27 September 2014

SWISS MEDICAL WEEKLY: ICU INFECTIONS.

Review article | Published 24 September 2014, doi:10.4414/smw.2014.14009
Cite this as: Swiss Med Wkly. 2014;144:w14009

Enterococci, Clostridium difficile and ESBL-producing bacteria: epidemiology, clinical impact and prevention in ICU patients

Jan A. Sidler, Manuel Battegay, Sarah Tschudin-Sutter, Andreas F. Widmer, Maja Weisser

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland

Summary

Abbreviations

ARE ampicillin-resistant enterococci

CI confidence interval

ESBL extended-spectrum ß-lactamase

ESBL-GNB extended-spectrum ß-lactamase producing gram-negative bacteria

ICU intensive care unit

MRSA methicillin-resistant Staphylococcus aureus

OR odds ratio

VRE vancomycin-resistant enterococci

Most hospital-acquired infections arise from colonising bacteria. Intensive care patients and immunocompromised individuals are at highest risk for microbial invasion and subsequent infection due to multiple invasive procedures in addition to frequent application of chemotherapeutics and presence of poor microperfusion leading to mucosal disruption. In this narrative review, we summarise the literature on bacterial colonisation in intensive care patients, in particular the epidemiology, the clinical impact and respective infection control strategies of three pathogens, i.e., Enterococcus spp., extended-spectrum ß-lactamase producing gram-negative bacteria and Clostridium difficile, which have evolved from commensals to a public health concern today.

Key words: Clostridium difficile; colonisation; enterococcus; enterobacteriaceae; ESBL; infection; intensive care unit; multidrug-resistant; outcome; VRE

Introduction

Infections are the leading cause of death in intensive care units (ICUs) worldwide and mortality in infected ICU patients is more than twice as high compared to non-infected patients [1, 2]. Despite significant advances in intensive care therapy and infection prevention, incidence of nosocomial infections in ICU patients has remained high [1, 3]. The bacteria causing most hospital-acquired infections are staphylococci including methicillin-resistant S. aureus (MRSA), enterococci including vancomycin-resistant enterococci (VRE), Candida spp., Clostridium difficile and different often multidrug-resistant gram-negative bacteria [1].

In healthy individuals, an ecological community of commensals, symbiotes and pathogens – the microbiome – is in equilibrium with the host. If anatomical barriers or host defenses are disrupted, invasion of colonising bacteria and subsequent infection can arise [4].

In ICU patients, multiple invasive procedures (e.g., central venous catheters) and the presence of poor microperfusion lead to integrity loss of skin and mucosae with risk of invasive infection [5]. Furthermore, ICU patients are per se immunocompromised due to the severity of the disease [6].

UK DAILY MAIL: Dr.JOHN RAE recognised after over 150 years.

Great Arctic explorer to be finally honoured after having career discredited for telling truth about British voyagers' cannibalism

John Rae was sent to find crew of Sir John Franklin lost in Arctic
Discovered that they had reported to cannibalism and reported back
But had reputation trashed and story discredited by Charles Dickens
To be honoured with plaque at Westminster Abbey next week

By Alex Finnis for MailOnline

Published: 18:50 GMT, 27 September 2014 | Updated: 18:51 GMT, 27 September

A painting by Stephen Pearce of Dr John Rae, who is to be honoured with a plaque at Westminster Abbey

One of Britain's greatest Arctic explorers, whose reputation was trashed when he reported cannibalism within a lost British crew, will be honoured with a plaque at Westminster Abbey.

Dr John Rae was sent to the Arctic to find out what had happened to Sir John Franklin and his crew - who went missing in 1846 - and made a discovery so shocking it was refused by the establishment.

Inuit tribesmen told Dr Rae that Franklin's men has starved to death and resorted to eating each other after their ships got trapped in the ice.

After three journeys across the Arctic, Dr Rae reported back, saying that the men had 'been driven to the last dread alternative as a means of supporting life'.

His unfavourable findings were widely criticised and led to him being completely discredited - Charles Dickens wrote a two-part essay theorising that it had actually been the Inuits who killed Franklin's men - and his version became the accepted story.

In his essays, Dickens wrote about the 'firmness, fortitude and courage' of the crew, compared with the Inuits - a 'gross handful of uncivilised people, with a domesticity of blood and blubber', The Times reports.

The successful campaign to sully Dr Rae's account was started by Franklin's widow, and he never recovered from it - he was the only Victorian explorer who was not knighted.