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1. An observational case study of hospital associated infections in a critical care unit in Astana, Kazakhstan

Author

Dmitriy Viderman, Yekaterina Khamzina, Zhannur Kaligozhin, Makhira Khudaibergenova, Agzam Zhumadilov, Byron Crape, and Azliyati Azizan

Subjects
Intensive care unit (ICU), Hospital associated infections (HAI), Surgical site infections (SSI), Ventilator associated pneumonia (VAP), Blood stream infections (BSI), Urinary tract infections (UTI), Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background Hospital Associated infections (HAI) are very common in Intensive Care Units (ICU) and are usually associated with use of invasive devices in the patients. This study was conducted to determine the prevalence and etiological agents of HAI in a Surgical ICU in Kazakhstan, and to assess the impact of these infections on ICU stay and mortality. Objective To assess the rate of device-associated infections and causative HAI etiological agents in an ICU at the National Research Center for Oncology and Transplantation (NRCOT) in Astana, Kazakhstan. Methods This retrospective, observational study was conducted in a 12-bed ICU at the NRCOT, Astana, Kazakhstan. We enrolled all patients who were admitted to the ICU from January, 2014 through November 2015, aged 18 to 90 years of age who developed an HAI. Results The most common type of HAI was surgical site infection (SSI), followed by ventilator-associated pneumonia (VAP), catheter-related blood stream infection (BSI) and catheter-associated urinary tract infection (UTI). The most common HAI was SSI with Pseudomonas aeruginosa as the most common etiological agent. The second most common HAI was VAP also with P. aeruginosa followed by BSI which was also associated with P. aeruginosa (in 2014) and Enterococcus faecalis, and Klebsiella pneumoniae (in 2015) as the most common etiological agents causing these infections. Conclusion We found that HAI among our study population were predominantly caused by gram-negative pathogens, including P. aeruginosa, K. pneumoniae, and E. coli. To our knowledge, this is the only study that describes ICU-related HAI situation from a country within the Central Asian region. Many developing countries such as Kazakhstan lack surveillance systems which could effectively decrease incidence of HAIs and healthcare costs for their treatment. The epidemiological data on HAI in Kazakhstan currently is underrepresented and poorly reported in the literature. Based on this and previous studies, we propose that the most important interventions to prevent HAI at the NRCOT and similar Healthcare Institutions in Kazakhstan are active surveillance, regular infection control audits, rational and effective antibacterial therapy, and general hygiene measures.

Published
2018
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2. Outbreak of catheter-related Burkholderia cepacia sepsis acquired from contaminated ultrasonography gel: the importance of strengthening hospital infection control measures in low resourced settings

Author

Dmitriy, Viderman, Makhira, Khudaibergenova, Vadim, Kemaikin, Agzam, Zhumadilov, and Dimitri, Poddighe

Subjects
Catheterization, Central Venous, Cross Infection, Catheters, Equipment Contamination, Humans, Burkholderia Infections, Burkholderia cepacia, Disease Outbreaks, Ultrasonography
Abstract

This article reports the largest nosocomial outbreak of B. cepacia-related Hospital Acquired Infectios (HAIs) and the epidemiological investigations leading to identification of ultrasound gel as a direct means of infection transmission. Multiple environmental sampling was conducted to identify the source and route of infection. The samples were collected from all sources considered to be potential reservoirs of B. cepacia. Standard methods for pathogen isolation and antibiotic sensitivity testing were used. In all, 61 patients developed B. cepacia-related sepsis and this agent was isolated only from ultrasonography gel. All patients required the placement of a central venous line to receive the chemotherapy for the underlying hematologic disease. The hospital outbreak persisted after identification of the source of infection and it took more than four months to be completely eradicated after the first cases. B. cepacia is a serious threat for hospitalized patients needing invasive procedures, including the central line placement for chemotherapy, regardless of the need of any intensive care. Implementation of protocols for active surveillance of HAIs should also target this opportunistic agent and include periodic sterility control of commonly used medical materials, including ultrasonography gel and equipment.

Published
2020

3. REGIONAL ANAESTHESIA AND ACUTE PAIN

Author

Dragana Unic-Stojanovic, Camilo Año, Alejandro Lucchelli, Gustavo Carradori, Rodriguez Perez Jose Maria, Carla Farré, Carlos E. Lorda, Carolina Henao, Yoram Shapira, Martin McNally, Fauzia Nawaz, Lee Krahe, Fauzia Khan, Michael Burns, Nurdan Özdemir Fatma, Opas Puchissa, Peter Chee Seong Tan, Garcia Rojo Blas, Andrey L. Melnikov Steinar, Anjolie Chhabra, Buzz Shephard, Tomas E. Lambertus, Edgar Omero, Jason Chou, Tobias Piegeler, Jayashree Simha, Susana Pacreu, Athanasia Tsaroucha, Elisabet Andersson, Takashi Suto, Mauro Gili, Valasubramaniam Mahadevan, Miguel Moreno, Aylin Incesu, Pavan Gurha, José Aguirre, Francisco Riberi, Norzalina Esa, Imran Ahmed, V Mehta, Sanoussi Samuela, Richard Minshall, Belen Posso, Hyun Seung Kim, Orozco Montes Javier, Jesús Carazo, Mubeen Khan, Maria E. Interiano, Svetlana Galitzine, Stefano Scalia Catenacci, Raveendranath Wadhwani, Naila Asad, Nicole Naccache, Ralf E. Gebhard, Chaibou M Sani, Eduardo Sadatsune, Rita Jawish, Maria Isabel Vasquez, Dominguez Serrano Nuria, Grant Mills, Francisco Gómez Armenta, Jong-Hun Ji Sang, Rafael Esturi, Senthil Nadarajan, Jamie Vivian, Ömer Yanarates, Vera Tesic, Altun Demet, Shobha Rani, Pablo Lassalle, Argyro Fassoulaki, Ivan Lisnyy, Serdar Kaymak, S. S. Nethra, Ena Miller, Roberto Contreras, Antonio Carlos Shimano, Tanvir Butt, Somi Ramachary Desikan, Gulden Ugur, Bon Nyeo Koo, Jose M. Galbis, Juan Carlos Elvira, William Knox, Gina Votta Velis, Maria Carolina Cabrera Schulmeyer, Yuryy Kuchin, Alexandr Zlotnik, Serena Calcinati, Youn-Woo Lee, Ulrich Johannes Spreng, Bertram Baenziger, Thitima Chinachoti, Coskun Fusun Bozkirli, Howard Palte, Jaime De la Maza, Miriam Estors, Yon Hee Shim, Mercedes Lluch Fernández, Izuru Nose, D. Devikarani, Andeia Andeia Paraskeva, Sirous Momenzadeh, Cezary Kosiñski, Ae Ryoung Lee, Sivendiran Mahalingam, Beatrice Beck-Schimmer, Fatma Nur Kaya, Oguz Kýlýçkaya, Edward R. Mariano, Daniel Abell, Adrian Pearce, Farrukh Afzal, Cheng Ong, Rodrigo Costa, Anuradha Borle, Joao Abrao, Karl Otto Geier, Franco Ravera, Soo Joo Choi, Azlina Abbas Azhar, Soha Bazyar, Abarchi Habibou, Juan Fernández Candil, Fernando Cacheiro, Suzie Ward, Saju Sharafudeen, Luiz Falcao, Agata Kacka, Nicolas Altolaguirre, Ivan Ilic, Guillermo Reeves, Raveenthiran Rasiah, Eduard Stahovskiy, Rajiv Kumar, Akbar Shah Romila, Encarna Miñana, Inmaculada Herrador Montiel, Ravindra Wadhwani, Ji Young Kim, Diego Guardabassi, Hee Pyoung Park, Ji Young Yoo, M. Nuri Deniz, Amlesh Seth, Christopher Pollitt, Cristián Manuello, Jung-Won Hwang, Cleverson R. Fernandes, Shigeru Saito, Binod Gautam, Dusica Vucurevic, Pablo Morgillo, Elialba Cascudo, Hisham Jabbour, Jessica Zavesky, Vasanth Rao Kadam, M. P. S. Lokesh, Asoumane Toudou Nouhou, Jose E. LLopis, Asadollah Saadatniaki, Nicolás Gastón Moreno, Eduardo Cardieri, Franco Frenquelli, Dariush Abtahi, Liliana Suárez Aguilar, Marco Antonio Jogaib, Vescovo Anibal, Yun T. Romy, Tarik Purtuloglu, Cristián Ovalle, Oscar Aguirre, Mohammad Ali, Hanafi Sidik, Evangelina Gagliardo, Seyed Saed Jahanbakhsh, Chee Kean Chen, Edward Kim, Perumal Tamilselvan, P. Siddalingeshwara, Jaime Ordoñez, Raúl Trotta, Virginia Funes, Leonardo Ferraro, Belgin Yavaşcaoğlu Oya Kutlay, Stephan M. Jakob, Bjørgo Ulf E. Kongsgaard, Adriana Demoner, Alessandro Buda, Duck Hwan Choi, Tomasz Lazowwski, Hicham AbouZeid, Maria Tardelli, Young-Tae Jeon, Mabhidli Mduduzi Mashinini, Roberto Flores, Fernando J. Sanchez, Liliana Vaula, Bruno Gatto Chiara, Young Hee Shin, B Stevens, Vegard Dahl, Ludmila Klimchuk, Jung-Hee Rhyu, Steven Gayer, Ulka Paralkar, Carlos Bollini, Ylmazlar Burak Demira, Shu Ching Teo, Aliya Ahmed, Daniel Espada Lahoz, Angela Maria Rios, Hasmizy Bin Muhammad, Gutierrez-Meca Maestre Maria Dolores, Aida Amirzhanova, Oliver Baehre, Nicholas Christelis, Khalil Jabbour, Daniel Rothen, Amisha Burumdayal, Kevin Kline, Scaglioni Maria, Seema Randive, Masaru Tobe, Pablo Ingelmo, Gabriel Cortés, Agzam Zhumadilov, Jean-Marie Parel, Guillermina Harvey, Manee Raksakietisak, Aziza Hussain, Moran Debbie Miller, Aikaterini Melemeni, Jong Bum Choi, Paul F. White, Rodrigo Okubo, Hanuman K. Murthy, Robyn S. Weisman, K. Gunashekar, Blasko Smiljanic, Mariusz Piotrowski, Matthew Irwin, Amarpal Bhalla, Dominguez Ximena, Sani Rachid, Sian Griffiths, Rajeshwari Subramaniam, Maria Patricia Gonzalez, Irimar de Paula Posso, Ana Maria Pagliaro, A.C. Lundgren, Ercan Kurt, Piotr Sarwiñski, Vicente Muedra, Diego García-Girona, Nora Hasiah Idris, Merican Naveenthiran Thevanthiran, Ali Sýzlan, Jairo Moyano, Perrín Turenne Hugo, Fabian Astore, Angkana Luingnateetape, M Dilkes, Eun Park, Mariano Souza, S. S. Harsoor, J. Gregg Melton, Sang-Hwan Do, Magdalena Sinczak, Goran Tockov, Alexandre Takeda, K. Brijesh, George Mathew, C. Kumaresan, José Luis Furno, Brendan Carvalho, Miomir Jovic, Alex Ramsden, Elvan Erhan, Gonzalo M. Rivas, Andres Missair, Aysun Yildiz, Tomasz Lazowski, Ortega Ortega, Gundappa Parameswara, Van Wijk Roelof John, María Angélica Iglesias Tinnirello, Hitoshi Shimada, Kimiko Takekawa, SangMook Lee, Rachel Farmer, Nur Kaya Aysun, Hideaki Obata, Renato Passos, and Jimena Palleiro

Subjects
Anesthesiology and Pain Medicine, business.industry, Anesthesia, Medicine, Regional anaesthesia, business, Acute pain
Published
2012
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4. Management of Super-Refractory Status Epilepticus with Isoflurane and Hypothermia

Author

Dmitriy Viderman, Charles P. Gilman, and Agzam Zhumadilov

Subjects
Mild hypothermia, SRSE, neurotrauma, Status epilepticus, lcsh:RC346-429, Epilepsy, isoflurane, medicine, lcsh:Neurology. Diseases of the nervous system, business.industry, Neurointensive care, Hypothermia, medicine.disease, Clinical Case Study, nervous system diseases, Neurology, Isoflurane, nervous system, neurocritical care, Anesthesia, Anesthetic, epilepsy, Neurology (clinical), medicine.symptom, business, hypothermia, Super refractory, medicine.drug, Neuroscience
Abstract

Super-refractory status epilepticus is status epilepticus that continues beyond 24 hours and includes those cases in which epilepsy is recurrent upon reduction or withdrawal of treatment. We describe the presentation and successful management of a male patient with super-refractory status epilepticus using the inhaled anesthetic, isoflurane, and mild hypothermia (HT). The potential utility of combined HT and volatile anesthesia is discussed.

Published
2015
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5. Risk of aspiration during anesthesia in patients with congenital insensitivity to pain with anhidrosis: case reports and review of the literature

Author

Alexander Zlotnik, Irene Rozet, Shaun E. Gruenbaum, Agzam Zhumadilov, and Yoram Shapira

Subjects
Male, Risk, medicine.medical_specialty, medicine.medical_treatment, Anesthesia, General, Amputation, Surgical, Laryngeal Masks, Oxygen Consumption, Congenital insensitivity to pain with anhidrosis, Laryngeal mask airway, Anesthesiology, medicine, Intubation, Intratracheal, Laryngopharyngeal Reflux, Intubation, Humans, Orthopedic Procedures, Anhidrosis, Hereditary Sensory and Autonomic Neuropathies, Child, Hypoxia, Intraoperative Complications, Leg, business.industry, Respiratory Aspiration, Osteomyelitis, Perioperative, Toes, medicine.disease, Rapid sequence induction, Respiration, Artificial, Surgery, Heart Arrest, Anesthesiology and Pain Medicine, Debridement, Anesthesia, Child, Preschool, Female, medicine.symptom, business
Abstract

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disease, characterized by episodes of unexplained fever, anhidrosis, pain insensitivity despite intact tactile perception, self-mutilating behavior, mental retardation, and autonomic nervous system (ANS) abnormalities. We present a case series of three patients with CIPA who underwent semielective orthopedic surgery under general anesthesia complicated by intraoperative regurgitation, and subsequent aspiration in two of the three cases. All three patients were nil per os (NPO) for at least 8 h prior to surgery. Two patients had their airways maintained with a laryngeal mask airway (LMA), and one patient had an endotracheal tube (ETT). The patients with an LMA suffered aspiration of gastric contents and subsequently developed hypoxic cardiac arrest. Although the patient with an ETT in situ regurgitated intraoperatively, the presence of the ETT prevented aspiration and any further potential complications. We review the perioperative complications typically observed in patients with CIPA and discuss the risks of using an LMA in these patients. We recommend that patients with CIPA always should be considered as having a “full stomach”, regardless of the duration of their NPO status, due to their coexisting ANS abnormalities. Therefore, rapid-sequence induction with an ETT should be utilized for the anesthetic management in every patient with CIPA.

Published
2010

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