Prophylaxis with antimicrobial agents and treatment of asymptomatic carriers are not recommended, while the use of probiotics remains controversial.30
Nosocomial sinusitis appears to occur due to impaired drainage of the sinus cavity, slowed venous drainage due to positive pressure ventilation and the presence of nasogastric and nasotracheal tubes. Sinusitis is a risk factor for the development of pneumonia. The prevention of sinusitis in the ICU setting is the systematic use of orotracheal intubation.32
Many of the serious HAIs often originate from endogenous sources such as patients’ own flora. Thus, eradication of the colonising bacteria that potentially could cause infections in critically ill patients reflects a strategy often performed in ICUs. Decolonisation policies commonly focus on the eradication/reduction of MRSA carriage on the skin and mucus membrane using different regimens. The local use of mupirocin alone as a 2 % ointment must be avoided because of significant relapse episodes or high reinfection rate. Better results have been reported with the combined use of mupirocin, chlorhexidine baths and systemic
1. Vincent JL, Rello J, Marshall J, et al., International study of the prevalence and outcomes of infection in intensive care units, JAMA, 2009;302:2323.
2. Doyle JS, Buising KL, Thursky KA, et al., Epidemiology of infections acquired in intensive care units, Semin Respir Crit Care Med, 2011;32:115–38.
3. Vallés J, Alvarez-Lerma F, Palomar M, et al., Health-care-associated bloodstream infections at admission to the ICU, Chest, 2011;139:810–5.
4. Ak O, Batirel A, Ozer S, Çolakoğlu S, Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: a prospective cohort study, Med Sci Monit, 2011;17:PH29–34.
5. Gatherer P, Geffers C, Brandt C, et al., Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections, J Hosp Infect, 2006;64:16–22.
6. Rosenthal VD, Maki DG, Jamulitrat S, et al., International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009, Am J Infect Control, 2010;38:95–104.
7. National Nosocomial Surveillance (NNIS) system report, data summary from January 1992- April 2000, issued June 2000, Am J Infect Control, 2000;28:429.
8. European Centre for Disease Control and Prevention/European Medicines Agency, The bacterial challenge: time to react, 2009. Available at: http://ecdc.europa.eu/en/publications/
px?ID=444 (accessed 23 August 2011).
9. European Centre for Disease Prevention and Control, Antimicrobial resistance surveillance in Europe 2009, Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net, 2010. Available at: http://ecdc.europa.eu/en/publications/Publications/Forms/ ECDC_DispForm.as
px?ID=580 (accessed 23 August 2011).
10. Siegel JD, Rhinehart E, Jackson M, et al., Healthcare Infection Control Practices Advisory Committee 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007. Available at: http://www.cdc.gov/hicpac/2007ip/2007isolationprecautions
. html (accessed 23 August 2011).
11. Guidelines jointly prepared by the WHO Regional Offices for South-East Asia and the Western Pacific, Practical Guidelines for Infection Control in Health Care Facilities, 2004. Available
reduction of the risk of infection after ingestion through antimicrobial stewardship, environmental control, room disinfection and barrier precautions.28,30
therapy with one or two antibiotics, such as rifampicin, doxycycline and trimethoprime-sulfamethoxazole, although recolonisation may occur. The intact skin and underlying good health status are very important determinants of success. Screening and decolonisation of hospital care workers remains controversial.
Another method of decontamination is the selective digestive decontamination (SDD) aiming to prevent colonisation by Gram-negative bacteria, S. aureus and yeasts in intensive care patients through the application of non-absorbable antimicrobial agents in the gastrointestinal tract. The most commonly used antibacterials include a parenteral third-generation cephalosporin (for example, cefotaxime), an enteral polymixin, an aminoglycoside and an antifungal agent. The aim of this intervention is to maintain patients’ anaerobic bacteria, although the concerns about the development of highly resistant bacteria have limited its adoption.33–35
In conclusion, ICU-acquired infections are a major cause of increased morbidity and mortality, prolonged hospitalisation and high cost, especially when MDR pathogens are involved. The cornerstone for their treatment is the early recognition of causative pathogens and sites of infections. Infection control in the ICU is based on hand hygiene, surveillance programmes and adequate and appropriate antibiotics use. These methods present an effective manner to reduce the incidence of those infections. n
PracticalguidelinSEAROpub-41.pdf (accessed 23 August 2011).
12. Boyce M, Pittet D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/IDSA, MMWR Recomm Rep, 2002;51:1.
13. Hayash Y, Paterson DL, Strategies for Reduction in Duration of Antibiotic Use in Hospitalized Patients, Clin Infect Dis, 2011;52:1232–40.
14. Malacarne P, Rossi C, Bertolini G, GiVi TIg. Antibiotic usage in intensive care units: a pharmaco-epidemiological multicentre study, J Antimicrob Chemother, 2004;54:221–4.
15. Arnold HM, Micek ST, Skrupky LP, Kollef MH, Antibiotic stewardship in the intensive care unit, Semin Respir Crit Care Med, 2011;32:215–27.
16. Morel J, Casoetto J, Jospé R, et al., De-escalation as part of a global strategy of empiric antibiotherapy management. A retrospective study in a medico-surgical intensive care unit, Crit Care, 2010;14:R225.
17. Blot S, Depuydt P, Vogelaers D, et al., Colonization status and appropriate antibiotic therapy for nosocomial bacteremia caused by antibiotic resistant gram-negative bacteria in an intensive care unit, Infect Control Hosp Epidemiol, 2005;26:575–9.
18. Galoisy-Guibal L, Soubirou JL, Desjeux G, et al., Screening for multidrug-resistant bacteria as a predictive test for subsequent onset of nosocomial infection, Infect Control Hosp Epidemiol, 2006;27:1233–41.
19. Depuydt P, Benoit D, Vogelaers D, et al., Outcome in bacteremia associated with nosocomial pneumonia and the impact of pathogen prediction by tracheal surveillance cultures, Intens Care Med, 2006;32:1773–81.
20. Depuydt PO, Blot SI, Benoit DD, et al., Antimicrobial resistance in nosocomial bloodstream infection associated with pneumonia and the value of systematic surveillance cultures in an adult intensive care unit, Crit Care Med, 2006;34:653–9.
21. Sanders K, Adhikari N, Friedrich J, et al., Previous cultures are not clinically useful for guiding empiric antibiotics in suspected
ventilator associated pneumonia: secondary analysis from a randomized trial, J Crit Care, 2008;23:58–63.
22. Papadomichelakis E, Kontopidou F, Antoniadou A, et al., Screening for resistant gram-negative microorganisms to guide empiric therapy of subsequent infection, Intensive Care Med, 2008;34:2169–75.
23. Baba H, Nimmo GR, Allworth AM, et al., The role of surveillance cultures in the prediction of susceptibility patterns of Gram-negative bacilli in the intensive care unit, Eur J Clin Microbiol Infect Dis, 2011;30:739–44.
24. Klompas M, Prevention of VAP, Expert Rev Anti Infect Ther, 2010;8:791–800.
25. Coffin SE, Klompas M, Classen D, et al., Strategies to prevent ventilator-associated pneumonia in acute care hospitals, Infect Control Hosp Epidemiol, 2008;29 (Suppl. 1):S31–40.
26. Kollef MH, Prevention of hospital-associated pneumonia and ventilator-associated pneumonia, Crit Care Med, 2004;32:1396–405.
27. O' Grady NP, Alexander M, Burns LA, et al., Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. Available at: www.cdc.gov/hicpac/pdf/guidelines/
bsi-guidelines-2011.pdf (accessed 23 August 2011).
28. Dhillon R, Clark J, Infection in the intensive care unit, Curr Anesth Crit Care, 2009;20:175–82.
29. Trautner B, Management of catheter-associated urinary tract infection (CAUTI), Curr Opin Infect Dis, 2010;23:76–82.
30. Kollef M, Smart approaches for reducing nosocomial Infections in the ICU, Chest, 2008;134:447–56.
31. Horan TC, Andrus M, Dudeck MA, CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting, Am J Infect Control, 2008;36:309–32.
32. Eggimann P, Pittlet D, Infection control in the ICU, Chest, 2001;120:2059–93.
33. Hebert C, Robicsek A, Decolonization therapy in infection control, Curr Opin Infect Dis, 2010;23:340–5.
34. de Smet AM, Kluytmans JA, Blok HE, et al., Selective digestive tract and oropharyngeal decontamination and antibiotic resistance in patients in ICUs: an open-label, clustered group-randomised, crossover study, Lancet Infect Dis, 2011;11:372–80.
35. Tacconelli E, Screening and isolation for infection control, J Hosp Infect, 2009;73:371–7.
EUROPEAN INFECTIOUS DISEASE
| Page 2
| Page 3
| Page 4
| Page 5
| Page 6
| Page 7
| Page 8
| Page 9
| Page 10
| Page 11
| Page 12
| Page 13
| Page 14
| Page 15
| Page 16
| Page 17
| Page 18
| Page 19
| Page 20
| Page 21
| Page 22
| Page 23
| Page 24
| Page 25
| Page 26
| Page 27
| Page 28
| Page 29
| Page 30
| Page 31
| Page 32
| Page 33
| Page 34
| Page 35
| Page 36
| Page 37
| Page 38
| Page 39
| Page 40
| Page 41
| Page 42
| Page 43
| Page 44
| Page 45
| Page 46
| Page 47
| Page 48
| Page 49
| Page 50
| Page 51
| Page 52
| Page 53
| Page 54
| Page 55
| Page 56
| Page 57
| Page 58
| Page 59
| Page 60
| Page 61
| Page 62
| Page 63
| Page 64
| Page 65
| Page 66
| Page 67
| Page 68
| Page 69
| Page 70
| Page 71
| Page 72
| Page 73
| Page 74
| Page 75
| Page 76
| Page 77
| Page 78
| Page 79
| Page 80
| Page 81
| Page 82
| Page 83
| Page 84
| Page 85
| Page 86
| Page 87
| Page 88
| Page 89
| Page 90
| Page 91
| Page 92