RESUMO
BACKGROUND: Pseudomonas aeruginosa (PA) is a common cause of healthcare-associated infection (PA-HAI) in the intensive care unit (ICU). AIM: To describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and to identify episodes of sink-to-patient PA transmission. METHODS: This was a prospective cohort study of patients in six ICUs from 2018 to 2019, with retrieval of PA clinical isolates, and PA-screening of antimicrobial-resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole-genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU-acquired PA was defined as PA isolated from specimens obtained ≥48 h after ICU admission in those with prior negative rectal swabs. Sink-to-patient PA transmission was defined as ICU-acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to collection date of the relevant patient specimen. FINDINGS: Over ten months, 72 PA-HAIs occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU-days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median: 26 vs 3 days uninfected; P < 0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAIs. Four patients with five PA-HAIs (6.9%) had closely related isolates previously recovered from their room/bedspace sinks. CONCLUSION: Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PA-HAIs were associated with sink-to-patient transmission. Sinks may be an under-recognized reservoir for HAIs.
Assuntos
Infecção Hospitalar , Unidades de Terapia Intensiva , Infecções por Pseudomonas , Pseudomonas aeruginosa , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/classificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/transmissão , Infecções por Pseudomonas/microbiologia , Estudos Prospectivos , Ontário/epidemiologia , Masculino , Pessoa de Meia-Idade , Feminino , Idoso , Adulto , Idoso de 80 Anos ou mais , Sequenciamento Completo do GenomaRESUMO
Twenty Asian psychiatric patients suffering from neurotic illness completed the Urdu version of the HAD Scale. The results were compared with the Clinical Interview Schedule. Somatic symptoms were significantly related to various measures of anxiety but not to those of depression. This finding contradicts the previously held view of linking somatic symptoms with the presentation of depression.