Most infants in NICUs are hospitalized continuously from bir
Most infants in NICUs are hospitalized continuously from birth, and MRSA infections are largely considered to be horizontally transmitted. Various studies had reported that viable MRSA can be found on the hands of up to 17% of healthcare workers, and on 59% of the environmental surfaces in rooms of patients with diarrhea. A significant increase in Staphylococcus aureus, the appearance of Pseudomonas aeruginosa, and changes among species of Gram-negative bacilli were observed 8–11 months after a new building had been opened. In this study, MRSA and CoNS were the major gram positive pathogens in both NICUs, but there was no statistically significant difference between the two groups. The fact is that the new environment did not reduce infection rate of MRSA and CoNS, which might be explained by the long period of the study (2 years) or healthworker factors, and the low incidence or cases of nosocomial infection. We found that Klebesiella pneumonia was the most frequently isolated KPT-185 in the old NICU group and the Gram-negative bacteria were the predominant organisms. The result was the same with studies in Egypt and Turkey, even in the tertiary NICU that just moved to a new building. The microorganism species K. pneumonia significantly declined from 4.6% in the old NICU to 0.7% in the new NICU (P = 0.01). In general, the new environment might affect the change of Gram-positive microorganism infections and catheter-related bundle care might affect the infections caused by Gram-negative pathogens. The decrease of the infection rates of K. pneumoniae and blood stream infection might be more influenced by the factor of implementation of device bundles than the new environment in our study, due to the difference and change of microorganisms in both groups.
Acknowledgements This research was supported by the infection control committee of Taichung Veterans General Hospital. The authors would like to acknowledge the staff of the Pathology and Laboratory Medicine Department of Taichung Veterans General Hospital for their assistance with microorganism survey. We also thank Wei-Cheng Chan and Ming-Chih Lin for statistical consultation.
Introduction Despite improvements in medical therapy and intensive care in the past decade, sepsis-related mortality rates have increased linearly according to the disease severity of sepsis ranging from 10–50%. Sepsis is associated with initial activation of coagulation and fibrinolysis followed by late impairment of fibrinolytic and natural anticoagulant systems, leading to thrombotic microangiopathy and disseminated intravascular coagulation. The outcomes of septic patients depend on the resolution of coagulopathy, which is related to multiple organ failures. In Gram-negative endotoxemia and sepsis, massive release of pro-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were induced by endotoxins like lipopolysaccharide (LPS), leading to inflammation and coagulation cascades. These cytokines may trigger the expression of tissue factor on monocytes and endothelial cells, and consequently activate coagulation and fibrin formation. In addition, cytokines impair fibrinolysis and further decrease fibrin removal, leading to microvascular thrombosis, tissue hypoperfusion, and even organ failure. Therefore, the type of medical intervention used to alleviate the activation of inflammation and coagulation has been regarded as an important issue. Levosimendan (LS) is a calcium sensitizer, which enhances cardiac contractility independent from the adrenergic system by binding to the troponin C within cardiomyocytes. LS opens potassium channels in smooth muscle, leading to venous, arterial and coronary vasodilation. Owing to its beneficial effects, LS may positively affect cardiac performance and tissue perfusion in patients with heart failure and/or septic shock. More importantly, both in vitro and in vivo studies demonstrate that LS has an anti-inflammatory property other than its cardiovascular effects. In a rat model of severe sepsis evoked by cecal ligation and incision, LS was reported to alleviate plasma IL-1β and IL-6 releases, attenuate hypotension and improve survival. LS is also known to be a potent phosphodiesterase-III (PDE-III) inhibitor leading to increased intracellular cAMP levels, which may modulate platelet function. Kaptan et al. have demonstrated that levosimendan has a significant inhibition of platelet aggregation at clinically relevant concentrations in an in vitro study. In contrast to the high dosage associated with in vitro findings, other in vitro and in vivo studies did not reveal a significant effect of LS at clinically relevant concentrations. However, the effect of LS on platelet and coagulation function in sepsis remains unclear.