RESUMEN
Device-associated infections are common in Neonatal Intensive Care Units (NICUs) in accordance with the frequent use of invasive devices, and they must be continuously and closely monitored for infection control. Six hundred newborn infants hospitalized longer than 72 hours in Ege University Children's Hospital NICU between January 2008 and December 2010 were prospectively followed for occurrence of device-associated infections (central venous catheter- and umbilical catheter-associated blood stream infections [CVC/UC BSI] and ventilator-associated pneumonia [VAP]). In a total of 10,052 patient days, the VAP rate was 13.76/1000 ventilator days with a ventilator utilization ratio of 0.29, and the CVC/UC BSI rate was 3.8/1000 catheter days with a catheter utilization ratio of 0.24. The CVC/UC BSI rate was lower than national averages, being close to rates reported from developed countries. The VAP rate was higher than the national and international rates and was associated with prolonged mechanical ventilation and very low birth weight. VAP also appeared to be an important risk factor for mortality. The most frequent agents were gram-negative pathogens for VAP and coagulase-negative staphylococci for CVC/UC BSIs, with resistance patterns similar to the previous years. In conclusion, with device utilization rates similar to those in developed countries, our CVC/UC BSI rate was comparable, but the VAP rate was higher than that of the developed countries. Necessary precautions are urgently needed to decrease VAP rates and VAP-related mortality.
Asunto(s)
Infecciones Relacionadas con Catéteres/epidemiología , Infección Hospitalaria/epidemiología , Neumonía Asociada al Ventilador/epidemiología , Bacteriemia/epidemiología , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/microbiología , Infección Hospitalaria/microbiología , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Neumonía Asociada al Ventilador/microbiología , Estudios Prospectivos , Turquía/epidemiologíaRESUMEN
We presented a sepsis outbreak caused by Serratia marcescens from contaminated propofol to raise awareness. Three patients had sepsis syndrome after chest surgery. Isolation of S marcescens from patients' respiratory and blood samples alerted us to a possible outbreak. Four syringes filled with propofol and 1 saline solution yielded S marcescens. Nine of 10 isolates from samples of patients and environment genotyped by pulsed-field gel electrophoresis were the same. Disobeying aseptic injection rules of propofol is still causing outbreaks.
Asunto(s)
Propofol/efectos adversos , Sepsis/epidemiología , Sepsis/etiología , Infecciones por Serratia/epidemiología , Infecciones por Serratia/etiología , Serratia marcescens/patogenicidad , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Contaminación de Medicamentos , Electroforesis en Gel de Campo Pulsado/métodos , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana/métodos , Persona de Mediana Edad , JeringasRESUMEN
Recently, an extended-spectrum beta-lactamase (PER-1) was found to be disseminated among Acinetobacter spp. and Pseudomonasaeruginosa isolates in Turkey. A population-based cohort study was conducted to elucidate predictive mortality factors in patients with nosocomial infections caused by Acinetobacter spp. and P. aeruginosa, with particular reference to PER-1-type extended-spectrum beta-lactamase (ESBL) production. The study group comprised 16 and 21 non-survivors and 82 and 126 survivors in cohorts infected with Acinetobacter and P. aeruginosa, respectively. In the Acinetobacter-infected cohort, nosocomial pneumonia, hypotension and infection with a PER-positive isolate were independent predictors of mortality. In the P. aeruginosa-infected cohort, impaired consciousness, a PER-positive isolate, male sex and (with a negative relative risk) urinary tract infection were independent predictors of death. This study demonstrated the relationship of PER-1-type ESBL-producing Acinetobacter spp. and P. aeruginosa with poor clinical outcome.
Asunto(s)
Infecciones por Acinetobacter/mortalidad , Acinetobacter/enzimología , Infección Hospitalaria/mortalidad , Infecciones por Pseudomonas/mortalidad , Pseudomonas aeruginosa/enzimología , beta-Lactamasas/genética , Infecciones por Acinetobacter/genética , Infecciones por Acinetobacter/microbiología , Adulto , Estudios de Cohortes , Infección Hospitalaria/microbiología , Femenino , Humanos , Masculino , Análisis Multivariante , Evaluación de Resultado en la Atención de Salud , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/mortalidad , Estudios Prospectivos , Infecciones por Pseudomonas/genética , Infecciones por Pseudomonas/microbiología , Factores de Riesgo , Factores Sexuales , Turquía/epidemiología , Infecciones Urinarias/microbiología , beta-Lactamasas/biosíntesisAsunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos , Infección Hospitalaria , Infecciones por Enterobacteriaceae , Recto/microbiología , Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , Enterobacteriaceae Resistentes a los Carbapenémicos/patogenicidad , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Hospitalización/estadística & datos numéricos , HumanosRESUMEN
OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of life-threatening human infections. The clinical impact of MRSA is mounting, not only due to the ever-increasing prevalence but also due to the occurrence of new, community-acquired MRSA strains. The aim of this prospective, multi-centre study was to determine the prevalence and genetic relatedness of clinically relevant MRSA isolates, in Turkey. METHODS: During a 1-year period, data from 20 successive patients with invasive S. aureus infections were collected from eight university hospitals, geographically distributed over the six main regions of Turkey. Among these S. aureus isolates, the genetic association of MRSA isolates was investigated by pulsed-field gel electrophoresis (PFGE) and spa typing. A selected number of isolates were also analyzed by multilocus sequence typing (MLST). Furthermore, Panton Valentine leucocidin (PVL) genes were examined. RESULTS: In this study, the rate of methicillin resistance in S. aureus in patients with apparent infections (sepsis, meningitis, lung abscess or septic arthritis) ranged from 12 to 75% within the seven participating centres. Typing by pulsed-field gel electrophoresis and spa typing revealed the presence of 22 closely related genotypes. According to the PFGE and spa typing results, 53 out of 54 MRSA isolates were closely related. These isolates were of spa type t030 or a related spa type, contain an SCC mec type III element and belong to sequence type ST239. None of the isolates contained the PVL genes. CONCLUSIONS: Despite the broad surface area of Turkey, a single predominant clone of ST239 circulates in hospitals in different regions and only few new types of MRSA were introduced over the past years. These results place Turkey in the epicenter of ST239 prevalence.