Pseudomonas aeruginosa device associated - healthcare associated infections and its multidrug resistance at intensive care unit of University Hospital: polish, 8.5-year, prospective, single-centre study.

BACKGROUND: Pseudomonas aeruginosa has recently shown to be one of the most important strains of bacteria and alert pathogens in Europe among Intensive Care Unit patients that provide serious therapeutic problems because of its multidrug resistance. METHODS: The purpose of this microbiological study was data analysis of device associated- healthcare associated infections (DA-HAIs) in an ICU in terms of the incidents of P.aeruginosa strain infections and its susceptibility within an 8.5-year observation. RESULTS: Among 919 isolated strains responsible for 799 DA-HAIs (17,62 ± 1,98/1000 patient-days) in 4010 ICU patients P.aeruginosa was the pathogen in 108/799 (13.52%) cases. Incidence rate (density) of: VAP/1000 MV- days, UTI /1000 UC- days and CLA-BSI/1000 CL- days were 11,15 ± 2.5, 6.82 ± 0.81, 2.35 ± 1.54.respectivelly. P.aeruginosa was the pathogen most frequently responsible for VAP 69/108 (63.88%). Mean frequency of VAP, UTI and CLA-BSI with P.aeruginosa etiology was 69/493 (14.28%), 32/299 (11.1%) and 7/127 (5.77%) respectively. The mean density of P.aeruginosa infection amounted to 2.43/1000 patient-days. The decrease was observed in the total number of DA-HAIs caused by the P.aeruginosa from 15.75% and 3.23/1000 patient-days in 2011 to 5.0% and 1.17/1000 in 2016 (p = 0.0104, p = 0.0348). Starting from 2016 to 2019 incidence and density of P.aeruginosa DA-HAIs increased to 12.33% and 2.63/1000 (p = 0.1388, p = 0.0818). P.aeruginosa was susceptible to ceftazidime, cefepime, amikacin, meropenem, ciprofloxacin, colistin, in 55.55, 58.33, 70.37, 53.73, 50, and 100% respectively. MDR characterised it in 40% in 2011 and 66.7% in 2019, (p = 0.177). CONCLUSIONS: The study revealed a changeable prevalence of P. aeruginosa strain infections; however their frequency was never highest in our ICU patients as it presented in the last years in Europe. The study showed a significant decrease in 2016 and increase in 2019, a nearly 3-fold increase of P.aeruginosa infections among Gram-negative strain infections, and a 2-fold increase of the P.aeruginosa DA-HAIs frequency between 2016 and 2019 as well as an increased resistance. Microbiological analysis of DA-HAIs in each hospital should be a standard method used in hospital infection control and antibiotic policy. In the case of P.aeruginosa, in order to minimize transmission, preventive infection methods should be assessed mainly in case of VAP.

Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011-2018.

Introduction: In recent years, an increase in healthcare-associated infections (HAIs) caused by resistant pathogens, which is a clinically troublesome trend, has been observed. The aim of the study was to analyze the microbial factors of HAIs and the drug resistance of microorganisms to selected antibiotics and their consumption. Material and Methods: The retrospective study included 3708 patients hospitalized in the intensive care unit (ICU) of the University Teaching Hospital in Wroclaw, who were diagnosed with 742 HAIs in the period from 1 January 2011 to 31 December 2018. The aim of the study was the analysis of microorganisms isolated in the respective clinical forms of HAIs, including the occurrence of "alert pathogens", presence of multidrug-resistant (MDR) strains, and consumption of selected antibiotics. Findings: During the study period, 846 microorganisms were cultured in patients with HAIs, and among them, Acinetobacter baumannii MDR represented 31.8%; Klebsiella pneumoniae ESBLs, 11.3%; Pseudomonas aeruginosa MDR, 4.1% and MRSA, 2.2%; and Enterococcus spp. vancomycin-resistant enterococci (VRE), 1.3%. Among all the pathogens, Gram-negative bacteria (GNB) were dominant (71.6%). Gram-positive bacteria and fungi accounted for 21.6% and 7%, respectively. The total number of strains responsible for ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and central line-associated blood stream infection (CLA-BSI) was as follows: 458 (54.1%), 274 (32.4%), and 114 (13.5%), respectively. Among the etiological factors of VAP, there was a prevalence of A. baumannii MDR (41.9%), as well as in the case of UTI (21.9%). With regards to CLA-BSI, MRCNS (29.8%) was the dominant pathogen. The "alert pathogens" accounted for 54.7% of all the analyzed strains. The MDR strains represented 72.6% and 9.7% among A. baumannii and P. aeruginosa, respectively. In the years 2011 vs. 2018, an increase in infections with MDR bacilli was observed, 34.6% vs. 61.0% (p = 0.0008), respectively, including A. baumannii MDR 16.54% vs. 34.56 % (p = 0.0009) and Enterobacterales ESBL+/AMPC 11.8% vs. 15.44 % (p = 0.3921). Resistance to methicillin was confirmed in 35.2% of S. aureus strains. Resistance to vancomycin was found among 30.9% of Enterococcus spp. The observed period was marked by an increase in the consumption of carbapenems: 197.7 vs. 235.9 defined daily dose (DDD)/1000 patients-days. Conclusions: Gram-negative bacteria were found to be dominant pathogens in healthcare-associated infections. The most frequently cultured pathogens were multidrug-resistant A. baumannii, K. pneumoniae ESBL(+), and P. aeruginosa. The study showed an increase in the incidence of "alert pathogens" and MDR bacilli, as well as the tendency of a growing resistance to antibiotics during the observed period. Microbiological analysis of HAIs and the consumption of antibiotics is the necessary element of the proper antibiotic policy in hospitals.

Analysis of Acinetobacter baumannii hospital infections in patients treated at the intensive care unit of the University Hospital, Wroclaw, Poland: a 6-year, single-center, retrospective study.

BACKGROUND: Acinetobacter baumannii (AB) is one of the most frequently isolated strains of bacteria in intensive care unit (ICU) patients, which provides huge therapeutic problems due to its multidrug resistance (MDR). PATIENTS AND METHODS: The overall purpose of the study was analysis of health care- associated infections in terms of the incidence of AB strain infections and the changing susceptibility of this strain within a 6-year observation (2011-2016). The study was carried out in an ICU of the University Hospital in Wroclaw (Poland). RESULTS: Among 589 isolated strains responsible for 540 health care-associated infections (21.2%) in 2549 ICU patients, AB was the pathogen in 183 (31%) cases. The incidence of AB infection amounted to 6.4/1000 patient-days. An increase was noted in the total number of hospital infections caused by AB strain from 16.5% and 3.39/1000 patient-days in 2011 to 41% and 9.64/1000 in 2016 (p=0.0003 and p=0.000, respectively). AB infections most frequently concerned ventilator-associated pneumonia (73.8%). AB was susceptible to colistin, amikacin, imipenem, meropenem, and ciprofloxacin in 100%, 10.7%, 12.3%, 11.5%, and 2.4% respectively, and it was characterized by MDR in 98.36% of the strains. CONCLUSION: The study revealed a 3-fold increase in the incidence of AB strain infections, significant increase in the resistance to carbapenems in the observed period, and a very high MDR. The solution to this problem would be the implementation of a repair program aiming at inhibition of AB strain transmission, measures to prevent infections, and restricted use of antibiotics.

Effect of universal chlorhexidine decolonisation on the infection rate in intensive care patients.

BACKGROUND: Healthcare-associated infections (HAIs), particularly intensive care unit-acquired infections (HAI-ICU), are an important cause of morbidity and mortality in hospitals. Most of these infections are caused by multidrugresistant organisms. The results of recent studies have suggested that daily bathing with chlorhexidine (CHX)-universal decolonisation can prevent ICU infections. The purpose of the study was to determine the influence of CHX bathing on the rate and type of HAI-ICU in critically ill patients. METHODS: This observational study, conducted in a mixed, 16-bed tertiary ICU, compared the following three 3-month periods: I) pre-intervention (traditional soap-water bathing), II) intervention (bathing with 2% CHX clothes), and III) post-intervention (soap-water bathing). The type and rate of HAI-ICU were registered according to the European Centre for Disease Prevention and Control (ECDC) guidelines. RESULTS: A total of 272 patients were included in the study. During the intervention period, the total infection rate was significantly lower than in the pre-intervention period (12.7% vs 22.2%, respectively). Significant decreases in the rate and density of catheter-related infections (CRI) were observed during the intervention period. A decrease in the isolation rate of multidrug-resistant bacteria was also observed during the intervention and post-intervention periods. CONCLUSIONS: Daily bathing of ICU patients with chlorhexidine-impregnated clothes significantly decreased the rate of HAI-ICU and the acquisition of CRI. This simple hygienic approach can be an important adjunctive intervention with the capability of reducing the burden of healthcare-associated infections in ICUs.

Urinary tract infections in intensive care unit patients - a single-centre, 3-year observational study according to the INICC project.

BACKGROUND: Urinary tract infections (UTI) in patients with urinary catheters could be a serious complication of hospitalisation in the intensive care unit (ICU). METHODS: A prospective study (01.01.2012-31.12.2014) was conducted in the 20-bed ICU of the University Hospital in Wroclaw, Poland. The frequency (density, incidence) and aetiology of UTI as well as prophylactic method compliance were estimated in patients of the ICU according to the INICC project. RESULTS: Among 1261 ICU patients, urinary tract infections were diagnosed in 91 (7%). The incidence index was 7.25/100 admissions to the ICU. CA-UTI constituted 36% of the device-associated, healthcare-associated infections (n = 255). A urinary catheter was used in 92.21 ± 4.51% of patients during 14,006 patient-days and 12,917 urinarycatheter- days. The density of CA-UTI/1000 catheter-days was 6.44, 6.84, 7.16 during the years 2012, 2013, and 2014, respectively. The main pathogens of CA-UTI were Enterococcus spp. (22%), Acinetobacter baumannii (20%), Klebsiella pneumoniae (18%), Pseudomonas aeruginosa (13%), and Candida spp. (13%). Only in four elements of the "Urinary Catheter Bundle" was 100% compliance noted. CONCLUSIONS: In the observed period of time, the incidence of CA-UTI was higher than in the INICC (2014) report and the NHSN/CDC (2012) report. Analysis of compliance with a "Urinary Catheter Bundle" to prevent UTI shows low implementation of preventative methods with the INICC protocol.