ABSTRACT
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) cause surgical site infections (SSIs) in intensive care units (ICUs). This study aimed to evaluate the impact of intervention and control measures to reduce CRE colonization and infection rates among patients in the ICU of a cardiac surgery hospital following a CRE outbreak. METHODS: An observational study of the pre- and postintervention status of a cohort of colonized or infected patients in the postoperative adult cardiac surgery ICU was performed between April 2013 and December 2014. As well as the usual measures of screening and cohort nursing, the control measures were enhanced during the intervention period by providing alcohol gel at the bedside, daily bathing with no-rinse 2% chlorhexidine-impregnated wash cloths, and disinfection of surfaces around the patient three times per day. RESULTS: The rates of CRE colonization (P<0.001), primary central-line-associated bloodstream infections (P<0.002) and SSIs (P< 0.003) decreased significantly during the postintervention period. CONCLUSION: The implemented measures were effective in controlling colonization and infection with CRE in the cardiac surgery ICU.
Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Enterobacteriaceae Infections/prevention & control , Enterobacteriaceae/isolation & purification , Infection Control/methods , Surgical Wound Infection/prevention & control , beta-Lactam Resistance , Adult , Disease Outbreaks , Enterobacteriaceae/enzymology , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae Infections/microbiology , Humans , Intensive Care Units , Surgical Wound Infection/epidemiology , Surgical Wound Infection/microbiology , Thoracic SurgeryABSTRACT
Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE), including polymyxin-resistant (PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life-threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE, including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE (PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carried blaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received at least one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higher in patients infected with PR-CRE (17% vs. 53%; P=0.06). In conclusion, mediastinitis due to CRE, including PR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a high mortality, particularly those infected with PR-CRE.
Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae/drug effects , Mediastinitis/epidemiology , Surgical Wound Infection/epidemiology , beta-Lactam Resistance , Aged , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/mortality , Female , Humans , Male , Mediastinitis/microbiology , Mediastinitis/mortality , Middle Aged , Polymyxins/pharmacology , Retrospective Studies , Surgical Wound Infection/microbiology , Surgical Wound Infection/mortality , Survival Analysis , Thoracic SurgeryABSTRACT
We reported a case of septicemia by Vibrio cholerae O1, in São Paulo, Brazil. A 70-year-old male patient, living in an urban area, entered the emergency service having sepsis, dying 12 hours later. Blood culture was positive for Vibrio cholerae O1. This is the first case of bacteremia by Vibrio cholerae O1 reported in South America.
Subject(s)
Bacteremia/microbiology , Vibrio Infections/microbiology , Vibrio cholerae O1/isolation & purification , Aged , Humans , Male , Polymerase Chain Reaction , Vibrio Infections/diagnosis , Vibrio cholerae O1/geneticsABSTRACT
We reported a case of septicemia by Vibrio cholerae O1, in São Paulo, Brazil. A 70-year-old male patient, living in an urban area, entered the emergency service having sepsis, dying 12 hours later. Blood culture was positive for Vibrio cholerae O1. This is the first case of bacteremia by Vibrio cholerae O1 reported in South America.
