Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles

REVIEW ARTICLE

Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art

Isabella Princess, Rohit Vadala

Keywords : Antibiogram, Antibiotics, Critical care, Immunoprophylaxis, Intensivist, Knowledge, Microbiology, Microorganisms, Outbreaks

Citation Information : Princess I, Vadala R. Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art. Indian J Crit Care Med 2021; 25 (5):566-574.

DOI: 10.5005/jp-journals-10071-23810

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

We live in an era of evolving microbial infections and equally evolving drug resistance among microorganisms. In any healthcare facility, intensivists play the most pivotal role with critically ill patients under their direct care. Majority of the critically ill patients already harbor a microorganism at admission or acquire one in the form of healthcare-associated infections during their course of intensive care unit stay. It is therefore rather imperative for intensivists to possess sound knowledge in clinical microbiology. On a negative note, most clinicians have very meager and remote knowledge acquired during their undergraduate years. This knowledge is rather theoretical than applied and wanes over the years becoming nonbeneficial in intensive patient care. We, therefore, intend to explore important concepts in applied microbiology and infection control that intensivists should know and implement in their clinical practice on a day-to-day basis.


PDF Share
  1. Bhattacharya S. Clinical microbiology: should microbiology be a clinical or a laboratory speciality? Indian J Pathol Microbiol 2010;53:217–221. DOI: 10.4103/0377-4929.64323.
  2. CLSI. Analysis and presentation of cumulative antimicrobial susceptibility test data; approved guideline-fourth edition. CLSI document M39-A4. Wayne, PA: Clinical and Laboratory Standards Institute; 2014.
  3. Joshi S. Hospital antibiogram: a necessity. Ind J Med Microbiol 2010;28(4):277–280. DOI: 10.4103/0255-0857.71802.
  4. Kollef MH, Bassetti M, Francois B, Burnham J, Dimopoulos G, Garnacho-Montero, et al. The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship. Intensive Care Med 2017;43(9):1187–1197. DOI: 10.1007/s00134-017-4682-7.
  5. American Thoracic Society and the Infectious Disease Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171(4):388–416. DOI: 10.1164/rccm.200405-644ST.
  6. Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Saunders: Philadelphia; 2015.
  7. Claus BOM, Hoste EA, Colpaert K, Robays H, Decruyenaere J, De Waele JJ. Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy. J Crit Care 2013;28(5):695–700. DOI: 10.1016/j.jcrc.2013.03.003.
  8. Taccone FS, Laterre P-F, Dugernier T, Spapen H, Delattre I, Wittebole X, et al. Insufficient β-lactam concentrations in the early phase of severe sepsis and septic shock. Crit Care 2010;14(4):R126. DOI: 10.1186/cc9091.
  9. Shimamoto Y, Fukuda T, Tanaka K, Komori K, Sadamitsu D. Systemic inflammatory response syndrome criteria and vancomycin dose requirement in patients with sepsis. Intensive Care Med 2013;39(7):1247–1252. DOI: 10.1007/s00134-013-2909-9.
  10. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015;132(15):1–52. DOI: 10.1161/CIR.0000000000000296.
  11. Tsuji BT, Rybak MJ. Short-course gentamicin in combination with daptomycin or vancomycin against Staphylococcus aureus in an in vitro pharmacodynamic model with simulated endocardial vegetations. Antimicrob Agents Chemother 2005;49(7):2735–2745. DOI: 10.1128/AAC.49.7.2735-2745.2005.
  12. Boselli E, Breilh D, Duflo F, Saux MC, Debon R, Chassard D, et al. Steady-state and intrapulmonary concentrations of cefepime adminstered in continuous infusion in critically ill patients with severe nosocomial pneumonia. Crit Care Med 2003;31(8):2102–2106. DOI: 10.1097/01.CCM.0000069734.38738.C8.
  13. Boselli E, Breilh D, Cannesson M, Xuereb F, Rimmelé T, Chassard D, et al. Steady-state plasma and intrapulmonary concentrations of piperacillin/tazobactam 4 g/0.5 g administered to critically ill patients with severe nosocomial pneumonia. Intensive Care Med 2004;30(5):976–979. DOI: 10.1007/s00134-004-2222-8.
  14. Wenzler E, Gotfried MH, Loutit JS, Durso S, Griffith DC, Dudley MN, et al. Plasma, epithelial lining fluid, and alveolar macrophage concentrations of meropenem-RPX7009 in healthy adult subjects. Antimicrob Agents Chemother 2015;59(12):7232–7239. DOI: 10.1128/AAC.01713-15.
  15. Gotfried MH, Danziger LH, Rodvold KA. Steady-state plasma and intrapulmonary concentrations of levofloxacin and ciprofloxacin in healthy adult subjects. Chest 2001;119(4):1114–1122. DOI: 10.1378/chest.119.4.1114.
  16. Rodvold KA, Danziger LH, Gotfried MH. Steady-state plasma and bronchopulmonary concentrations of intravenous levofloxacin and azithromycin in healthy adults. Antimicrob Agents Chemother 2003;47(8):2450–2457. DOI: 10.1128/aac.47.8.2450-2457.2003.
  17. Onufrak NJ, Forrest A, Gonzalez D. Pharmacokinetic and pharmacodynamic principles of anti-infective dosing. Clin Ther 2016;38(9):1930–1947. DOI: 10.1016/j.clinthera.2016.06.015.
  18. Burkhardt O, Brunner M, Schmidt S, Grant M, Tang Y, Derendorf H. Penetration of ertapenem into skeletal muscle and subcutaneous adipose tissue in healthy volunteers measured by in vivo microdialysis. J Antimicrob Chemother 2006;58(3):632–636. DOI: 10.1093/jac/dkl284.
  19. Nau R, Sörgel F, Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev 2010;23(4):858–883. DOI: 10.1128/CMR.00007-10.
  20. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39(9):1267–1284. DOI: 10.1086/425368.
  21. Landersdorfer CB, Bulitta JB, Kinzig M, Holzgrabe U, Sorgel F. Penetration of antibacterials into bone. Clin Pharmacokinet 2009;48(2):89–124. DOI: 10.2165/00003088-200948020-00002.
  22. Potter BK, Forsberg JA, Silvius E, Wagner M, Khatri V, Schobel SA, et al. Combat-related invasive fungal infections: development of a clinically applicable clinical decision support system for early risk stratification. Mil Med 2019;184(1-2):235–242. DOI: 10.1093/milmed/usy182.
  23. Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, et al. Melioidosis. Nat Rev Dis Primers 2018;4:17107. DOI: 10.1038/nrdp.2017.107. PMID: 29388572; PMCID: PMC6456913.
  24. Rhee P, Nunley MK, Demetriades D, Velmahos G, Doucet JJ. Tetanus and trauma: a review and recommendations. J Trauma 2005;58:1082–1088. DOI: 10.1097/01.ta.0000162148.03280.02.
  25. Ding X, Yu Y, Chen M, Wang C, Kang Y, Lou J. Causative agents and outcome of spontaneous bacterial peritonitis in cirrhotic patients: community-acquired versus nosocomial infections. BMC Infect Dis 2019;14(1):463:1–8. DOI: 10.1186/s12879-019-4102-4.
  26. Monegro AF, Regunath H. Hospital acquired infections. [Updated 2020 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441857/.
  27. Schäffler H, Breitrück A. Clostridium difficile – from colonization to infection. Front Microbiol 2018;9:646:1–12. DOI: 10.3389/fmicb.2018.00646.
  28. Tan TL, Gomez MM, Kheir MM, Maltenfort MG, Chen AF. Should preoperative antibiotics be tailored according to patient's comorbidities and susceptibility to organisms? J Arthroplast 2017;32(4):1089–1094. DOI: 10.1016/j.arth.2016.11.021.
  29. Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg 2019;1:111–117. DOI: 10.1503/cjs.004818.
  30. Mundhada AS, Tenpe S. A study of organisms causing surgical site infections and their antimicrobial susceptibility in a tertiary care Government Hospital. Indian J Pathol Microbiol 2015;58(2):195–200. DOI: 10.4103/0377-4929.155313.
  31. Gonzalez L, Cravoisy A, Barraud D, Conrad M, Nace L, Lemarié J, et al. Factors influencing the implementation of antibiotic de-escalation and impact of this strategy in critically ill patients. Critical Care 2013;17(4):1–8. DOI: 10.1186/cc12819.
  32. Masterton RG. Antibiotic de-escalation. Crit Care Clin 2011;27(1):149–162. DOI: 10.1016/j.ccc.2010.09.009.
  33. Ohji G, Doi A, Yamamoto S, Iwata K. Is de-escalation of antimicrobials effective? A systematic review and meta-analysis. Int J Infect Dis 2016;49:71–79. DOI: 10.1016/j.ijid.2016.06.002.
  34. Bonten MJ, Weinstein, RA. The role of colonization in the pathogenesis of nosocomial infections. Infect Control Hosp Epidemiol 1996;17(3):193–200. DOI: 10.1086/647274.
  35. Albrich WC, Harbarth S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8(5):289-301. DOI: 10.1016/S1473-3099(08)70097-5.
  36. Kurukulasooriya MRP, Tillekeratne LG, Wijayaratne WMDGB, Bodinayake CK, de Silva AD, Nicholson BP. Methicillin-resistant Staphylococcus aureus: prevalence of and risk factors associated with colonization of patients on admission to the Teaching hospital, Karapitiya. J Univ Ruhuna 2018;6(2):70–75. DOI: 10.4038/jur.v6i2.7878.
  37. Tschudin-Sutter S, Lucet JC, Mutters NT, Tacconelli E, Zahar JR, Harbarth S. Contact precautions for preventing nosocomial transmission of extended-spectrum β lactamase-producing Escherichia coli: a point/counterpoint review. Clin Infect Dis 2017;65(2):342–347. DOI: 10.1093/cid/cix258.
  38. Azim A, Dwivedi M, Rao PB, Baronia AK, Singh RK, Prasad KN, et al. Epidemiology of bacterial colonization at intensive care unit admission with emphasis on extended-spectrum beta-lactamase- and metallo-beta-lactamase-producing gram-negative bacteria–an Indian experience. J Med Microbiol 2010;59(Pt 8):955–960. DOI: 10.1099/jmm.0.018085-0.
  39. McConville TH, Sullivan SB, Gomez-Simmonds A, Whittier S, Uhlemann AC. Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study. PLoS One 2017;12(10):e0186195. DOI : 10.1371/journal.pone.0186195 [Accessed on: 08/02/2020].
  40. Salomão MC, Guimarães T, Duailibi DF, Perondi MBM, Letaif LSH, Montal AC, et al. Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: prevalence, risk factors, and acquisition rate. J Hosp Infect 2017;97(3):241–246. DOI: 10.1016/j.jhin.2017.08.012.
  41. Kaarme J, Riedel H, Schaal W, Yin H, Nevéus T, Melhus Å. Rapid increase in carriage rates of enterobacteriaceae producing extended-spectrum β-lactamases in healthy preschool children, Sweden. Emerg Infect Dis 2018;24(10):1874–1881. DOI: 10.3201/eid2410.171842.
  42. Pilmis B, Cattoir V, Lecointe D, Limelette A, Grall I, Mizrahi A, et al. Carriage of ESBL-producing Enterobacteriaceae in French hospitals: the PORTABLSE study. J Hosp Infect 2018;98(3):247–52. DOI: 10.1016/j.jhin.2017.11.022.
  43. Ramanathan YV, Venkatasubramanian R, Nambi PS, Ramabathiran M, Venkataraman R, Thirunarayan MA, et al. Carbapenem-resistant enterobacteriaceae screening: a core infection control measure for critical care unit in India? Indian J Med Microbiol 2018;36(4):572–576. DOI: 10.4103/ijmm.IJMM_18_437.
  44. Goodman KE, Simner PJ, Klein EY, Kazmi AQ, Gadala A, Rock C, et al. CDC Prevention Epicenters Program. How frequently are hospitalized patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) already on contact precautions for other indications? Infect Control Hosp Epidemiol 2018;39(12):1491–1493. DOI: 10.1017/ice.2018.236.
  45. Mahamat OO, Tidjani A, Lounnas M, Hide M, Benavides J, Somasse C, et al. Fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in hospital and community settings in Chad. Antimicrob Resist Infect Control 2019;8:169. DOI: 10.1186/s13756-019-0626-z [Accessed on: 08/02/2020].
  46. Hagel S, Makarewicz O, Hartung A, Weiß D, Stein C, Brandt C, et al. ESBL colonization and acquisition in a hospital population: The molecular epidemiology and transmission of resistance genes. PLoS One 2019;14(1):e0208505. DOI: 10.1371/journal.pone.0208505 [Accessed on: 08/02/2020].
  47. Reuken PA, Torres D, Baier M, Löffler B, Lübbert C, Lippmann N, et al. Correction: risk factors for multi-drug resistant pathogens and failure of empiric first-line therapy in acute cholangitis. PLoS One 2017;12(2):e0172373. DOI : 10.1371/journal.pone.0172373 [Accessed on: 08/02/2020].
  48. Cortegiani A, Fasciana T, Iozzo P, Raineri SM, Gregoretti C, Giammanco A, et al. What healthcare workers should know about environmental bacterial contamination in the intensive care unit. BioMed Res Int 2017. DOI: 10.1155/2017/6905450 [Accessed on: 08/02/2020].
  49. Mukhopadhyay C, Krishna S, Shenoy A, Prakashini K. Clinical, radiological and microbiological corroboration to assess the role of endotracheal aspirate in diagnosing ventilator-associated pneumonia in an intensive care unit of a tertiary care hospital, India. Int J Infect Control 2010;6(2):1–9. DOI: 10.3396/ijic.v6i2.4104.
  50. Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia: a review. Eur J Intern Med 2010;21:360–368. DOI: 10.1016/j.ejim.2010.07.006.
  51. Bouza E, Sousa D, Rodríguez-Créixems M, Lechuz JG, Muñoz P. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections? J Clin Microbiol 2007;45(9):2765–2769. DOI: 10.1128/JCM.00140-07.
  52. Lee A, Weinstein MP, Mirrett S, Reller LB. Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol 2007;45(11):3546–3548. DOI: 10.1128/JCM.01555-07.
  53. Principles and procedures for blood cultures; approved guideline, CLSI document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute (CLSI); 2007.
  54. Park KH, Lee MS, Lee SO, Choi SH, Sung H, Kim MN, et al. Diagnostic usefulness of differential time to positivity for catheter-related candidemia. J Clin Microbiol 2014;52(7):2566–2572. DOI: 10.1128/JCM.00605-14.
  55. Meadows C, Creagh-Brown, Nia T, Bonnici K, Finney S. Definition of catheter-related bloodstream infection as a quality improvement measure in intensive care. Crit Care 2009;13:P191. DOI: 10.1186/cc7355 [Accessed on: 08/02/2020].
  56. Sastry AS, Bhat S. In: Essentials of medical microbiology. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2016.
  57. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available from: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf [Accessed on: 10/02/2020].
  58. Marr KA. Delayed opportunistic infections in hematopoietic stem cell transplantation patients: a surmountable challenge. Hematology Am Soc Hematol Educ Program 2012;2012:265–270. DOI: 10.1182/asheducation-2012.1.265.
  59. Leblebicioglu H, Rodriguez-Morales AJ, Rossolini GM, López-Vélez R, Zahar JR, Rello J. Management of infections in critically ill returning travellers in the intensive care unit-I: considerations on infection control and transmission of resistance. Int J Infect Dis 2016;48:113–117. DOI: 10.1016/j.ijid.2016.04.019.
  60. Global antimicrobial resistance surveillance system: manual for early implementation. Geneva: World Health Organization; 2015. Available from: http://www.who.int/antimicrobial-resistance/publications/surveillance-system-manual/en/.
  61. Diagnostic stewardship: a guide to implementation in antimicrobial resistance surveillance sites. Geneva: World Health Organization; 2016.
  62. Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB Jr, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis 2013;57(4):22–121. DOI: 10.1093/cid/cit278.
  63. Patel R, Fang FC. Diagnostic stewardship: opportunity for a laboratory–infectious diseases partnership. Clin Infect Dis 2018;67(5):799–801. DOI: 10.1093/cid/ciy077.
  64. Dokouhaki P, Blondeau JM. Advances in laboratory diagnostic technologies in clinical microbiology and what this means for clinical practice. Clin Pract 2012;9(4):347–352. DOI: 10.2217/CPR.12.32.
  65. Blondeau JM, Idelevich EA. The 24-h clinical microbiology service is essential for patient management. Future Microbiol 2018;13:1625–1628. DOI: 10.2217/fmb-2018-0228.
  66. Gastmeier P, Stamm-Balderjahn S, Hansen S, Nitzschke-Tiemann F, Zuschneid I, Groneberg K, et al. How outbreaks can contribute to prevention of nosocomial infection: analysis of 1,022 outbreaks. Infect Control Hosp Epidemiol 2005;26:357–61. DOI: 10.1086/502552.
  67. Vonberg RP, Weitzel-Kage D, Behnke M, Gastmeier P. Worldwide outbreak database: the largest collection of nosocomial outbreaks. Infection 2011;39(1):29–34. DOI: 10.1007/s15010-010-0064-6.
  68. Morgan DJ, Rogawski E, Thom KA, Johnson JK, Perencevich EN, Shardell M, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med 2012;40(4):1045–1051. DOI: 10.1097/CCM.0b013e31823bc7c8.
  69. Damani N Pittet D. Manual of infection control procedures. 3rd ed. London: Oxford University Press; 2012.
  70. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38(5 Suppl. 1):25–33. DOI: 10.1016/j.ajic.2010.04.196.
  71. Kramer A, Assadian O. Survival of microorganisms on inanimate surfaces. 2014. Available from: https://www.researchgate.net/publication/283999635. DOI: 10.1007/978-3-319-08057-4_2 [Accessed on: 13/02/2020].
  72. Ling ML, Apisarnthanarak A, Thu le TA, Villanueva V, Pandjaitan C, Yusof MY. APSIC guidelines for environmental cleaning and decontamination. Antimicrob Resist Infect Control 2015;29;4:58. DOI: 10.1186/s13756-015-0099-7. PMID: 26719796; PMCID: PMC4696151.
  73. Russotto V, Cortegiani A, Fasciana T, Iozzo P, Raineri SM, Gregoretti C, et al. What healthcare workers should know about environmental bacterial contamination in the intensive care unit. BioMed Res Int DOI: 10.1155/2017/6905450 [Accessed on: 14/02/2020].
  74. Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29(7):593–599. DOI: 10.1086/588566.
  75. Carling PC, Parry MF, Bruno-Murtha LA, Dick B. Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission. Crit Care Med 2010;38(4):1054–1059. DOI: 10.1097/CCM.0b013e3181cdf705.
  76. CDC. Immunization of health-care personnel: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 2011;60(RR-7):1-45.
  77. Immunization action coalition. Healthcare personnel vaccination recommendations. Available from: www.immunize.org/catg.d/p2017 [Accessed on: 13/02/2020].
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.