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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Late onset perinatal sepsis in the neonatology intensive care unit – risk factors

Abstract

The lowest-birth-weight premature is very susceptible for nosocomial infections. These infants require the most invasive therapeutic interventions and the longest exposure to environment conductive for microbial colonization. Incidence of nosocomial infection and risk factors in premature has been compared over two years, 2010 and 2015. We examined the effects of common procedures on the incidence of nosocomial sepsis. Birth weight, distribution of pathogens and the therapeutically procedures had been analysed. We tried to find strategies to minimise the risks for acquiring sepsis. Hospital documentation from neonatal intensive care unit (NICU) has been analysed retrospectively during two different years in the University Hospital Osijek. Incidence of nosocomial sepsis among hospitalised premature has been 8.9% in 2010, and 4.8% in 2015. The highest rate of affected infants weighed below 1,500 g in both periods. Statistically significance in these two periods has been found in the percentage of pre-term infants with umbilical vein catheter (UVC), and in the number of pre-term on invasive mechanical ventilation. The most common pathogen in 2010 was methicillin-resistant Staphylococcus epidermidis (MRSE), and in 2015 coagulase negative Staphylococci (CONS). The percentage of Candida parapsylosis was higher in 2015. Lowering the incidence of late-onset sepsis has been accomplished by using peripherally inserted central catheters (PICCs) and non-invasive mechanical ventilation. Invasive procedures must be avoided as much as possible.

Key words: low-birth-weight pre-term infants, nosocomial infections, risk factors, umbilical venous catheters, NICU, PICC, mechanical ventilation, high-flow nasal cannula

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The significance of demographic factors (age, sex, preoperative physiological status) and type of surgery on patients’ outcome in ICU

Abstract

The incidence of postoperative death has changed little in recent years. Most deaths occur in older patients with coexisting medical diseases who undergo major surgery.

The objective of our research was to investigate the significance of demographic factors (age, gender, preoperational physiological status) and type of surgery on the outcome of treatment. This study included 288 patients older than 18 years of age that were treated in the intensive care unit (ICU) for at least 24 hours after a surgical procedure (both elective and emergency) between 1st January 2010 and 31st March 2011. The average age of patients included in the survey was 68 (range 19-88). APACHE II score was between 2.9 and 83.1 points, with an average value of 12.90 points. In this study, male gender (n=186) was much more common than female gender (n=102). Age of patients who died in the ICU was higher than the age of those who were discharged but it was not a statistically significant predictor of patient death. APACHE II score is associated with increased age of patients, neurosurgical operations and incidence of nosocomial infections. Patients’ age and female gender had a strong negative correlation with nosocomial infection. Actual mortality rate for patients was 21%. Ratio between actual and predicted mortality was 1.4.

Key words: demographics, ICU, APACHE, type of surgery, nosocomial infections.

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The risk of central line-associated bloodstream infections with different types of central vascular catheters in a multidisciplinary neonatal and pediatric intensive care unit

Abstract

Objective. Central line-associated bloodstream infections (CLABSIs) are a significant cause of morbidity in critically ill neonates and children. The objective of this study was to compare CLABSI rate associated with different types of central vascular catheters (CVCs) in a multidisciplinary neonatal and pediatric intensive care unit (ICU).
Methods. A prospective cohort study was conducted in a multidisciplinary neonatal and pediatric ICU. All patients, admitted between January 1st 2011 and February 29th 2012, requiring a CVC were included and monitored for CLABSI (defined by CDC/NHSN criteria). CLABSI rates were calculated for each type of CVC as CLABSI episodes/1000 catheter-days. CLABSI rates were compared between patients with single and multiple CVCs.
Results. Of the 557 patients admitted, 362 (65%) required insertion of a CVC (4259 patient-days, 3225 catheter-days, CVC utilization ratio 0.76). There were 14 episodes of CLABSI. CLABSI rate was lowest for umbilical catheters (0/1000 catheter-days), followed by short-term noncuffed and nontunneled CVCs (3.1/1000 catheter-days) and peripherally inserted CVCs (8.8/1000 catheter-days). Higher rates were observed with long-term cuffed and tunneled CVCs (15.9/1000 catheter days) and noncuffed, nontunneled CVCs for temporary renal replacement therapy (RRT) (20.0/1000 catheter days). CLABSI rate expressed per 1000 catheter-days was 3.0 and 19.7 for patients with single or multiple CVCs at the same time, respectively.
Conclusion. The use of noncuffed, nontunneled CVCs for temporary RRT and the presence of multiple CVCs at the same time are associated with a significant increase in the rate and risk of developing CLABSI in a multidisciplinary neonatal and pediatric ICU population.

Key words: central line-associated bloodstream infections, nosocomial infections, central vascular catheter, bloodstream infections, pediatric intensive care unit, neonate, child

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