Intraventricular Antimicrobial Therapy in children with Multi-Drug Resistant Ventriculitis: A tertiary hospital experience and literature review

Background@#Intraventricular antimicrobial therapy (IVT), defined as the direct installation of antimicrobial agents into the lateral ventricles has been utilized as the last therapeutic option for the treatment of multidrug-resistant ventriculitis. The aim of this case series is to report our institution’s experience with IVT in pediatric patients with ventriculitis. @*Material and Methods@#Retrospective chart review was done. The demographic data, cerebrospinal fluid (CSF) culture isolates, treatment regimens, and clinical outcomes of these patients were collected and described. @*Results@#Between 2016 to 2018, seven (7) pediatric patients diagnosed with ventriculitis caused by multidrug-resistant organisms underwent intraventricular antimicrobial therapy in combination with intravenous therapy. The median age was 1 year (range 1 month to 17 years old, mean: 4.4 years). Fifty-seven (57) percent of the patients were females. The isolated pathogens were Acinetobacter baumannii MDRO (n = 3), Klebsiella pneumoniae MDRO (n = 2), Methicillin-resistant Staphylococcus aureus (n = 1), and Methicillin-resistant Staphylococcus epidermidis (n = 2).One patient had mixed isolates on CSF culture (Acinetobacter baumannii and MRSE). The antimicrobial agents for IVT used were colistin (n = 4), vancomycin (n = 2), and gentamicin (n = 1). The mean time to initiation of intraventricular therapy from the diagnosis of ventriculitis was 19 days. The mean duration of IVT therapy was 15 days. The survival rate was 57%. @*Conclusion@#Ventriculitis caused by drug-resistant organisms is an emerging concern. Optimal therapy is not yet established and experience with IVT is limited. This series showed that there were no adverse effects related to IVT thus it may be considered an option for MDRO ventriculitis. Gram negative organisms are more common causes of ventriculitis in our institution.

Analysis on risk factors and etiology of MDRO infection in patients with stroke associated pneumonia in ICU / 重庆医学

Objective To investigate the risk factors of multi-drug resistant organism(MDRO) infection in the patients with stroke associated pneumonia in ICU (ICU-SAP) and to analyze the composition of pathogenic bacteria.Methods The medical record data of 158 inpatients with ICU-SAP in our hospital from January 2013 to June 2016 were collected and screened the influence factors for MDRO infection occurrence in ICU-SAP.Results One hundred fity-eight cases of ICU-SAP,106 cases developed MDRO infection,and the infection rate was 67.1％.A total of 146 strains of MDRO were isolated,of which 31 strains (21.2％) were Gram-positive bacteria and 115 strains(78.8 ％) were Gram-negative bacteria.The Logistic regression analysis showed that the risk factors for MDRO infection in ICU-SAP patients included late-onset SAP,ICU stay time(≥72 h),disturbance of consciousness,swallowing disorders and APACHE Ⅱ (＞25 points).Conclusion The proportion of ICU-SAP patients infected with MDRO is high,and Gram-negative bacilli are the primary pathogen.These factors such as late-onset SAP,long ICU stay time,disturbance of consciousness,swallowing disorders and increased disease severity increase the MDRO infection risk,which should be paid attention to in order to reduce the morbidity of MDRO infection.

Analysis on risk factors and etiology of MDRO infection in patients with stroke associated pneumonia in ICU / 重庆医学

Objective To investigate the risk factors of multi-drug resistant organism(MDRO) infection in the patients with stroke associated pneumonia in ICU (ICU-SAP) and to analyze the composition of pathogenic bacteria.Methods The medical record data of 158 inpatients with ICU-SAP in our hospital from January 2013 to June 2016 were collected and screened the influence factors for MDRO infection occurrence in ICU-SAP.Results One hundred fity-eight cases of ICU-SAP,106 cases developed MDRO infection,and the infection rate was 67.1％.A total of 146 strains of MDRO were isolated,of which 31 strains (21.2％) were Gram-positive bacteria and 115 strains(78.8 ％) were Gram-negative bacteria.The Logistic regression analysis showed that the risk factors for MDRO infection in ICU-SAP patients included late-onset SAP,ICU stay time(≥72 h),disturbance of consciousness,swallowing disorders and APACHE Ⅱ (＞25 points).Conclusion The proportion of ICU-SAP patients infected with MDRO is high,and Gram-negative bacilli are the primary pathogen.These factors such as late-onset SAP,long ICU stay time,disturbance of consciousness,swallowing disorders and increased disease severity increase the MDRO infection risk,which should be paid attention to in order to reduce the morbidity of MDRO infection.

An Xpert screen to identify carbapenemases.

To prevent the spread of carbapenemases-producing Enterobacteriaceae (CPE) active surveillance, contact isolation and cohorting infected patients should be practiced. Rectal swabs for the Xpert MDRO-assay of 32 patients were included. 71.85% were positive for targets incorporated into the MDRO-assay; whereas 28% were phenotypically not CRE and Xpert negative (9.37% had different mechanism [blaOXA]). The assay identified 59.3%, 9.37% and 3.1% as blaNDM, blaNDM+VIM and blaVIM, respectively. The assay is a screening test that identifies CPE harbouring organism within an hour and can be installed at tertiary-care facilities to screen colonized patients.

Targeted monitor and comprehensive intervention of multidrug-resistant organism infection in a general hospital / 中国感染控制杂志

Objective To evaluate the occurrence of multidrug-resistant organism (MDRO)infection in a general hospital,and take effective comprehensive intervention measures,so as to reduce MDRO infection.Methods Targeted monitoring on MDROs was performed from October 2012 to December 2013,comprehensive intervention measures were conducted,the occurrence of MDRO infection before and after intervention was compared.Results A total of 62 384 pa-tients were investigated,17.91%(n=11 176)were sent specimens for pathogen culture,606 times of culture for patients’ specimens were detected MDROs,292(0.47%)cases were MDRO healthcare-associated infection(HAI),314 were com-munity-acquired infection or colonization.MDRO infection case rate decreased from 0.65%(75/11 603)before intervention to 0.26%(36/13 875)after intervention (χ2 =21.08,P <0.05).Conclusion Comprehensive intervention measures can effectively reduce the occurrence of MDRO HAI.

Link Monitor of Hospital Infection Management of MDRO / 中华医院感染学杂志

OBJECTIVE To further strengthen the link monitor of hospital infection management of MDRO,prevent and control the occurrence and spread of MDRO in the hospital and ensure medical safety.METHODS The occurrence of MDRO,and the sterilization were monitored to guarantee the medical care personnel not infected with MDRO,Asepsis process during treatment and nursing,was supervised to cut off the weak link of MDRO spread,carry out standard prevention sense throughout,normalize the use of antibiotics,and fulfill the education of MDRO infection knowledge.RESULTS Through hospital infection management of MDRO,it got the effect of early prevention,early diagnosis and early control,reduced the infection rate of MDRO,prevented the occurrence and spread of MDRO in the hospital and ensure the medical safety.CONCLUSIONS Well done in the link of hospital infection management of MDRO is one of essential contents to evaluate the hospital infection management level,and improve medical care quality and ensure medical safety.