Gentamicin and Tobramycin Resistant Gram-Negative Bacilli in a Community Hospital

1980 ◽  
Vol 1 (4) ◽  
pp. 249-252 ◽  
Author(s):  
C. Richard Magnussen ◽  
Maria Sammartino
Keyword(s):  
Community Hospital ◽  
Gram Negative ◽  
Recent Treatment ◽  
One Year

AbstractThe incidence and spectrum of resistance to gentamicin and tobramycin among gram-negative bacilli (GNB) isolated in a community hospital over a one-year period were studied. The overall incidence of resistance was 3.7%. Pseudomonads constituted almost half of the resistant organisms. The majority of resistant GNB was isolated from the respiratory and urinary tracts. Acquisition of resistance was correlated with both the total use of gentamicin in the hospital and recent treatment of individual patients with gentamicin plus tobramycin. The overall incidence of resistant isolates (3.7%) and the incidence of resistance for the enterobacteriaceae (1.9%) were lower than rates reported by comparable studies at several university or municipal hospitals.

Longitudinal Analysis of Endemic Gentamicin- and Tobramycin-Resistant Gram-Negative Bacilli in a Community Hospital

1984 ◽  
Vol 5 (2) ◽  
pp. 88-92 ◽  
Author(s):  
C. Richard Magnussen ◽  
Maria T. Jacobson
Keyword(s):  
Risk Factors ◽  
Longitudinal Analysis ◽  
Community Hospital ◽  
Comparison Group ◽  
The Body ◽  
Aminoglycoside Resistance ◽  
Gram Negative ◽  
Original Analysis ◽  
One Year ◽  
Matched Comparison

AbstractThe epidemiology of endemic gentamicin- and tobramycin-resistant gram-negative bacilli at a community hospital was analyzed over a one-year period three years following an original analysis at the same hospital. The frequency and distribution of resistant organisms remained stable over the time spanning the two studies. Only 2.8% of all gram-negative bacilli were resistant to gentamicin or tobramycin, and the majority of resistant isolates were non-Enterobacteriaceae. The respiratory and urinary tracts remained the body sites most prone to harbor resistant organisms. Risk analysis using a matched comparison group again revealed prior treatment with an aminoglycoside to be the only significant factor pre-disposing to acquisition of resistant gram-negative bacilli. This analysis indicates that community hospitals may not be important reservoirs of endemic aminoglycoside-resistant gram-negative bacilli, and reconfirms the observation that each hospital must define its own pattern of aminoglycoside resistance and unique risk factors.

scholarly journals Characteristic of infectious status in patients with acutely decompencated chronic heart failure and its impact on annual prognosis

Kardiologiia ◽  
2019 ◽  
Vol 59 (8S) ◽  
pp. 56-62
Author(s):  
V. A. Kostenko ◽  
M. Yu. Sitnikova ◽  
E. A. Skorodumova ◽  
E. G. Skorodumova ◽  
A. N. Fedorov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intestinal Bacteria ◽  
Mycoplasma Hominis ◽  
Chronic Obstructive ◽  
Infectious Agents ◽  
Gram Negative ◽  
Inflammatory Stress ◽  
Barr Virus ◽  
Epstein Barr ◽  
One Year

Aim. The assessment of infectious status in patients with acutely decompensated chronic heart faiure (ADCHF) without evident signs of acute inflammatory stress and its impact on the 1 year prognosis.Material and methods. Totally, 65 patients with ADCHF of ischemic origin investigated, age 67,3±2,3 y.o. All patients were taken markers of phagocytosis and inflammatory stress as well as antibodies to Streptococcus, Cytomegalovirus (CMV), Epstein-Barr virus (VEB), Candida albicans, Toxoplasma gondii, Aspergillus, Mycoplasma hominis and pneumonia and also level of lipopolysaccharids (LPS) of gram-negative bacteriae.Results. More often LPS of gram-negative bacteriae were revealed in patients with ADCHF and further in decreasing order – antibodies to CMV, VEB, Streptococcus, Candida, Aspergillus and LPS. All patients have been infected by at least 2 pathogens, more than 90 % of them had 3 ones or more. Mortality in first 12 months observation correlated with quantity of patient`s pathogenic patterns (r=0,52, p=0,004). Dependency of one-year mortality from degree of viral-bacterial mixt contamination was almost linear. CMV was a monopathogen with strongest correlation with mortality (r=0,39, p=0,001). In patients with more significant infection bigger rate of re-hospitalizations about new ADCHF correlated with number of pathogens was observed (r=0,61, p=0,001).Conclusion. Chronic latent infection with a significant number of pathogens is characteristic of patients with low-ejection ADCHF of ischemic genesis with a significant number of pathogens: more than 90 % of patients had three or more. The most common exogenous pathogens in the study sample of patients with chronic obstructive heart failure were CMV, EBV, and hemolytic streptococcus, of the potentially endogenous ones, gram-negative intestinal bacteria. The number of infectious agents in patients with chronic obstructive heart failure has a direct correlation with deaths and re-admission to hospital with total heart failure within 1 year after discharge from the hospital.

Proteeae Groin Skin Carriage in Ambulatory Geriatric Outpatients

1989 ◽  
Vol 10 (4) ◽  
pp. 150-154 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Debra G. Eckert ◽  
Blanca C. Alfonso ◽  
Lee B. Moskowitz
Keyword(s):  
Nursing Home ◽  
Chronic Disease ◽  
Nursing Homes ◽  
Gram Negative ◽  
Negative Bacillus ◽  
Annual Prevalence ◽  
Skin Ulcers ◽  
Gram Negative Bacillus ◽  
One Year ◽  
Private Homes

AbstractAerobic gram-negative bacillus (AGNB) groin skin carriage was prospectively studied in ambulatory geriatric outpatients: 42 from three nursing homes and 44 from private homes. Initially, 12 (28.6%) Proteeae carriers were in the former group and 3 (6.8%) were in the latter (P=0.01). At one year, 6 of 7 surviving nursing home carriers remained Proteeae carriers while none from private homes remained carriers (P=0.007). The annual prevalence of Proteeae carriage was 14 (33.3%) in nursing homes and 4 (9.1%) in private homes (P=0.008); of non-Proteeae AGNB carriage, the annual prevalence was 2 (4.8%) and 4 (11.4%), respectively. Nursing home subjects had similar initial health characteristics; however, by one year, 5 of 12 carriers in contrast to 3 of 30 noncarriers were dead of chronic disease (P=0.03). These nursing homes included persons with chronic diseases that apparently facilitated Proteeae carriage. Urethral catheters, skin ulcers, and recent antibiotics were not factors.

scholarly journals Bacteraemia in Intensive Care Unit: Clinical, Bacteriological, and Prognostic Prospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Zineb Lachhab ◽  
Mohammed Frikh ◽  
Adil Maleb ◽  
Jalal Kasouati ◽  
Nouafal Doghmi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Intensive Care Units ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Common Source ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamases ◽  
Gram Negative Organisms ◽  
One Year

Objectives.We conducted a one-year observational study from December 2012 to November 2013 to describe the epidemiology of bacteraemia in intensive care units (ICU) of Mohammed V Military Teaching Hospital of Rabat (Morocco).Methods.The study consisted of monitoring all blood cultures coming from intensive care units and studying the bacteriological profile of positive blood cultures as well as their clinical significance.Results.During this period, a total of 46 episodes of bacteraemia occurred, which corresponds to a rate of 15,4/1000 patients. The rate of nosocomial infections was 97% versus 3% for community infections. The most common source of bacteraemia was the lungs in 33%, but no source was identified in 52% of the episodes. Gram negative organisms were isolated in 83,6% of the cases withAcinetobacter baumanniibeing the most frequent. Antibiotic resistance was very high with 42,5% of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and 100% of carbapenemase inAcinetobacter baumannii. The antibiotherapy introduced in the first 24 hours was adequate in 72% of the cases.Conclusions.Bloodstream infections in ICU occur most often in patients over 55 years, with hypertension and diabetes. The bacteria involved are mainly Gram negative bacteria multiresistant to antibiotics. Early administration of antibiotics significantly reduces patients mortality.

scholarly journals The Performance of Direct Disk Diffusion for Community Acquired Bacteremia due to Gram-Negative Bacilli and Its Impact on Physician Treatment Decisions

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Peter Daley ◽  
Adam Comerford ◽  
Jurgienne Umali ◽  
Carla Penney
Keyword(s):  
Antibiotic Treatment ◽  
Susceptibility Testing ◽  
Treatment Decisions ◽  
Empiric Therapy ◽  
Blood Cultures ◽  
Disk Diffusion ◽  
Direct Result ◽  
Gram Negative ◽  
Early Results ◽  
One Year

Background.Direct disk diffusion susceptibility testing provides faster results than standard microtitre susceptibility. The direct result may impact patient outcome in sepsis if it is accurate and if physicians use the information to promptly and appropriately change antibiotic treatment.Objective.To compare the performance of direct disk diffusion with standard susceptibility and to consider physician decisions in response to these early results, for community acquired bacteremia with Gram-negative Bacilli.Methods.Retrospective observational study of all positive blood cultures with Gram-negative Bacilli, collected over one year. Physician antibiotic treatment decisions were assessed by an infectious diseases physician based on information available to the physician at the time of the decision.Results.89 bottles growing Gram-negative Bacilli were included in the analysis. Direct disk diffusion agreement with standard susceptibility varied widely. In 47 cases (52.8%), the physician should have changed to a narrower spectrum but did not, in 18 cases (20.2%), the physician correctly narrowed from appropriate broad coverage, and in 8 cases (9.0%), the empiric therapy was correct.Discussion.Because inoculum is not standardized, direct susceptibility results do not agree with standard susceptibility results for all drugs. Physicians do not act on direct susceptibility results.Conclusion.Direct susceptibility should be discontinued in clinical microbiology laboratories.

Sustained reductions in unnecessary antimicrobial administration and hospital Clostridioides difficile rates via stewardship in a nonacademic setting

2021 ◽  
pp. 1-3
Author(s):  
Neil Gaffin ◽  
Brad Spellberg
Keyword(s):  
Community Hospital ◽  
Community Setting ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Gram Negative ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Acquisition Costs ◽  
Hospital Acquired ◽  
Antimicrobial Administration

Abstract A large community hospital sought to reduce its burden of hospital-acquired Clostridioides difficile infection (CDI). We implemented an antimicrobial stewardship program (ASP), resulting in marked reductions in unnecessary antimicrobial use, CDI rates, antimicrobial acquisition costs, with preservation of gram-negative susceptibilities. ASP programs are effective in a community setting.

Retrospective Cost Analysis of Testing for HIT Antibodies in a Community Hospital

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4544-4544
Author(s):  
Raimonda Goldman ◽  
Berry Ustun ◽  
Randy L. Levine
Keyword(s):  
Cost Analysis ◽  
Retrospective Review ◽  
Mayo Clinic ◽  
Community Hospital ◽  
Elisa Test ◽  
Bleeding Complications ◽  
Antibody Testing ◽  
Heparin Induced Thrombocytopenia ◽  
One Year ◽  
The Cost

Abstract Background: Heparin-Induced Thrombocytopenia is a serious, immune-mediated complication of heparin therapy. At Lenox Hill Hospital when HIT is suspected, a test for heparin associated antibodies is ordered. Like many community hospitals, Lenox Hill Hospital does not perform this test “in house”, so it is sent to a reference lab. We use the Mayo Clinic Laboratory as our reference lab. It takes about 7 days for results to come back to Lenox Hill Hospital from the Mayo Clinic Lab. Meanwhile, patients are started on Argatroban or Lepirudin infusions in order to avoid thrombosis. We performed a retrospective review of all patients suspected of having HIT in a one year period, in order to assess the cost effectiveness of sending out these tests and treating these patients with alternative anticoagulants while waiting for the test results. Methods: We performed a retrospective review of all patients who were tested for HIT Antibodies. We obtained a list of patient specimens sent to Mayo Clinic for heparin associated antibodies from January 2007 to January 2008. A list of patients placed on either Argatroban or Lepirudin infusions was also obtained for the same time frame from our Pharmacy Department. We then recorded the results for the ELISA test for the HIT antibodies from our computer system. Results: There were 150 patient samples sent for heparin associated antibody tests to the Mayo Clinic Laboratory during these 12 months. Only 12 out of 150 patient samples tested positive for HIT by ELISA. Four out of 150 tested equivocal for HIT. All the remaining reports were negative. The hospital was charged $300 for each ELISA test, so our community hospital spent $ 45,000 in one year on heparin associated antibody testing. 15 of these patients were placed on Argatroban infusion while awaiting lab results. All fifteen patients who were placed on Argatroban ultimately tested negative for HIT. Four patients were started on Lepuridin infusions. Only one of the patients on Lepuridin tested positive for HIT. In total, there were 19 patients treated with either Argatroban or Lepuridin during this 12 months period. Only one patient, out of the 19 treated patients tested positive for HIT. The 12 months cost analysis showed that 100 vials of Lepirudin were used at a cost of $158.80/vial, for a total of $15,880. The 12 months cost analysis for Argatroban showed that 15 vials were ordered each month at a cost of $985/vial for a total of $177,300. The total amount spent including testing and expectant came to $238,180.00. Only one patient truly needed to be treated with an alternative anticoagulant. Discussion: Lepirudin and argatroban are two accepted drugs for treatment of HIT. These are direct thrombin inhibitors that are given intravenously. Argatroban binds to the catalytic site of thrombin. It gets metabolized by the liver and should be dose adjusted with careful monitoring in patients with hepatic impairment. No dose adjustment is necessary in patients with renal dysfunction. Lepirudin binds to both catalytic and a fibrinogen-binding site of thrombin. It gets excreted in the urine and should be carefully monitored in patients with renal insufficiency. Both drugs can lead to bleeding complications. These drugs should be used with great caution when there is an increased risk of a hemorrhagic event. The cost of Argatroban and Lepirudin infusions was obtained from the pharmacy purchase orders. The cost of HIT antibody testing was obtained from our main labarotory. The cost of the machine at the Mayo Labarotory that is used in the Special Coagulation laboratory (DSX ELISA processing system) was $52,000. The machine was purchased prior to 2004. We concluded that our community hospital spends a total of $238,000 per year in the evaluation and expected management of heparin-induced thrombocytopenia. Conclusion: In this retrospective review of 150 patients who have had HIT antibodies testing and 19 who were started on anticoagulation therapy and have had their HIT antibodies tests sent out for HIT confirmation, only 1 had a positive result. We concluded that our community hospital spends a total of $238,000 per year in the evaluation and expectant management of heparin-induced thrombocytopenia. The hospital would save money and improve patient care if it purchased the laboratory equipment and ran the tests in-house, providing faster turn around and more accurate assessment of risk.

scholarly journals Gram negative rod meningitis due to Strongyloides stercoralis

2017 ◽  
Vol 4 (2) ◽  
pp. 28
Author(s):  
Nicholas S. Hendren ◽  
Shahzad Chindhy ◽  
Kaylee Shepard
Keyword(s):  
Strongyloides Stercoralis ◽  
Altered Mental Status ◽  
Chronic Infections ◽  
Travel History ◽  
Gram Negative ◽  
Immunosuppressive Medications ◽  
Dexamethasone Therapy ◽  
Immunosuppressed Patients ◽  
High Doses ◽  
One Year

A 57-year-old male Mexican immigrant living in Dallas presented with altered mental status, progressive confusion, mild headache and fevers. He was diagnosed with embryonal liver sarcoma one year prior to admission and had recently started dexamethasone therapy for metastatic spinal lesions. Blood and cerebrospinal fluid cultures from a lumbar puncture were both positive for Escherichia coli. He was diagnosed with spontaneous gram negative rod (GNR) meningitis. Given his travel history, immunosuppression and GNR meningitis, a stool ova and parasite sample was obtained to screen for Strongyloides stercoralis. His stool was markedly positive for Strongyloides stercoralis larvae and he was further diagnosed with Strongyloides hyperinfection syndrome. Strongyloides is capable of chronically re-infecting human hosts without an external life cycle via autoinfection. In chronic infections, hyperinfection can be triggered with immunosuppressive medications, especially steroids. Disseminated Strongyloides should be considered as the source for unexplained GNR bacteremia or meningitis especially in immunosuppressed patients. Our patient likely had a chronic asymptomatic Strongyloides infection acquired in Mexico that became a hyperinfection resulting in GNR meningitis after starting high doses of dexamethasone.

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