ABSTRACT
PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.
Subject(s)
Catheter-Related Infections/epidemiology , Cross Infection/epidemiology , Infection Control/methods , Urinary Tract Infections/epidemiology , Americas/epidemiology , Asia/epidemiology , Catheter-Related Infections/prevention & control , Cross Infection/prevention & control , Developing Countries/statistics & numerical data , Europe/epidemiology , Female , Hand Hygiene/statistics & numerical data , Humans , Male , Middle Aged , Morocco/epidemiology , Program Evaluation , Prospective Studies , Urinary Catheters/statistics & numerical data , Urinary Tract Infections/prevention & controlSubject(s)
Antineoplastic Agents, Hormonal/pharmacology , Apoptosis/drug effects , Dexamethasone/pharmacology , Glucocorticoids/pharmacology , Growth Inhibitors/pharmacology , Interleukin-6/antagonists & inhibitors , Interleukin-6/pharmacology , Multiple Myeloma/drug therapy , Drug Synergism , Humans , Interleukin-6/analogs & derivatives , Tumor Cells, CulturedABSTRACT
Bisphosphonates (BPs) are commonly used in the treatment of myeloma-associated osteolytic lesions. Recent reports have suggested that BPs may also exert direct antitumor effects on myeloma cells. Here, we show that the treatment of myeloma cell lines with the combination of the potent BP zoledronate and dexamethasone inhibits cell growth and synergistically induces apoptotic cell death, providing a rationale for potential applications in vivo.
