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  • 1
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    Online Resource
    Bloodstream Infections Caused by Metallo- β -Lactamase/ Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae among Intensive Care Unit Patients in Greece: Risk Factors for Infection and Impact of Type of Resistance on Outcomes
    Cambridge University Press (CUP) ; 2010
    In:  Infection Control & Hospital Epidemiology Vol. 31, No. 12 ( 2010-12), p. 1250-1256
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 31, No. 12 ( 2010-12), p. 1250-1256
    Abstract: To determine risk factors for bloodstream infections (BSIs) caused by Klebsiella pneumoniae producing metallo-β-lactamases (MBLs) or K. pneumoniae carbapenemases (KPCs), as well as risk factors for mortality associated with carbapenem-resistant K. pneumoniae , among intensive care unit (ICU) patients. Methods. Two case-control studies were conducted in a patient cohort with K. pneumoniae BSIs in an 8-bed ICU in a Greek hospital from January 1, 2007, through December 31, 2008. In study 1, patients with K. pneumoniae BSIs were allocated among 3 groups according to isolate susceptibility profile: (1) carbapenem-susceptible insolates (control group), (2) MBL-producing isolates, or (3) KPC-producing isolates. The MBL and KPC groups were compared with the control group to identify risk factors for development of K. pneumoniae BSI. In study 2, patients with K. pneumoniae BSIs who died were compared with survivors to identify risk factors for mortality. Results. Fifty-nine patients had K. pneumoniae BSIs (22 with carbapenem-susceptible isolates, 18 with MBL-producing isolates, and 19 with KPC-producing isolates). All KPC-producing isolates carried the bla KPC-2 gene, and 17 of 18 MBL-producing isolates carried bla VIM-1 Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.13 [95% confidence interval, 1.03–1.25]; P = .02) was independently associated with KPC-producing K. pneumoniae BSIs. Nine (41%) of 22 control patients, 8 (44%) of 18 MBL group patients, and 13 (68%) of 19 KPC group patients died in the ICU. Nine (41%) of 22 control patients, 10 (56%) of 18 MBL group patients, and 15 (79%) of 19 KPC group patients died in the hospital. Isolation of KPC-producing K. pneumoniae was an independent predictor of ICU death ( P = .04) and in-hospital death ( P = .03) but not infection-attributable death. Conclusions. BSIs due to KPC-producing K. pneumoniae resulted in significantly increased mortality. The accurate and rapid detection of these pathogens is necessary for therapeutic considerations and for the implementation of infection control measures to contain them.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/657135
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2010
    detail.hit.zdb_id: 2106319-9
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  • 2
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    Epidemiology and outcomes of ventilator-associated events in critically ill children: Evaluation of three different definitions
    Cambridge University Press (CUP) ; 2023
    In:  Infection Control & Hospital Epidemiology Vol. 44, No. 2 ( 2023-02), p. 216-221
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 44, No. 2 ( 2023-02), p. 216-221
    Abstract: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in pediatric intensive care units (PICUs), but its definite diagnosis remains controversial. The CDC Ventilator-Associated Event (VAE) module (validated in adults) constitutes a new approach for VAP surveillance. Design: We described epidemiological characteristics of PICU VAE cases, investigated possible risk factors, and evaluated 3 different sets of diagnostic VAE criteria. Setting: This study was conducted in a PICU in a tertiary-care general hospital in northern Greece during 2017–2019. Patients: The study included patients aged 35 days–16 years who received mechanical ventilation. Methods: From medical records, we retrieved epidemiological data, clinical data, and laboratory characteristics as well as ventilator settings for our analysis. We assessed “oxygen deterioration” for the tier 1 CDC VAE module using 3 sets of diagnostic criteria: (1) CDC adult VAE criteria [increase of daily minimum fraction of inspired oxygen (FiO2) ≥ 0.2 or positive end expiratory pressure (PEEP) ≥ 3 cmH2O for 2 days], (2) the US pediatric VAE criteria [increase of FiO2 ≥ 0.25 or mean airway pressure (MAP) ≥ 4 cmH2O for 2 days] , and (3) the European pediatric VAE criteria (increase of FiO2 ≥ 0.2 or PEEP ≥ 2 cmH2O for 1 day or increase of FiO2 ≥ 0.15 and PEEP ≥ 1 cm H2O for 1 day). Results: Among 326 children admitted to the PICU, 301 received mechanical ventilation. The incidence rate according to the CDC adult VAE criteria was 4.7 per 1,000 ventilator days. For the US pediatric VAE criteria the incidence rate was 6 per 1,000 ventilator days. For the European pediatric VAE criteria the incidence rate was 9.7 per 1,000 ventilator days. These results revealed statistically significant correlation of all 3 algorithms with adverse outcomes, including mortality. Conclusions: All VAE algorithms were associated with higher mortality rates. Our findings highlight the need for a unified pediatric VAE definition to improve preventive strategies.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2022.97
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2106319-9
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  • 3
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    SARS-CoV-2 molecular testing in Greek hospital paediatric departments: a nationwide study
    Cambridge University Press (CUP) ; 2021
    In:  Epidemiology and Infection Vol. 149 ( 2021)
    Details
    In: Epidemiology and Infection, Cambridge University Press (CUP), Vol. 149 ( 2021)
    Abstract: As most children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) present with mild symptoms or they are asymptomatic, the optimal strategy for molecular testing it is not well defined. The aim of the study was to determine the extent and aetiology of molecular testing for SARS-CoV-2 in Greek paediatric departments during the first phase of the pandemic and identify possible differences in incidence, depending on the age group and geographical area. We conducted a nationwide study of molecular testing for SARS-CoV-2 of children in paediatric departments between March and June 2020. A total of 65 paediatric departments participated in the study, representing 4901 children who were tested for SARS-CoV-2 and 90 (1.8%) were positive. Most paediatric cases were associated with topical outbreaks. Adolescents 11–16 years had the highest positivity rate (3.6%) followed by children 6–10 years (1.9%). However, since the testing rate significantly differed between age groups, the modified incidence of SARS-CoV-2 infection per age group was highest in infants 〈 1 year (19.25/10 5 population). Most children tested presented with fever (70.9%), respiratory (50.1%) or gastrointestinal symptoms (28.1%). Significant differences were detected between public and private hospitals regarding the positivity rate (2.34% vs. 0.39%, P -value 〈 0.001). Significant variation in SARS-CoV-2 molecular testing positivity rate and incidence between age groups indicate discrepancies in risk factors among different age groups that shall be considered when ordering molecular testing.
    Type of Medium: Online Resource
    ISSN: 0950-2688 , 1469-4409
    URL: Article
    DOI: 10.1017/S0950268821000455
    RVK:
    XA 41125
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2021
    detail.hit.zdb_id: 1470211-3
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  • 4
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    Differential Correlation Between Rates of Antimicrobial Drug Consumption and Prevalence of Antimicrobial Resistance in a Tertiary Care Hospital in Greece
    Cambridge University Press (CUP) ; 2008
    In:  Infection Control & Hospital Epidemiology Vol. 29, No. 7 ( 2008-07), p. 615-622
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 29, No. 7 ( 2008-07), p. 615-622
    Abstract: To investigate whether there is a correlation between the rates of antimicrobial drug consumption in hospital departments and the prevalence of antimicrobial resistance among clinically important bacteria recovered in the hospital. Design. Retrospective study. Setting. Tertiary care hospital in Greece. Methods. Data on antimicrobial consumption (from January 2001 through December 2004) were expressed as defined daily doses per 100 bed-days. The prevalence of antimicrobial resistance among isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcusfaecium recovered during the same time period were calculated by the microbiology department. We then performed the following analyses: (1) a comparison of the consumption rates for different antimicrobial groups in individual hospital departments, (2) a comparison of the prevalence of resistance to different antimicrobials, and (3) a correlation analysis of antimicrobial consumption rates and the prevalence of antimicrobial resistance. Results. The rates of antimicrobial consumption and the prevalence of resistance varied substantially among the hospital's departments. The annual rate of consumption for carbapenems correlated with the rate of consumption for glycopeptides and third-generation cephalosporins (P 〈 .05). Among P. aeruginosa isolates, the prevalence of imipenem resistance correlated with the prevalence of resistance to amikacin, ciprofloxacin, and ceftazidime ( P 〈 .05). The rate of carbapenem consumption correlated with the prevalence of imipenem resistance among P. aeruginosa and A. baumannii isolates ( P 〈 .05). The rate of aminoglycoside consumption correlated with the prevalence of amikacin resistance among P. aeruginosa, K. pneumoniae, and E. coli isolates ( P 〈 .05). However, the rate of consumption for fluoroquinolones and glycopeptides had no correlation with the prevalence of ciprofloxacin resistance among gram-negative bacteria or vancomycin resistance among E. faecium isolates. Conclusions. These data are suggestive of a differential relationship between antimicrobial consumption and the prevalence of antimicrobial resistance among various species and for various antimicrobial agents. These findings may help to optimize antimicrobial prescription policies in the hospital, especially in departments that have both high rates of antimicrobial consumption and a high prevalence of antimicrobial resistance.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/589333
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2008
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  • 5
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    A 5-Year Epidemiological Study of Nosocomial Bloodstream Infections in a Neurosurgery Department
    Cambridge University Press (CUP) ; 2010
    In:  Infection Control & Hospital Epidemiology Vol. 31, No. 4 ( 2010-04), p. 414-417
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 31, No. 4 ( 2010-04), p. 414-417
    Abstract: The characteristics of nosocomial bloodstream infections (BSIs) in a neurosurgical department were studied over a 5-year period. The rate of nosocomial BSI was 3.0%. Gram-negative bacteria were the most commonly isolated pathogens (65.9% of isolates). For all the pathogens isolated, the rate of resistance to commonly used antimicrobial agents was high. Of the 101 patients with nosocomial BSI, 50 (49.5%) died during their stay at the Department of Neurosurgery. At the same time, overall mortality rate among neurosurgical inpatients without nosocomial BSI was 5.4% (ie, 175 of 3,216 patients died).
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/651310
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2010
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  • 6
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    Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments
    Cambridge University Press (CUP) ; 2021
    In:  Infection Control & Hospital Epidemiology Vol. 42, No. 6 ( 2021-06), p. 702-709
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 42, No. 6 ( 2021-06), p. 702-709
    Abstract: To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP). Design: Prospective multicenter before-and-after study. Setting: This study was conducted in 7 surgical departments of 3 major Greek hospitals. Methods: Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback. Results: Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% ( P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% ( P = .001). In 4 of 7 departments, compliance with appropriate timing was already 〉 90%; an increase from 44.3% to 73% ( P = .001) and from 20.4% to 60% ( P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% ( P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% ( P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP. Conclusion: An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2020.1276
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2021
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  • 7
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    Online Resource
    Evaluation of the New Centers for Disease Control and Prevention Ventilator-Associated Event Module and Criteria in Critically Ill Children in Greece
    Cambridge University Press (CUP) ; 2016
    In:  Infection Control & Hospital Epidemiology Vol. 37, No. 10 ( 2016-10), p. 1162-1166
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 37, No. 10 ( 2016-10), p. 1162-1166
    Abstract: To evaluate the new adult Centers for Disease Control and Prevention (CDC) ventilator-associated event (VAE) module in critically ill children and compare with the traditionally used CDC definition for ventilator-associated pneumonia (VAP). DESIGN Retrospective observational study of mechanically ventilated children in a pediatric intensive care unit in Greece January 1-December 31, 2011. METHODS Assessment of new adult CDC VAE module including 3 definition tiers: ventilator-associated condition (VAC), infection-related VAC, and possible/probable ventilator-associated pneumonia (VAE-VAP); comparison with traditional CDC criteria for clinically defined pneumonia in mechanically ventilated children (PNEU-VAP). We recorded Pediatric Risk of Mortality score at admission (PRISM III), number of ventilator-days, and outcome. RESULTS Among 119 patients with mechanical ventilation (median [range] number of ventilator-days, 7 [1–183] ), 19 patients experienced VAC. Criteria for VAE-VAP were fulfilled in 12 of 19 patients with VAC (63%). Children with either VAC or VAE-VAP were on ventilation more days than patients without these conditions (16.5 vs 5 d, P=. 0006 and 18 vs 5 d, P 〈 . 001, respectively), whereas PRISM-III score was similar between them. Mortality was significant higher in patients with new VAE-VAP definition (50%), but not in patients with VAC (31.6%), than the patients without new VAE-VAP (14%, P=. 007) or VAC (15%, P=. 1), respectively. No significant association was found between PNEU-VAP and death. Incidences of PNEU-VAP and VAE-VAP were similar, but the agreement was poor. CONCLUSIONS VAE-VAP and PNEU-VAP found similar prevalence in critically ill children but with poor agreement. However, excess of death was significantly associated only with VAE-VAP. Infect Control Hosp Epidemiol 2016:1–5
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2016.135
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2016
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