Search results for: nosocomial

Authors: Zahra Tolou-Ghamari

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Objective: Health care associated with multiresistant pathogens is rising globally. It is well known that nosocomial infections increase hospital stay, morbidity, mortality, and disability. Therefore, the aim of this study was to define the occurrence of nosocomial infections in a tertiary hospital in Isfahan/Iran. Materials and Methods: The data were extracted from the official database of hospital nosocomial infections records that included 9152 vertical rows. For each patient, the reported infections were coded by number as UTI-SUTI; Code 55, VAE-PVAP; Code 56, BSI-LCBI Code 19, SSI-DIP; Code 14, and so on. For continuous variables, mean ± standard deviation and for categorical variables, the frequency was used. Results: The study population was 5542 patients, comprised of males (n=3282) and females (n=2260). With a minimum of 15 and a maximum of 99, the mean age in 5313 patients was 58.5 ± 19.1 years old. The highest reported nosocomial infections (n= 77%) were associated with the ages 30-80 years old. Sites of nosocomial infections in 87% were as: VAE-PVAP; 27.3%, VAE-IVAC; 7.7, UTI-SUTI; 29.5%, BSI-LCBI; 12.9%, SSI-DIP; 9.5% and other individual infection (13%) with the main pathogens klebsiella pneumonia, acinetobacter baumannii and staphylococcus. Conclusions: For an efficient surveillance system, adopting pharmacotherapy used antibiotics in terms of monotherapy or polypharmacy control policy, in addition to advanced infection control programs at regional and national levels in Iran recommended.

Keywords: infection, nosocomial, ventilator, blood stream, Isfahan, Iran

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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This study was done to determine the prevalence of nosocomial infections in the ICU and to identify the common microorganisms causing these infections and their antimicrobial sensitivity pattern. Nosocomial infection or hospital-acquired infection is a localized or a systemic condition resulting from an adverse reaction to the presence of infectious agents. Nosocomial infections are not present or incubating when the patient is admitted to hospital or other health care facility. They are caused by pathogens that easily spread through the body. Many hospitalized patients have compromised immune systems, so they are less able to fight off infections. These infections occur worldwide, both in the developed and developing the world. They are a significant burden to patients and public health. They are a major cause of death and increased morbidity in hospitalized patients, which is a matter of serious concern today. This study was done during the period of one year (2012-2013) in the ICU of the tertiary care hospital in eastern India. Prevalence of nosocomial infection was determined; site of infection and the pattern of microorganisms were identified along with the assessment of antibiotic susceptibility profile. Patients who developed an infection after 48 hours of admission to the ICU were included in the study. A total of 324 ICU patients were analyzed, of these 79 patients were found to have developed a nosocomial infection (24.3% prevalence). Urinary tract infection was found to be more predominant followed by respiratory tract infection and soft tissue infection. The most frequently isolated microorganism was E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae followed by other organisms respectively. Antibiotic susceptibility test of these isolates was done against commonly used antibiotics. Patients admitted to the ICU are especially susceptible to nosocomial infections. Despite adequate antimicrobial treatment, nosocomial ICU infections can significantly affect ICU stay and can cause an increase in patient’s morbidity and mortality. Adherence to infection protocol, proper monitoring and the judicious use of antibiotics are important in preventing such infections on a regular basis.

Keywords: antibiotic susceptibility, intensive care unit, nosocomial infection, nosocomial pathogen

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Authors: Wissem Abdaoui, Ilhem Mokhtari, Adel Gouri, Benouareth Djamel Eddine

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Contracted in a health facility, hospital-acquired infections are a major public health problem in recent years. The increase of nosocomial infections is partly related to diagnostic and therapeutic advances in medicine. The aim of our study was to isolate and diagnose some types of bacteria that are circulating in the hospital by performing different samples at two medical services: Pulmonary and Infectious Diseases. The antibiotic susceptibility tests were performed for bacterial isolates. The results have shown that there is a predominance of enterobacteria followed by the staphylococcus with its two species epidermidis ans saprophyticus. The study of the antibiogramme identified that some of these bacteria have a resistant profile against all the tested antibiotics. The fight against nosocomial infections is difficult because it must act on several factors: quality of care, safety of the hospital environment, hygiene, wearing gloves etc. are all areas that should be of heightened vigilance and preventive measures.

Keywords: nosocomial infection, isolation, identification, sensitivity and resistance to antibiotics

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Authors: M. Bouzid, A. Djadi, C. Aribi, A. Irekti, B. Bezzazi, F. Halouene

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The nature of materials structuring our health institutions promote the development of germs. The sustainability of nosocomial infections remains significant (12% and 15%). One of the major factors is the portland cement which is brittle and porous. As part of a national plan to fight nosocomial infections, led by the University Hospital of Blida, we opted for a composite coating, application by multilayer model, composed of epoxy-polyester resin as a binder and calcium carbonate as mineral fillers. The application of composite materials reinforce the wall coating of hospital units and eliminates the hospital infectious areas. The resistance to impact, chemicals, raising temperature and to a biologically active environment gives satisfactory results.

Keywords: nosocomial infection, microbial load, composite materials, portland cement

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Authors: A. Lardjam, R. Mazid, S. Y. Boudghene, A. Izarouken, Y. Dali, N. Djebli, H. Toumi

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Origanum glandulosum is an aromatic plant, common in Algeria and widely used by local people for its medicinal properties. The essential oil from this plant, which grows in the west of Algeria, was studied to evaluate and determine its antibacterial activity. The extraction of the essential oil was performed by water steam distillation; the yield obtained from the aerial parts (1.78 %) is interesting, its chromatographic profile revealed by TLC showed the presence of phenolic compounds thymol and carvacrol. The evaluation of the activity of the essential oil of Origanum glandulosum on bacterial strains of hospital origin, ATCC, MRB, and HRB, most implicated in nosocomial infections (Staphylococcus aureus ATCC 25923, Staphylococcus aureus ATCC 43300, Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus resistant to meticillin, Enterococcus faecium, VA R and R TEC, Acinetobacter baumanii, IMP R and R CAZ, Klebsiella pneumonia carbapenemase-producing) by the method of aromatogramme and micro atmosphere, shows that the antibacterial potency of this oil is very high, expressed by significant inhibition diameters on all strains except Pseudomonas aeruginosa, and low MICs and is characterized by a bactericidal action.

Keywords: antibacterial activity, essential oil, HRB, MBR, nosocomial infections, origanum glandulosum

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Authors: S. Ben Fredj, H. Ghali, M. Ben Rejeb, S. Layouni, S. Khefacha, L. Dhidah, H. Said

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Background: The Intensive Care Unit (ICU) provides continuous care and uses a high level of treatment technologies. Although developed country hospitals allocate only 5–10% of beds in critical care areas, approximately 20% of nosocomial infections (NI) occur among patients treated in ICUs. Whereas in the developing countries the situation is still less accurate. The aim of our study is to assess mortality rates in ICUs and to determine its predictive factors. Methods: We carried out a nested case-control study in a 630-beds public tertiary care hospital in Eastern Tunisia. We included in the study all patients hospitalized for more than two days in the surgical or medical ICU during the entire period of the surveillance. Cases were patients who died before ICU discharge, whereas controls were patients who survived to discharge. NIs were diagnosed according to the definitions of ‘Comité Technique des Infections Nosocomiales et les Infections Liées aux Soins’ (CTINLIS, France). Data collection was based on the protocol of Rea-RAISIN 2009 of the National Institute for Health Watch (InVS, France). Results: Overall, 301 patients were enrolled from medical and surgical ICUs. The mean age was 44.8 ± 21.3 years. The crude ICU mortality rate was 20.6% (62/301). It was 35.8% for patients who acquired at least one NI during their stay in ICU and 16.2% for those without any NI, yielding an overall crude excess mortality rate of 19.6% (OR= 2.9, 95% CI, 1.6 to 5.3). The population-attributable fraction due to ICU-NI in patients who died before ICU discharge was 23.46% (95% CI, 13.43%–29.04%). Overall, 62 case-patients were compared to 239 control patients for the final analysis. Case patients and control patients differed by age (p=0,003), simplified acute physiology score II (p < 10-3), NI (p < 10-3), nosocomial pneumonia (p=0.008), infection upon admission (p=0.002), immunosuppression (p=0.006), days of intubation (p < 10-3), tracheostomy (p=0.004), days with urinary catheterization (p < 10-3), days with CVC ( p=0.03), and length of stay in ICU (p=0.003). Multivariate analysis demonstrated 3 factors: age older than 65 years (OR, 5.78 [95% CI, 2.03-16.05] p=0.001), duration of intubation 1-10 days (OR, 6.82 [95% CI, [1.90-24.45] p=0.003), duration of intubation > 10 days (OR, 11.11 [95% CI, [2.85-43.28] p=0.001), duration of CVC 1-7 days (OR, 6.85[95% CI, [1.71-27.45] p=0.007) and duration of CVC > 7 days (OR, 5.55[95% CI, [1.70-18.04] p=0.004). Conclusion: While surveillance provides important baseline data, successful trials with more active intervention protocols, adopting multimodal approach for the prevention of nosocomial infection incited us to think about the feasibility of similar trial in our context. Therefore, the implementation of an efficient infection control strategy is a crucial step to improve the quality of care.

Keywords: intensive care unit, mortality, nosocomial infection, risk factors

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Authors: Kaous Samira

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The lack of hand hygiene can contribute to nosocomial infections, including Central-venous-catheter-related bloodstream infections (CRBSI). An investigation from severally hospitals examined the frequency of hand hygiene in an OR among perioperative staff members who did not perform a surgical scrub. Among 50 operations (120 hours) that were observed, only 2% of staff members performed hand hygiene practices upon entering the OR, and 8.4% of staff performed hand hygiene upon leaving the OR. In addition, when performing radial arterial catheter placement, 0% of staff members wore gloves. Another study (A1170) surveyed healthcare providers regarding hand hygiene compliance. All of the 107 providers surveyed agreed that they should maintain hand hygiene, and most respondents believed that their own compliance was high. The author suggests that the low compliance problem associated with hand hygiene worldwide is a behavioral one among healthcare providers that requires acknowledgment and change.

Keywords: aneshesia, investigation, IOP, SBP

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Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

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Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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Authors: W. Mazari, K. Boucherit, Z. Boucherit-Otmani, M. N. Rahmoun, M. Benabdallah

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The hospital or any other establishment of care can be considered as an ecosystem where the patient comes into contact with a frightening microbial universe and a risk to contract infection that is referred to as nosocomial or health care-associated. In these last years, the incidence of these infections has risen sharply. Several microorganisms are the cause of these nosocomial infections and the emergence of resistance of the microbial strains against antibiotics creates a danger to public health. The search for new antimicrobial agents to overcome this problem has produced interesting compounds through chemical synthesis, which plays a very important role in the research and discovery of new drugs. It is in this framework that our study was conducted at our laboratory and it involves evaluating the antibacterial activity of thirteen 2-pyridone derivatives synthesized by two methods, the diffusion disc method and the dilution method against eight Gram negative bacterial strains. The results seem interesting especially for two products that have shown the best activities against Escherichia coli ATCC 25922 and Enterobacter cloacae ATCC 13047 with CMI of 512µg/ml.

Keywords: heterocyclic derivatives, chemical synthesis, antimicrobial activity, biotechnology

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Authors: Ibeku Bernadine Ezenwanyi

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Hospital-Acquired Infections (HAI), also called ‘Nosocomial Infection’ is an infection you get while in the hospital for another reason. They are an important cause of morbidity and mortality. This study examined the epidemiology, clinical outcomes of some instruments used on patients especially catheter that was passed on them during their stay in the hospital. It was discovered that they had catheter–associated urinary tract infection (CAUTI). An observational study was carried out from January to March, 2022, on 180 patients (80 males and 100 females) admitted in the surgical wards, medical wards, dialysis unit and intensive care unit (ICU) of the hospital. The patient’s urine samples were collected for urine culture and the isolation was carried out using plate count agar medium and macconkey agar. Among the 80 males, 45 had Urinary Tract Infections (UTI) mostly proteus infection and among the 100 females, 70 also had (UTI) and the most common was caused by Escherichia coli. Other strain of microorganisms such as Klebsiella, Staphylococcus aureus and Pseudomonas aeruginosa. It is important to follow up patients that these devices were used on with antibiotics to make sure that these infections are not developed because the rate of these infections (UTI) are high especially in females.

Keywords: catheter, urinary tract infection, nosocomial infection, microorganisms

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Authors: Sadaf Ilyas, Saba Riaz

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The extensive use of antibiotics has led to increases emergence of antibiotic-resistant organisms. Pseudomonas is a notorious opportunistic pathogen involoved in nosocomial infections and exhibit innate resistance to many antibiotics. The present study was conducted to assess the prevalence, levels of antimicrobial susceptibility and resistance mechanisms of Pseudomonas. A total of thirty clinical strains of Pseudomonas were isolated from different clinical sites of infection. All clinical specimens were collected from Chughtais Lahore Lab. Jail road, during 8-07-2010 to 11-01-2011. Biochemical characterization was done using routine biochemical tests. Antimicrobial susceptibility was determined by Kirby-Baeur method. The plasmids were isolated from all the strains and digested with restriction enzyme PstI and EcoRI. Transfer of Multi-resistance plasmid was checked via transformation and conjugation to confirm the plasmid mediated resistance to antibiotics. The prevalence of Pseudomonas in clinical specimens was found out to be 14% of all bacterial infections. IPM has shown to be the most effective drug against Pseudomonas followed by CES, PTB and meropenem, wheareas most of the Pseudomonas strains have developed significant resistance against Penicillins and some Cephalasporins. Antibiotic resistance determinants were carried by plasmids, as they conferred resistance to transformed K1 strains. The isolates readily undergo conjugation, transferring the resistant genes to other strains, illustrating the high rates of cross infection and nosocomial infection in the immunocompromised patients.

Keywords: pseudomonas, antibiotics, drug resistance, horizontal gene transfer

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Authors: Abeer N. Alshukairi, Abdulrahman A. Alrajhi, Abdulfattah W. Alamri, Adel F. Alothman

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We described the nosocomial transmission of a pre-XDR or an MDR case of pulmonary tuberculosis in a HIV negative health care worker in an area endemic for MDR & XDR tuberculosis. With inadequate therapy and non-compliance, his strain developed acquired resistance and he presented with extra-pulmonary XDR tuberculosis in the form of multi-focal osteomyelitis and encysted pleural effusion. He was cured after 2 years of therapy with various anti-tuberculous drugs in addition to interferon gamma.

Keywords: osteomyelitis, treatment, XDR tuberculosis, successful treatment

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Authors: Si Jack Chong, Chew Theng Yap, Wan Loong James Mok

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Introduction: Regional burn centres face the spectra of introduced multi-drug resistant organisms (MDRO) from transfer patients resident in MDRO endemic countries. MDRO can cause severe nosocomial infection, which in massive burn patients, will lead to greater morbidity and mortality and strain the institution financially. We aim to highlight 4 key measures that have effectively prevented transmission of imported MDRO. Methods: A case of Candida auris (C. auris) from a massive burn patient transferred from an MDRO endemic country is used to illustrate the measures. C. auris is a globally emerging multi-drug resistant fungal pathogen causing nosocomial transmission. Results: Infection control measures used to mitigate the risk of outbreak from transfer cases are: (1) Multidisciplinary team approach involving Infection Control and Infectious Disease specialists early to ensure appropriate antibiotics use and implementation of barrier measures, (2) aseptic procedures for dressing change with strict isolation and donning of personal protective equipment in the ward, (3) early screening of massive burn patient from MDRO endemic region, (4) hydrogen peroxide vaporization terminal cleaning for operating theatres and rooms. Conclusion: The prevalence of air travel and international transfer to regional burn centres will need effective infection control measures to reduce the risk of transmission from imported massive burn patients. In our centre, we have effectively implemented 4 measures which have reduced the risks of local contamination. We share a recent case report to illustrate successful management of a potential MDRO outbreak resulting from transfer of massive burn patient resident in an MDRO endemic area.

Keywords: burns, burn unit, cross infection, infection control

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Authors: Zainab Idrees Ahmad, Mahjabeen Qureshi, Zainab Hussain

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Standard precautions are a set of infection control practices used to prevent the transmission of diseases that can be acquired by contact with body fluids, non-intact skin, and mucous membranes. Lack of practice of SPs can result in a considerable increase in morbidity and mortality rates. Medical students (the future physicians) should have the highest knowledge of standard precautions to prevent the spread of nosocomial infections and ensure their safety as well. This study was designed. To assess the knowledge of medical students regarding standard precautions. And explore the attitude of medical students of MBBS in the third, fourth and final year towards standard precautions.: A descriptive cross-sectional study was conducted in the setting of Rawalpindi Medical University, Pakistan including the students of MBBS in their 3rd, 4th and final years. The study duration was from October 2022 to February 2023. The sample size calculated was 282 with a confidence interval of 95%. A questionnaire was structured utilizing the WHO guidelines on SPs assessing knowledge and attitude regarding hand hygiene, needle stick injury, use of gloves and mask, and sharp disposal. A total of 300 responses were received utilizing the technique of non-random convenience sampling. Data was analyzed using the latest version of SPSS.:Knowledge score regarding components of SPs, hand hygiene, and moments of hand hygiene was satisfactory. However, score regarding the use of PPE, needle stick injury, and sharp disposal was low. Almost all the students were compliant with the proper washing of hands but the observation of recommended time length was lacking. Compliance with the use of correct PPE and informing the supervisor upon getting a needle stick injury was low. This study signifies that medical students lack knowledge regarding standard precautions. This is alarming as this can be the vehicle for the spread of nosocomial infections. Proper training should be given to medical students to prevent the spread of hospital-acquired infections.

Keywords: attitude, knowledge, medical students, standard precautions

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Authors: Liaqat Ali, Hubert E. Blum, Türkân Sakinc

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Enterococcus faecium is an emerging multidrug-resistant nosocomial pathogen increased dramatically worldwide and causing bacteremia, endocarditis, urinary tract and surgical site infections in immunocomprised patients. The capsular polysaccharides that contribute to pathogenesis through evasion of the host innate immune system are also involved in hindering leukocyte killing of enterococci. The gene cluster (enterococcal polysaccharide antigen) of E. faecalis encoding homologues of many genes involved in polysaccharide biosynthesis. We identified two putative loci with 22 kb and 19 kb which contained 11 genes encoding for glycosyltransferases (GTFs); this was confirmed by using genome comparison of already sequenced strains that has no homology to known capsule genes and the epa-locus. The polysaccharide-conjugate vaccines have rapidly emerged as a suitable strategy to combat different pathogenic bacteria, therefore, we investigated a polysaccharide biosynthesis CapD protein in E. faecium contains 336 amino acids and had putative function for N-linked glycosylation. The deletion/knock-out capD mutant was constructed and complemented by homologues recombination method and confirmed by using PCR and sequencing. For further characterization and functional analysis, in-vitro cell culture and in-vivo a mouse infection models were used. Our ΔcapD mutant shows a strong hydrophobicity and all strains exhibited biofilm production. Subsequently, the opsonic activity was tested in an opsonophagocytic assay which shows increased in mutant compared complemented and wild type strains but more than two fold decreased in colonization and adherence was seen on surface of uroepithelial cells. However, a significant higher bacterial colonialization was observed in capD mutant during animal bacteremia infection. Unlike other polysaccharides biosynthesis proteins, CapD does not seems to be a major virulence factor in enterococci but further experiments and attention is needed to clarify its function, exact mechanism and involvement in pathogenesis of enteroccocal nosocomial infections eventually to develop a vaccine/ or targeted therapy.

Keywords: E. faecium, pathogenesis, polysaccharides, biofilm formation

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Authors: O. Davies, K. Veravalli, P. Panwalkar, M. Tofighi, P. Butterick, B. Healy, A. Mofidi

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Vancomycin resistant enterococcus infection is a condition that usually impacts ICUs, transplant, dialysis, and cancer units, often as a nosocomial infection. After an outbreak in the acute trauma and orthopaedic unit in Morriston hospital, we aimed to access the conditions that predispose VRE infections in our unit. Thirteen cases of VRE infection and five cases of VRE colonisations were identified in patients who were treated for orthopaedic care between 1/1/2020 and 1/11/2021. Cases were reviewed to identify predisposing factors, specifically looking at age, presenting condition and treatment, presence of infection and antibiotic care, active haemo-oncological condition, long term renal dialysis, previous hospitalisation, VRE predisposition, and clearance (PREVENT) scores, and outcome of care. The presenting condition, treatment, presence of postoperative infection, VRE scores, age was compared between colonised and the infected cohort. VRE type in both colonised and infection group was Enterococcus Faecium in all but one patient. The colonised group had the same age (T=0.6 P>0.05) and sex (2=0.115, p=0.74), presenting condition and treatment which consisted of peri-femoral fixation or arthroplasty in all patients. The infected group had one case of myelodysplasia and four cases of chronic renal failure requiring dialysis. All of the infected patient had sustained an infected complication of their fracture fixation or arthroplasty requiring reoperation and antibiotics. The infected group had an average VRE predisposition score of 8.5 versus the score of 3 in the colonised group (F=36, p<0.001). PREVENT score was 7 in the infected group and 2 in the colonised group(F=153, p<0.001). Six patients(55%) succumbed to their infection, and one VRE infection resulted in limb loss. In the orthopaedic cohort, VRE infection is a nosocomial condition that has peri-femoral predilection and is seen in association with immunosuppression or renal failure. The VRE infection cohort has been treated for infective complication of original surgery weeks prior to VRE infection. Based on our findings, we advise avoidance of infective complications, change of practice in use of antibiotics and use radical surgery and surveillance for VRE infections beyond infective precautions. PREVENT score shows that the infected group are unlikely to clear their VRE in the future but not the colonised group.

Keywords: surgical site infection, enterococcus, orthopaedic surgery, vancomycin resistance

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Authors: Preeti Madan, Shalini Malhotra, Nirmaljit Kaur, Charoo Hans, VK Sabarwal

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Hospital is one of the most diverse and complex institutions frequented by people from every walk of life without any distinction between age, sex, gender, religion or intellect. This is over and above the normal inhabitant of hospital i.e. doctors, patients, and paramedical staff. The hospital waste generated 85% is non hazardous, 10% infectious and around 5% are non-infectious but hazardous waste. The management of biomedical waste is still in its infancy. There is a lot of confusion with the problems among the generators, operators, decision makers, and general community about the safe management of biomedical waste prompt action initiated to seek new scientific, safe, and cost-effective management of waste.

Keywords: biomedical waste, nosocomial infection, waste management, hospitals

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Authors: Isma Benmazouz, Bálint Joszef Nagy, Bence Bálacs, Gábor Kardos, László Kővér

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Vancomycin-resistant enterococci (VRE) are among the major nosocomial threats, which have a potential for zoonotic transmission due to the ubiquity of enterococci in the environment and in animal microbiota, e.g., wild birds. . In order to assess the prevalence in an urbanized bird species, 221 fecal samples were collected from Hooded crows (Corvus cornix) in 2020. Fecal samples were screened using VRE agar plates. None of the samples yielded VRE. The absence of VRE isolates in sampled urban hooded crows indicates that crows residing in the city do not necessarily constitute a reservoir of VREs.

Keywords: resistance, crows, Enterococci, wild birds

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Authors: Lillian Musila, Valerie Oundo, Daniel Erwin, Willie Sang

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Staphylococcus aureus infections are a major cause of nosocomial infections in Kenya. Methicillin resistant S. aureus (MRSA) infections are a significant burden to public health and are associated with considerable morbidity and mortality. At a hospital in Western Kenya two clusters of MRSA cases emerged within short periods of time. In this study we explored whether these clusters represented a nosocomial outbreak by characterizing the isolates using phenotypic and molecular assays and examining epidemiological data to identify possible transmission patterns. Specimens from the site of infection of the subjects were collected, cultured and S. aureus isolates identified phenotypically and confirmed by APIStaph™. MRSA were identified by cefoxitin disk screening per CLSI guidelines. MRSA were further characterized based on their antibiotic susceptibility patterns and spa gene typing. Characteristics of cases with MRSA isolates were compared with those with MSSA isolated around the same time period. Two cases of MRSA infection were identified in the two week period between 21 April and 4 May 2015. A further 2 MRSA isolates were identified on the same day on 7 September 2015. The antibiotic resistance patterns of the two MRSA isolates in the 1st cluster of cases were different suggesting that these were distinct isolates. One isolate had spa type t2029 and the other had a novel spa type. The 2 isolates were obtained from urine and an open skin wound. In the 2nd cluster of MRSA isolates, the antibiotic susceptibility patterns were similar but isolates had different spa types: one was t037 and the other a novel spa type different from the novel MRSA spa type in the first cluster. Both cases in the second cluster were admitted into the hospital but one infection was community- and the other hospital-acquired. Only one of the four MRSA cases was classified as an HAI from an infection acquired post-operatively. When compared to other S. aureus strains isolated within the same time period from the same hospital only one spa type t2029 was found in both MRSA and non-MRSA strains. None of the cases infected with MRSA in the two clusters shared any common epidemiological characteristic such as age, sex or known risk factors for MRSA such as prolonged hospitalization or institutionalization. These data suggest that the observed MRSA clusters were multi strain clusters and not an outbreak of a single strain. There was no clear relationship between the isolates by spa type suggesting that no transmission was occurring within the hospital between these cluster cases but rather that the majority of the MRSA strains were circulating in the community. There was high diversity of spa types among the MRSA strains with none of the isolates sharing spa types. Identification of disease clusters in space and time is critical for immediate infection control action and patient management. Spa gene typing is a rapid way of confirming or ruling out MRSA outbreaks so that costly interventions are applied only when necessary.

Keywords: cluster, Kenya, MRSA, spa typing

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Authors: V. Verma, Syed Riyaz-ul-Hassan

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Staphylococcus aureus is one of the most commonly found pathogenic bacteria and is hard to eliminate from the human environment. It is responsible for many nosocomial infections, besides being the main causative agent of food intoxication by virtue of its variety of enterotoxins. Routine detection of S. aureus in food is usually carried out by traditional methods based on morphological and biochemical characterization. These methods are time-consuming and tedious. In addition, misclassifications with automated susceptibility testing systems or commercially available latex agglutination kits have been reported by several workers. Consequently, there is a need for methods to specifically discriminate S. aureus from other staphylococci as quickly as possible. Data on protocols developed using molecular means like PCR technology will be presented for rapid and specific detection of this pathogen in food, clinical and environmental samples, especially milk.

Keywords: food Pathogens, PCR technology, rapid and specific detection, staphylococcus aureus

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Authors: Francis Gyapong, Denis Yar

Abstract:

The use of cell phones has become an indispensable tool in the hospital's settings. Cell phones are used in hospitals without restrictions regardless of their unknown microbial load. However, the indiscriminate use of mobile devices, especially at health facilities, can act as a vehicle for transmitting pathogenic bacteria and other microorganisms. These potential pathogens become exogenous sources of infection for the patients and are also a potential health hazard for self and as well as family members. These are a growing problem in many health care institutions. Innovations in mobile communication have led to better patient care in diabetes, asthma, and increased in vaccine uptake via SMS. Notwithstanding, the use of cell phones can be a great potential source for nosocomial infections. Many studies reported heavy microbial contamination of cell phones among healthcare workers and communities. However, limited studies have been reported in our region on bacterial contamination on cell phones among healthcare workers. This study assessed microbial contamination of cell phones of health care workers (HCWs) at the Mampong Municipal Government Hospital (MMGH), Ghana. A cross-sectional design was used to characterize bacterial microflora on cell phones of HCWs at the MMGH. A total of thirty-five (35) swab samples of cell phones of HCWs at the Laboratory, Dental Unit, Children’s Ward, Theater and Male ward were randomly collected for laboratory examinations. A suspension of the swab samples was each streak on blood and MacConkey agar and incubated at 37℃ for 48 hours. Bacterial isolates were identified using appropriate laboratory and biochemical tests. Kirby-Bauer disc diffusion method was used to determine the antimicrobial sensitivity tests of the isolates. Data analysis was performed using SPSS version 16. All mobile phones sampled were contaminated with one or more bacterial isolates. Cell phones from the Male ward, Dental Unit, Laboratory, Theatre and Children’s ward had at least three different bacterial isolates; 85.7%, 71.4%, 57.1% and 28.6% for both Theater and Children’s ward respectively. Bacterial contaminants identified were Staphylococcus epidermidis (37%), Staphylococcus aureus (26%), E. coli (20%), Bacillus spp. (11%) and Klebsiella spp. (6 %). Except for the Children ward, E. coli was isolated at all study sites and predominant (42.9%) at the Dental Unit while Klebsiella spp. (28.6%) was only isolated at the Children’s ward. Antibiotic sensitivity testing of Staphylococcus aureus indicated that they were highly sensitive to cephalexin (89%) tetracycline (80%), gentamycin (75%), lincomycin (70%), ciprofloxacin (67%) and highly resistant to ampicillin (75%). Some of these bacteria isolated are potential pathogens and their presence on cell phones of HCWs could be transmitted to patients and their families. Hence strict hand washing before and after every contact with patient and phone be enforced to reduce the risk of nosocomial infections.

Keywords: mobile phones, bacterial contamination, patients, MMGH

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Authors: Asma Naim, Warda Mushtaq

Abstract:

Staphylococcus species are the most versatile and adaptive organism. They are widespread and naturally found on the skin, mucosa and nose in humans. Among these, Staphylococcus aureus is the most important species. These organisms act as opportunistic pathogens and can infect various organs of the host, causing minor skin infection to severe toxin mediated diseases, and life threatening nosocomial infections. Staphylococcus aureus has acquired resistance against β-lactam antibiotics by the production of β-lactamase, and Methicillin-Resistant Staphylococcus aureus (MRSA) strains have also been reported with increasing frequency. MRSA strains have been associated with nosocomial as well as community acquired infections. Medicinal plants have enormous potential as antimicrobial substances and have been used in traditional medicine. Search for medicinally valuable plants with antimicrobial activity is being emphasized due to increasing antibiotic resistance in bacteria. In the present study, the antibacterial potential of Rosmarinus officinalis (Rosemary) and Murraya koenigii (curry leaves) was evaluated. These are common household herbs used in food as enhancer of flavor and aroma. The crude aqueous infusion, decoction and ethanolic extracts of curry leaves and rosemary and essential oil of rosemary were investigated in the present study for antibacterial activity against multi-drug resistant Staphylococcus strains using well diffusion method. In the present study, 60 Multi-drug resistant clinical isolates of S. aureus (43) and Coagulase Negative Staphylococci (CoNS) (17) were screened against different concentrations of crude extracts of Rosmarinus officinalis and Murraya koenigii. Out of these 60 isolates, 43 were sensitive to the aqueous infusion of rosemary; 23 to aqueous decoction and 58 to ethanolic extract whereas, 24 isolates were sensitive to the essential oil. In the case of the curry leaves, no antibacterial activity was observed in aqueous infusion and decoction while only 14 isolates were sensitive to the ethanolic extract. The aqueous infusion of rosemary (50% concentration) exhibited a zone of inhibition of 21(±5.69) mm. against CoNS and 17(±4.77) mm. against S. aureus, the zone of inhibition of 50% concentration of aqueous decoction of rosemary was also larger against CoNS 17(±5.78) mm. then S. aureus 13(±6.91) mm. and the 50% concentrated ethanolic extract showed almost similar zone of inhibition in S. aureus 22(±3.61) mm. and CoNS 21(±7.64) mm. whereas, the essential oil of rosemary showed greater zone of inhibition against S. aureus i.e., 16(±4.67) mm. while CoNS showed 15(±6.94) mm. These results show that ethanolic extract of rosemary has significant antibacterial activity. Aqueous infusion and decoction of curry leaves revealed no significant antibacterial potential against all Staphylococcal species and ethanolic extract also showed only a weak response. Staphylococcus strains were susceptible to crude extracts and essential oil of rosemary in a dose depend manner, where the aqueous infusion showed highest zone of inhibition and ethanolic extract also demonstrated antistaphylococcal activity. These results demonstrate that rosemary possesses antistaphylococcal activity.

Keywords: antibacterial activity, curry leaves, multidrug resistant, rosemary, S. aureus

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Authors: Azna Zuberi

Abstract:

Biofilm is a sessile bacterial accretion in which bacteria adapts different physiological and morphological behavior from planktonic form. It is the root cause of about 80% microbial infections in human. Among them, E. coli biofilms are most prevalent in medical devices associated nosocomial infections. The objective of this study was to inhibit biofilm formation by targeting LuxS gene, involved in quorum sensing using CRISPRi. luxS is a synthase, involved in the synthesis of Autoinducer-2(AI-2), which in turn guides the initial stage of biofilm formation. To implement CRISPRi system, we have synthesized complementary sgRNA to target gene sequence and co-expressed with dCas9. Suppression of luxS was confirmed through qRT-PCR. The effect of luxS gene on biofilm inhibition was studied through crystal violet assay, XTT reduction assay and scanning electron microscopy. We conclude that CRISPRi system could be a potential strategy to inhibit bacterial biofilm through mechanism base approach.

Keywords: biofilm, CRISPRi, luxS, microbial

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Authors: Gulcan Sahal, Nermin Hande Avcioglu, Isil Seyis Bilkay

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Klebsiella species which are natural colonizers of human upper respiratory and human gastrointestinal tracts are also responsible for every reoccurring nosocomial infections by means of having ability to form slimy layers known as biofilm on many surfaces. Therefore, in this study, investigation of biofilm formation in K. pneumoniae and K. rhinoscleromatis and examination of each Klebsiella strains’ clinical information in the light of their biofilm formation results were aimed. In this respect, biofilm formation of Klebsiella strains was analyzed via crystal violet binding assay. According to our results, biofilm formation levels of K. pneumoniae and K. rhinoscleromatis strains were different from each other. Additionally, in comparison to K. rhinoscleromatis strains, K. pneumoniae was observed to include higher amounts of strong biofilm forming strains. Besides, it was also seen that clinical information of patients from which strong biofilm forming Klebsiella strains were isolated were similar to each other. Our results indicate that there should be more precautions against K. pneumoniae which includes higher amount of strong biofilm forming strains.

Keywords: biofilm formation, Klebsiella pneumoniae, Klebsiella rhinoscleromatis, biosystems engineering

Procedia PDF Downloads 390

Authors: Abdessamad Dali-Ali, Houaria Beldjillali, Fouzia Agag, Asmaa Oukebdane, Ramzi Tidjani, Arslane Bettayeb, Khadidja Meddeber, Radia Dali-Yahia, Nori Midoun

Abstract:

Healthcare-associated infections are a real public health problem, especially in intensive care units. The aim of our study was to describe the epidemiological profile and to estimate the incidence of these infections at the intensive care unit of our teaching hospital. A prospective study was conducted, from June 2012 to December 2013. During this period, 305 patients having a duration of hospitalization equal or more than 48 hours were included in the study. In terms of the incidence of healthcare associated infections, nosocomial pneumonia occupied the first position with a cumulative incidence rate of 20.0%, followed by bacteremia (5.6%), central venous catheter infections (4%), and urinary tract infections (3%). In the case of isolated microorganisms, Gram-negative bacilli not enterobacteriaceae occupied the first place with 48.5%, followed by enterobacteria (32.1%). Acinetobacter baumannii was the most common germ (27.6%). Our study showed that the rate of health-care-associated infections was relatively high in the intensive care unit. A control program to reduce all infections is a priority for the Infection Control Associated Committee.

Keywords: epidemiological profile, healthcare associated infections, intensive care units, teaching hospital of Oran, Algeria

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Authors: Sara El Mansouria Beghdadi

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Quantitative structure–activity relationship (QSAR) modelling is one of the main computer tools used in medicinal chemistry. Over the past two decades, the incidence of fungal infections has increased due to the development of resistance. In this study, the QSAR was performed on a series of esters of 2-carboxamido-3-(1H-imidazole-1-yl) propanoic acid derivatives. These compounds have showed moderate and very good antifungal activity. The multiple linear regression (MLR) was used to generate the linear 2d-QSAR models. The dataset consists of 115 compounds with their antifungal activity (log MIC) against «Candida albicans» (ATCC SC5314). Descriptors were calculated, and different models were generated using Chemoffice, Avogadro, GaussView software. The selected model was validated. The study suggests that the increase in lipophilicity and the reduction in the electronic character of the substituent in R1, as well as the reduction in the steric hindrance of the substituent in R2 and its aromatic character, supporting the potentiation of the antifungal effect. The results of QSAR could help scientists to propose new compounds with higher antifungal activities intended for immunocompromised patients susceptible to multi-resistant nosocomial infections.

Keywords: quantitative structure–activity relationship, imidazole, antifungal, candida albicans (ATCC SC5314)

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Authors: Tayaba Dastgeer, Farhan Rasheed, Muhammad Saeed, Maqsood Ahmad, Zia Ashraf, Abdul Waheed, Muhammad Kamran, Mohsin Khurshid

Abstract:

Objectives: The study aimed to determine the efficacy of linezolid against clinical isolates of methicillin-resistant staphylococcus aureus (MRSA). Methodology: This cross-sectional study was conducted in the microbiology department of Allama Iqbal Medical College Lahore from August 2017 to September 2019. Isolates were confirmed as MRSA via the presence of the mec-A gene. Confirmed MRSA isolates were processed for susceptibility testing against different antimicrobials, especially linezolid, via the disc diffusion method. Zone sizes were interpreted according to CLSI guidelines. Results: Various types of clinical samples were included in the study; however, the highest frequency of MRSA isolates was found in pus samples, followed by other clinical samples. Among hospitalized patients, most MRSA isolates were obtained from patients in the surgical ward. Of 243 mec-A gene detected isolates, Vancomycin and linezolid showed 100% susceptibility, chloramphenicol showed declining resistance 78 (32.09%), and emerging sensitivity 165 (67.90%) against MRSA. Conclusion: Linezolid is a very efficient drug against MRSA, but the use of this novel drug must be conserved for vancomycin-resistant Staphylococcus aureus or when more resistant pathogens are suspected.

Keywords: MRSA, chloramphenicol, linezolid, nosocomial infections

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Authors: A. Dali-Ali, F. Agag, H. Beldjilali, A. Oukebdane, K. Meddeber, R. Dali-Yahia, N. Midoun

Abstract:

The ability of Acinetobacter baumannii to develop multiple resistances towards to the majority of antibiotics explains the therapeutic difficulties encountered in severe infections. Furthermore, its persistence in the humid or dry environment promotes cross-contamination in intensive care units. The aim of our study was to describe the epidemiological and bacterial resistance profiles of hospital-acquired infections caused by Acinetobacter baumannii in the intensive care unit of our teaching hospital. During the study period (June 3, 2012 to December 31, 2013), 305 patients having duration of hospitalization equal or more than 48 hours were included in the study. Among these, 36 had developed, at least, one health-care associated infection caused by Acinetobacter baumannii. The rate of infected patients was equal to 11.8% (36/305). The rate of cumulative incidence of hospital-acquired pneumonia was the highest (9.2%) followed by central venous catheter infection (1.3%). Analysis of the various antibiotic resistance profile shows that 93.8% of the strains were resistant to imipenem. The nosocomial infection control committee set up a special program not only to reduce the high rates of incidence of these infections but also to descrease the rate of imipenem resistance.

Keywords: Acinetobacer baumannii, epidemiological profile, hospital acquired infections, intensive care unit

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Authors: Rifa’ah Mahmudah Bulu’

Abstract:

MRSA is an important nosocomial pathogen in the world. Therefore, the prevention and effort to control MRSA is still very important to conduct. One of the preventions of MRSA, which have been reported by several studies, is Cefriaxone and Ethanol Extract of Ant Plant. This research is an experimental test to determine the potency of MRSA’s anti-bacterial with Cefriaxone (30 μg) and Ethanol Extract of Ant Plant (13 mg/ml) based on inhibition zone on LAB (Lempeng Agar Biasa). The size of inhibition zone that is formed on Cefriaxone is adjusted with CSLI criteria, which ≥ 21 mm of inhibition zone is called sensitive; ≤13 mm is called resistance and between 14-20 mm is called intermediate. This research is conducted three times. Comparative test between Cefriaxone and Ethanol Extract of Ant Plant is analyzed by Maan Whitney’s statistic method. The Result of Cefriaxone anti-bacterial potency shows the variety of inhibition zone. Cefriaxone forms approximately 16,5-20 mm with average 18,22mm of inhibition zone that make Cefriaxone’s criteria to MRSA’s inhibition is intermediate. Anti-bacterial potency of Ethanol Extract of Ant Plant is about 0,5-2 mm with average 1,17 mm of inhibition zone that prove MRSA is sensitive to Ant Plant. The conclusion of this research shows that Cefriaxone is intermediate to MRSA’s inhibition, while MRSA is sensitive to Ethanol Extract of Ant Plant, which at the end; it creates different potency of anti-bacterial between Cefriaxone and Ethanol Extract of Ant Plant.

Keywords: MRSA, cefriaxone, ant plant, CSLI, mann whitney

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Authors: Rosetta Moshirian Farahi, Ahya Abdi Ali, Sara Gharavi

Abstract:

The major mechanism of Pseudomonas aeruginosa resistance to fluoroquinolones is the alteration of target enzymes, type II and IV topoisomerases due to mutations in the quinolone resistance-determining regions (QRDR) of the gyrA and parC genes coding A subunits of these enzymes. 37 isolates from patients with burn wounds and 20 isolates from blood, urine and sputum specimen were selected to evaluate mutations involved in antibiotic resistance and were subsequently verified for their resistance to ciprofloxacin. QRDRs regions of gyrA and parC were amplified by polymerase chain reaction (PCR) and were subsequently sequenced. 90% of isolates with MIC≥8 µg/ml to ciprofloxacin had a mutation in gyrA gene in which threonine at position 83 changed to isoleucine. 87.5% of isolates had mutation in parC, Serine 87 changed. 75% had Ser87Leu and 12.5% possessed Serin87Trp. Various silent mutations were also detected such as Val103Val, Ala118Ala, Ala136Ala, His132His in gyrA and Ala115Ala in parC. The data indicates that the common mutation in gyrA is Thr83Ile and in parC is Ser87Leu/Trp. No individual parC mutation was observed while mutations in gyrA and parC occurred simultaneously and appears to be the main reason of high-level resistance to fluoroquinolones in patients with burn wounds and urine infection. The vast majority of P.aeruginosa isolates had mutation in parC which can play a crucial role in increased resistance of these isolates. This is a report of parC mutations from resistant P. aeruginosa isolates from Iran, Tehran.

Keywords: P. aeruginosa, fluoroquinolones, gyrA, parC, antibiotic resistance

Procedia PDF Downloads 293