RESUMO
Background: For general intensive care unit (ICU) patients, ICU discharge delay (ICUDD) has been associated with an increased hospital length of stay (LOS) and the acquisition of multi-resistant organism (MRO) infections. The impact of ICUDD on liver transplant (LT) recipients is unknown. Methods: We retrospectively studied consecutive adult LT between 2011 and 2019. ICUDD was defined as >8 h between a patient being cleared for discharge to ward and the patient leaving the ICU. Results: 550 patients received LT and the majority (68.5%) experienced ICUDD. The median time between clearance for ward and the patient leaving the ICU was 25.6 h. No donor or recipient variables were associated with ICUDD. Patients cleared for discharge early in the week (Sunday-Tuesday) and those discharged outside routine work hours were more likely to experience ICUDD (p = 0.001 and p < 0.001, respectively). The median hospital LOS was identical (18 days, p = 0.96) and there were no differences in other patient outcomes. Patients who became colonized with MRO in the ICU spent a longer time there compared to those who remained MRO-free (9 vs. 6 days, p < 0.001); however, this was not due to ICUDD. Conclusion: ICUDD post-LT is common and does not prolong hospital LOS. ICUDD is not associated with adverse patient outcomes or MRO colonization.
RESUMO
Abstract Background: Multidrug-resistant bacteria present in food of animal origin raise human and animal health concerns. Objective: To assess antimicrobial resistance of Escherichia coli isolates from sheep carcasses subjected to spray-chilling with water (4 and 10 hours) during cooling. Methods: Thirty surface swabs were collected from carcasses before and after the last water spray in two slaughter periods. In a first assessment (1st sampling), three spray-chilled carcasses (4 hours), three non-sprayed and one control carcass were sampled. In a second assessment (2nd sampling), the same number of carcasses and treatments were maintained, but spray-chilling was extended to 10 hours. All samples collected were isolated and submitted to susceptibility test using 16 (1st sampling) and 17 (2nd sampling) antimicrobials, respectively. Results: Overall, E. coli isolates were resistant most antimicrobials. Spray-chilled and control carcasses (10 hours) showed resistance to meropenem. Conclusion: E. coli isolates from carcasses subjected to spray-chilling with water for 10 hours had higher antimicrobial resistance to one, two, and four antimicrobial classes, characterizing a multidrug resistance profile. These results highlight the need to monitor health status throughout the meat production processes.
Resumen Antecedentes: las bacterias multirresistentes presentes en alimentos de origen animal son motivo de alerta para la salud humana y animal. Objetivo: verificar la resistencia a antimicrobianos de aislados de Escherichia coli en canales ovinas sometidas a aspersión (4 y 10 h) durante la refrigeración. Métodos: Luego de dos faenas de sacrificio, treinta hisopos fueron colectados en la superficie de las canales antes y después de la última aspersión. En un primer sacrificio (1era colecta) se recolectaron muestras de tres canales sometidas a aspersión (4 horas), tres sin aspersión y una canal como control. En un segundo sacrificio (2da colecta), el mismo número de canales y tratamientos se mantuvo, y el período de aspersión se extendió a 10 horas. Las muestras recogidas fueron aisladas y sometidas a la prueba de susceptibilidad utilizándo 16 (1.ª colecta) y 17 (2.ª colecta) antimicrobianos, respectivamente. Resultados: los aislamientos de E. coli fueron, en general, resistentes a las principales clases de antimicrobianos. Las canales con aspersión y el control (10 h) presentaron resistencia al meropenem. Conclusión: cuando la asperción duró 10 h, los aislados de E. coli presentaron mayor resistencia para una, dos y cuatro clases de antimicrobianos, es decir, fueron multirresistentes a los fármacos utilizados. Esto resalta la necesidad de monitorear el estado de salud durante todos los procesos de producción de carne.
Resumo Antecedentes: bactérias multirresistentes presentes em alimentos de origem animal são motivo de preocupação e alerta na saúde humana e animal. Objetivo: verificar a resistência antimicrobiana em isolados de Escherichia coli de carcaças de ovinos pulverizadas ou não (4 e 10 horas) durante a refrigeração. Métodos: foram coletados trinta swabs de superfície em carcaças antes e após a última aspersão em dois abates. Em outubro do 2015, três carcaças aspergidas foram amostradas, três sem aspersão e uma carcaça para controle, por um período de 4 horas. Em julho de 2016 (2ª coleta), o mesmo número de carcaças e tratamentos foram mantidos e o período de aspersão foi prolongado em 10 horas. As amostras coletadas foram isoladas e submetidas ao teste de susceptibilidade em 16 (1ª coleta) e 17 (2ª coleta) antimicrobianos, respectivamente. Resultados: isolados de E. coli foram, em geral, resistentes às principais classes de antimicrobianos. As carcaças e o controle aspergidos (10 h) apresentaram resistência ao meropenem. Conclusão: quando a aspersão de água durou 10 horas, os isolados de E. coli apresentaram maior resistência antimicrobiana a uma, duas e quatro classes de antimicrobianos, o que é uma multirresistência aos fármacos testados. Isso alerta para a necessidade de monitorar os aspectos de saúde durante todos os processos de produção de carne.
RESUMO
BACKGROUND: Acinetobacter bacteremia is an emerging nosocomial infection. We tried to find significant risk factors associated with the prognosis of patients with Acinetobacter bacteremia. METHODS: Retrospective case-control study was designed. The odds ratio estimation and multiple logistic regression for the categorical variables and Mann-Whitney test for the continuous variables were done. RESULTS: From September 1, 1999 to December 31, 2000 there were 25 adult patients with Acinetobacter bacteremia in Ajou University Hospital and 24 patients were confirmed as hospital acquired. The median age and hospital length of stay before bacteremia was 52 years old and 9.5 days respectively. There were 16 male patients. The overall mortality was 45.8 % (11 of 24). Thus there were 11 cases (death) and 13 controls (survival) of mortality. Statistical analysis revealed statistically significant differences between cases and controls in the terms of types of wards, central venous catheter, mechanical ventilation, total parenteral nutrition, and multi-resistant organisms. The multiple logistic regression analysis revealed that the more significant independent factors associated with mortality were mechanical ventilation and multi-resistant organisms. CONCLUSION: Acinetobacter bacteremia is a significant nosocomial infection. Especially mechanical ventilation and multi-resistant organisms were independent risk factors associated with high mortality with Acinetobacter bacteremia.
