Nosocomial infection

Nosocomial infection

see also Nosocomial meningitis.


Hospital-acquired infection (HAI) — also known as nosocomial infection — is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff.


In a single-center, retrospective analysis of critically ill pediatric trauma patients, nosocomial infections were more frequently observed in patients admitted following polytrauma with traumatic brain injury than in patients with isolated traumatic brain injury or trauma without traumatic brain injury 1).


In the last few decades, there has been a tremendous advancement in foetal and maternal care, and it has led to premature babies born as early as 25 weeks of gestation being nursed and cared for in neonatal and pediatric intensive care units. However, these children can pick up a number of uncommon and rare hospital-acquired infections including central nervous system infections.

Wagh and Sinha have given their own insight as to the prevention of healthcare-associated infections in paediatric intensive care settings and reviewed the current literature on the topic.

Healthcare-associated infections are largely preventable provided adequate prevention and protective measures are put in place and prevention guidelines are stritctly followed 2).


In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year.

In Europe, where hospital surveys have been conducted, the category of gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to gram-negative bacteria that can infect people outside the hospital.

Hospital-acquired infections are an important category of hospital-acquired conditions. HAI is sometimes expanded as healthcare associated infection to emphasize that infections can be correlated with health care in various settings (not just hospitals), which is also true of hospital-acquired conditions generally.


Data on nosocomial bloodstream infections (NBSI) in neurosurgery is limited. A study aimed to analyze the epidemiology, microbiology, outcome, and risk factors for death in neurosurgical patients with NBSI in a multidrug resistant setting.

Neurosurgical patients with a confirmed NBSI within the period 2003-2012 were retrospectively analyzed. NBSI was diagnosed when a pathogen was isolated from a blood sample obtained after the first 48 h of hospitalization. Patients’ demographic, clinical, and microbiological data were recorded and analyzed using univariate and multivariate analysis.

A total of 236 patients with nosocomial infection (NI) were identified and 378 isolates were recovered from blood cultures. Incidence of NI was 4.3 infections/1000 bed-days. Gram negative bacteria slightly predominated (54.5 %). The commonest bacteria were coagulase-negative Staphylococcus (CoNS, 26 %), Klebsiella pneumoniae (15.3 %), Pseudomonas aeruginosa (14.8 %), and Acinetobacter baumannii(13.2 %). Carbapenem resistance was found in 90 % of A. baumannii, in 66 % of P. aeruginosa, and in 22 % (2003-2007) to 77 % (2008-2012) of K. pneumoniae isolates (p < 0.05). Most CoNS and Staphylococcus aureus isolates (94 and 80 %, respectively) were methicillin-resistant. All Gram-negative isolates were sensitive to colistin and all Gram-positive isolates were sensitive to vancomycin and linezolid. Antimicrobial consumption decreased after 2007 (p < 0.05). Overall mortality was 50.4 %. In multivariate analysis, advanced age and stay in an Intermediate Care Unit (IMCU) were independent risk factors for in-hospital mortality (p < 0.05).

Overall, high incidence of NBSI and considerable resistance of Gram positive and particularly Gram negative bacteria were noted in neurosurgical patients. Mortality was high with advanced age and stay in IMCU being the most important death-related factor 3).


Case series

In one hundred fifty-three patients with aSAH. Delayed cerebral ischemia (DCI) was identified in 32 patients (20.9%). Nosocomial infection (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.09-11.2, p = 0.04), ventriculitis (OR 25.3, 95% CI 1.39-458.7, p = 0.03), aneurysm re-rupture (OR 7.55, 95% CI 1.02-55.7, p = 0.05), and clinical vasospasm (OR 43.4, 95% CI 13.1-143.4, p < 0.01) were independently associated with the development of DCI. Diagnosis of nosocomial infection preceded the diagnosis of DCI in 15 (71.4%) of 21 patients. Patients diagnosed with nosocomial infection experienced significantly worse outcomes as measured by the modified Rankin Scale score at discharge and 1 year (p < 0.01 and p = 0.03, respectively).

Nosocomial infection is independently associated with DCI. This association is hypothesized to be partly causative through the exacerbation of systemic inflammation leading to thrombosis and subsequent ischemia 4).

References

1)

Sribnick EA, Hensley J, Moore-Clingenpeel M, Muszynski JA, Thakkar RK, Hall MW. Nosocomial Infection Following Severe Traumatic Injury in Children. Pediatr Crit Care Med. 2020 Feb 25. doi: 10.1097/PCC.0000000000002238. [Epub ahead of print] PubMed PMID: 32106190.
2)

Wagh A, Sinha A. Prevention of healthcare associated infections in pediatric intensive care unit. Childs Nerv Syst. 2018 Aug 18. doi: 10.1007/s00381-018-3909-4. [Epub ahead of print] PubMed PMID: 30121831.
3)

Tsitsopoulos PP, Iosifidis E, Antachopoulos C, Anestis DM, Karantani E, Karyoti A, Papaevangelou G, Kyriazidis E, Roilides E, Tsonidis C. Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence. Acta Neurochir (Wien). 2016 Sep;158(9):1647-54. doi: 10.1007/s00701-016-2890-5. Epub 2016 Jul 25. PubMed PMID: 27452903.
4)

Foreman PM, Chua M, Harrigan MR, Fisher WS 3rd, Vyas NA, Lipsky RH, Walters BC, Tubbs RS, Shoja MM, Griessenauer CJ. Association of nosocomial infections with delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. J Neurosurg. 2016 Dec;125(6):1383-1389. PubMed PMID: 26871202.

Una proteína del alzhéimer podría transmitirse por la contaminación del instrumental quirúrgico

Se ha comprobado que miles de personas que fueron inyectadas con hormonas del crecimiento extraídas quirúrgicamente de las glándulas pituitarias de cadáveres, un procedimiento médico que se realizó en el Reino Unido entre 1958 y 1985, han acabado desarrollando ECJ. Se cree que las hormonas transportaban los priones de la ECJ, que se habrían adherido a los instrumentos quirúrgicos durante el proceso de extracción.
Al estudiar esos ocho cerebros, el equipo de Collinge descubrió que en seis de ellos había beta-amiloides, asociados con el alzhéimer. En cuatro casos, los depósitos de amiloides estaban extendidos, apuntan los científicos, que aclaran que ninguno de los pacientes presentaban signos de padecer alzhéimer hereditario de aparición temprana. Los expertos creen que el tratamiento con la hormona del crecimiento que se hizo a todos los pacientes pudo estar en el origen de la aparición del alzhéimer así como de la ECJ, debido a esa transmisión por neurocirugía.
Los fragmentos de la proteína beta-amiloide pueden adherirse también a las superficies de metal y resisten la esterilización convencional, argumentan. “Es posible que haya tres maneras de que se generen las semillas de estas proteínas en el cerebro -explica Collinge-. Pueden aparecer espontáneamente con la edad, que haya un gen defectuoso o que surjan tras haber sido expuesto a un accidente médico”. “Esta es nuestra hipótesis”, afirma el científico.

Los expertos descartan que los rastros de alzhéimer procedieran de la enfermedad de Creutzfeldt-Jakob, pues, en otro estudio, 116 pacientes afectados de este mal que no habían sido tratados con la hormona del crecimiento extraída de cadáveres no presentaban marcadores de alzhéimer. Collinge advierte de que, en el caso de las proteínas del alzhéimer, “potencialmente, las semillas podrían adherirse a la superficie de cualquier instrumento de metal”, lo que incluye los utilizados por el dentista en procedimientos que afectan al tejido nervioso.
El experto subrayó, no obstante, que no hay pruebas de transmisión epidemiológica que sugieran que la enfermedad pueda contagiarse por transfusiones de sangre y señaló que el mal de Alzhéimer “no es una enfermedad contagiosa”. “No puede contraerse por vivir con una persona con alzhéimer o por cuidarla”, aseveró. Otros expertos han advertido de que, aunque interesantes, las conclusiones de este informe son prematuras, pues solo se refieren a ocho pacientes.

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