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OBJECTIVE: This study aimed to investigate the clinical significance of multi-drug resistant organism (MDRO) screening and infection risk factor analysis in the intensive care unit (ICU). METHOD: A total of 210 patients treated in the ICU of our hospital were enrolled as the study subjects, and were divided into the MDRO group (n=100 cases) and the non-MDRO group (n=110) according to the presence or absence of MDRO infection after examination of the pharyngeal swabs. The pathogens of MDRO infection and drug resistance were analyzed. The single-factor as well as multifactor logistic regression analysis of MDRO infections were carried out and the 30-d mortality rate, hospitalization time and treatment costs were compared between the two groups. RESULTS: A total of 158 MDRO strains were detected in 100 patients with MDRO infection, of which G-84 accounted for 53.16% and G+ 74 accounted for 46.84%. The resistance analysis revealed that G-MDRO was sensitive to imipenem and G+ MDRO was sensitive to vancomycin, and no vancomycin-resistant MDROs were found. The logistic regression model and multifactorial analysis showed that mechanical ventilation, arterial and venous intubation, implementation of fiberoptic bronchoscopy, concurrent chronic lung disease and chronic cardiovascular disease were independent risk factors for the development of MDRO infection (P<0.05). The length of hospital stay, cost of treatment, and 30-d mortality rate in the MDRO group were significantly higher than those in the non-MDRO group (P<0.05). CONCLUSION: ICU mechanical ventilation, arterial and intravenous intubation, fiberoptic bronchoscopy, concurrent chronic lung disease and chronic cardiovascular disease are the independent risk factors for MDRO infection.
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BACKGROUND: Carbapenems are a family of end line antibiotics with increasing levels of resistance that are a cause for concern. AIM: To ascertain whether the CPE screening programme employed in an acute tertiary hospital is fit for purpose. METHOD: We outlined the current working algorithm employed using a universal screening programme over a 26-month screening period. Rectal swabs are cultured on arrival. Those with suspicious growth are further investigated using NG-Carba 5 lateral flow tests and Vitek 2.0 sensitivity cards. These practices were compared with NHS guidelines. FINDINGS & CONCLUSIONS: In all, 53 true positives were detected from 45 patients since the screening was implemented in early 2018 (46 OXA-48, 6 KPC, 1 NDM). As the rate of screening increased, the number of positive screens decreased over time. There were a lot of similarities between the HSE guidelines and the published NHS CPE toolkit. It was evident that there is no standard practice being employed across all hospitals. Comparing the MUH to national guidelines it appears to be quicker and more effective with universal screening in place at reducing the potential contacts and identifying carriers. Cost analysis indicates that the need to confirm all positive strains in a reference lab is costly, unnecessary and time consuming. There are adequate confirmatory tests available in-house for routine positive screens. It was concluded that infection prevention and control are key to identifying and controlling possible outbreaks in a hospital setting.
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Screening on hospital admission to identify multidrug-resistant organism (MDRO) colonization is a frequently discussed topic. We report the results of microbiological screening in 141 Italian and 354 migrant children candidates for cardiac surgery conducted in 2015-2016. In all, 25% of Italian children and more than 65.4% of African and Romanian children carried at least one MDRO (meticillin-resistant Staphylococcus aureus; extended-spectrum ß-lactamase enzymes; carbapenemase producers; and vancomycin-resistant enterococci). Based on our findings, we propose that non-geographically limited approaches are needed to improve infection prevention and control.