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Published on: March 2, 2020
Visualization of multidrug-resistant bacterial infection trends in the intensive care units
Woojae Jeon1, Yu-Mi Lee2,3, Dong Youn Kim2
1College of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
Background:
The Korean National Healthcare-associated Infections Surveillance System (KONIS) monitors multidrug-resistant (MDR) bacterial infections in intensive care units (ICUs). However, simultaneously monitoring hundreds of ICUs remains challenging. Our study aimed to visualize the trends of MDR gram-negative bacterial infections in ICUs monitored by KONIS.
Methods:
We evaluated KONIS data from 137 ICUs (2006-2011) and from 368 ICUs (2017-2022). Pneumonia, urinary tract infection, and bloodstream infection caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii were analyzed. Transformation was employed to convert the infection rate graphs of each ICU into arrows. The length and angle of the arrows reflect changes in carbapenem susceptibility and infection rate, respectively. ICUs are categorized into red (rapid shift from susceptible to resistant bacteria and increased infection rate), yellow (slow shift from susceptible to resistant bacteria and decreased infections rate), and green (shift from resistant to susceptible bacteria) groups. The proportional changes in each ICU category were compared during the first and last five years of the study periods.
Results:
For K. pneumoniae, the proportion of red category ICUs increased (0% to 17%, p-value 0.586), while the proportions of yellow (33.3% to 7%, p-value 0.288) and green category ICUs (66.6% to 36%, p-value 0.290) decreased. For P. aeruginosa, the proportions of red (12% to 27%, p-value 0.016) and green category ICUs (38% to 46%, p-value 0.358) increased, while the proportion of yellow category ICUs decreased (8% to 2%, p-value 0.043). For A. baumannii, the proportions of red (19% to 14%, p-value 0.649) and yellow category ICUs (5% to 1%, p-value 0.187) decreased, while the proportion of green category ICUs increased (19% to 72%, p-value <0.001).
Conclusions:
Graph transformation allowed the observation of MDR Gram-negative bacterial infection trends in ICUs. Further studies should aim to confirm whether our arrow indicators are useful for infection control and in identifying factors for reducing infections.
Insights
This study visualized multidrug-resistant gram-negative bacterial infection trends in intensive care units (ICUs) using a novel graph transformation method. Results show shifts in infection rates and resistance patterns for key pathogens like Acinetobacter baumannii.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health Surveillance
Background:
- The Korean National Healthcare-associated Infections Surveillance System (KONIS) tracks multidrug-resistant (MDR) bacterial infections in intensive care units (ICUs).
- Monitoring hundreds of ICUs simultaneously presents significant challenges for infection control.
- This study aimed to visualize MDR gram-negative bacterial infection trends within KONIS-monitored ICUs.
Purpose of the Study:
- To develop and apply a novel visualization method for tracking trends in MDR gram-negative bacterial infections in ICUs.
- To analyze changes in infection rates and carbapenem susceptibility for key pathogens over time.
- To categorize ICUs based on infection trends for better understanding of resistance dynamics.
Main Methods:
- Evaluated KONIS data from 137 ICUs (2006-2011) and 368 ICUs (2017-2022).
- Analyzed infections (pneumonia, UTI, bloodstream) caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii.
- Transformed infection rate graphs into arrows indicating changes in carbapenem susceptibility and infection rates, categorizing ICUs into red, yellow, and green groups.
Main Results:
- For Klebsiella pneumoniae, a significant increase in the 'red' ICU category (0% to 17%) was observed, with decreases in 'yellow' and 'green' categories.
- Pseudomonas aeruginosa showed an increase in 'red' (12% to 27%) and 'green' (38% to 46%) categories, and a decrease in 'yellow' (8% to 2%).
- Acinetobacter baumannii demonstrated a notable increase in the 'green' category (19% to 72%), indicating a shift towards susceptibility, with decreases in 'red' and 'yellow' categories.
Conclusions:
- Graph transformation provides a useful method for observing MDR gram-negative bacterial infection trends in ICUs.
- The study highlights varying trends for different pathogens, with Acinetobacter baumannii showing improvement in susceptibility.
- Further research is needed to validate these arrow indicators for infection control and identify factors reducing infections.
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