpatients of the SICU admitted in one month. Nosocomial infection was diagnosed according to Diagnostic Criteria of Nosocomial Infection published by Ministry of Health. The nurse who was responsible for the study should observe each patient carefully and fill in the progress note and monthly report of each ICU patient every day. When a case of infection was found, it should be recorded in the Record of Nosocomial Infection Case. The data were analyzed after the completion of the study. Results All the inpatients had undertaken prolonged use of interventional equipments such as urethral catheter, arterial or venous cannula, artificial ventilation, etc. The nosocomial infection rate was 22.7% in 22 inpatients. The daily infection incidence of urinary tract, blood, and lung was 26.8‰, 9.5‰, and 65.8‰, respectively. One patient was found to have pulmonary infection, urinary tract infection and bacteremia simultaneously. From the specimens from patients with nosocomial infection pathogenic bacteria were identified, including Stenotrophomonas maltophilia, Streptococcus viridans, Staphylococcus epidermidis, Pseudomonas aeruginosa, E. coli, Staphylococcus aureus, Achromobacter xylosoxidans, and Candida tropicalis were isolated. At the same time the drug sensitivity tests were carried out. During the monitoring period an outbreak of infection was controlled. Conclusions The aim of an objective monitoring is to solve the clinical problem and cut down the infection rate. In this group there are many risk factors, including old age, malignant tumor, major operation, severe pathological condition, long duration of stay, and so on. SICU is the department where rate of nosocomial infection is high. Comprehensive control measures must be carried out to lower the incidence of nosocomial infection.