International study of the prevalence and outcomes of infection in intensive care units

Structures on Manifolds

ObjectiveTo determine epidemiology and risk factors for nosocomial infections in intensive care unit (ICU).DesignProspective incidence survey.SettingAn adult general ICU in a university hospital in western Turkey.PatientsAll patients who stayed more than 48 h in ICU during a 2-year period (2000–2001).Measurements and resultsThe study included 434 patients (7394 patient-days). A total of 225 infections were identified in 113 patients (26%). The incidence and infection rates were 56.8 in 1000-patient days and 51.8%, respectively. The infections were pneumonia (40.9%), bloodstream (30.2%), urinary tract (23.6%) and surgical site infections (5.3%). Pseudomonas aeruginosa (22.6%), methicillin-resistant Staphylococcus aureus (22.2%) and Acinetobacter spp. (11.9%) were frequently isolated micro-organisms. Median length of stay with nosocomial infection and without were 13 days (Interquartile range, IQR, 20) and 2 days (IQR, 2), respectively (P<0.0001). In logistic regression analysis, mechanical ventilation [odds ratio (OR): 16.35; 95% confidence interval (CI): 8.26–32.34; P<0.0001), coma (OR: 15.04; 95% CI: 3.41–66.33; P=0.0003), trauma (OR: 10.27; 95% CI: 2.34–45.01; P=0.002), nasogastric tube (OR: 2.94; 95% CI: 1.47–5.90; P=0.002), tracheotomy (OR: 5.77; 95% CI: 1.10–30.20; P=0.04) and APACHE II scores 10–19 (OR: 10.80; 95% CI: 1.10–106.01; P=0.04) were found to be significant risk factors for nosocomial infection. Rate of nosocomial infection increased with the number of risk factors (P<0.0001). Mortality rates were higher in infected patients than in non-infected patients (60.9 vs 22.1%; P<0.0001).ConclusionThese data suggest that, in addition to underlying clinical conditions, some invasive procedures can be independent risk factors for nosocomial infection in ICU.

Nosocomial infections in intensive care unit in a Turkish university

Mechanisms of antibiotic resistance in Staphylococcus aureus

Introduction: Klebsiella pneumoniae is one of the most important infectious agents in neonates. There are “classic” and hypervirulent strains of K. pneumoniae. The “classic” non-virulent strain of K. pneumoniae, producing extended-spectrum beta-lactamases (ESBLs), is associated with nosocomial infections. Hypervirulent K. pneumoniae strains are associated with invasive infections in previously healthy adult people, and most of them exhibit antimicrobial susceptibility. The role of virulent strains of K. pneumoniae (including hv-KP) in neonatal infections is unknown. The aim of the study was the assessment of the impact of virulence factors and antibiotic resistance of K. pneumoniae strains on clinical features and outcomes of neonatal infection.

Materials and Methods: Two groups of infants were enrolled. The first group consisted of 10 neonates with sepsis caused by K. pneumoniae. The second group consisted of 10 neonates with urinary tract infection (UTI) caused by K. pneumoniae. We investigated the susceptibility of K. pneumoniae isolates to antibiotics, the ability of the microorganism to produce ESBL, and virulence factors, including the rmpA gene, aerobactin, and colibactin genes. In neonates with sepsis, we investigated K. pneumoniae isolates, which was taken from the blood, in neonates with UTI—from the urine.

Results: In neonates with sepsis testing of K. pneumoniae isolates for ESBL production was positive in 60% of cases, in neonates with UTI—in 40% of cases. All blood and urine ESBL producing K. pneumoniae isolates were resistant to ampicillins, including protected ones, and third-generation cephalosporins. At the same time, these isolates were sensitive to meropenem, amikacin, and ciprofloxacin. The rmpA gene was detected in four blood, and three urine K. pneumoniae isolates. In neonates with sepsis rmpA gene in two cases was detected in ESBL-producing K. pneumoniae isolates. They were infants with meningitis, and both cases were fatal. In the group of infants with UTI, the rmpA gene was detected only in K. pneumoniae isolates not producing ESBL. Aerobactin and colibactin genes were detected in two neonates with sepsis and in three neonates with UTI. In all cases, aerobactin and colibactin genes were detected only in rmpA-positive K. pneumoniae isolates. Out of three fatal outcomes, two cases were caused by hv-KP producing ESBL.

Conclusion: The prevalence of virulent strains of K. pneumoniae among neonates with sepsis and other neonatal infection is higher than we think. The most severe forms of neonatal sepsis with an unfavorable outcome in our study were due to virulent strains of K. pneumoniae.

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Virulence Factors and Antibiotic Resistance of Klebsiella pneumoniae Strains Isolated From Neonates With Sepsis.

Thrombocytopenia is one of the common hematological problems encountered in the neonatal period particularly in the sick newborns, premature babies and neonates admitted in neonatal intensive care units and usually indicate an underlying pathologic process. Thrombocytopenia is reported in neonates with bacterial, fungal, rickettsial, protozoal and viral infection. Some patients with bacterial septicemia may develop coagulopathy associated with DIC. The presence of thrombocytopenia is seen frequently in early sepsis with or without laboratory evidence of overt DIC. This study was conducted on 85 neonates admitted in NICU with clinical diagnosis of septicemia and 50 age and weight matched neonates served as control. Thrombocytopenia was seen in 83.5% cases where as bacterial culture was positive in only 41.1% cases. Further it was noted that, in gram negative (Gm −ve) septicemia, thrombocytopenia was more severe as compared to gram positive (Gm +ve) septicemia. It is concluded that thrombocytopenia is early predictor of septicemia but other causes of neonatal thrombocytopenia should also be ruled out.

Thrombocytopenia and bacterial sepsis in neonates.

In this paper, we introduce a new class of sets and a new class of functions called geodesic E-convex sets and geodesic E-convex functions on a Riemannian manifold. The concept of E-quasiconvex functions on Rn is extended to geodesic E-quasiconvex functions on Riemannian manifold and some of its properties are investigated. Afterwards, we generalize the notion of epigraph called E-epigraph and discuss a characterization of geodesic E-convex functions in terms of its E-epigraph. Some properties of geodesic E-convex sets are also studied.

On Geodesic E -Convex Sets, Geodesic E -Convex Functions and E -Epigraphs

We extend the notion of anti-invariant and Langrangian Riemannian submersion to the case when the total manifold is nearly Kaehler. We obtain the integrability conditions for the horizontal distri- bution while it is noted that the vertical distribution is always integrable. We also investigate the geometry of the foliations of the two distributions and obtain the necessary and sufficient condition for a Langrangian submersion to be totally geodesic. The decomposition theorems for the total manifold of the submersion are obtained.

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Anti-invariant Riemannian submersions from nearly Kaehler manifolds

B. Sahin [12] introduced the notion of semi-invariant Riemannian submersions as a generalization of anti-invariant Riemmanian submersions [11]. As a generalization to semi-invariant Riemannian submersions we introduce the notion of generic submersion from an almost Hermitian manifold onto a Riemannian manifold and investigate the geometry of foliations which arise from the definition of a generic Riemannian submersion and find necessary and sufficient condition for total manifold to be a generic product manifold. We also find necessary and sufficient conditions for a generic submersion to be totally geodesic.

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Generic riemannian submersions

In this paper, we introduce a new class of functions called geodesic semi- E -convex functions and discuss some of their properties.

Shahid Ali

Papers

Thrombocytopenia and bacterial sepsis in neonates.

On Geodesic E -Convex Sets, Geodesic E -Convex Functions and E -Epigraphs

Anti-invariant Riemannian submersions from nearly Kaehler manifolds

Generic riemannian submersions

Some properties of geodesic semi-E-convex functions