Epidemiology and clinical outcome of Healthcare-Associated Infections: a 4-year experience of an Italian ICU.

BACKGROUND: Due to their impact on the outcome, hospital-acquired infections (HAIs) in ICUs represent a critical issue of patients' assistance. This study describes microbiological and clinical findings of a surveillance program covering 4 years in an Italian ICU. METHODS: Patients staying for >48 hours were prospectively followed until discharge or death. For each patient, infections after admissions, duration of device exposure and causal pathogens were noted. A multivariable logistic regression analysis concerning ICU mortality was made. RESULTS: Incidence density rates were 23.14 VAPs, 6.6 CLABSIs and 5.45 CAUTIs (per 1000 device-days) with an increase in yearly rates during the study period (P<0.001). Use of invasive devices was significantly longer among infected patients (P<0.001, for each), whose proportion was higher among medical admissions (P=0.009). The most frequent source of infection was the lung (78%), followed by bloodstream (23%). MSSA was the most frequently isolated pathogen (26%) but Gram-negatives were found in 86.1% of infected patients, with a high degree of resistance to carbapenems (27.5% for Klebsiella pneumoniae). APACHE score, immunosuppression, duration of mechanical ventilation, surgical admission and abdominal infections were independent predictors of ICU mortality (P<0.001; P<0.001; P=0.006; P=0.027; P=0.006, respectively). CONCLUSION: Our infection rates are higher than those reported by other studies. The use of devices and a medical admission share a significant relationship with infection presence. A greater degree of organ failure and the development of an abdominal sepsis are risk factors for mortality.

Nutritional assessment in head injured patients through the study of rapid turnover visceral proteins.

BACKGROUND & AIMS: Nutritional monitoring of rapid turnover visceral protein is important in the recognition of malnutrition in patients admitted to the Intensive Care Unit (ICU). We studied prealbumin and retinol-binding protein in patients who received three different kinds of artificial nutrition in order to evaluate the appropriateness of artificial nutrition. METHODS: 45 consecutive head injury patients received enteral (Group A), parenteral (Group B) or both enteral and parenteral nutrition (Group C) at random. We considered these parameters: prealbumin, retinol binding protein and nitrogen balance before (T1), after 3 (T2), 7 (T3) and 11 (T4) days after the beginning of study. Statistical analysis was performed with Kruskal-Wallis test and Bonferroni's t -test. RESULTS: Plasma prealbumin and Retinol binding protein (RBP) showed an increasing of basal values during the study period in all groups (<< 0.0001) and more significantly in group A (Enteral nutrition P < 0. 001 vs Total parenteral nutrition (TPN) and Enteral P<< 0.01 vs Enteral and parenteral nutrition). CONCLUSION: Data obtained in the present study indicate that a laboratory is essential for monitoring nutritional assessment and for checking the appropriateness of nutritional therapy. We found prealbumin to be the most sensitive measure and found it to be the test of choice for early assessment and intervention.

Prognostic value of brainstem auditory evoked potentials in pediatric patients with traumatic coma.

This paper studies the auditory evoked potentials of the brainstem (BAEPs) in 30 pediatric patients with serious head trauma admitted to a particular hospital. The results have shown the importance of BAEPs especially in those patients whose prognoses are uncertain.

Improvement of the ventilator associated pneumonia rate with infection control practices in an Italian ICU.

BACKGROUND: To assess the impact of an intervention to improve respiratory infection control practices and reduce the ventilator associated pneumonia (VAP) rate in an intensive care unit, at the request of the ICU staff. DESIGN: prospective surveillance before-after study. Baseline VAP rates were determined over a 4-month period of active surveillance without an infection control program (period 1) and compared to VAP rates following implementation of an infection control program (period 2). The ICU staff requested the implementation of infection control practices. SETTING: Intensive Care Unit (ICU) at a university teaching hospital in Italy. PATIENTS: A total of 185 patients admitted to the ICU were included in the study. RESULTS: PATIENTS assessed during period 1 were similar to patients assessed during period 2 with regard to age, sex, origin, type of admission and mortality. PATIENTS who were admitted during period 2 had significantly lower simplified acute physiology scores (SAPS) II and acute physiology and chronic health evaluation (APACHE) II scores than patients admitted during period 1 (P<0.05). During period 1, there were 27 cases of VAP, and the incidence rate was 36.9/1000 MV-days. During period 2, the VAP rate decreased significantly (P=0.049): there were only 17 cases of VAP, and the incidence rate was 22.5/1,000 MV-days, with a rate-ratio of 0.61. CONCLUSION: Despite our short study period, the results appear to be encouraging and show a measurable impact on the incidence of VAP.

Successful early voriconazole treatment of Aspergillus infection in two non immunocompromised patients in Intensive Care Unit.

We report two cases of respiratory Aspergillus infection that occurred in patients admitted to the Intensive Care Unit of a teaching hospital during renovation works and treated with new triazole voriconazole (Vfend). The first patient was affected with cerebral hemorrhage, the second with polytrauma and both developed Aspergillus Pneumonia during their ICU stay. Bronchoalveolar lavage, dosage with anti-Aspergillus antibodies, antigen measurements and galactomannan research with Sanofi Platelia were performed. Therapy was carried out with voriconazole for 12 days. Chest X-ray and laboratory tests showed complete resolution after 12 days of therapy; clinical symptoms were negative after 4 days. Aspergillus infection can be observed frequently in non-immunocompromised patients during ward renovation or in hospitals near building areas. Since treatment is often unsuccessful, we preferred to immediately employ new agents to reduce the impact of this disease.