Acinetobacter baumannii infection in prior ICU bed occupants is an independent risk factor for subsequent cases of ventilator-associated pneumonia.

OBJECTIVE: We aimed to evaluate risk factors for ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii (AbVAP) in critically ill patients. METHODS: This was a prospective observational study conducted in an intensive care unit (ICU) of a district hospital (6 beds). Consecutive patients were eligible for enrolment if they required mechanical ventilation for >48 hours and hospitalization for >72 hours. Clinical, microbiological, and laboratory parameters were assessed as risk factors for AbVAP by univariate and multivariate analysis. RESULTS: 193 patients were included in the study. Overall, VAP incidence was 23.8% and AbVAP, 11.4%. Previous hospitalization of another patient with Acinetobacter baumannii infection was the only independent risk factor for AbVAP (OR (95% CI) 12.016 (2.282-19.521) P < 0.001). ICU stay (25 ± 17 versus 12 ± 9 P < 0.001), the incidence of other infections (OR (95% CI) 9.485 (1.640-10.466) P = 0.002) (urinary tract infection, catheter related infection, and bacteremia), or sepsis (OR (95% CI) 10.400 (3.749-10.466) P < 0.001) were significantly increased in patients with AbVAP compared to patients without VAP; no difference was found with respect to ICU mortality. CONCLUSION: ICU admission or the hospitalization of patients infected by Acinetobacter baumannii increases the risk of AbVAP by subsequent patients.

Diabetes and hemoglobin a1c as risk factors for nosocomial infections in critically ill patients.

UNLABELLED: Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients. Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012. INCLUSION CRITERIA: ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU. Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91-20.17; P = 0.002) and blood transfusion 3.33 (1.23-9.02; P = 0.018) were independent risk factors for VAP. BSI in ICU (P = 0.044) and ICU mortality (P = 0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14-5.29; P = 0.022) and stroke on admission2.77 (1.12-6.88; P = 0.029). Sepsis 3.34 (1.47-7.58; P = 0.004) and parenteral feeding 6.29 (1.59-24.83; P = 0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU. Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.

A gastroenteritis outbreak due to Norovirus infection in Xanthi, Northern Greece: management and public health consequences.

A gastroenteritis outbreak was observed in the town of Xanthi on Jan 28, 2005. A total of 709 patients (350 males and 359 females, mean age 23.8 +/- 19.95 years) visited the local hospital over a period of two weeks with symptoms of fever (22.3%), abdominal pain (78.6%), nausea (85.5%), vomiting (67.1%) and diarrhea (72.5%). PCR for Norovirus in randomly selected stool specimens examined was positive in all cases (8/8). No other pathogen was revealed. As 85.1% of the primary affected individuals had been using water from a single well (supplying approximately 40% of the 34,889 inhabitants), and water specimens from this well were found to carry a high bacterial load, the waterborne transmission of Norovirus was the main suspected cause of the outbreak. People were advised to consume bottled water and to wash their hands carefully especially after toilet use until the remission of the outbreak. Additionally, more chloride was added to the suspected well (10 ppm or 10 mg/l). Fourteen days later, the outbreak waned and all measures were withdrawn.