scholarly journals Effect of Short-Term Carbapenem Restriction on Antimicrobial Susceptibility of Resistant Gram-Negative Bacilli in an ICU

2020 ◽  
Vol 41 (S1) ◽  
pp. s200-s201
Author(s):  
Mariana Melo ◽  
Raquel Bandeira ◽  
lio de Castro Giselle Dias ◽  
Braulio Couto
Keyword(s):  
High Mortality ◽  
Bacterial Resistance ◽  
Statistical Significance ◽  
Public Health Problem ◽  
Resistance Rate ◽  
Second Phase ◽  
Short Term ◽  
Intervention Phase ◽  
Carbapenem Resistant ◽  
The Impact

Background: Carbapenem-resistant GNB infections are a serious public health problem worldwide, particularly due to the high mortality associated with them and the low number of therapeutic options. One approach to this challenge is the development of antimicrobial stewardship programs. Objective: We evaluated the impact of a carbapenem restriction program on reducing of bacterial resistance in an intensive care unit (ICU). Methods: A retrospective study conducted in 2 phases in the 80-bed ICU of an acute-care public hospital in Minas Gerais, Brazil. The preintervention phase lasted 16 months (January 2018–April 2019) and the second phase (carbapenem restriction), after the intervention, lasted 4 months (May–August 2019). The intervention was defined as carbapenem-sparing and the use of meropenem was authorized in 3 situations: (1) treatment of serious infections documented by extended-spectrum β-lactamase–producing Enterobacteriacea (ESBL); (2) therapeutic failure with the use of another antimicrobial; and (3) infectious disease recommendation. Data were obtained through consultation of electronic medical records and microbiological results, as standardized by the CLSI, for patients with a >48-hour stay in the ICU and who met the criteria for healthcare-associated infection (HAI) according to the CDC NHSN definition. Results: Before the intervention, on average, 50 cultures were obtained with positive results for multidrug-resistant GNB–MER-GNB (SD, 12.2) and in the intervention phase, this number was 31 cultures (SD, 12.8; P = .010). Average carbapenem consumption decreased significantly with corresponding increase in cefepime consumption in the same period (Fig. 1). The ATB (DDD per 1,000 patient days) before the intervention for carbapenems was 110.6 (SD, 97.1) and for cefepime was 8.2 (SD, 5.9). In the intervention phase, the ATB for carbapenems was 44.7 (SD, 38.5; P = .015) and for cefepime it was 32.0 (SD, 20.3; P < .001). In terms of multidrug resistance rate, before the intervention, 95 of 149 of Acinetobacter (64%) were resistant and during the intervention, 13 of 30 Acinetobacter (43%) were resistant (P = .043). Other GNB (Klebsiella, Proteus, Escherichia coli, and Pseudomonas) reduced the resistance rate, but without statistical significance. We observed a reduction in the HAI rate per MDR-GNB (Fig. 2): before the intervention, it was 22.7 (SD, 5.5) and during the intervention phase it was 16.5 (SD, 7.7; P = .07), although this change did not reach statistical significance. Nevertheless, the ICU Klebsiella infection rate did significantly decrease; it was 5.5 (SD, 1.9) before the intervention and 2.4 (SD, 1.8) after the intervention (P = .009). Conclusions: Short-term carbapenem restriction may be an effective strategy to reduce the incidence of carbapenem-resistant GNB infections in the ICU. The scarce arsenal available for the treatment of MDR-GNB and the high mortality rate justify the growing need for stewardship programs in Brazilian ICUs.Funding: NoneDisclosures: None

scholarly journals Clinicopathological features of Egyptian colorectal cancer patients regarding somatic genetic mutations especially in KRAS gene and microsatellite instability status: a pilot study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Neemat M. Kassem ◽  
Gamal Emera ◽  
Hebatallah A. Kassem ◽  
Nashwa Medhat ◽  
Basant Nagdy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Microsatellite Instability ◽  
Cpg Island ◽  
Human Cancer ◽  
Statistical Significance ◽  
Public Health Problem ◽  
World Health ◽  
Cpg Island Methylator Phenotype ◽  
Number Of Patients ◽  
The Impact

Abstract Background Colorectal cancer (CRC) is the third most common cause of cancer-related deaths which contributes to a significant public health problem worldwide with 1.8 million new cases and almost 861,000 deaths in 2018 according to the World Health Organization. It exhibits 7.4% of all diagnosed cancer cases in the region of the Middle East and North Africa. Molecular changes that happen in CRCs are chromosomal instability, microsatellite instability (MSI), and CpG island methylator phenotype. The human RAS family (KRAS, NRAS, and HRAS) is the most frequently mutated oncogenes in human cancer appearing in 45% of colon cancers. Determining MSI status across CRCs offers the opportunity to identify patients who are likely to respond to targeted therapies such as anti-PD-1. Therefore, a method to efficiently determine MSI status for every cancer patient is needed. Results KRAS mutations were detected in 31.6% of CRC patients, namely in older patients (p = 0.003). Codons 12 and 13 constituted 5/6 (83.3%) and 1/6 (16.7%) of all KRAS mutations, respectively. We found three mutations G12D, G12C, and G13D which occur as a result of substitution at c.35G>A, c.34G>T, and c.38G>A and have been detected in 4/6 (66.6%), 1/6 (16.7%), and 1/6 (16.7%) patients, respectively. Eleven (57.9%) patients had microsatellite instability-high (MSI-H) CRC. A higher percentage of MSI-H CRC was detected in female patients (p = 0.048). Eight patients had both MSI-H CRC and wild KRAS mutation with no statistical significance was found between MSI status and KRAS mutation in these studied patients. Conclusion In conclusion, considering that KRAS mutations confer resistance to EGFR inhibitors, patients who have CRC with KRAS mutation could receive more tailored management by defining MSI status. MSI-high patients have enhanced responsiveness to anti-PD-1 therapies. Thus, the question arises as to whether it is worth investigating this association in the routine clinical setting or not. Further studies with a larger number of patients are needed to assess the impact of MSI status on Egyptian CRC care.

Abstract 275: Cardiac Arrest Etiology and Associated Cognitive Impairment in Survivors

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Allison C Koller ◽  
Jon C Rittenberger ◽  
Thomas J Songer ◽  
Andrea L Rosso ◽  
Jessica E Salerno ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Statistical Significance ◽  
Cohort Analysis ◽  
Public Health Problem ◽  
The United States ◽  
Exam Score ◽  
Modifying Factors ◽  
The Impact ◽  
Normal Cognition ◽  
Moca Score

Background: Cardiac arrest is a significant public health problem, impacting over 500,000 people in the United States annually. The four major etiologies of arrest are cardiac, respiratory, traumatic, and other. The objective was to determine the impact of etiology on cognition in cardiac arrest survivors using the Montreal Cognitive Assessment (MOCA). Hypothesis: Cardiac arrest etiology impacts cognitive exam score, and patient demographics and characteristics modify that relationship. Methods: A retrospective cohort analysis was performed on all Pittsburgh Post Cardiac Arrest Service (PCAS) patients from 2012-18. Data were acquired through medical record review. T-tests, linear and logistic regression were used to assess the relationships between exam score and modifying factors. MOCA score was analyzed as a binomial variable using a pass/fail threshold of 26/30 points (86.7%) and above for normal cognition. For statistical significance, an alpha level of 0.05 was used. Results: In total, 192 patients completed the MOCA: 104 with cardiac etiology, 35 with respiratory, 4 with trauma, and 49 with other. Median age for all patients was 59.3 years, and 58% were male. Mean (SE) MOCA score for all patients was 72.8 (1.1) percent. When MOCA score was converted to a binomial indicator of normal cognition, respiratory, traumatic, and other etiologies were more likely to exhibit impairment than cardiac etiology arrest when age, sex, witnessed status, length of ICU stay and coma were controlled for (OR: 2.52, 3.43, 2.18 respectively). These findings were nullified when time from arrest to MOCA administration was included. Of the MOCA subcategories, delayed recall was the most severely impacted, with patients recalling an average of 1.67 of 5 words after 5 minutes. Additionally, respiratory arrests performed significantly worse than cardiac etiology arrests in attention (4.1 vs 4.9 points, p=0.004) and language domains (1.9 vs. 2.3, p=0.04). Conclusions: Respiratory, traumatic, and other etiologies were more likely to exhibit abnormal cognition on the MOCA than those with a cardiac etiology. The etiological findings were nullified when time to cognitive examination was controlled for. Timing appears to influence cognitive assessments more than etiology.

Molecular epidemiologic factors contributing to quinolone resistance in clinical multidrug-resistant Klebsiella pneumoniae isolates from Shanghai, China

2021 ◽  
Author(s):  
Yan Wang ◽  
Guoping Cai ◽  
Jinan Zhang ◽  
Xiaogang Xu ◽  
Hongzhou Lu
Keyword(s):  
Klebsiella Pneumoniae ◽  
Point Source ◽  
Bacterial Resistance ◽  
Multidrug Resistant ◽  
Resistance Rate ◽  
Quinolone Resistance ◽  
Epidemiologic Factors ◽  
Selective Pressures ◽  
Carbapenem Resistant ◽  
Epidemiologic Surveillance

Abstract BackgroundThe soaring quinolone-resistance rate of Klebsiella pneumoniae, a common pathogen in immunocompromised individuals, has seriously undermined the wide applications of antimicrobials of this class. This study aimed to investigate the emerging key contributors to quinolone-resistance in multidrug resistant K. pneumoniae (MDR-KP) isolates from a clinical setting with continuing point-source infection outbreaks in Shanghai, China. ResultsBetween January and March 2017, a total of 34 K. pneumoniae isolates, including 30 carbapenem-resistant K. pneumoniae (CRKP), were selected and characterized from a teaching hospital participating in an ongoing Bacterial Resistance Surveillance Project in Shanghai, China. Two predominant high-risk CRKP clones, ST11-wzi64 and ST15-wzi19/wzi24, caused three point-source nosocomial outbreaks in intensive care unit and/or neurosurgery department potentially by respiratory-route, promoting the co-selection and evolution of multidrug-resistant determinants. Multiple quinolone resistance-determining region (QRDR) mutations occurred in isolates of ST15 (S83F, D87A; S80I), ST11 (S83I, D87G; S80I), and ST218 (D87A; S80I). Plasmid-mediated quinolone resistance determinants, qnrS1, aac(6’)-Ib-cr, oqxAB, were detected in 32 (94.1%) isolates alone or in combination, spreading accompanied with β-lactamases (mainly, KPC-2-type carbapenemase and CTX-M-type extended-spectrum β-lactamase), 16S rRNA methylases (ArmA and RmtB), and putrescine ABC transporter permease (PotI) variants, independently of QRDR-mutations. AcrR, AcrAB transcriptional repressor, was insertion-inactivated by IS5-transposase in isolates of ST11. Thirteen ompK36 variants associated with specific ST (n=7) and wzi-allele (n=9) clustered into 10 (sub)lineages in the phylogenetic tree possibly affecting the MDR phenotype and the infection outcome of isolates. Isolates of ST11, ST15, and ST218 had frameshift disruptions in OmpK35 coupled with specific GD-insertion at position 134-135 in OmpK36, all showing distinct microevolution clusters of ompK36 genotypes. Seven quinolone-susceptible isolates kept the porin genes integral, including two each CRKPs of ST13-wzi74 (carbapenemase KPC-2 and NDM-1-coproducers) and ST65-wzi72. ConclusionsUnder selective pressures, accumulation of mutations of three types (QRDR, AcrR, OmpK36/OmpK35) and acquisition of resistance-conferring genes has been continuously contributing to quinolone-resistance in clinical MDR-KP isolates, reinforcing the importance of ongoing epidemiologic surveillance on the evolution and transmission of these isolates. Our findings provided detailed mechanistic analyses and epidemiologic implications for further infection control and antibiotic stewardship initiatives.

scholarly journals Augmenting Performance: Vocal Activity Compared to Presence in the Social Facilitation of Running

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Humza Malik ◽  
Kate Flowers
Keyword(s):  
High School Students ◽  
Social Facilitation ◽  
Statistical Significance ◽  
Short Term ◽  
School Students ◽  
Long Distance ◽  
Sports Team ◽  
Verbal Encouragement ◽  
The Impact

Objective The impact of encouragement on performance has been observed in the setting of exercise, but further research is necessary in running. To compare the improvement in pace experienced by subjects of different backgrounds (from a running team, non-running sports team, or no sports team) as a result of active (verbal encouragement) and passive social facilitation, this study was conducted. Method Eighteen male high school students, age 17.3±0.75 years were recruited for this study, six from each background listed above. Participants were randomly assigned to one of three treatments: external verbal encouragement (EVE), without external verbal encouragement (WEVE), or no presence. Improvement in pace after the introduction of a social facilitator was recorded along with overall consistency in pace. Statistical significance was set at α = 0.10. Results A significant improvement in short-term pace among subjects from a running team was generated by EVE, t(1) = -5.198, p = 0.0605, and no presence generated a significant improvement in short-term pace among subjects from a non-running sports team, t(1) = -5, p = 0.0669. EVE also generated a significant improvement in long-term pace among subjects from a running team, t(1) = -5.069, p = 0.0620. A conclusion on consistency was not reached. Conclusion Verbal encouragement saw to long-term and short-term improvement in pace of subjects selected from a running team, while the lack of presence assisted the short-term performance of subjects selected from non-running sports teams. Results obtained offer potential to impact competitive long-distance running.

scholarly journals The Impact of Sampling and Measurement on the Prevalence of Self-Reported Pain in Canada

2003 ◽  
Vol 8 (3) ◽  
pp. 157-163 ◽  
Author(s):  
Elizabeth G Van Den Kerkhof ◽  
Wilma M Hopman ◽  
Tanveer E Towheed ◽  
Tassos P Anastassiades ◽  
David H Goldstein
Keyword(s):  
Chronic Pain ◽  
General Population ◽  
Health Survey ◽  
Public Health Problem ◽  
Short Term ◽  
Canadian Population ◽  
Prevalence Estimates ◽  
Prevalence Of Pain ◽  
The Impact ◽  
Age And Sex

BACKGROUND: Pain is an important public health problem in Canada. International estimates of general population pain prevalence range from 2% to 46%.OBJECTIVES: The purpose of this paper is to critically examine the potentially misleading use of overall prevalence estimates in the pain literature and to use two Canadian population-based surveys to assess the impact of sampling and measurement on prevalence.METHODS: Two of the secondary data sets used were the 1996/97 National Population and Health Survey (NPHS) and the Canadian Multicentre Osteoporosis Study (CaMos). This paper is based on the assessment of chronic pain in the NPHS, and the assessment of short term pain using the Medical Outcomes Trust's 36-item health survey and the Health Utilities Index, both collected by CaMos. Data are presented as frequencies and percentages overall and stratified by age and sex. CaMos prevalence estimates were age and sex-standardized to the NPHS population.RESULTS: The overall prevalence of pain was 39% for one-week pain, 66% for four-week pain and 15% for chronic pain. Women were more likely to report pain than men and the prevalence of pain increased with age.CONCLUSIONS: This study yields useful information about the self-reported responses to a variety of questions assessing pain in the general population. Responses to the different questions likely represent different categories of pain, such as short term versus chronic pain, which in turn may have different epidemiological risk factors and profiles. Longitudinal studies of the epidemiology, predictors and natural history of chronic pain are urgently needed in the Canadian population.

scholarly journals Antimicrobials and resistant bacteria in global fish farming and the possible risk for public health

2020 ◽  
Vol 87 ◽  
Author(s):  
Luís Eduardo de Souza Gazal ◽  
Kelly Cristina Tagliari de Brito ◽  
Renata Katsuko Takayama Kobayashi ◽  
Gerson Nakazato ◽  
Lissandra Souto Cavalli ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Diseases ◽  
Pathogenic Bacteria ◽  
Bacterial Resistance ◽  
Public Health Problem ◽  
Fish Farming ◽  
Cross Resistance ◽  
Resistant Bacteria ◽  
The Impact ◽  
Selection Of

ABSTRACT: The use of antimicrobials in fish farming is a reflection of the fast aquaculture development worldwide. The intensification of aquaculture to achieve market demands could lead to an increase in infectious diseases by pathogenic bacteria. Consequently, antimicrobials act as controls for emerging infectious diseases, but their use must follow the rules and regulations of the country where the activity is performed. Although the regulations impose limits to the use of antimicrobials in fish farming, many studies show that resistant bacteria are isolated from this system. The selection of resistant bacteria is not limited only to the use of antimicrobials, but also to co-selection of resistance genes or even with cross-resistance processes. Resistant bacteria from fish farming are a serious concern because they can be acquired by humans with handling or food chain, which may represent a public health problem. In the present review, we present an overview of antimicrobials use in aquaculture, the antimicrobial resistance and the impact of antimicrobial and bacterial resistance from a public health perspective.

scholarly journals The landscape of diabetic foot in Peru

2021 ◽  
Vol 62 (3) ◽  
pp. 276-289
Author(s):  
Ericka Saravia-Hernández ◽  
José Salvador-Carrillo ◽  
Alejandra Zevallos ◽  
Jorge Calderón-Ticona
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Bacterial Resistance ◽  
Scientific Evidence ◽  
Resistance Rate ◽  
Diabetic Patients ◽  
Significant Deterioration ◽  
The Impact ◽  
Local Research

Diabetic foot (DF) is one of the main complications responsible for the significant deterioration of the quality of life in diabetic patients, particularly, in developing countries. In Peru, 18.9% of diabetic inpatients present DF and 61% develop a foot sepsis. Therefore, the burden of DF is considerable in the country. In this work, we summarize the current scientific evidence of DF in the Peruvian population describing its epidemiology, risk factors, increase of time of hospitalization, bacterial resistance, rate of amputations, and the theoretical medical costs for disease management. According to the reviewed literature, we suggest that more local research should be conducted to better understand the impact of the DF on the Peruvian population.

scholarly journals The short-term impact of analyst recommendations: evidence from the Indian stock market

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Shreya Sharda
Keyword(s):  
Statistical Tests ◽  
Statistical Significance ◽  
Abnormal Returns ◽  
Information Value ◽  
Strong Form ◽  
Analyst Recommendations ◽  
Short Term ◽  
Content Type ◽  
Stock Recommendations ◽  
The Impact

Purpose This study aims to evaluate the short-term impact of brokerage analysts’ recommendations on abnormal returns using a sample selected from the S&P BSE 100 in the Indian context. The efficient market hypothesis, specifically, its semi-strong form, is tested for “Buy” stock recommendations published in the electronic version of Business Standard. The crucial issue is, are there any abnormal returns that can be earned following a recommendation? If so, how quickly do prices incorporate the information value of these recommendations? It tests the impact of analyst recommendations on average abnormal returns (AARs) and standardized abnormal returns (SRs) to determine their statistical significance. Design/methodology/approach Using a sample of stock recommendations published in the e-version of Business Standard, the event study methodology is used to determine whether AARs and SRs are significantly different from zero for the duration of the event window by using several significance tests. Findings The findings indicate a marginal opportunity for profit in the short term, restricted to the event day. However, the effect does not persist, i.e. the market is efficient in its semi-strong form implying that investors cannot consistently earn abnormal returns by following analysts’ recommendations. Post the event date, the market reaction to analyst recommendations becomes positive, however, insignificant until the ninth day after the recommendation providing support to the underreaction hypothesis given by Shliefer (2000) and post-recommendation price drift documented by Womack (1996). The study contributes by using different statistical tests to determine the significance of returns. Practical implications There are important implications for traders, investors and portfolio managers. The speed with which market prices incorporate publicly available information is useful in formulating trading strategies. However, stock characteristics such as market capitalization, volatility and level of analyst coverage need to be incorporated while making investment decisions. Originality/value The study contributes by using different statistical tests to determine the significance of returns.

scholarly journals Hit evaluation of an α-helical peptide: Ala-scan, truncation and sidechain-to-sidechain macrocyclization of an RNA polymerase Inhibitor

2019 ◽  
Vol 400 (3) ◽  
pp. 333-342
Author(s):  
Ahmed Ashraf Moustafa Kamal ◽  
Monica Habib ◽  
Joerg Haupenthal ◽  
Rolf Wolfgang Hartmann ◽  
Martin Empting
Keyword(s):  
Biological Activity ◽  
Rna Polymerase ◽  
Bacterial Resistance ◽  
Cd Spectroscopy ◽  
Resistance Rate ◽  
Novel Structure ◽  
C Terminus ◽  
Helical Content ◽  
Natural Amino Acids ◽  
The Impact

Abstract RNA polymerase (RNAP) remains a relatively underexplored target with only rifampicin and fidaxomicin in clinical use. Hence, the concurrent rise in bacterial resistance rate urges the search for novel RNAP inhibitors with a novel mode of action. In this work, we investigated the impact of several systematic modifications including sidechain-to-sidechain macrocylization in the α-helical content and biological activity of a previously identified inhibitory sigma factor fragment. Ala-scan results, peptide truncation from both the N- and C-terminus and modifications inspired by other RNAP inhibitors revealed novel structure activity relationships but did not yield a superior sequence. Additionally, four insertion points for non-natural amino acids bearing side chains required for macrocylization were explored. Linear precursors showed improved stabilization of the α-helical content compared to the original sequence as demonstrated by circular dichroism (CD) spectroscopy. However, this increase in α-helicity did not translate into improved biological activity. Instead, complete abolishment of RNAP inhibitory activity occurred. We hypothesize three possible reasons for such a discrepancy and offer the basis for further optimization efforts for this peptidic RNAP inhibitor.

scholarly journals Impact of ketamine on spontaneous coordinate activity and short memory behavior in rodents chronic unpredictable stress model

2021 ◽  
pp. 76-76
Author(s):  
Ana Starcevic ◽  
Darko Laketic ◽  
Ana Cirovic ◽  
Aleksandra Zelenovic ◽  
Jelena Boljanovic ◽  
...  
Keyword(s):  
Short Term Memory ◽  
Single Injection ◽  
Statistical Significance ◽  
Male Rats ◽  
Control Group ◽  
Chronic Unpredictable Stress ◽  
Short Term ◽  
Short Memory ◽  
The Impact ◽  
Experimental Group

Introduction/Objective. This research aims to evaluate the impact of chronic stress on behavioral effects of ketamine, which are not sufficiently clear, still. Methods. Wistar male rats aged five weeks were used in the experiment. The animals were divided into two equal groups: control and experimental. After being exposed to a chronic unpredictable stress paradigm for 42 days, experimental rats had received a single injection of ketamine (10 mg/kg; day 45) as well as control group. The impact of ketamine was assessed using behavioral tests, spontaneous coordinate activity, and water maze tests for the evaluation of short-term memory. Results. The experimental group rats showed less spontaneous motoric activity than before ketamine application. Statistical significance was shown in gaining weight after time of ketamine application in control group and also in experimental group where they showed weight loss during stress paradigm and then increased their weight after ketamine application. There was no statistical significance in speed measurements in both groups showing no effects on short memory behavior. Conclusion. These findings show that ketamine in single subanesthetic dose has antidepressant and anxiolytic like effects in male rats exposed to chronic unpredictable stress paradigm

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