Background: Acinetobacter spp are present everywhere in the environment and cause many epidemics in tropical countries.\r\n', u'Objectives: This study aims to learn about the status of multidrug resistance in ubiquitous and domination acinetobacter Spp caused nosocomial infections. Subjects and method: A descriptive, epidemiologic cross-sectional study on 65 nosocomial Acinetobacter spp isolated from 244 patients hospitalized at the intensive-care units, Bach Mai hospital and burn patients from the National Burn Institute from April, 2007 to May, 2008. Results: Rates of A.baumannii were 70.8% of the isolates. Acinetobacter spp were isolated from patients in intensive-care units showed resistant to almost all commercially available antibiotics groups, among Penicillin ranged from 94.6 to 97.4%; beta- Lactam ranged from 80.5 to 90%; Cephems were 97.6%; Aminoglycosides group ranged from 62.5 to 100% and Quinolon were 100%. The isolates that were susceptible to Netilmycin was 35% and Imipenem was 34.1%. Acinetobacter spp were isolated from burn patients, which showed resistant to Penicillin was 86, 7%; beta- Lactam was 93, 3%; Aminoglyco- sides ranged from 25% to 87.5% and Quinolon was 81,3%. The isolates were susceptible to Netilmycin was 75% and Imipenem was 31.3%. \r\n', u'Conclusion: Analysis of risk factors may help the study of epidemiology Acinetobacter to prevent hospital infections and reduce the mortality rate. \r\n', u'
Acinetobacter spp ; nosocomial infections

Sharing information systematically and verifying nosocomial infection measures are considered useful for evaluating the validity of the measures and solving these problems.The Pharmacist Association of the Aichi-Koseiren set up an expert committee for studying measures to prevent nosocomial infection in 2002. The questionnaire survey was performed from 2002 to 2003, to define current practice for preventing hospital-acquired infections in each facility and to find whether antibiotics are being used properly. Based on the findings problems were brought to light and the target for prophylaxis was set.As a result, one or more of several target problems were solved in 2004. At the same time, the continuance problems in the future a come to the surface. The results were obtained by effectively using Aichi-Koseiren with the pharmacist association playing a central role.
Nosocomial Infections ; Prevention ; Concrete ; Action ; Evaluation

BACKGROUND: THe Korean Society for Nosocomial Infection Control (KOSNIC) orfanized the Korean Nosocomial Infections Surveillance System (KONIS) to establish a nationwide database of Nosocomial infection (NI) rate in the intensive care units (ICUs) of Korean hospitals. This report is a summary of the data from July through September 2006. METHODS: The KONIS performed a prospective sruveillance for nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 76 ICUs in 44 hospitals. NI rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: A total of 846 nosocomial infections were fOlllld during the study period: 407 UTIs (397 cases were urinary catheter-associated), 204 BSIs (182 were central line-associated), and 235 PNEUs (161 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.61 cases per 1,000 device-days and urinary catheter utilization ratio was 0.83. The rate of central line-associated BSIs was 3.16 and the utilization ratio was 0.55. The rate of ventilator-associated PNEUs was 3.80 and the utilization ratio was 0.41. Although the ventilator utilization ratio was lower in the hospitals with 400-699 beds than in the hospitals with more than 900 beds, the rate of ventilator-associated pneumonia was higher in the smaller hospitals than in the larger ones. The rates of all three device-associated infections were the highest in the neurosurgical ICUs and the rates were the lowest in the surgical ICUs. CONCLUSION: This study may contribute to the development of effective strategies for NI control according to the size of hospital and the type of ICUs.
Cross Infection* ; Intensive Care Units ; Pneumonia ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

BACKGROUND: To determine whether multiple short-term surveillances are as effective as long-term surveillance for estimating the incidence rates of nosocomial infections (NIs), we prospectively performed 9-month surveillance in four intensive care units (ICUs). METHODS: NI surveillance was performed prospectively from November 2002 through July 2003, with long-term surveillance performed over the 9-month period, and short-term surveillance performed during the middle 3 weeks of each calendar quarter. The incidence rate of NIs or device-associated infections was calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: We observed no significant differences between the incidence rates of total NIs determined from these two methods (9.6 [CI95 8.2-11.3] vs 10.4 [CI95 7.5-14.4], P=.66). In addition, these two methods did not differ significantly in estimating the rates of ventilator-associated pneumonia (5.1 [CI95 3.4-7.6] vs 7.5 [CI95 3.8-15.0], P=.35), catheter-associated urinary tract infection (2.4 [CI95 1.7-3.4] vs 1.7 [CI95 0.7-4.1], P=.47), and central line-associated bloodstream infection (2.2 [CI95 1.4-3.4] vs 3.7 [CI95 1.9-7.4], P=.21). Plotting of the NI rates showed that the trends in multiple short-term surveillances were similar to those in long-term surveillance, except in one ICU. CONCLUSION: Our findings suggest that multiple short-term surveillances could replace long-term surveillance in estimating the baseline incidence rates of NIs in the circumstances of the relatively large number of patients in the ICUs, which would be especially useful in countries with limited resources.
Cross Infection* ; Epidemiology ; Humans ; Incidence ; Infection Control ; Intensive Care Units ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Urinary Tract Infections

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the intensive care unit (ICU), with an incidence ranging from 8% to 38%. Patients who acquire VAP have higher mortality rates and longer ICU and hospital stays. Because there are other potential causes of fever, leukocytosis, and pulmonary infiltrates, clinical diagnosis of VAP is overly sensitive. The only alternative approach to the clinical diagnosis of VAP is the Clinical Pulmonary Infection Score (CPIS). Employing quantitative cultures of respiratory secretions in the diagnosis of VAP leads to less antibiotic use and probably to lower mortality. With respect to microbiologic diagnosis, however, it is not clear that the use of invasive sampling using bronchoscopy is associated with better outcomes. Delayed administration of antibiotic therapy is associated with an increased mortality, and inadequate antibiotic therapy is also associated with higher mortality. Therefore, prompt initiation of adequate antibiotic therapy is a cornerstone of the treatment of VAP. The initial antibiotic therapy should be based on the most common organisms in each hospital and the most likely pathogens for that specific patient. When final cultures and susceptibilities are available, de-escalation to less broad spectrum antibiotics should be done. Since clinical improvement usually takes 2 to 3 days, clinical responses to the initial empirical therapy should be evaluated by day 3. A short course of antibiotic therapy appears to be equivalent to a traditional course of more than 14 days, except when treating non-fermenting gram-negative organisms. If patients receive initially adequate antibiotic therapy, efforts should be made to shorten the duration of therapy to as short as 7 days, provided that the etiologic pathogen is not a non-fermenting gram-negative organism.
Anti-Bacterial Agents ; Bronchoscopy ; Cross Infection ; Fever ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Leukocytosis ; Pneumonia, Ventilator-Associated

Recent studies have shown that educational interventions for ventilator-associated pneumonia (VAP) prevention may result in positive outcomes in intensive care units. However, other studies investigating this kind of intervention have produced inconsistent results. Thus this paper reports a protocol for systematic review and planned meta-analysis to investigate the association of instituted VAP educational interventions with clinician learning and patient outcomes. In this review, the authors will identify relevant citations from electronic databases, reference lists, and other sources; screen articles against predetermined eligibility criteria; appraise each study using the Cochrane Collaboration’s risk of bias assessment tools and combine acquired evidence using the meta-analytic approach. The results of this review are crucial to assist clinicians and policy-makers in making well-informed decisions regarding VAP prevention practices for mechanically ventilated patients. This review protocol followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 guidelines and was registered with PROSPERO as CRD42016051561.
Pneumonia, Ventilator-Associated

Nosocomial infections are known cause of increased mortality and morbidity and are an important factor in prolonging the length of hospital stay. The intensive care unit (ICU) is highly vulnerable to nosocomial infections largely due to disease severity and consequent lowered resistance to infection as well as the frequency of invasive interventions for the patients. This manuscript will briefly review the epidemiology, risk factors and control measures for nosocomial infections focused on patients in the ICU. Furthermore, recent strategies to control device-associated infections such as catheter-associated urinary tract infections, catheter-associated blood- stream infections and ventilator-associated pneumonias will be described.
Cross Infection ; Humans ; Infection Control ; Intensive Care Units ; Length of Stay ; Pneumonia, Ventilator-Associated ; Risk Factors ; Rivers ; Urinary Tract Infections ; Critical Care

PURPOSE: Patients in the intensive care unit (ICU) are more susceptible to nosocomial infections, including central line-associated bloodstream infection (CLABSI), surgical site infection, urinary tract infection or ventilator-associated pneumonia. This study is a comparative analysis of how central venous catheter (CVC) management staff affects CLABSI. METHODS: We performed a two-phase review of all patients transferred to the surgical ICU (SICU) from January 2013 to June 2014. CVC management staff was introduced in October 2013. Electronic medical records provided the data for a comparative analysis of incidence rates and risks of CLABSI, as well as the subjects' general characteristics. RESULTS: This study included 248 patients before the introduction of a CVC management staff member and 196 patients after the introduction. General patient characteristics before and after the CVC management staff was in place did not differ significantly. The CLABSI rate decreased by 4.61 cases/1,000 device days after the introduction (6.26 vs. 1.65; odds ratio, 4.47; 95% confidence interval, 1.39~14.37; p=0.009). However, the mortality rate and length of ICU stay did not change after CVC management staff was in place (12.9% vs. 10.7%, p=0.480; 16.00±24.89 vs. 15.87±18.80, p=0.954; respectively). CONCLUSION: In this study, the introduction of CVC management staff effectively reduced CLABSI rates in current ICU system.
Central Venous Catheters* ; Critical Care* ; Cross Infection ; Electronic Health Records ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Odds Ratio ; Pneumonia, Ventilator-Associated ; Surgical Wound Infection ; Urinary Tract Infections

PURPOSE: Acinetobacter species are aerobic gram-negative rods that can be widely found in nature and are a part of the normal flora of humans. The most clinical isolates of A. baumannii reflect infection rather than colonization. Recent reports suggest that the organisms cause serious and often fetal nosocomial infection such as ventilator-associated pneumonia. METHODS: From March to September 1998, we experienced thirty clinical isolates of A. baumannii in fifteen patients in Sonchunhyang University Chunan Hospital neonatal intensive care unit. Clinical characteristics, bacteriologic investigation, and molecular epidemiologic investigation by randomly amplified polymorphic DNA (RAPD) method was performed. RESULTS: The number of clinical isolates of A. baumannii were thirty and the number of Acinetobacter cases were fifteen. The duration of hospitalization and ventilator support were significantly longer in the patient group than in the control group. The most common culture site of A. baumannii was the endotracheal tube (83.3%). The thirty clinical isolates showed resistance to the most commonly used antibiotics. The RAPD result of A. baumannii isolated from fifteen patients showed the same band patterns, designating they were of the same strain. Surveillance cultures of medical staffs' hands, incubators, and ventilators failed to identify the source of infections. CONCLUSOIN: It is possible to have an outbreak of A. baumannii in a neonatal intensive care unit. In A. baumannii infection, the durations of hospitalization and ventilator support were significantly longer. It is very difficult to discover the source of A. baumannii outbreak.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; Chungcheongnam-do ; Colon ; Cross Infection ; DNA ; Hand ; Hospitalization ; Humans ; Incubators ; Infant, Newborn ; Intensive Care, Neonatal* ; Pneumonia, Ventilator-Associated ; Ventilators, Mechanical

Purpose: The purpose of this study is to determine the risk adjusted nosocomial infection (NI) rate and distribution of Nls and their causative pathogens in adult lCU. Methods: Prospective surveillance was performed at 12 lCU's of 5 acute care hospitals in Seoul and Kyonggi Do during a 3-months period from May to July 2002. The case finding was done by direct reviews of medical charts regularly for all patients by ICPs using CDC definitions. Results: Total NI rate was 10.18/1,000 patient-days in Medical-surgical ICU (MSICU) and 12.35/1,000 patient-days in Neurosurgucal ICU(NCI). Risk adjusted infection rate was 3.44 in indwelling catheter associated UTI 2.12 in central line associated BSI. 3.51/1,000 device-days in ventilator associated pneumonia in MSICU. There were 3.72, 2.26, 6.06/1,000 device-days in NCU. The infection rate by leu type showed no significant difference. The distribution of Nls were PNEU (28.99%). UTI (28.99%), BSI (18,84%), SSI(4.35%) in MSICU, and UTI(48.0%), PNEU(24.0%), BSI (14.0%), SSI(6.I) in NCU. The most commonly isolated organisms were Candida spp (38.6%), Enterococcus spp. (13.4%) in UTI, Staphylococcus aureus(36.2%), p. aeruginosa(18.8%) in PNEU and Coagulase negative staphylococcus(44.1%). S. aureus (14.7%) in BSL, S. aureus (19.8%) was the most common organism from overall nosocomial infections in the ICU, and 96.3% of S. aureus were MRSA. Conclusion: Distribution of site-specific nosocomial infection and isolated organisms were similar to the results of KOSNIC (Korea society for nosocomial infection control) surveillance in 1996. However, the total infection rate and a risk adjusted infection rate at MSJCU is lower than 1996's. This decrease is considered to be a result of efforts to prevention and control nosocomial infections.
Adult ; Candida ; Catheters, Indwelling ; Centers for Disease Control and Prevention (U.S.) ; Coagulase ; Cross Infection* ; Enterococcus ; Gyeonggi-do ; Humans ; Korea* ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Seoul ; Staphylococcus