ORCID Profile
0000-0002-0645-7664
Current Organisations
Dar Al Fouad Hospital
,
Cairo University Kasr Alainy Faculty of Medicine
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2005
DOI: 10.1097/01.INF.0000168804.09875.95
Abstract: Rates of sepsis exceeding 50% in a neonatal intensive care unit (NICU) in Cairo, Egypt, were not controlled by routine antimicrobial therapy. We investigated these conditions in September 2001. Case series and retrospective cohort studies were conducted on 2 groups of NICU infants admitted to an academic medical center between February 12 and July 31, 2001. Observation of clinical practices led us to culture in-use intravenous (i.v.) fluids and medications. We monitored rates of i.v. fluid contamination, clinical sepsis and mortality after interventions to establish new procedures for handling and disposal of i.v. fluids, infection control training and improved clinical laboratory capacity. Among infants in the retrospective cohort group, 88 (77%) of 115 had clinical sepsis, and 59 (51%) died. In the case series group, we documented the time of initial positive blood culture 21 (64%) of 33 were septic <24 hours after birth. Klebsiella pneumoniae accounted for 24 (73%) of 33 isolates 14 (58%) of 24 were extended spectrum beta-lactamase-producing and aminoglycoside-resistant. On admission, all neonates received glucose-containing i.v. fluids i.v. bottles (500 mL) were ided among multiple infants. The i.v. fluids were prepared at the bedside poor hand hygiene and poor adherence to aseptic techniques were observed. K. pneumoniae was isolated from 13 (65%) of 20 in-use glucose-containing i.v. fluids. Fluid contamination, sepsis and mortality rates declined significantly after intervention. Extrinsically contaminated i.v. fluids resulted in sepsis and deaths. Standard infection control precautions significantly improve mortality and sepsis rates and are prerequisites for safe NICU care.
Publisher: Cambridge University Press (CUP)
Date: 28-04-2023
DOI: 10.1017/ICE.2023.69
Abstract: To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03 95% CI, 1.03–1.04 P .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04 95% CI, 1.03–1.04 P .0001), surgical hospitalization (aOR, 1.12 95% CI, 1.03–1.21 P .0001), tracheostomy use (aOR, 1.52 95% CI, 1.23–1.88 P .0001), hospitalization at a publicly owned facility (aOR, 3.04 95% CI, 2.31–4.01 P .0001) or at a teaching hospital (aOR, 2.91 95% CI, 2.22–3.83 P .0001), hospitalization in a middle-income country (aOR, 2.41 95% CI, 2.09–2.77 P .0001). The ICU type with highest risk was adult oncology (aOR, 4.35 95% CI, 3.11–6.09 P .0001), followed by pediatric oncology (aOR, 2.51 % CI, 1.57–3.99 P .0001), and pediatric (aOR, 2.34 95% CI, 1.81–3.01 P .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01 95% CI, 2.71–3.33 P .0001), followed by femoral (aOR, 2.29 95% CI, 1.96–2.68 P .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48 95% CI, 1.02–2.18 P = .04). The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy using PICC instead of internal-jugular or femoral CL and implementing evidence-based CLABSI prevention recommendations.
Publisher: Cambridge University Press (CUP)
Date: 2023
DOI: 10.1017/ASH.2022.339
Abstract: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Prospective cohort study. This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. The study included patients admitted to ICUs across 24 years. In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22 95% confidence interval [CI], 1.16–1.28 P .0001) longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07 95% CI, 1.07–1.08 P .0001) mechanical ventilation (MV) utilization ratio (aOR, 1.27 95% CI, 1.23–1.31 P .0001) continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38 95% CI, 11.57–15.48 P .0001) tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31 95% CI, 7.21–9.58 P .0001) endotracheal tube connected to a MV (aOR, 6.76 95% CI, 6.34–7.21 P .0001) surgical hospitalization (aOR, 1.23 95% CI, 1.17–1.29 P .0001) admission to a public hospital (aOR, 1.59 95% CI, 1.35-1.86 P .0001) middle-income country (aOR, 1.22 95% CI, 15–1.29 P .0001) admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05 95% CI, 3.22–5.09 P .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48 95% CI, 1.78–3.45 P .0001) and admission to a respiratory ICU (aOR, 2.35 95% CI, 1.79–3.07 P .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63 95% CI, 0.51–0.77 P .0001). Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.
Publisher: Oxford University Press (OUP)
Date: 10-11-2014
DOI: 10.1093/CID/CIU871
No related grants have been discovered for Amani El Kholy.