Comparison of outcomes of acute kidney injury in elderly and non-elderly hospitalized patients in a tertiary care hospital in India: a prospective observational study

Background: The prevalence of acute kidney injury (AKI) progressively increases with age. A higher rate of dialysis dependency and mortality is observed in elderly with AKI. Here we have studied the comparison of clinical features, outcomes of AKI between elderly (age � years) and non-elderly AKI patients and their risk factors for mortality. Methods: This prospective observational study enrolled 100 patients with AKI, with elderly and non-elderly in a 1:1 ratio for comparison, from September 2021 to January 2023 at AIIMS Rishikesh in India. Detailed history, clinical examination, relevant laboratory and radiological investigations were done to evaluate for the cause of AKI. Etiological causes, complications of AKI, and in-hospital outcomes were observed. They were given standard treatment and dialysis as per standard indications. We analysed the mortality risk of these groups using the Cox proportional hazards model. Results: The in-hospital mortality rates among these two groups were non-significant (p=0.29). A significantly higher number of patients with non-elderly AKI were HD-dependent at discharge (p=0.027). Elderly patients had significantly lesser complications like uremic encephalopathy and fluid overload compared to non-elderly. There was a significant association between mortality and female gender, intensive care unit (ICU) admissions, hospital-acquired AKI, pre-renal/renal causes, chronic obstructive pulmonary disease (COPD) as comorbidity, multiple organ dysfunction syndrome (MODS), mechanical ventilation requirement, vasopressor support requirement, need for hemodialysis and prolonged ICU stay. Conclusions: Elderly patients with AKI do not experience worse mortality outcomes than non-elderly patients with AKI. Therefore, elderly patients should not be denied timely treatment, solely based on their age.

Ventilator associated pneumonia: unravelling prevalence risk factor and antibiotic usage

Background: Hospital acquired infections, are a leading cause of mortality and morbidity. Ventilator associated pneumonia, one of the hospital acquired illnesses. The purpose of this study was to evaluate the prevalence, risk factors, causative organism, and antibiotic usage for the treatment of ventilator-associated pneumonia. Methods: Between May 2022 and October 2022, 50 patients participated in an ambispective and observational study conducted across several ICU departments at Adichunchanagiri Hospital, BG Nagara, Karnataka. Reviewing and evaluating daily patient case sheets, laboratory results, and treatment charts of participants who were hospital inpatients provided pertinent data needed for the study. Volunteers were enrolled after taking consent from each of them, a suitably designed data collection form was used to collect all the necessary information. Microsoft Excel was used to enter the data. Version 28 of SPSS was used to analyze the data. Statistical significance was determined by using a P-value of less than 0.05. Results: The study included 50 patients and discovered a 60% prevalence of ventilator-associated pneumonia in the general community. Staphylococcus aureus accounted for 26.7% of all gram-positive bacteria, whereas Enterobacter and Klebsiella species accounted for 16.7%. Metronidazole was given in 64% of instances, with accidents being the most frequent risk factor (40%). Conclusions: Within the specified population, the incidence of ventilator-associated pneumonia is 60%, with Staphylococcus aureus identified as the most predominant bacterial pathogen. Metronidazole is the most frequently prescribed antibiotic, and accidents are the key risk factors that cause ventilator-associated pneumonia.

Effectiveness of extensively hydrolyzed formula in treating feeding intolerance in preterm infants / 中国儿童保健杂志

【Objective】 To analyze the effect of extensively hydrolyzed formula(eHF) in the treatment of feeding intolerance in preterm infants and the effect on hospital infection, in order to provide reference for the clinical treatment of feeding intolerance in preterm infants. 【Methods】 A total of 208 cases of preterm infants with feeding intolerance diagnosed and treated in Shandong Heze Municipal Hospital from April 2017 to February 2020 were selected into the clinical trial for eligibility assessment, then were randomly assigned into study group(n=100) and control group(n=100) after screening and exclusion. Children in the control group were fed with standard preterm formula, while children in the study group were fed with eHF. Feeding tolerance indicators, including daily milk intake, time to meconium evacuation, time to full gastrointestinal nutrition, total gastric residual counts(GRV1) in the 7-d period after resumption of breastfeeding, ratio of all-day gastric residual counts/all-day estimated milk intake after resumption of breastfeeding(GRV2) were compared between the two groups, and growth indicators(body weight growth rate, head dimension growth rate), complication incidence [necrotizing enterocolitis(NEC), pathological jaundice, positive fecal occult blood or blood in stool] and incidence of hospital-acquired infections. 【Results】 The daily milk intake(t=5.037) of the study group was higher than that of the control group, and the time of foetal excretion(t=9.217), the time to reach full gastrointestinal nutrition(t=15.833), GRV1(t=6.737), GRV2(t=9.956) were lower than those of the control group, and the differences were all statistically significant(P<0.05). The rate of weight gain(t=2.454) and head dimension growth(t=5.469) in the study group was significantly higher than those of the control group(P<0.05). The incidence of the three complications of NEC, pathological jaundice and positive fecal occult blood or blood in stool(χ2=4.310) and the incidence of hospital infections(χ2=4.688) were significantly lower in the study group than in the control group(P<0.05). 【Conclusions】 Compared with the standard formula milk for preterm infants, eHF can significantly improve the feeding intolerance of preterm infants, promote growth and development, and reduce the occurrence of hospital-acquired infections. Therefore, eHF can be widely used in clinic for preterm infants with feeding intolerance.

Impact of coronavirus disease pandemic on antimicrobials consumption and antimicrobial resistance during the first and second wave in a tertiary care hospital, in India

Background: This study measured the impact of the first and second wave of COVID-19 pandemic (in the year 2020-21) on the antibiotics uses and their effect on gram nehative bacterial species Klebsiella, Enterobacter, Pseudomonas and Acinetobacter. Methods: The number of patient admission month-wise, antibiotic consumption, blood cultures collected, number of positive BCs, and antibiotic resistance were analysed retrospectively for the years 2020, 2021, and 2019 for comparison, in tertiary care hospital (ca. 840 beds). Results: Half of patients admitted in years 2020 and 2021 in our hospital had COVID-19. A significant increase in total antibiotic consumption during the years 2020 (75.53 DDD per 100 admissions) and 2021 (91.71 DDD per 100 admissions) occurred in comparison to the year 2019 (52.5 DDD per 100 admissions). The rate ratio of BCs per 100 admissions increased by 74% in the year 2020, and 118% in the year 2021 in comparison with the rate ratio to the year 2019. The BSI rate per 100 admissions increased overall by 24% in March 2020 and 115% in April 2020, the rate ratio of BSIs per 100 admissions raised 58.4% for Klebsiella and 239.3% for E. coli, but remain the same for Acinetobacter and Aeruginosa. A sharp increase in the rate of BSIs caused by microorganisms resistant to cephalosporins was also observed in the years 2020 and 2021. Conclusions: present study highlights the impact of the first and second waves of the COVID-19 pandemic on antibiotic consumption and the increasing prevalence hospital-acquired infections and antimicrobial resistance.

90 day and 1-year mortality and renal outcomes of patients who started hemodialysis treatment for the first time / Mortalidad a los 90 días y al año y resultados renales de pacientes que iniciaron tratamiento con hemodiálisis por primera vez

ABSTRACT Aim: This study aims to investigate the 90-day and 1-year mortality and the affecting factors of mortality in patients who have started dialysis treatment for the first time. Methods: Patients who started intermittent hemodialysis for the first time in the hemodialysis unit were evaluated. Patients who received hemodialysis treatment for any reason before, patients who underwent hemodialysis due to methyl alcohol, lithium, or mushroom poisoning, and patients who started dialysis in the intensive care unit were excluded from the study. The clinical and laboratory data were obtained from the patients, at admission time, from the electronic data record system and patients' charts.Univariate and multivariate logistic regression analyses were used to identify predictive factors for 90-days and 1-year mortality-dependent variables. Results: 229 patients were included in this study. 133(58.8%) of the patients were male, 96(41.9%) were female, and the median age was 64 years. While 166 patients had pre-existing renal disease, 63 patients had no prior renal disease. The number of patients who died within 90 days, which refers to short-term mortality, was 49 (21.4%). 73 patients (31.9%) died in one year (long-term mortality). At the end of one year, 38% of the whole group of patients continued receiving renal replacement therapy, while 10% of all CKD patients had not a requirement of dialysis, and only 9.17% of the patients had renal recovery. In the multivariate analysis established for short-term mortality, the following parameters showed significant predictive features: ejection fraction (OR = 3.80, 95% CI: 1.05-13.72, p=0.042), CRP (OR = 0.20, 95% CI: 0.04-0.92, p= 0.039), age (OR = 0.21, 95% CI: 0.05-0.91, p= 0.038), and diastolic blood pressure (OR = 0.08, 95% CI: 0.02-0.28, p< 0.001). The multivariate analysis for long-term mortality indicated that systolic blood pressure (OR = 0.26, 95% CI: 0.08-0.82, p= 0.022), diastolic blood pressure (OR = 0.21, 95% CI: 0.68-0.66, p= 0.008), and potassium (OR = 0.27, 95% CI: 0.10-0.70, p= 0.007) were independent predictive markers. Conclusion: Patients with CKD who have not yet started hemodialysis treatment should be followed closely, as hypervolemia, hypotension, and hemodynamic instability increase the risk of death, according to our study. In addition, we recommend that clinical conditions such as hemodynamic instability or sepsis, which may cause hypotension in AKI-D, should be addressed as soon as possible, and optimizing the fluid-electrolyte balance carefully in those patients we determined to be at risk.

RESUMEN Objetivo: Este estudio tiene como objetivo investigar la mortalidad a 90 días y 1 año y los factores que afectan la mortalidad en pacientes que han iniciado tratamiento de diálisis por primera vez. Métodos: Se evaluaron pacientes que iniciaron hemodiálisis intermitente por primera vez en la unidad de hemodiálisis. Se excluyeron del estudio los pacientes que recibieron tratamiento de hemodiálisis por cualquier motivo anteriormente, los pacientes que se sometieron a hemodiálisis por intoxicación con alcohol metílico, litio o hongos y los pacientes que iniciaron diálisis en la unidad de cuidados intensivos. Los datos clínicos y de laboratorio se obtuvieron de los pacientes al momento del ingreso, del sistema de registro electrónico de datos y de las historias clínicas de los pacientes. Se utilizaron análisis de regresión logística univariados y multivariados para identificar factores predictivos para variables dependientes de mortalidad a 90 días y 1 año. Resultados: 229 pacientes fueron incluidos en este estudio. 133 (58,8%) de los pacientes eran hombres, 96 (41,9%) eran mujeres y la mediana de edad fue de 64 años. Mientras que 166 pacientes tenían enfermedad renal preexistente, 63 pacientes no tenían enfermedad renal previa. El número de pacientes que fallecieron dentro de los 90 días, que se refiere a la mortalidad a corto plazo, fue de 49 (21,4%). 73 pacientes (31,9%) fallecieron en un año (mortalidad a largo plazo). Al cabo de un año, el 38% de todo el grupo de pacientes continuaba recibiendo terapia de reemplazo renal, mientras que el 10% de todos los pacientes con ERC no requerían diálisis y solo el 9,17% de los pacientes presentaban recuperación renal. En el análisis multivariante establecido para la mortalidad a corto plazo, los siguientes parámetros mostraron características predictivas significativas: fracción de eyección (OR = 3,80, IC 95%: 1,05-13,72, p=0,042), PCR (OR = 0,20, IC 95%: 0,04 -0,92, p= 0,039), edad (OR = 0,21, IC 95%: 0,05-0,91, p= 0,038) y presión arterial diastólica (OR = 0,08, IC 95%: 0,02-0,28, p< 0,001). El análisis multivariado para la mortalidad a largo plazo indicó que la presión arterial sistólica (OR = 0,26, IC 95%: 0,08-0,82, p= 0,022), la presión arterial diastólica (OR = 0,21, IC 95%: 0,68-0,66, p= 0,008), y el potasio (OR = 0,27, IC 95%: 0,10-0,70, p= 0,007) fueron marcadores predictivos independientes. Conclusión: Los pacientes con ERC que aún no han iniciado tratamiento con hemodiálisis deben ser seguidos de cerca, ya que la hipervolemia, la hipotensión y la inestabilidad hemodinámica aumentan el riesgo de muerte, según nuestro estudio. Además, recomendamos que las condiciones clínicas como la inestabilidad hemodinámica o la sepsis, que pueden causar hipotensión en AKI-D, deben abordarse lo antes posible y optimizar cuidadosamente el balance de líquidos y electrolitos en aquellos pacientes que determinamos que están en riesgo.

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.

Research progress on the epidemiology of pneumonia / 预防医学

@#Pneumonia is a common lower respiratory tract infection, which causes a large disease and economic burden worldwide, and is an important public health problem to be solved urgently. Based on review of publications pertaining to the epidemiology of pneumonia from 2013 to 2023, this article summaries the epidemiological characteristics and main influencing factors of pneumonia. It is found that the epidemiological characteristics of pneumonia vary in different areas; men, the elderly and children are the high-risk groups of pneumonia incidence and mortality; and age, smoking, alcohol consumption, air pollution, comorbidity and vaccination are the main factors affecting the incidence and mortality of pneumonia. Strengthening health education, reducing exposure to risk factors and promoting vaccination are recommended to lower the morbidity and mortality of pneumonia in susceptible populations.

Factors influencing pulmonary infection in elderly neurocritical patients and their predictive values: a data analysis for consecutive four-year / 中华危重病急救医学

Objective:To analyze the factors influencing pulmonary infections in elderly neurocritical patients in the intensive care unit (ICU) and to explore the predictive value of risk factors for pulmonary infections.Methods:The clinical data of 713 elderly neurocritical patients [age ≥ 65 years, Glasgow coma score (GCS) ≤ 12 points] admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from 1 January 2016 to 31 December 2019 were retrospectively analyzed. According to whether or not they had HAP, the elderly neurocritical patients were divided into hospital-acquired pneumonia (HAP) group and non-HAP group. The differences in baseline data, medication and treatment, and outcome indicators between the two groups were compared. Logistic regression analysis was used to analyze the factors influencing the occurrence of pulmonary infection.The receiver operator characteristic curve (ROC curve) was plotted for risk factors and a predictive model was constructed to evaluate the predictive value for pulmonary infection.Results:A total of 341 patients were enrolled in the analysis, including 164 non-HAP patients and 177 HAP patients. The incidence of HAP was 51.91%. According to univariate analysis, compared with the non-HAP group, mechanical ventilation time, the length of ICU stay and total hospitalization in the HAP group were significantly longer [mechanical ventilation time (hours): 171.00 (95.00, 273.00) vs. 60.17 (24.50, 120.75), the length of ICU stay (hours): 263.50 (160.00, 409.00) vs. 114.00 (77.05, 187.50), total hospitalization (days): 29.00 (13.50, 39.50) vs. 27.00 (11.00, 29.50), all P < 0.01], the proportion of open airway, diabetes, proton pump inhibitor (PPI), sedative, blood transfusion, glucocorticoids, and GCS ≤ 8 points were significantly increased than those in HAP group [open airway: 95.5% vs. 71.3%, diabetes: 42.9% vs. 21.3%, PPI: 76.3% vs. 63.4%, sedative: 93.8% vs. 78.7%, blood transfusion: 57.1% vs. 29.9%, glucocorticoids: 19.2% vs. 4.3%, GCS ≤ 8 points: 83.6% vs. 57.9%, all P < 0.05], prealbumin (PA) and lymphocyte count (LYM) decreased significantly [PA (g/L): 125.28±47.46 vs. 158.57±54.12, LYM (×10 9/L): 0.79 (0.52, 1.23) vs. 1.05 (0.66, 1.57), both P < 0.01]. Logistic regression analysis showed that open airway, diabetes, blood transfusion, glucocorticoids and GCS ≤ 8 points were independent risk factors for pulmonary infection in elderly neurocritical patients [open airway: odds ratio ( OR) = 6.522, 95% confidence interval (95% CI) was 2.369-17.961; diabetes: OR = 3.917, 95% CI was 2.099-7.309; blood transfusion: OR = 2.730, 95% CI was 1.526-4.883; glucocorticoids: OR = 6.609, 95% CI was 2.273-19.215; GCS ≤ 8 points: OR = 4.191, 95% CI was 2.198-7.991, all P < 0.01], and LYM, PA were the protective factors for pulmonary infection in elderly neurocritical patients (LYM: OR = 0.508, 95% CI was 0.345-0.748; PA: OR = 0.988, 95% CI was 0.982-0.994, both P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting HAP using the above risk factors was 0.812 (95% CI was 0.767-0.857, P < 0.001), with a sensitivity of 72.3% and a specificity of 78.7%. Conclusions:Open airway, diabetes, glucocorticoids, blood transfusion, GCS ≤ 8 points are independent risk factors for pulmonary infection in elderly neurocritical patients. The prediction model constructed by the above mentioned risk factors has certain predictive value for the occurrence of pulmonary infection in elderly neurocritical patients.

Clinical analysis of different types of neonatal sepsis: a multi-center retrospective study / 中国新生儿科杂志

Objective:To study the clinical characteristics of different types of neonatal sepsis.Methods:From January 2012 to December 2019, neonates with confirmed sepsis from 5 neonatal centers of central-south China were reviewed. The neonates were assigned into early-onset sepsis (EOS) and late-onset sepsis (LOS) group, and the latter was further subgrouped into hospital-acquired LOS (hLOS) group and community-acquired LOS (cLOS) group. The etiological and clinical characteristics were analyzed. SPSS 26.0 was used for statistical analysis.Results:A total of 580 neonates were enrolled, including 286 (49.3%) in the EOS group and 294 (50.7%) in the LOS group. In LOS group, 147 were in hLOS group and 147 were in cLOS group. The gestational age and birth weight of hLOS group were significantly lower than the other two groups [(32.7±3.6) weeks vs. (37.1±3.7) weeks and (37.7±3.0) weeks, (1 810±717) g vs. (2 837±865) g and (3 024±710) g] ( P<0.05). The common pathogens in EOS and cLOS groups were coagulase-negative staphylococci and Escherichia coli, while Klebsiella pneumoniae was common in hLOS group. Carbapenems usage in the hLOS group was significantly higher than the other two groups [62.6% vs. 28.7% and 16.2%] ( P<0.05). Antibiotics duration in the hLOS group was longer than the other two groups [19 (14, 27) d vs. 15 (12, 20) d and 14 (12, 19) d] ( P<0.05). Conclusions:The clinical characteristics of neonatal sepsis vary among different types of infections, and it is necessary to establish appropriate prevention, control, diagnosis and treatment protocols.

The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

Bed bath protocol for infection reduction: a quasi-experimental study / Protocolo de higiene de pacientes en la cama para reducir infecciones: estudio cuasiexperimental / Protocolo de banho no leito para redução de infecções: estudo quase experimental

ABSTRACT Objective: To analyze the effect of implementing a bed bath protocol in relation to infection-free time and the prevalence of Healthcare-Associated Infections. Method: A quasi-experimental study with a comparison between two groups. In the Control Group, the data were retrospectively collected between January and April 2018. Implementation of the bed bath protocol in an Intensive Care Unit took place from May to October 2018. Data from the Intervention Group were collected from November 2018 to February 2019 through daily follow-up during the hospitalization period. Results: There were 157 participants in the Control Group and 169 in the Intervention Group, with a mean age of 56 and 54 years old, respectively, and majority of male individuals. The occurrence of Healthcare-Associated Infections was higher in the Control Group (n=32; 20.4%) compared to the Intervention Group (n=10; 5.9%), which presented a 2.86 times lower risk of developing Healthcare-Associated Infections (p<0.01). The Intervention Group presented a longer infection-free time when compared to the Control Group, which had a mean of 2.46 times higher risk of developing infections in the Intensive Care Unit (95%CI: 1.18; 5.11). Conclusion: The study provides support for standardizing the bed bath technique and to preventing health-care associated infections. There is a limitation in generalization of the results, as the groups come from a quasi-experimental before-after design with a non-equivalent Control Group due to the absence of random distribution in the compared groups.

RESUMEN Objetivo: analizar el efecto de implementar un protocolo de higiene de pacientes en la cama en relación con el tiempo sin infección y la prevalencia de Infecciones Relacionadas con la Atención de la Salud. Método: estudio cuasi experimental con comparación entre dos grupos. En el Grupo Control, los datos se recolectaron retrospectivamente entre enero y abril de 2018. La implementación del protocolo de higiene de pacientes en la cama de una Unidad de Cuidados Intensivos tuvo lugar entre mayo y octubre de 2018. Los datos del Grupo Intervención se recolectaron entre noviembre de 2018 y febrero de 2019 por medio del seguimiento diario durante el período de internación. Resultados: hubo 157 participantes en el Grupo Control y 169 en el Grupo Intervención, con una media de edad de 56 y 54 años, respectivamente, y la mayoría del sexo masculino. La incidencia de Infecciones Relacionadas a la Atención de la Salud fue mayor en el Grupo Control (n=32; 20,4%) que en el Grupo Intervención (n=10; 5,9%), y este último presentó 2,86 veces menos riesgo de desarrollar Infecciones Relacionadas a la Atención de la Salud (p<0,01). El Grupo Intervención presentó mayor tiempo sin infección en comparación con el Grupo Control, cuyos participantes tuvieron un promedio de 2,46 veces mayor riesgo de desarrollar infecciones en la Unidad de Cuidados Intensivos (IC95%: 1,18; 5,11). Conclusión: el estudio ofrece aportes para estandarizar la técnica de higiene de pacientes en la cama y prevenir infecciones relacionadas con la atención de la salud. Existe cierta limitación en cuanto a la generalización de los resultados, puesto que los grupos provienen de un diseño cuasiexperimental del tipo "antes-después" con un Grupo Control no equivalente, debido a la ausencia de distribución aleatoria en los grupos comparados.

RESUMO Objetivo: Analisar o efeito da implementação de um protocolo de banho no leito em relação ao tempo livre de infecção e à prevalência de Infecção Relacionada à Assistência à Saúde. Método: Estudo quase experimental, com comparação entre dois grupos. No grupo controle, os dados foram coletados retrospectivamente entre janeiro e abril de 2018. A implementação do protocolo de banho no leito em uma Unidade de Terapia Intensiva ocorreu de maio a outubro de 2018. Os dados do grupo intervenção foram coletados de novembro de 2018 a fevereiro de 2019, por meio do acompanhamento diário durante o período de internação. Resultados: 157 participantes no grupo controle e 169 no grupo intervenção, com média de idade de 56 e 54 anos, respectivamente, sendo a maioria do sexo masculino. A ocorrência de Infecção Relacionada à Assistência à Saúde foi maior no grupo controle (n=32; 20,4%) comparado ao grupo intervenção (n=10; 5,9%), este que apresentou 2,86 menor risco de desenvolver Infecção Relacionada à Assistência à Saúde (p<0,01). O grupo intervenção apresentou maior tempo livre de infecção comparado ao grupo controle, estes que tem, em média, 2,46 vezes maior risco de desenvolver infecção na Unidade de Terapia Intensiva (IC95% 1,18; 5,11). Conclusão: O estudo oferece subsídios para padronização da técnica do banho no leito e prevenção de infecções relacionadas à assistência à saúde. Há limitação na generalização dos resultados, pois os grupos são oriundos de um delineamento quase experimental antes-depois com grupo controle não equivalente, devido à ausência de distribuição aleatória nos grupos comparados.

Etiological profile, prescribing pattern of antibiotics and clinical outcomes of pneumonia patients in a tertiary care hospital in South India during 5-year period

Background: Pneumonia is one of the most important and serious lower respiratory tract infections, which requires implacable attention. This work aimed to document the causative organisms, antibiotics used, and outcome of pneumonia patients hospitalized in a tertiary care hospital. Materials and Methods: A retrospective study was conducted in the medical departments of a tertiary care teaching hospital for 5 years. Demographic details and clinical details including pertinent laboratory values of patients diagnosed with pneumonia were documented and analyzed using a specifically designed data collection form. Results: The study was conducted on 190 patients. The average age of the study population was 56.7 ± 22.6 years and there was a male preponderance of 111(58.4%) patients. Klebsiella pneumonia was found to be the most frequently isolated pathogen in 12.5% of the sputum culture, followed by Acinetobacter baumannii in 10.22% and Pseudomonas aeruginosa in 9.09%. The most commonly prescribed empirical antibiotics were beta-lactam antibiotics mostly in combination with macrolides for synergy irrespective of Pneumonia Severity Index (PSI) classes. Definitive therapy was classified based on World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification of antibiotics, watch category antibiotics were prescribed according to culture report and reserve antibiotics were prescribed only in those cases where watch category antibiotics were resistant. On analyzing PSI of community-acquired pneumonia (176 patients), most of the patients in the study belong to class 4: 61 patients (34.7%) and class 5: 44 patients (25%). For the high-risk patients (PSI class 4 and 5), mortality was approximately 3.8% (4 of 105) and for low-risk patients, there was zero mortality reported within 30 days. Conclusion: Gram-negative bacteria were the major pathogens causing Pneumonia in the study site contradictory to the data from developed countries. Identifications of pathogens and appropriate antibiotic therapy based on PSI score can bring down the duration of hospital stay and mortality of patients with pneumonia.

Infecciones asociadas al cuidado de salud en la unidad de quemados durante la pandemia SARS-CoV-2 / Healthcare-associated infections in the burn unit during the SARS-CoV-2 pandemic

Introducción: a partir de la pandemia por Covid19 se reportó variabilidad en la incidencia de las infecciones asociadas al cuidado de la salud (IACS). Con el objetivo de describir y comparar las tasas de IACS en la Unidad de Quemados de un hospital pediátrico de tercer nivel, antes y después del inicio de la pandemia se llevó a cabo este estudio. Material y métodos: estudio de cohorte, retrospectivo, descriptivo, de vigilancia epidemiológica. Se registraron todos los eventos de IACS en la Unidad de Quemados desde el 01/07/2018 hasta el 31/06/2021. Se compararon las tasas de las IACS entre el período I (PI) previo a la pandemia (07/2018-12/2019) y el período II (PII) posterior al inicio de la misma (01/2020- 06/2021). Resultados: se registraron 74 episodios de IACS, en un total de 8232 pacientes-día. Se registró una tasa global de IACS similar en ambos períodos, 10,08 ‰ pacientes-día (PI) vs 7,34 ‰ pacientes-día (PII), sin encontrarse diferencias estadísticamente significativas en las tasas de bacteriemia asociada a catéter venoso central (BSI-CVC) 3,32 ‰ días uso de CVC (PI) vs 3,20 ‰ (PII), neumonía asociada a ARM 1.43 ‰ días de uso de ARM (PI) vs un 2.02 ‰ (PII), ni infección urinaria asociada a sonda vesical (SV) 7,36 ‰ días de uso de SV (PI) vs 3,64 ‰ (PII). Conclusiones: no se observaron diferencias estadísticamente significativas en las tasas de IACS entre ambos períodos, lo cual podría justificarse con el estricto protocolo en control de infecciones implementado previo al inicio de la pandemia (AU)

Introduction: since the start of the Covid19 pandemic, variability in the incidence of healthcare-associated infections (HAIs) has been reported. This study was conducted to describe and compare the rates of HAIs in the burn unit of a tertiary pediatric hospital before and after the onset of the pandemic. Material and methods: a retrospective, descriptive, epidemiological surveillance cohort study was conducted. All HAI events in the burn unit from 01/07/2018 to 31/06/2021 were recorded. HAI rates between the pre-pandemic period I (PI) (07/2018- 12/2019) and post-pandemic period II (PII) (01/2020-06/2021) were compared. Results: 74 episodes of HAI were recorded in a total of 8232 patient-days. There was a similar overall rate of HAIs in both periods, 10.08 ‰ patient-days (PI) vs 7.34 ‰ patient-days (PII), with no statistically significant differences found in the rates of central venous catheter-related bloodstream infections (CVC-BSI) 3.32 ‰ days CVC use (PI) vs 3.20 ‰ (PII), ventilator-associated pneumonia 1. 43 ‰ days MV use (PI) vs a 2.02 ‰ (PII), or catheter-associated urinary tract infection 7.36 ‰ days catheter use (PI) vs 3.64 ‰ (PII). Conclusions: no statistically significant differences were observed in the rates of HAIs between both periods, which may be explained by the strict infection control protocol implemented prior to the onset of the pandemic (AU)

Clinical characteristics and factors associated with acute kidney injury among patients hospitalized with coronavirus disease: an observational retrospective study

ABSTRACT BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.

Implicações das infeções associadas aos cuidados de saúde na gestão em saúde: revisão

Resumo: Objetivo: Metodologia: Resultados: Conclusões:

Resumen: Objetivo: Metodología: Resultados: Conclusiones: Las IAAS tienen repercusiones directas e indirectas en la vida de los pacientes, ya que representan una amenaza para la seguridad y la calidad de la atención. Los programas de prevención y las medidas de control de la infección se consideran eficaces para reducir la tasa de incidencia de las IAAS y, en consecuencia, los costes.

Abstract: Objective: Method: Results: Conclusions:

Características clinicoepidemiológicas de pacientes con infecciones intrahospitalarias en un servicio de medicina interna de Santiago de Cuba / Clinical-epidemiological characteristics of patients with hospital acquired infections in a service of internal medicine from Santiago de Cuba

Introducción: La infección nosocomial o intrahospitalaria constituye un importante problema de salud en todos los hospitales del orbe. Objetivo: Describir las características clínicas y epidemiológicas de pacientes con infecciones intrahospitalarias. Métodos: Se realizó un estudio descriptivo y transversal de 57 pacientes con infecciones intrahospitalarias, ingresados en el Servicio de Medicina Interna del Hospital Provincial Docente Clínico-Quirúrgico Saturnino Lora de Santiago de Cuba, de octubre a diciembre de 2019, para lo cual se analizaron las variables edad, enfermedades asociadas, factores predisponentes, tipo de infección y gérmenes aislados. Resultados: En la serie sobresalieron el grupo etario de 60-69 años y la hipertensión arterial como enfermedad crónica concomitante (26,0 %). Entre los factores predisponentes resultó más frecuente el tabaquismo (32,8 %) y el tipo de infección preponderante fue la bronconeumonía bacteriana (47,0 %), cuyo germen causal en la mayoría de los casos (35,1 %) fue la Klebsiella pneumoniae. Conclusiones: Las infecciones intrahospitalarias aquejaron principalmente a pacientes de edad avanzada con enfermedades crónicas asociadas, como la diabetes mellitus y la hipertensión arterial. Cabe destacar la importancia de conocer la flora microbiana existente en el servicio donde se adquiere la infección, a fin de lograr tanto la prevención como el diagnóstico oportuno y el tratamiento adecuado.

Introduction: The cross or hospital infections constitute an important health problem in all the hospitals of the world. Objective: To describe the clinical and epidemiological characteristics of patients with hospital infections. Methods: A descriptive and cross-sectional study of 57 patients with hospital acquired infections was carried out. They were admitted to the Internal Medicine Service of Saturnino Lora Clinical-surgical Teaching Provincial Hospital of Santiago de Cuba, from October to December, 2019, for which the variables age, associated diseases, predisposing factors, type of infection and isolated germs were analyzed. Results: In the series the 60-69 years age group and hypertension as concomitant chronic disease (26.0 %) were notable. Among the predisposing factors nicotine addiction (32.8 %) was more frequent and the preponderant type of infection was the bacterial bronchopneumonia (47.0 %) whose causal germ in most of the cases (35.1 %) was the Klebsiella pneumoniae. Conclusions: The hospital acquired infections mainly afflicted patients of advanced age with associated chronic diseases, as diabetes mellitus and hypertension. It is necessary to highlight the importance of knowing the existent microbial flora in the service where the infection is acquired, in order to achieve boththe prevention, the opportune diagnosis and the appropriate treatment.

Microbiology and Drug Resistance Pattern in Clinically Significant Isolates of urine from Medical Wards of a Tertiary Care Hospital in North India.

Urinary tract infections (UTIs) are one of the most common bacterial infections encountered in clinical practice both in community and hospital settings in all age groups. It is the second most frequently occurring infection in general population after upper respiratory tract infection .Urinary tract infections (UTIs) are the leading cause of Gram negative sepsis in hospitalized patients and are the origin for about half of all hospital acquired infections caused by urinary catheters and are associated with considerable cost in terms of morbidity and economic and research expenditure. Material And Methods: This prospective cross sectional study was carried out in the Department of Microbiology of Government Medical College, Srinagar. A total of 800 patients were taken up for the study. The sample falling under the set inclusion criteria were selected from the urine specimen received in the laboratory for urine culture and sensitivity from Hospitalized patients (IPD). Culture and sensitivity reports and patient data obtained from hospital records was analyzed for this study. Out of 800 samples taken up for the study 208 (26%) were culture positive and 592Results: (74%) were negative. 208 positive samples 125(60.10%) were females and 83(39.90%) were males. female predominance was observed with 71% whereas 29% males were affected by UTI. UTI was predominantly in females of age group (21-40 yrs). most common organism isolated on culture was Escherichia coli(43.26%) both in short stay patients (<48hrs hospital stay) /OPD 22.59% as well as in IPD (>48hrs hospital stay) 20.67%.E.coli was isolated from patients of both uncomplicated and complicated UTI. The second most common organism isolated in our study was Enterococcus faecalis(22.59%), the rate of isolation was much higher 18.75% in inpatients (>48hrs hospital stay) and only 3.84% in OPD/short stay patients (<48hrs hospital stay). In our study Enterococcus spp ranked second amongst uropathogens, in IPD patients isolation rate was almost 5 times higher. Pseudomonas spp was 1 isolate in OPD (0.48%) and 6 (2.88%) in IPD, Acinetobacter 3 (1.44%), Proteus 1 (0.48%) found only in hospitalized patients (stay >48hrs). E.coli showed following sensitivity pattern 96.7% to nitrofurantoin, 93.3% to imipenem, 90.0% to amikacin, 75.6% to gentamycin, 73.3% to cefoperazone-salbactam and meropenem both, 68.9% to pipercillin tazobactam.The sensitivity to TMP-SMX was 45.6%, and to ceftriaxone and cefipime was only 22.2% and 21.1% respectively. The organism also showed resistance to drugs like levofloxacin 82.2% and ciprofloxacin 76.7%.Enterococcus faecalis isolated in our study was sensitive to Vancomycin 95.74% followed by Linezolid (93.6%), Nitrofurantoin (78.7%), HL-Amikacin (74.5%),HL- Gentamycin (70.2%). Enterococcus faecalis showed resistance to drugs commonly used to treat UTI i.e. 91.5% resistant to Ciprofloxacin and 89.4% resistant to Levofloxacin. Gram negative bacteria were most predominantConclusion: microorganisms resulting in more than 50% infections causing urinary tract infection. In our study we have seen that Gram positive cocci especially Enterococcus result in UTI in a significant proportion of patients. In our study Enterococcus spp ranked second amongst uropathogens, in IPD patients isolation rate was almost 5 times higher. The implementation of antibiotic stewardship programs is crucial to minimize resistance. Appropriate antibiotics need to be prescribed based on the antibiotic susceptibility testing which will be narrow spectrum, effective and less expensive with least side effects.

Analysis of risk factors of hospital-acquired pneumonia after craniocerebral trauma / 中国医师进修杂志

Objective:To analyze the risk factors of hospital-acquired pneumonia (HAP) after craniocerebral trauma.Methods:A total of 329 patients undergoing craniocerebral trauma surgery from December 2014 to December 2019 in Yicheng People′s Hospital of Zaozhuang City were enrolled. The data were reviewed and divided into HAP group (42 patients) and non-HAP group (287 patients) according to whether HAP occurred after surgery. The age, onset to operation time, surgery duration, and hospital stay between the two groups were compared. The differences of preoperative factors, intraoperative factors and postoperative factors between the two groups were compared. The risk factors of HAP after craniocerebral trauma were analyzed by Logistic multi-factor regression analysis.Results:The age, onset to operation time, surgery duration, hospital stay in HAP group were longer than those in the non-HAP group: (55.09 ± 8.14) years vs. (45.98 ± 8.06) years, (9.65 ± 0.54) h vs. (7.43 ± 0.72) h, (332.54 ± 72.65 )min vs. (281.09 ± 78.54) min, (17.13 ± 2.56) d vs. (5.02 ± 3.09), the differences were statistically significant ( P<0.05). The differences in the types of brain diseases between the two groups were statistically significant ( P<0.05). The results of single factor analysis showed that the history of pulmonary disease, scores of Glasgow Coma Scale (GCS) < 8 points and ≥8 points, whether or not emergency operation, preoperatie antibiotics, reintubated, endotracheal intubation, indwelling gastric tube, and raise the head of a bed 30° to 45°, proton pump inhibitors, craniocerebral trauma and non traumatic diseases, mechanical ventilation, floor nutrition start time, giving glucocorticoid between the HAP group and non-HAP group had significant difference ( P<0.05). The Logistic multi-factor regression analysis showed that the age >50 years old, surgery duration >4 h, preoperative GCS<8 points, emergency surgery, tracheotomy and indwelling gastric tube were independent risk factors of HAP after surgery ( P<0.05). Conclusions:For patients undergoing surgical treatment of craniocerebral trauma, it is necessary to estimate the risk of postoperative HAP based on age, preoperative GCS score, elective surgery after emergency, operation time, and control risk factors.

Differential gene expression and bioinformatics analysis in sepsis secondary to pneumonia / 中华危重病急救医学

Objective:To analyze and screen the key genes of sepsis secondary to pulmonary infection by bioinformatics, and to provide theoretical basis for the basic research of the disease and find an ideal animal model program.Methods:Experiment 1 (bioinformatics analysis): gene expression data sets of pulmonary infection secondary sepsis patients and multiple sepsis animal models were screened by Gene Expression Omnibus (GEO) Database, and gene differences were analyzed by R software. Differential genes were analyzed by gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Correlation analysis was conducted between differential genes and clinical symptoms in the data set of pulmonary infection secondary sepsis, and the correlation heat map between differential genes and clinical symptoms was drawn. Key genes were screened by weighted gene co-expression network analysis (WGCNA) and protein-protein interaction network analysis (PPIN) clustering. Experiment 2 (sepsis animal model preparation): male mice weighing 21-25 g were randomly divided into the key genes group and the control (Sham) group. And cecal ligation and puncture (CLP) was used to establish mouse sepsis model, while the mice in sham group were performed by exposure of cecum. And all the mice were scarified 24 hours after surgery to extract the total RNA from lung tissue, real time fluorescent quantitative polymerase chain reaction (RT-qPCR) was used to detect mRNA expression of key genes.Results:Experiment 1 (bioinformatics analysis): 319 differential genes were showed by GSE 134364 and GSE 65682 data set analysis of pulmonary infection secondary sepsis. And there was no genetic difference between community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP) in patients with pulmonary infection secondary to sepsis. Obvious differences existed between differential genes in animal models, and there was no common differential gene. Differential genes in patients and animal models were similarly enriched in GO function, mainly in cell differentiation, regulation of cell process, and regulation of cellular response to stimuli, there were significant differences in pathway enrichment, among which, CLP animal models showed higher consistency with patients. The key genes obtained by WGCNA and PPIN analysis were MAPK14, NLRC4 and LCN2. Experiment 2 (sepsis animal model preparation): animal experiment results showed that the mRNA expressions of MAPK14, NLRC4 and LCN2 in lung tissue of CLP model mice were significantly up-regulated compared with the sham group.Conclusions:MAPK14, NLRC4 and LCN2 are key genes involved in the regulation of biological processes of pulmonary sepsis secondary to infection, and are potential research directions of this disease. What's more, CLP animal model can better reflect the biological characteristics of patients with pulmonary infection secondary sepsis, and is one of the ideal animal model schemes for pulmonary infection secondary sepsis.

Risk factors for acquisition of ESBL-producing Escherichia coli and Klebsiella pneumoniae on non-ventilator-associated hospital-acquired pneumonia in a tertiary care hospital in Indonesia

Aims@#This study was aimed to identify the risk factors for the acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae on non-ventilator hospital-acquired pneumonia (NV-HAP) patients in a tertiary care hospital in Indonesia.@*Methodology and results@#A case-control study was performed between March 31, 2018, and August 31, 2019. Twenty-eight ESBL-producing E. coli and K. pneumoniae isolates and 28 susceptible strains of E. coli and K. pneumoniae obtained from NV-HAP patients were included in this study. Phenotypic screening for ESBL production was performed by the Vitek2 system and subsequently confirmed by double-disk synergy tests. The use of 3rd generation cephalosporin as initial antibiotic therapy for more than three days was the significant risk factor for the acquisition of ESBL-producing E. coli and K. pneumoniae among NV-HAP patients (odds ratio [OR] 41.827; p=0.001). The length of stay of patients with NV-HAP acquiring the ESBL strains was longer than 10 days (OR 17.334; p=0.001).@*Conclusion, significance and impact of study@#The use of 3rd generation cephalosporin as the initial antibiotic for NV-HAP should be restricted to prevent the emergence of ESBL-producing strains. Infection prevention measures are required to control the acquisition of ESBL-producing E. coli and K. pneumoniae in NV-HAP patients.