1. Benefit of surveillance cultures at NICU
[Fatima Dajani]
2007
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2. 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
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4. Distribution of normal flora
Areas with rich normal flora
Oropharynx
Gastrointestinal
Vagina and cervix uteri
Skin
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5. Skin Flora
Transient microorganism carried for a short time spread from patient to patient by hand.
Resident bacteria grow attached to squames
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6. 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.
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7. Potentially pathogenic microorganisms
Microorganisms able to cause infections only in hosts with impaired defense mechanisms
Community acquired
Hospital acquired (PPN)
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8. Community acquired
Carried by healthy persons in throat , gastrointestinal tract.
Streptococcus pneumonia
Haemophilus influenza
Branhamella catarallis
Escherichia coli
Staphylococcus aureus
Candida albicans
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9. 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
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10. 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
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12. 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.
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13. 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.
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14. Spread of resistance bacteria
Transient contamination of hands in hospital.
Environmental contamination.
Excessive usage of antibiotics
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15. END
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20. Incidence resistance bacteria carriage Using SDD, Literature review
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25. 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.
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29. 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.
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30. Essential of prevention
Regular surveillance studies
Throat
Rectal
The source of potential pathogens
Blind treatment can be undertaken
SDD selective digestive decontamination
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