Impact of Multidrug-Resistant Organisms on Severe Acquired Brain Injury Rehabilitation: An Observational Study.

Healthcare-associated infections (HAIa) and antimicrobial resistance are expected to be the next threat to human health and are most frequent in people with severe acquired brain injury (SABI), who can be more easily colonized by multidrug-resistant organisms (MDROs). The study's aim is to investigate the impact of MDRO colonizations and infections on SABI rehabilitation outcomes. This retrospective observational study was performed in a tertiary referral specialized rehabilitation hospital. The main outcomes were the presence of carbapenemase-producing Enterobacteriaceae (CPE) colonization, type and timing of HAI and MDRO HAI, and the number of CPE transmissions. We included 48 patients, 31% carrying CPE on admission and 33% colonized during the hospitalization. A total of 101 HAI were identified in 40 patients, with an overall incidence of 10.5/1000 patient days. Some 37% of patients had at least one MDRO infection, with a MDRO infection incidence of 2.8/1000 patient days. The number of HAIs was significantly correlated with the length of stay (LOS) (r = 0.453, p = 0.001). A significant correlation was found between colonization and type of hospital room (p = 0.013). Complications and HAI significantly affected LOS. We suggest that CPE carriers might be at risk of HAI and worse outcomes compared with non-CPE carriers.

Health-Care-Associated Infections Management, sow the seed of good habits: a grounded theory study.

BACKGROUND AND AIM OF THE WORK: The reasons that condition and motivate adherence to good practices have a multifactorial nature. From the literature review, emerged different elements that interact within the operating context and represent a part of the variables that condition the "Best Practice". The aim of this research was to investigate the variables that influence adherence to operators' good practices. METHODS: A qualitative study with Grounded Theory (GT) methodology was carried out, which leads to the establishment of a theory about basic social processes. This theory is based on the observation and perception of the social scene and evolves during data collection. Data collection took place through interviews with the participants, through an ad hoc semi-structured interview grid. The initial sampling consisted of 12 health workers, while the theoretical sample was made up of 6 health workers. RESULTS: The analysis organization through the creation of schemes and diagrams has allowed to formulate different concepts including: false beliefs, knowledge and emotions experienced, that connect with the initial condition of Unconsciousness unaware; awareness of the consequences, team, welcome the new, which are connected to the intermediate phase of Revolution of the professional oneself; awareness of the limits, culture, responsibility, context, rigor and control that connects to the final state of Attentive Habit. CONCLUSIONS: The theoretical model develops through a path of growth and revolution that starts from the roots of an Unconsciousness unaware and brings with it the seed of a model.

Septic shock due to NSTI caused by Actinomyces Turicensis: the role of clinical pharmacology. Case report and review of the literature.

Critical septic patients affected by necrotizing soft tissue infections (NSTI) require an early, aggressive and multidisciplinary treatment. Pharmacokinetic alterations in antibiotic therapy are peculiar in these infections. Clinical pharmacology represents a first step in this setting. We report a case of septic shock due to NSTI in which clinical pharmacology is taken into account.