Infections in Critically Ill Children

Health care–associated infections (HAI) directly influence the survival of children in pediatric intensive care units (PICU), the most common being central line–associated bloodstream infection (CLABSI) 25–30%, followed by ventilator-associated pneumonia (VAP) 20–25%, and others such as catheter-associated urinary tract infection (CAUTI) 15%, surgical site infection (SSI) 11%. HAIs complicate the course of the disease, especially the critical one, thereby increasing the mortality, morbidity, length of hospital stay, and cost. The incidence of HAI in Western countries is 6.1–15.1% and in India, it is 10.5 to 19.5%. The advances in healthcare practices have reduced the incidence of HAIs in the recent years which is possible due to strict asepsis, hand hygiene practices, surveillance of infections, antibiotic stewardship, and adherence to bundled care. The burden of drug resistance and emerging infections are increasing with limited antibiotics in hand, is still a dreadful threat. The most common manifestation of HAIs is fever in PICU, hence the appropriate targeted search to identify the cause of fever should be done. Proper isolation practices, judicious handling of devices, regular microbiologic audit, local spectrum of organisms, identification of barriers in compliance of hand hygiene practices, appropriate education and training, all put together in an efficient and sustained system improves patient outcome.

A Study on Burden of Carbapenem-Resistant Pseudomonas aeruginosa and Acinetobacter baumannii Infections in a Tertiary Care Hospital of Eastern India

Introduction: Healthcare associated infections(HAI) bymulti-drug resistant organisms(MDRO) are major cause ofmortality and morbidity having significant impact on qualityof life and economic burden. HAI by carbapenem-resistantPseudomonas aeruginosa (CRPsA) and Acinetobacterbaumannii (CRAB) are emerging threat for their highantibiotic resistance and spread via mobile genetic elements.Objectives of this study were to detect prevalence of CRPsAand CRAB infections in a tertiary care hospital of EasternIndia and to determine their antimicrobial resistance profile.Material and methods: This observational study was done inDepartment of Microbiology from January 2018-June 2019.From HAI patients, different clinical samples were collected.Culture and identification by standard conventional methodsand antimicrobial susceptibility tests by modified KirbyBauer disc-diffusion method following CLSI guidelines wereperformed. CRPsA and CRAB cases were identified whenisolates were resistant to ≥1 carbapenem, 10µg imipenemdisc(zone diameter ≤15mm for P. aeruginosa or ≤18mm forA. baumanii) or meropenem disc (≤15mm for P. aeruginosa or≤14mm for A. baumanii).Result: From 27,043 clinical samples, 1785(6.6%)Acinetobacter baumannii and 777(2.87%) Pseudomonasaeruginosa were isolated. CRAB and CRPsA prevalencewere 74.17% and 62.29% respectively. Carbapenemresistance were further categorised into imipenem-resistantmeropenem-resistant (IRMR) (A. baumanii-63.19%, P.aeruginosa-51.61%), imipenem-resistant-meropenemsensitive (IRMS) (A. baumanii-10.48%, P. aeruginosa-9.13%), meropenem-resistant-imipenem-sensitive (MRIS)(A. baumanii -0.51%, P. aeruginosa -1.54%) phenotypes.Fourth category was imipenem-sensitive-meropenemsensitive (ISMS) (A. baumanii -25.82%, P. aeruginosa-37.71%). Carbapenem-resistant groups showed significantlyhigh resistance for all antibiotics excepting colistin.Conclusion: Carbapenems are often used for treatingMDRO. But high carbapenem-resistance in HAI is alarming,warranting judicious use of antibiotics.

Antibiotic-resistant Enterobacteriaceae in healthy gut flora: A report from north Indian semiurban community

Background & objectives: Rampant use of ?-lactam antibiotics in both community and hospitals has transformed the human healthy intestinal gut flora into a reservoir of antibiotic-resistant organisms. This study was conducted to find the faecal presence of antibiotic-resistant Enterobacteriaceae in faecal samples in the community in north India. Methods: In this prospective study, 207 stool samples were collected from apparently healthy individuals residing in a semiurban community in Chandigarh, India, from August to October, 2015. Isolates belonging to family Enterobacteriaceae were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and antibiotic susceptibility was determined using Clinical Laboratory Standard Institute disc diffusion method. Detection of extended spectrum ?-lactamases (TEM, SHV, OXA-1, CTXM 1, CTXM 2, CTXM 9 and CTXM 8/25), carbapenemases (IMP, VIM and KPC) and New Delhi metallo-?-lactamase was done by multiplex PCR. Results: Of the population studied, 55.5 per cent were females and 60 per cent were illiterate or had only primary education; 43.4 per cent individuals were aged <20 yr. Overall, 70.5 per cent of stool samples had antibiotic-resistant isolates. Maximum resistance was seen for cephalosporins (60.4%) followed by fluoroquinolones (41.5%). The multidrug-resistant (MDR) isolates were 2.4 per cent. The most commonly detected genes were TEM, SHV, OXA-1, CTXM-1, CTXM-2, CTXM-9 and CTXM-8/25 ?-lactamases. Escherichia coli was the most common resistant isolate, and TEM was the most common gene detected. Interpretation & conclusions: Overall, 70.5 per cent members of Enterobacteriaceae had antibiotic resistance in the community and 2.4 per cent were MDR. Higher resistance rates were observed for most commonly used drugs such as cephalosporins and fluoroquinolones. High rate of antibiotic-resistant Enterobacteriaceae in gut of healthy individuals points towards the need for active screening and prevention of dissemination.

The Antibiogram of Isolated Pathogens from Tracheal Aspirate among Intubated patients 2 months – 5 years old with very Severe Community Acquired Pneumonia Admitted in Pediatric Intensive Care Unit of a Tertiary Hospital in Cebu City from 2013-2016

Objective@#To determine the antibiogram of tracheal aspirate cultures (TACS) among intubated children aged 2 months to 5 years old with very severe community acquired pneumonia (CAP). @*Methodology@#A retrospective chart review using total enumerative sampling. @*Results@#66 out of the 343 patients had positive TACS. The top 5 most common isolates were Klebsiella pneumoniae(37.8%), Pseudomonas aeruginosa (25.7%), Acinetobacter baumanii (15.1%), Enterobacter cloacae (12.1%) and Methicillin Resistant Staphylococcus aureus (MRSA) (6%). The gram-negative isolates were highly sensitive to amikacin and carbapenems. Majority of these patients (92.42%) had history of Pentavalent immunization. Majority of patients who were TACS positive had history of antibiotic use prior to admission (92.42%), mostly second-generation cepahalosporin (cefuroxime, 32.42%). High rates of resistance to ampicillin and gentamicin were noted for patients with Klebsiella pneumoniae and Enterobacter cloacae isolates. Majority of patients with Klebsiella pneumoniae, Acinetobacter baumanii and MRSA expired. @*Conclusion/Recommendation@#Majority of those patients with positive isolates had MDR organisms thus for patients with very severe CAP who already received antibiotic as outpatient, broad spectrum antibiotics should be considered as empiric therapy and TACS be done on all patients with very severe CAP.

Effectiveness and safety of carbapenem antimicrobial management / 中华医院管理杂志

Objective To investigate the effectiveness and safety of carbapenem antimicrobial management programs (ASP). Methods 671 patients who were discharged from the emergency department of the hospital from January 2017 to April 2018 were enrolled. These patients were subject to before-and-after self-control studies, using such intervention measures as MDT proactive management-feedback-training. January-September of 2017 was set as the pre-intervention stage, and September 2017-April 2018 as the post-intervention stage. The two stages were compared in such indicators as the monthly antibacterial use, quality of care and hospital acquired infection. Results Thanks to the ASP measure against antibiotics like carbapenems, the use rate of carbapenems at the emergency department ward fell from 36.7% to 18.6% , the defined drug doses (DDDs) of carbapenems fell from 211.92 to 82.22, and the antibiotics use density (AUD) of carbapenems fell from 29. 18 DDDs/100 day/patient to 11. 56. The pathogen detected rate increased significantly (0.61 ± 0.08 versus 0.78 ± 0.16), with a difference of statistical significance (P=0.020). On the other hand, the mean days of stay, average cost per hospitalization, proportion of antibiotics use, incidence of hospital acquired infections, and the infection/colonization rate of carbapenem-resistant organisms ( CROs ) present no significant changes. There was a moderate positive correlation between carbapenem DDDs and mean days of stay ( P=0.034), and also a moderate positive correlation between hospital acquired infection incidence and CROs infection/colonization rate ( r = 0.545, P = 0.029 ). Conclusions The carbapenem ASP at the hospital proves safe and effective. CROs infection/colonization may be the cause of hospital acquired infection. Prevention and control against multi-drug resistant bacteria on the basis of ASP may add to the effect of ASP.

Analysis of Active Screening and Risk Factors for Multidrug-resistant Organisms in Elderly Patients of ICU / 中国药房

OBJECTIVE:To investigate risk factors of multidrug-resistant organisms (MDROs) infection in elderly patients of ICU,and to provide reference for formulation and implementation of MDROs prevention and control measures.METHODS:A total of 146 elderly patients were selected from ICU of our hospital during Dec.2013-Jun.2016.Throat swab,sputum swab and anal swab specimens (1 copy,respectively) were collected to conduct active screening of MRSA and ESBLs-producing Enterobacteriaceae.Risk factors of MDROs infection,pathogen distribution and drug resistance were analyzed.RESULTS:Among samples of 146 patients,there were 34 MRSA positive samples in throat swab with positive rate of 23.3％;there were 30 MRSA positive samples in sputum swab with positive rate of 20.5％;there were 99 ESBLs-producing bacteria positive samples in anal swab (containing 50 ESBLs-producing Escherichia coli positive samples and 49 ESBLs-producing Klebsiella pneumoniae positive samples) with positive rate of 67.8％.The positive rate of throat swab MRSA screening was not correlated with patient's gender,age,tracheal intubation or mechanical ventilation (P＞0.05),but it was related with hospitalization time in ICU (P＜0.05).The positive rate of sputum swab MRSA screening was not correlated with patient' s gender,tracheal intubation or mechanical ventilation;the positive rate of anal swab ESBLs-producing bacteria screening were not related with patient's gender(P＞0.05).But they were related with age and hospitalization time in ICU (P＜0.05).Compared with negative patients,there was no statistical significance in the times of fiberoptic bronchoscopy in throat/sputum swab MRSA screening positive patients (P＞0.05).The times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter in anal swab ESBLs-producing bacteria screening positive patients were significantly more or longer than negative patients,with statistical significance (P＜0.05).Binary Logistic regression analysis showed that hospitalization time in ICU was risk factor of positive active screening of throat swab in elderly patients of ICU[OR=1.119,95 ％ CI (1.071,1.385),P=0.021];age was risk factor of positive active screening of sputum swab[OR=1.893,95 ％ CI (1.232,4.042),P=0.032];age and hospitalization time in ICU were risk factors of positive active screening of anal swab [OR were 1.046,1.022,95％CI were (1.005,1.088) (1.006,3.283),P were 0.027,0.031].A total of 163 strains of MDROs were detected,among which there were 64 strains of MRSA,50 strains of ESBLs-producing E.coli and 49 strains of ESBLs-producing K.pneumoniae.They were generally highly resistant to compound preparation containing enzyme inhibitors.CONCLUSIONS:The results of MDROs active screening in elderly patients of ICU are related with age,hospitalization time in ICU,the times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter.Age and hospitalization time in ICU were risk factors of MDROs infection.The pathogens are mainly ESBLs-producing Enterobacteriaceae,and drug resistance is severe.For elderly critical patients with MDROs infection,clinical prevention and intervention measures should be taken to prevent and control the prevalence and spread of MDROs in ICU.

Path Analysis of Performance of Multidrug-Resistant Organisms Management Guidelines among Intensive Care Unit Nurses : With Focus on the Theory of Planned Behavior and Patient Safety Culture / 중환자간호학회지

PURPOSE: The purpose of this study was to analyze factors influencing the adherence to guidelines for intensive care unit (ICU) nurses to control infections due to multidrug-resistant organisms (MDRO).METHOD: Participants were 194 ICU nurses at 3 university hospitals. Questions for the survey inquired about attitude, subjective norms, perception of patient safety culture to carry out MDRO management guidelines, perceived behavior control (PBC), and intention, based on the theory of planned behavior. Path analysis were utilized.RESULTS: The path analysis presented that PBC, perception of patient safety culture, and intent had a direct effect on MDRO management guidelines. Attitude towards following the manual did not have any correlation. The hypothetical model based on the theory of planned behavior was revealed as applicable; the degree of the variance in explaining adherence to the manual was 23 %, and the variance in explaining intention to fulfill the manual was 33 %.CONCLUSION: The results of this study suggest that we should develop a program to improve PBC to increase adherence to MDRO management guidelines. ICU nurses' perceptions of patient safety culture should also be surveyed.

Risk factors for multidrug-resistant bacteria recurrent infections in orthopedic patients from 2011 to 2017 / 中华创伤骨科杂志

Objective To explore the clinical characteristics of multidrug-resistant organisms (MDROS) and analyze the risk factors for MDROS recurrent infections in orthopedic in-patients.Methods A retrospective study was conducted of the clinical data of 296 in-patients with MDROS infection from June 2011 to August 2017.They were 216 males and 80 females with an average age of 49.9 years.Their average hospital stay was 37.2 days.Univariate analysis was conducted for items like age,hospital stay,bedridden time,concomitant internal disease (chronic obstructive pulmonary disease,chronic cardiovascular disease and diabetes),open or closed fracture,uninary catheter,use of hormone,stay in ICU,implantation material,incision grade,albumin level,hemoglobin level,reoperation,type of antibiotics and duration of antibiotics use.Multivariate logistic regression analysis was performed using SPSS 20.0 for items with significant differences.Results A total of 352 strains of pathogens were isolated,including methicillin-resistant staphylococcus aureus (26.7％),extended-spectrum β-lactamase-producing Escherichia coli (24.4％) and multidrug-resistant acinetobacter baumannii (24.1％).The pathogens were observed mostly at surgical sites (34.1％) and open wounds (23.0％).Forty-two patients reinfected the same strain after treatment.The multivariate logistic regression analysis revealed the following as the independent risk factors for MDROS recurrent infections in the orthopedic in-patients:hospital stay [OR =4.918,95％ CI (1.642,14.731),P =0.004],long bedridden time [OR=3.583,95％ CI (1.081,11.876),P=0.037],open injury [OR=2.375,95％CI (1.291,4.368),P=0.005],diabetes [OR=6.360,95％ CI (2.112,19.149),P=0.001],and chronic obstructive pulmonary disease [OR=4.170,95％ CI (1.419,12.251),P=0.009].Conclusions To prevent recurrent MDROS infections in orthopedic patients,surgeons should shorten unnecessary hospital stay,encourage ambulation as early as possible,effectively control blood sugar and actively treat concomitant internal diseases in addition to regular use of antibiotics.

Factores de riesgo en infecciones por organismos multidroga resistentes en pacientes pediátricos oncológicos en la Unidad Nacional de Oncología Pediátrica (UNOP) de Guatemala

Introducción: Las infecciones por organismos multidroga resistentes (MDR) en pacientes oncológicos pediátricos se han convertido en una causa frecuente de morbilidad y mortalidad. Objetivos: El objetivo principal de este estudio fue determinar la incidencia y los factores de riesgo para estas infecciones en una muestra de pacientes de la UNOP. Métodos: Se realizó un estudio de tipo retrospectivo. Se incluyeron pacientes de la unidad de nosocomiales con infección por organismos MDR con cultivo positivo (hemocultivo, uro cultivo, aspirado oro traqueal cultivo de secreción). Se revisaron los registros comprendidos entre 1 de enero del 2015 al 31 de diciembre del 2015; obteniendo los registros médicos de 30 pacientes que cumplían con los criterios de inclusión. Resultados: Se observó que el 60% de los pacientes con infecciones por organismo MDR son del sexo femenino, el 70% poseen el diagnóstico de un tumor hematológico y el 37% tuvieron como diagnóstico bacteriemia/sepsis, siendo la incidencia de ésta de 3.49%. Palabras Claves: factores de riesgo, Infecciones por organismos multidroga resistentes, pacientes oncológicos pediátricos. A. baumannii, K. pneumonie; cancer pediátrico.

Introduction: Multidrug resistant (MDR) organism infections in pediatric oncology patients have become a frequent cause of morbidity and mortality. The main objective of the following study was to determine the incidence and risk factors associated to MDR organisms infections in a sample of patients from UNOP. Methods: Retrospective study. The inclusion criteria were documented MDR infection with positive culture (blood, urinary, tissue or endotracheal aspirate). We reviewed medical records between January 1st, 2015 to December 31st, 2015; obtaining the medical records of 30 patients who fulfilled the inclusion criteria. Results: Sixty percent (60%) of patients female; 70% had the diagnosis of hematologic malignancy; 37% of patients were diagnosed with clinical sepsis and the incidence of sepsis was 3.49%. Key words: risk factors, infections by multidrug-resistant organisms, pediatric cancer patients. A. baumannii, K. pneumonie; pediatric cancer

Xpert CARBA-R Assay for the Detection of Carbapenemase-Producing Organisms in Intensive Care Unit Patients of a Korean Tertiary Care Hospital

Carbapenemase-producing organisms (CPO) are rapidly disseminating worldwide, and their presence in tertiary care hospitals poses a significant threat to the management of nosocomial infections. There is a need to control CPO, especially in intensive care unit (ICU) patients, because these organisms are resistant to most beta-lactam antibiotics and are easily transmitted. At present, the identification of CPO is time-consuming; hence, this study focused on the use of the Xpert CARBA-R assay (Cepheid, USA) to determine intestinal colonization rates of CPO in patients admitted to the ICU of a tertiary care hospital in Korea. Forty clinical stool samples were collected and inoculated both in a CARBA-R cartridge and in conventional culture plates. The CARBA-R assay required only ~one hour to screen CPO, while the time required for conventional culture was over three days. We also found that the prevalences of intestinal colonization by carbapenem-resistant organisms and Enterobacteriaceae were 17.5% (7 out of 40) and 7.5% (3 out of 40), respectively. Among the colonizing strains, three that contained carbapenemase, including Klebsiella pneumonia carbapenemase (KPC), and imipenem (IMP) and Verona integron-mediated metallo-beta-lactamase (VIM) were found. With its convenience, the Xpert CARBA-R assay can be included in CPO surveillance strategies.

Aerobic bacterial profile and antibiotic resistance in patients with diabetic foot infections

ABSTRACTINTRODUCTION: This study aimed to determine the frequencies of bacterial isolates cultured from diabetic foot infections and assess their resistance and susceptibility to commonly used antibiotics.METHODS: This prospective study included 41 patients with diabetic foot lesions. Bacteria were isolated from foot lesions, and their antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method and/or broth method [minimum inhibitory concentration (MIC)].RESULTS: The most common location of ulceration was the toe (54%), followed by the plantar surface (27%) and dorsal portion (19%). A total of 89 bacterial isolates were obtained from 30 patients. The infections were predominantly due to Gram-positive bacteria and polymicrobial bacteremia. The most commonly isolated Gram-positive bacteria were Staphylococcus aureus, followed by Staphylococcus saprophyticus, Staphylococcus epidermidis, Streptococcus agalactiae, and Streptococcus pneumoniae. The most commonly isolated Gram-negative bacteria were Proteus spp. and Enterobacterspp., followed by Escherichia coli, Pseudomonasspp., and Citrobacterspp. Nine cases of methicillin-resistant Staphylococcus aureus (MRSA) had cefoxitin resistance, and among these MRSA isolates, 3 were resistant to vancomycin with the MIC technique. The antibiotic imipenem was the most effective against both Gram-positive and Gram-negative bacteria, and gentamicin was effective against Gram-negative bacteria.CONCLUSIONS: The present study confirmed the high prevalence of multidrug-resistant pathogens in diabetic foot ulcers. It is necessary to evaluate the different microorganisms infecting the wound and to know the antibiotic susceptibility patterns of the isolates from the infected wound. This knowledge is crucial for planning treatment with the appropriate antibiotics, reducing resistance patterns, and minimizing healthcare costs.

Analysis of multi-resistant organisms in the hospital during the past 4 consecutive years / 国际检验医学杂志

Objective To investigate the change trend and the drug resistance rate of the multi-resistant organisms in the hospi-tal during the past four years,so as to guide the clinical medication,and strengthen the management of antibiotics application.Meth-ods Kirby-Bauer test which was recommended by the clinical and laboratory standards institute was used to conduct the suscepti-bility test,with the results evaluated based on US Clinical and Laboratory Standards Institute.Results Strains of bacteria were de-tected from January 201 1 to December 2014 in each year for the basic trend.The gram-negative bacterium was in the dominant posi-tion.The bacteria in the top five were:Escherichia coli,Staphylococcus epidermidis,Staphylococcus aureus,Pseudomonas aeruginosa and Pneumonia crayresearch coli.In each year,the overall situation of bacteria distribution had little changed.From the antimicrobial susceptibility test results,425 strains of multi-resistant bacteria were detected during the past four years.The detection rate and constituent ratio of multi-resistant bacteria then fell slightly in the first three years,but rebound in 2014.There was no statistically significant difference between the four years.Conclusion In the past four years,our hospital actively participates in monitoring and controlling the multiple drug-resistant bacteria,but nosocomial infection of the multiple drug-resistant bacteria has not been effec-tively controlled because of a variety of factors.We should continue to strengthen monitoring the clinical multiple drug-resistant bacteria,and understand the change tendency.In order to strengthen the management of the use of antibiotics and to guide clinical rational drug use,the drug sensitive test and the resistance situation of the hospital should be considered for the reasonable selection of antimicrobial agents.Strengthening the biological monitoring of clinical departments,enhancing the consciousness of sterile oper-ation of clinicians can help prevent the spread of drug-resistant strains.

COMMON INFECTIONS IN THE ELDERLY IN THE HOME OR NURSING HOME SETTING

Infections in the elderly are associated with high morbidity and mortality. Diagnosing infections in the elderly is challenging due to their atypical and subtle presentation. A high index of suspicion is often needed. Commonly encountered infections in the elderly include bacterial pneumonia, urinary tract infection, cellulitis and Herpes zoster. In addition, institutionalised elderly and those with multiple hospital admissions are at risk of infection with Multidrug-resistant Organisms (MROs); this can be difficult to manage. The purpose of this article is to look at some common infections in the elderly encountered in the home or nursing home, and review their management.

Analysis of distribution and drug resistance of multidrug-resistant organisms / 国际检验医学杂志

Objective To investigate the distribution and antimicrobial resistance of multidrug‐resistant organisms(MDROs) . Methods The distribution and antimicrobial resistance of MDROs ,isolated from 2010 to 2014 ,were retrospectively analyzed . MDROs were identified according to international consensus .The WHONET5 .6 software was used to analyze data .Results A to‐tal of 5 709 strains of MDROs were isolated in five years ,in which 2 441 strains were Staphylococcus(42 .76% ) ,2 091 strains were non‐fermentive bacterial(36 .63% ) ,737 strains were Enterococcus(12 .90% ) ,440 strains were Enterobacter(7 .71% ) .Of the 5 709 MDROs isolates ,55 .04% were isolated from respiratory tract specimens .The resistant rate of multidrug‐resistant E .coli and K . pneumoniae against cefoperazone/sulbactam ,imipenem and meropenem was less than 30% .The resistance of multidrug‐resistant A . baumanii was higher than 90% ,except to minocycline and cefoperazone/sulbactam ,20 .2% and 50 .6% respectively .The resistant rate of multidrug‐resistant P .aeruginosa was 71 .4% -97 .0% against other antimicrobial agents ,except to polymyxin B .The resist‐ance of multidrug‐resistant E .faecium against the antimicrobials was higher than 90% ,except 13 .8% to minocycline and less than 3% to linezolid ,teicoplanin and vancomycin .Meanwhile ,1 linezolid resistant strain was identified in 1 914 methicillin resistant S .au‐reus(MRSA) strains and all MRSA strains were susceptible to vancomycin and teicoplanin .Conclusion MDROs could be predomi‐nated by A .bauman and MRSA in this hospital .Monitoring and control measures to healthcare‐associated infections should be in‐tensified to prevent the spread of MDROs .

Antimicrobial Resistance: Community and Hospital

Antimicrobial resistance (AMR) increases the morbidity, mortality and costs of treating infectious diseases. (Hawkey and Jones, 2009)1. The threat from resistant organisms is now a global problem, both in the hospital and to some extent in the community. The key drivers are: medical care complexity; widespread antimicrobial use in animal husbandry; antimicrobial contaminated food distribution; international travel, and food distribution of food contaminated with multidrug resistant organism. Strategies for infection control are: good understanding of what needs to be done, consistent application of infection control measures, use of “search and destroy” techniques; and effective antimicrobial stewardship. This paper reviews the current issues and potential solutions.

Emerging Infections and Role of Family Physician

Emerging infections may be defined as infectious diseases whose incidence in humans has increased in the past 2 decades or threatens to increase in the near future. They include: new infections resulting from changes or evolution of existing organisms; known infections spreading to new geographic areas or populations; previously unrecognised infections appearing in areas undergoing ecological transformation; and old infections re-emerging as a result of antimicrobial resistance in known agents. Emerging infections occur as the result of four groups of factors: novel zoonotic emergence factors; climate change; nonzoonotic emergence factors; and human practices. As frontline doctors, family physicians have at least five roles that they must perform well: participate in global and local surveillance of emerging infections; assist in societal learning; pandemic preparedness; legislation compliance; and antibiotic stewardship.

Community-acquired Pneumonia.

Despite the availability of potent new antimicrobials and effective vaccines, community-acquired pneumonia (CAP) remains a common and potentially serious illness associated with considerable morbidity and mortality, particularly in elderly patients and those with significant comorbidities. The emergence of penicillin-resistant Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, the pathogens that account for approximately 85% of CAP cases, is a serious threat to public health. Of additional concern is that penicillin-resistant organisms are also frequently resistant to other agents, particularly first-generation cephalosporins, erythromycin, tetracycline and trimethoprim-sulfamethoxazole. Cefaclor, a broad-spectrum semi-synthetic second-generation oral cephalosporin with documented activity against many gram-positive and gram-negative pathogens, as well as some anaerobes, is a good therapeutic option.

The development trend of multidrug-resistant organisms / 中国小儿急救医学

Multidrug-resistant organisms are growing worldwide public health problem and few therapeutic options remain available.The traditional antimicrobials (glycopeptides) for multidrug-resistant Grampositive infections are declining in efficacy.New antimicrobials that are presently available are linezolid,daptomicin and tigecycline,which have well-defined indications for severe multidrug-resistant organisms infections.Unfortunately,the therapies available for multidrug-resistant Gram-negatives including carbapenem-resistant Pseudomonas aeruginosa,Acinetobacter baumannii and Enterobacteriaceae are limited to colistin and tigecycline only.Distribution of multidrug-resistant organisms are changing in recent years.Strains of multidrug-resistant organisms were dominated by Gram-negative bacteria in most hospital particularly in intensive care unit.Multidrug-resistant/pandrug-resistant Pseudomonas aeruginosa,Acinetobacter baumannii are increasing rapidly in trend.Strategy that includes surveillance,infection control procedures,isolation and antimicrobial principle should be emphasized and implemented to reduce multidrug-resistant organism diffusion.

Colonization and infection of multidrug-resistant organisms / 中国小儿急救医学

There are much more multidrug-resistant organisms (MDRO) in the intensive care unit than ever.If the doctors could distinguish the colonization from infection of MDRO,they can make right decision on the rational clinical use of antibiotics to reduce resistant organisms and nosocomial infection.However,it's a confused problem for clinicians to distinguish between colonization and infection.Bacterial culture combined with clinical symptoms and signs maybe helpful,but it is limited.There should be more objective indicators.This article was aimed to state the definition and relationship between colonization and infection,and how to determine the colonization and infection of MDRO.

Cost of antimicrobial treatment in patients infected with multidrug-resistant organisms in the Intensive Care Unit / Costo de la terapia antimicrobiana en pacientes infectados con microorganismos multirresistentes en la Unidad de Cuidados Intensivos

This study aims to compare the costs of antimicrobial drugs used in the treatment of patients infected with multidrug-resistant organisms (MDRO) or those not infected with this type of organisms in an intensive care unit (ICU). It is a retrospective comparative case-control study, performed in a public hospital in the capital city of Brazil, comprising the years 2007, 2008 and 2009. Information on age, sex, length of hospitalization, clinical outcome, antimicrobial drugs, microorganisms and microbial sensitivity to antibiotics was collected. Spearman and Mann-Whitney tests were used for statistical analysis. The level of significance was set at p < 0.05. The sample consisted of 401 patients with a mean age of 51.36 years (± 19.68) being 226 (56.4%) male. As for the length of stay, 32.9% of the patients remained more than 20 days, with 195 discharged and 206 deaths. Global cost of antimicrobial treatment was US$ 1113 221.55 during the three year period. Treatment cost for patients with MDRO was higher than for those without (p = 0.010). At least one MDR strain was isolated in 54.6% of the patients. According to these results, nosocomial infections due to MDRO and the high costs involved may endanger the effectiveness of antimicrobial therapy in ICU and Health Centers.

El presente estudio tuvo como objetivo comparar los costos del tratamiento con fármacos antimicrobianos para las infecciones debidas a organismos multirresistentes (OMDR) versus aquellas debidas a gérmenes no multirresistentes, en la Unidad de Cuidados Intensivos (UCI) de un hospital público de Brasilia, Distrito Federal. Fue un estudio retrospectivo, de casos y controles y abarcó un período de tres años (2007, 2008, 2009). Se recolectó información sobre edad, sexo, tiempo de internación, resultados clínicos, antimicrobianos usados, microorganismos aislados y su sensibilidad a los antibióticos. Se utilizaron en el análisis estadístico las pruebas de Spearman y de Mann-Whitney, con p < 0.05. La muestra consistió en 401 pacientes con media de edad de 51.36 años (± 19.68), siendo 226 varones (56.4%). En cuanto al tiempo de internación, un 32.9% de los pacientes permanecieron más de 20 días, con 195 altas y 206 óbitos. El tratamiento antimicrobiano costó US$ 1113 221.55 en los tres años, siendo éste mayor para los que presentaron OMDR que para los que no los presentaron (p = 0.01). Se comprobó la presencia de, por lo menos, un microorganismo multirresistente en el 54.6% de los pacientes. La infección intrahospitalaria con OMDR y el elevado costo del tratamiento de los pacientes infectados con estos microorganismos puede comprometer la efectividad de la terapia antimicrobiana en estas Unidades y Centros de Salud.