Benefit of surveillance cultures at NICU

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Presentation transcript:

Benefit of surveillance cultures at NICU [Fatima Dajani] 2007 11/09/1440

Infection in ICU ongoing challenge Rate of pneumonia septicemia not changed since 1960 1/3 of ICU patients die 40 years later the problems worst No new antibiotics available 11/09/1440

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Distribution of normal flora Areas with rich normal flora Oropharynx Gastrointestinal Vagina and cervix uteri Skin 11/09/1440

Skin Flora Transient microorganism carried for a short time spread from patient to patient by hand. Resident bacteria grow attached to squames 11/09/1440

Development of normal flora Fetus in the uterus is uncontaminated unless in prolonged rupture membrane. Development of normal flora depends on Feeding mode. Gestational age. Once normal flora formed it is difficult for other organisms to develop. 11/09/1440

Potentially pathogenic microorganisms Microorganisms able to cause infections only in hosts with impaired defense mechanisms Community acquired Hospital acquired (PPN) 11/09/1440

Community acquired Carried by healthy persons in throat , gastrointestinal tract. Streptococcus pneumonia Haemophilus influenza Branhamella catarallis Escherichia coli Staphylococcus aureus Candida albicans 11/09/1440

Hospital acquired Colonized by patients with impaired defense following underlying disease medical investigation and advanced age. Klebsiella * Proteus Morganella * Enterobacter Citrobacter * Serratia Acinetobacter * Pseudomonas MRSA * Enterococcus 11/09/1440

Defense Colonization defense Infection defense First line of defense oropharyngeal cavity and gastrointestinal canal , respiratory tract and skin against colonization Infection defense Involves macrophage and proteins IgG IgM and complements 11/09/1440

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Pathogenesis of infection Primary endogenous infection caused by organisms that are part of the patient oropharyngeal or gastrointestinal. Secondary endogenous infection microorganisms acquired during hospital stay. Exogenous infection caused by microorganism not present in the patient’s oral and gastrointestinal. 11/09/1440

Antimicrobial Resistance in ICU Multiple exogenous isolation Contaminated ventilation. Endogenous flora from the ICU patient gut, Klebsiella, Enterobacter and Pseudomonas. Antibiotics cause mutation and selection of Resistance bacteria. 11/09/1440

Spread of resistance bacteria Transient contamination of hands in hospital. Environmental contamination. Excessive usage of antibiotics 11/09/1440

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Incidence resistance bacteria carriage Using SDD, Literature review 11/09/1440

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RESULT 57/197=29% 57/342=17% The infection rate of patients with carriage is 29%. The infection rate of patients admitted to NICU is 17% p <0.05. 11/09/1440

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Chris Stoutenbeek manoeuvre In 1980 advocated a new management of infection SDD Selective Digestive Decontamination based on: Surveillance study Use of prophylactic antibiotics enteral and parental. 11/09/1440

Essential of prevention Regular surveillance studies Throat Rectal The source of potential pathogens Blind treatment can be undertaken SDD selective digestive decontamination 11/09/1440