الفهرس 
HEALTH CARE ASSOCIIATED INFECTIIONSOnly 14 pages are availabe for public view
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Abstract
HAI is a global problem with multi facet outcomes. The problem is well pronounced in developing countries. Epidemiological and etiological characteristics of HAIs show variations among countries and even among different hospitals in the same country.
Medical devices are responsible for a large portion of HAIs, particularly in critically ill patients. These HAIs include CLABSI, CAUTI, and VAP.
At present, the emergence of resistance to antimicrobial agents is a global public health problem, particularly in pathogens causing HAIs and it results in increased morbidity, mortality and health-care costs.
This study aimed to determine the rate of DA-HAIs among ICU patients at Ain Shams University Hospital and identify the causative microorganisms and their antibiotic resistance pattern.
This study was conducted at Surgery ICUs of Ain Shams University Hospital during the period from June 2013 to November2013.Four ICU centers were included;these are general surgery,emergency room,cardiothoracic surgery and neurosurgery ICUs.
The study included 152 patients who developed device-associated health care -associated infections during their stay in the surgery ICU: CA-UTI (70 samples), VAP (52 samples) and CLA-BSI (30 samples). The age of the patients ranged from 19 years to 72 years old and mean age of 47 years. They were 108 (71٪) males and 44 (29٪) females.
Data were collected on a daily basis from all the patients admitted to the ICUs using pre-structured sheets.Lower respiratory tract ,blood and urine samples were collected from suspected cases.The different samples were cultured onto suitable media, isolates were identified using conventional methods, and susceptibility to different antimicrobials were tested.DA-HAIs incidence rates and device utilization ratios were calculated.
The most encountered type of DAIs in the 4 ICUs was CAUTI (46.05%) followed by VAP (34.21%) and the least was CLABSI (19.73%).
As regards the frequency of different isolated organisms causing DAIs; E.coli (34.28%) was the most prevalent organism in CAUTI samples followed by S.aureus (20 %), P.mirabilis and P.aeuroginosa (12.85%), and K.pneumoniae and Candida spp. (10%). K.pneumoniae (30.76%) was the most prevalent organism in VAP samples followed by P.aeuroginosa and S.aureus (26.92%) and E.coli (15.38%). S.aureus (33.33%) was the most prevalent organism in CLABSI samples followed by CONS and P. aeuroginosa (20%), E. coli (13.33%), Candida spp. (10%) and K. pneumoniae (3.33%).
As regards the antimicrobial sensitivity of different isolated organisms causing DAIs;the most effective antibiotic against E.coli was amikacin (100%) followed by gentamycin (86.11%) and trimethoprim/ sulfamethoxazole (50%). For E.coli isolated from urine the most effective antibiotic was sulfisoxazole (66.66%) followed by nitrofurantoin (62.5%).
The most effective antibiotic against K.pneumoniae was imipinem (100%) followed by cefepime (73.91%) and ciprofloxacin (60.86%). For K.pneumoniae isolated from urine the most effective antibiotic was nitrofurantoin (100%) followed by cephalothin (66.66%).
The most effective antibiotics against p.mirabilis were amikacin, ceftriaxone, cefuroxime, piperacillin and cephalothin (100%) followed by gentamycin and sulfisoxazole (77.77%), ciprofloxacin, cefepime and Amoxicillin –clavulinic acid (66.66%).
The most effective antibiotic against P.aeruginosa was ciprofloxacin (79.31%) followed by imipinem and amikacin (58.62%). For P.aeruginosa isolated from urine, sensitivity to norfloxacin was (44.44%).
The overall prevalence of ESBL producing isolates was 23.47% (23/98).In E.coli 27.77% (10/36) were ESBL producers, representing 10.2% (10/23) of total ESBL isolates,while in k.pneumoniae 20.83% (5/24) were ESBL producers,representing 5.10%(5/23) of total ESBL isolates.In p.aeuroginosa 27.6%(8/29) were ESBL producers representing 8.16% (8/23) of total ESBL isolates.
Regarding ESBL producing isolates, they were common among E.coli (27.77%) followed by P.aeuroginosa (27.6%) and K. pneumoniae (20.83%).
The most effective antibiotic against S.aureus was vancomycin (78.94%) followed by trimethoprim-sulfamethoxazole (60.52%) and ciprofloxacin (55.26%). For S.aureus isolated from urine the most effective antibiotic was nitrofurantion (92.85%) followed by sulfisoxazole (78.57%).
The most effective antibiotic against CoNS was vancomycin (83.33%) followed by ciprofloxacin (66.66%).
Regarding methicillin resistance among Staphylococcus spp., 60.52% of S.aureus isolates were MRSA and 50% of CoNS were MR-CoNS.
Regarding overall infection rates, overall VAP rate was the highest (26.07) followed by overall CAUTI rate (25.3) and overall CLABSI rate (19.84).
Regarding overall device utilization ratio, overall catheter utilization ratio was the highest (0.75) followed by overall ventilator utilization ratio (0.54) and overall central line utilization ratio (0.41).