目的 探究老年导管相关尿路感染(catheter-associated urinary tract infection, CAUTI)中微生物群落的动态变化及其抗生素耐药性的发展,以期对CAUTI的预防和治疗策略提供新的理论依据。方法 本前瞻性队列研究共纳入30名老年导管尿路感...目的 探究老年导管相关尿路感染(catheter-associated urinary tract infection, CAUTI)中微生物群落的动态变化及其抗生素耐药性的发展,以期对CAUTI的预防和治疗策略提供新的理论依据。方法 本前瞻性队列研究共纳入30名老年导管尿路感染患者,分为CAUTI组(n=15)和对照组(n=15)。通过16S rRNA基因测序技术分析微生物种类,使用Kirby-Bauer纸片扩散法进行抗生素敏感性测试,并采用统计学方法比较两组间微生物群落结构和抗生素耐药性的差异。结果 两组患者的一般人口学特征相似。在微生物群落结构分析中,CAUTI组患者样本中大肠埃希菌属、葡萄球菌属和链球菌属的丰度显著高于对照组(大肠埃希菌属9.25%±2.44%vs 8.00%±2.49%,P<0.05;葡萄球菌属9.38%±2.70%vs 7.03%±2.17%,P<0.05;链球菌属10.09%±2.65%vs 8.95%±3.73%,P<0.05)。α多样性指数中,Simpson指数在CAUTI组有显著下降(0.58±0.31 vs 0.77±0.26,P<0.05)。β多样性分析揭示两组微生物群落分布存在显著差异。抗生素敏感性测试结果表明,CAUTI组抑菌圈直径普遍小于对照组(β内酰胺类18.45±1.23 mm vs 20.67±1.56 mm,P<0.05;喹诺酮类21.57±1.78 mm vs 23.89±1.45 mm,P<0.05;大环内酯类19.32±1.65 mm vs 22.43±1.29 mm,P<0.05)。CAUTI组耐药菌株比例显著高于对照组(46.7%vs 20%,P<0.05)。结论 CAUTI患者的尿液和导尿管样本中微生物群落组成存在显著差异,且表现出更高的抗生素耐药性。这些数据表明CAUTI的临床治疗需要更加关注抗生素的合理选择和使用,同时也提示了未来研究需要关注微生物群落对治疗响应的影响。展开更多
Background: In 2008, the catheter associated urinary tract infection (CAUTI) rate at King Fahad Medical City (KFMC) was 3.8/1000 urinary catheter days with some variability between departments. KFMC is the newest tert...Background: In 2008, the catheter associated urinary tract infection (CAUTI) rate at King Fahad Medical City (KFMC) was 3.8/1000 urinary catheter days with some variability between departments. KFMC is the newest tertiary, referral and teaching hospital with 1100 beds in Riyadh, Saudi Arabia. The Infection Control Department at KFMC decided to implement a quality improvement project by applying the bladder bundle in our general ward (Non-ICU) using the model of National Health Service (NHS) hospitals in England even though there was good evidence supporting this infection control practice only in ICU patients?[1][2]. Our objective was to decrease CAUTI in two non-ICU units by at least 50% in one year. Study design: This was a prospective interventional quality improvement project aiming to decrease CAUTI in two non-ICU inpatient units with a total of?193 beds including children and adult patients. Our intervention includes insertion and maintenance components. Results: CAUTI decreased significantly in both departments from 23 infections in?2008 (Rate: 5.03/1000 CDs) to 12 infections in 2009 (Rate: 1.92/1000 CDs) (P?= 0.0001);in RH (Rehabilitation hospital) from 18 in 2008 (Rate: 4/1000 CDs) to 11 infections in 2009 (Rate: 0.36/1000?CDs) (P?< 0.0001) and in NSI (National Neuroscience Institute) from 5 in 2008 (Rate: 5.42/1000?CDs) to 1 infections in 2009 (Rate: 3.16/1000 CDs) (P?< 0.0001). Conclusion: Implementation of urinarycatheter insertion and daily care bundles, and creation of a competitive spirit among employees were associated with a significant reduction in catheter associated urinary tract infections.展开更多
The high incidence of catheter-associated urinary tract infections,which are dominated by drugresistant bacteria,has attracted an increasing number of researchers interested in solving this public health problem.The p...The high incidence of catheter-associated urinary tract infections,which are dominated by drugresistant bacteria,has attracted an increasing number of researchers interested in solving this public health problem.The purpose of this study was to explore the killing effect of lowtemperature air plasma(LTAP)on extended-spectrum beta-lactamase-producing Escherichia coli and high level gentamycin resistance enterococci under two simulated environments in vitro.The results showed that the survival rate of these two kinds of bacteria decreased to less than20%after being treated by LTAP in different environments for 5 min.A comparison of the LTAP treatments showed that the killing efficacy of the two kinds of bacteria in the early stage(0-1 min)was up to 50%.Moreover,the results of transmission electron microscopy,reactive nitrogen species measurement,and a temperature test indicated that the bactericidal effect of the LTAP treatment on the two kinds of bacteria worked through the destruction of the ribosome and other organelles inside the bacteria,rather than the thermal effect,to achieve sterilization.展开更多
Introduction: Catheter Associated Urinary Tract Infection is the most common hospital acquired infection worldwide. Urinary Tract Infections among catheterised patients are on rise regardless of antibiotic use and thi...Introduction: Catheter Associated Urinary Tract Infection is the most common hospital acquired infection worldwide. Urinary Tract Infections among catheterised patients are on rise regardless of antibiotic use and this is due to erratic use of antibiotics, treatment failure, antimicrobial resistance and emergency of Extended Spectrum Beta Lactamase producing bacteria leading to patient distress, increased healthcare costs, long hospital stay and poor patient response to antibiotics. In Uganda, no previous studies have sought to study the burden of CAUTI among catheterized patients, the bacterial pathogens involved and their antimicrobial susceptibility patterns yet there is upsurge in antimicrobial resistance of uropathogens. The effective management of patients suffering from Catheter Associated Urinary Tract infection (CAUTI) relays on the identification of uropathogens that cause CAUTI and the selection of an effective antibiotic agent to the uropathen in question. Objectives: The objectives of this study were to determine incidence, etiology and antibiotic susceptibility pattern among the uropathogens causing Catheter Associated Urinary Tract Infections among patients with indwelling catheters at Kabale Regional Referral Hospital. Methods: Using a descriptive prospective observational hospital-based study, the study was conducted on 150 catheterized patients recruited from Emergency, Obstetrics and gynecology, Medical, Maternity and Surgical wards at Kabale Regional Referral Hospital between April and May 2019. The urine samples from study participants were processed in Kabale RRH microbiology laboratory as per standard operating procedures. After isolation and identification, all the isolates were subjected to antibiotic susceptibility testing for commonly used antibiotics. Results: Following the urine culture from 150 catheterized patients, urine from 23 (15.3%) patients showed significant growth. The common bacterial isolates were Escherichia coli 12 (52%), followed by the Klebsiella pneumoniae 6 (26%), Staphylococcus aureus 3 (13%) and Pseudomonas spp. 2 (8.7%). All Gram-negative isolates were sensitive to Imipenem 20 (100%) while all S. aureus isolates (3) were 100% sensitive to Vancomycin and Cefoxitin. Isolates were sensitive to Gentamicin 20 (82.6), Ceftriaxone 16 (69.6), Ciprofloxacin 10 (43.5) and Nitrofurantoin 9 (39.1). All isolates were 100% resistant to Cotrimoxazole. 6 gram negative isolates were resistant to ceftazidime and were tested for Extended Spectrum Beta (ß) Lactamase (ESBL), 5 (83.3%) were identified as ESBL-producing bacteria. K. pneumonia 3 (60%) presented the highest percentage of ESBLs as compared to E. coli 2 (40%). Conclusions: The Incidence of CAUTI among patients with indwelling urinary catheters at Kabale Regional Referral Hospital is high (15.3%) and is mostly caused by E. coli and K. pneumoniae. These bacteria are resistant to most commonly used antibiotics and thus there is a need to put more emphasis on CAUTI prevention strategies and use culture and sensitivity tests before prescription of antibiotics.展开更多
Urinary tract infections (UTI) are very common in all the developed as well as developing countries in which the majority of infections are catheter associated. Catheter associated urinary tract infections (CAUTI) is ...Urinary tract infections (UTI) are very common in all the developed as well as developing countries in which the majority of infections are catheter associated. Catheter associated urinary tract infections (CAUTI) is one of the major causes of hospital acquired infections. The aim of this study is to investigate influential demographic factors responsible for contamination associated with the rate of CAUTI, while taking into account type of urinary catheter used, the most common organisms found, patient diagnosis, age, gender, and comparison with other studies. During the study, 22 uropathogenic species were isolated from the different segments of urinary catheter samples of the patients collected from 12 different hospitals of Amravati city, Maharashtra, India from January 2015 to 2018. Gram negative organisms were the most frequent isolates, with <i>Pseudomonas aeruginosa</i> (16.08%) being the most common followed by <i>Escherichia coli</i> (10%) and <i>Candida albicans</i> accounted for almost 11% of all the uropathogens. It was found that the majority of uropathogens were isolated from the section A (Catheter segment inside the bladder) and section E (Catheter segment connected to drainage tube) of the urinary catheter. The duration of the catheterization plays the major role in the contamination and further infection to continue. It was observed that the female catheterized patients are more prone to the contamination and infection as compared to male catheterized patient. The antibiotic sensitivity pattern indicates that MAR (Multiple Antibiotic Resistance) index was more than 0.2 for almost all the uropathogens tested concluding that there is antibiotic stress on uropathogens and rate of resistance increased rapidly. Also it was found that there was a statistically significant association between the duration of catheterization, type of disease, age of patient and type of catheter with respect to gender.展开更多
文摘目的 探究老年导管相关尿路感染(catheter-associated urinary tract infection, CAUTI)中微生物群落的动态变化及其抗生素耐药性的发展,以期对CAUTI的预防和治疗策略提供新的理论依据。方法 本前瞻性队列研究共纳入30名老年导管尿路感染患者,分为CAUTI组(n=15)和对照组(n=15)。通过16S rRNA基因测序技术分析微生物种类,使用Kirby-Bauer纸片扩散法进行抗生素敏感性测试,并采用统计学方法比较两组间微生物群落结构和抗生素耐药性的差异。结果 两组患者的一般人口学特征相似。在微生物群落结构分析中,CAUTI组患者样本中大肠埃希菌属、葡萄球菌属和链球菌属的丰度显著高于对照组(大肠埃希菌属9.25%±2.44%vs 8.00%±2.49%,P<0.05;葡萄球菌属9.38%±2.70%vs 7.03%±2.17%,P<0.05;链球菌属10.09%±2.65%vs 8.95%±3.73%,P<0.05)。α多样性指数中,Simpson指数在CAUTI组有显著下降(0.58±0.31 vs 0.77±0.26,P<0.05)。β多样性分析揭示两组微生物群落分布存在显著差异。抗生素敏感性测试结果表明,CAUTI组抑菌圈直径普遍小于对照组(β内酰胺类18.45±1.23 mm vs 20.67±1.56 mm,P<0.05;喹诺酮类21.57±1.78 mm vs 23.89±1.45 mm,P<0.05;大环内酯类19.32±1.65 mm vs 22.43±1.29 mm,P<0.05)。CAUTI组耐药菌株比例显著高于对照组(46.7%vs 20%,P<0.05)。结论 CAUTI患者的尿液和导尿管样本中微生物群落组成存在显著差异,且表现出更高的抗生素耐药性。这些数据表明CAUTI的临床治疗需要更加关注抗生素的合理选择和使用,同时也提示了未来研究需要关注微生物群落对治疗响应的影响。
文摘Background: In 2008, the catheter associated urinary tract infection (CAUTI) rate at King Fahad Medical City (KFMC) was 3.8/1000 urinary catheter days with some variability between departments. KFMC is the newest tertiary, referral and teaching hospital with 1100 beds in Riyadh, Saudi Arabia. The Infection Control Department at KFMC decided to implement a quality improvement project by applying the bladder bundle in our general ward (Non-ICU) using the model of National Health Service (NHS) hospitals in England even though there was good evidence supporting this infection control practice only in ICU patients?[1][2]. Our objective was to decrease CAUTI in two non-ICU units by at least 50% in one year. Study design: This was a prospective interventional quality improvement project aiming to decrease CAUTI in two non-ICU inpatient units with a total of?193 beds including children and adult patients. Our intervention includes insertion and maintenance components. Results: CAUTI decreased significantly in both departments from 23 infections in?2008 (Rate: 5.03/1000 CDs) to 12 infections in 2009 (Rate: 1.92/1000 CDs) (P?= 0.0001);in RH (Rehabilitation hospital) from 18 in 2008 (Rate: 4/1000 CDs) to 11 infections in 2009 (Rate: 0.36/1000?CDs) (P?< 0.0001) and in NSI (National Neuroscience Institute) from 5 in 2008 (Rate: 5.42/1000?CDs) to 1 infections in 2009 (Rate: 3.16/1000 CDs) (P?< 0.0001). Conclusion: Implementation of urinarycatheter insertion and daily care bundles, and creation of a competitive spirit among employees were associated with a significant reduction in catheter associated urinary tract infections.
文摘The high incidence of catheter-associated urinary tract infections,which are dominated by drugresistant bacteria,has attracted an increasing number of researchers interested in solving this public health problem.The purpose of this study was to explore the killing effect of lowtemperature air plasma(LTAP)on extended-spectrum beta-lactamase-producing Escherichia coli and high level gentamycin resistance enterococci under two simulated environments in vitro.The results showed that the survival rate of these two kinds of bacteria decreased to less than20%after being treated by LTAP in different environments for 5 min.A comparison of the LTAP treatments showed that the killing efficacy of the two kinds of bacteria in the early stage(0-1 min)was up to 50%.Moreover,the results of transmission electron microscopy,reactive nitrogen species measurement,and a temperature test indicated that the bactericidal effect of the LTAP treatment on the two kinds of bacteria worked through the destruction of the ribosome and other organelles inside the bacteria,rather than the thermal effect,to achieve sterilization.
文摘Introduction: Catheter Associated Urinary Tract Infection is the most common hospital acquired infection worldwide. Urinary Tract Infections among catheterised patients are on rise regardless of antibiotic use and this is due to erratic use of antibiotics, treatment failure, antimicrobial resistance and emergency of Extended Spectrum Beta Lactamase producing bacteria leading to patient distress, increased healthcare costs, long hospital stay and poor patient response to antibiotics. In Uganda, no previous studies have sought to study the burden of CAUTI among catheterized patients, the bacterial pathogens involved and their antimicrobial susceptibility patterns yet there is upsurge in antimicrobial resistance of uropathogens. The effective management of patients suffering from Catheter Associated Urinary Tract infection (CAUTI) relays on the identification of uropathogens that cause CAUTI and the selection of an effective antibiotic agent to the uropathen in question. Objectives: The objectives of this study were to determine incidence, etiology and antibiotic susceptibility pattern among the uropathogens causing Catheter Associated Urinary Tract Infections among patients with indwelling catheters at Kabale Regional Referral Hospital. Methods: Using a descriptive prospective observational hospital-based study, the study was conducted on 150 catheterized patients recruited from Emergency, Obstetrics and gynecology, Medical, Maternity and Surgical wards at Kabale Regional Referral Hospital between April and May 2019. The urine samples from study participants were processed in Kabale RRH microbiology laboratory as per standard operating procedures. After isolation and identification, all the isolates were subjected to antibiotic susceptibility testing for commonly used antibiotics. Results: Following the urine culture from 150 catheterized patients, urine from 23 (15.3%) patients showed significant growth. The common bacterial isolates were Escherichia coli 12 (52%), followed by the Klebsiella pneumoniae 6 (26%), Staphylococcus aureus 3 (13%) and Pseudomonas spp. 2 (8.7%). All Gram-negative isolates were sensitive to Imipenem 20 (100%) while all S. aureus isolates (3) were 100% sensitive to Vancomycin and Cefoxitin. Isolates were sensitive to Gentamicin 20 (82.6), Ceftriaxone 16 (69.6), Ciprofloxacin 10 (43.5) and Nitrofurantoin 9 (39.1). All isolates were 100% resistant to Cotrimoxazole. 6 gram negative isolates were resistant to ceftazidime and were tested for Extended Spectrum Beta (ß) Lactamase (ESBL), 5 (83.3%) were identified as ESBL-producing bacteria. K. pneumonia 3 (60%) presented the highest percentage of ESBLs as compared to E. coli 2 (40%). Conclusions: The Incidence of CAUTI among patients with indwelling urinary catheters at Kabale Regional Referral Hospital is high (15.3%) and is mostly caused by E. coli and K. pneumoniae. These bacteria are resistant to most commonly used antibiotics and thus there is a need to put more emphasis on CAUTI prevention strategies and use culture and sensitivity tests before prescription of antibiotics.
文摘Urinary tract infections (UTI) are very common in all the developed as well as developing countries in which the majority of infections are catheter associated. Catheter associated urinary tract infections (CAUTI) is one of the major causes of hospital acquired infections. The aim of this study is to investigate influential demographic factors responsible for contamination associated with the rate of CAUTI, while taking into account type of urinary catheter used, the most common organisms found, patient diagnosis, age, gender, and comparison with other studies. During the study, 22 uropathogenic species were isolated from the different segments of urinary catheter samples of the patients collected from 12 different hospitals of Amravati city, Maharashtra, India from January 2015 to 2018. Gram negative organisms were the most frequent isolates, with <i>Pseudomonas aeruginosa</i> (16.08%) being the most common followed by <i>Escherichia coli</i> (10%) and <i>Candida albicans</i> accounted for almost 11% of all the uropathogens. It was found that the majority of uropathogens were isolated from the section A (Catheter segment inside the bladder) and section E (Catheter segment connected to drainage tube) of the urinary catheter. The duration of the catheterization plays the major role in the contamination and further infection to continue. It was observed that the female catheterized patients are more prone to the contamination and infection as compared to male catheterized patient. The antibiotic sensitivity pattern indicates that MAR (Multiple Antibiotic Resistance) index was more than 0.2 for almost all the uropathogens tested concluding that there is antibiotic stress on uropathogens and rate of resistance increased rapidly. Also it was found that there was a statistically significant association between the duration of catheterization, type of disease, age of patient and type of catheter with respect to gender.
