Antimicrobial Resistance and Predictors of Adverse Outcomes in Neonates with Bacterial Meningitis: a Retrospective Study from a Tertiary Care Hospital of Northern India

2021 ◽  
Author(s):  
Sandeep N. Lal ◽  
Arti Maria ◽  
Tapas Bandyopadhyay
Keyword(s):  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Medical Care ◽  
Adverse Outcome ◽  
Univariate Analysis ◽  
Adverse Outcomes ◽  
Neonatal Meningitis ◽  
Care Hospital ◽  
Increased Risk ◽  
Sepsis Screen

AbstractThis study aimed to determine antimicrobial resistance pattern and predictors of adverse outcome in neonatal meningitis. A retrospective study by analyzing case files of 134 cases of neonatal meningitis. We noted an alarming degree of multidrug resistance (MDR) among both gram-negative (Klebsiella spp., 50%; Escherichia coli, 100%; and and Acinetobacter spp., 50%), as well as positive (Enterococcus, 100%) isolates in cerebrospinal fluid (CSF) culture. The incidence rate of adverse outcome (i.e., mortality and abnormal neurological examination at discharge) was 8.2 and 17.2%, respectively. On univariate analysis, delayed seeking of medical care, bulging anterior fontanelle, vomiting, positive sepsis screen, shock during hospital course, ventriculitis, diversion procedures for raised intracranial pressure, central line placement, low CSF sugar, and failed hearing screening test at discharge were associated with increased risk of adverse outcome. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MDR infections were independently found to be associated with adverse outcomes. An alarming degree of antimicrobial resistance among the CSF isolates necessitates the need to understand the pathogenesis of resistance and curtail the irrational prescription of antibiotics in neonatal meningitis. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MRD infection may have prognostic value in neonatal meningitis

scholarly journals 2445. Risk for Readmission and Mortality Amongst LTACH Residents with New-Onset Healthcare-Associated Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S845-S845
Author(s):  
Kyle D Massey ◽  
Melissa Murphy ◽  
Todd Miano ◽  
Shawn Binkley ◽  
Steven C Morgan ◽  
...  
Keyword(s):  
Acute Care ◽  
Primary Outcome ◽  
Univariate Analysis ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Model ◽  
Unplanned Readmission ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Increased Risk ◽  
Healthcare Associated

Abstract Background Long-term acute care hospitals (LTACH) provide cost-effective alternatives for stable patients requiring ICU-level care. LTACH patients are at increased risk for adverse outcomes including healthcare-associated infections (HAI). There is a paucity of data describing outcomes associated with HAIs in LTACH patients. Methods This was a single-center, retrospective study of LTACH patients over a 3 year period. Patients with an HAI (bloodstream [BSI], pneumonia [PNA], urinary tract [UTI], and Clostridioides difficile [CDI] infections) as defined by NHSN criteria were matched by length of stay (LOS) at the time of inclusion to unexposed patients. Follow-up was 30 days from the date of inclusion. The primary outcome was a composite of unplanned readmission to an acute care hospital or death at the LTACH. Secondary outcomes included all-cause mortality. Patients with HAIs were further evaluated to determine risk factors associated with readmission Antibiotics and cultured organisms were collected. Outcomes were analyzed using Cox proportional hazards model. Variables found to have a P < 0.1 on univariate analysis and those of clinical interest were included in the models. Results 250 patients were included, 125 in each group. The distribution of HAIs was 40 BSI, 39 UTI, 26 PNA, and 20 CDI. The incidence of the primary outcome and mortality were 26.0% and 11.6% respectively. HAI was associated with increased risk of the primary outcome, but the effect varied over time: Risk increased seven-fold during the first 5 days (HR, 7.47 [95% CI, 2.86–19.42]) but was smaller and non-significant after day five (HR, 1.94 [95% CI, 0.85–4.43]). Mortality was not significantly different between groups (HR, 1.58 [95% CI, 0.74–3.38]). After adjustment, only hypotension (HR, 2.27 [95% CI 1.21–4.27]) and referral hospital LOS > 28 days (HR, 1.97 [95% CI 1.10–3.53]) were associated with readmission. 37% of cultured organisms were multi-drug-resistant. 17% of Enterobacteriaceae were carbapenem resistant. Empiric antibiotics failed to cover in 35% of infections. Conclusion HAI was associated with a significant increase in risk of readmission. Exploration of modifiable variables of infection, including hypotension and antibiotic selection, may help to reduce rates of readmission. Disclosures All authors: No reported disclosures.

scholarly journals Strategy of Medical Care for Pregnant Women with Congenital Heart Disease

2021 ◽  
pp. 64-69
Author(s):  
S. O. Siromakha ◽  
Yu. V. Davydova ◽  
A. O. Tarnavska ◽  
N. I. Volkova ◽  
N. B. Nakonechna
Keyword(s):  
Cardiac Surgery ◽  
Cardiovascular Risk ◽  
Medical Care ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Congenital Heart ◽  
Adverse Outcomes ◽  
Long Term Results ◽  
Increased Risk

Grown-up congenital heart (GUCH) is a global challenge nowadays. The strategy of medical care for GUCH women dur-ing pregnancy, childbirth and the postpartum period is a topic of active discussion in the expert community. These patients have significantly increased risk of maternal and perinatal loss. A national obstetric cardiology and cardiac surgery multi-disciplinary team (OCCS) established in academic institutions in 2013 has provided medical support to 896 GUCH pregnant women over the last 7 years. In total, GUCH patients accounted for 36% of the cohort of all the examined pregnant women. Of these, 474 (53%) were primigravid. The mean age of the patients at the time of the first visit was 27.3 ± 5.7 years. Patients with uncorrected CHD accounted for 66.2% (n = 593), and 33.8% (n = 303) of pregnant women had undergone correction, including hemodynamic correction of complex CHD in 5 patients. Risk stratification was performed using several scores (mWHO, ZAHARA, CARPREG) for the comprehensive assessment of cardiovascular risk and prediction of pregnancy, deliv-ery, and postpartum period course. 82 patients were classified as having high cardiovascular risk (CVR) after the stratifica-tion. They needed admission to the cardiac surgery facility to receive different types of medical care. There were 2 (2.4%) cases of maternal loss and 3 (3.8%) cases of adverse perinatal outcomes in this group of patients. The article presents the algorithms for multidisciplinary care strategy choice in GUCH pregnant women with high CVR and their routing principles developed by the OCCS. These algorithms significantly reduced adverse outcomes of pregnancy and childbirth in this group of patients. Long-term results were evaluated in 69 patients (86.3%). The follow-up period ranged from 1 to 91 months, on average 34.4 ± 23.6 months. There were no long-term maternal losses or repeated cardiac surgeries. There was one case of unexplained death of a child 8 months after birth. The strategy of multidisciplinary medical care of a high-class GUCH pregnant woman should be personalized depending on the clinical data and in accordance with the ESC 2018 guidelines.

scholarly journals Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

2018 ◽  
Vol 51 (4) ◽  
pp. 1702037 ◽  
Author(s):  
Kristian Hellenkamp ◽  
Piotr Pruszczyk ◽  
David Jiménez ◽  
Anna Wyzgał ◽  
Deisy Barrios ◽  
...  
Keyword(s):  
At Risk ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
Prognostic Impact ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a post hoc analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5–3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7–2.5) died due to PE. Patients with copeptin ≥24 pmol·L−1 had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6–15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3–25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1–9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5–15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6–27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2–43.6, p<0.001; highest risk group versus all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6–22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4–16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.

Vitamin D Status as a Predictor of Postoperative Hypocalcemia after Thyroidectomy

2020 ◽  
Vol 163 (3) ◽  
pp. 501-507
Author(s):  
Samuel J. Rubin ◽  
Jong H. Park ◽  
Elizabeth N. Pearce ◽  
Michael F. Holick ◽  
David McAneny ◽  
...  
Keyword(s):  
Vitamin D ◽  
Retrospective Study ◽  
Serum Calcium ◽  
Study Design ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Single Center ◽  
Postoperative Hypocalcemia ◽  
Vitamin D Levels

Objective To determine whether perioperative vitamin D levels are predictive of postoperative hypocalcemia in patients receiving thyroidectomy. Study Design Single center retrospective study. Subjects and Methods This study included all patients receiving total or completion thyroidectomy between January 2007 and March 2017 at a single tertiary care hospital. 25-Hydroxyvitamin D (25[OH]D) levels were measured within 42 days prior to surgery or 1 day postoperatively. Hypocalcemia was defined as an adjusted serum calcium <8.0 mg/dL (based on albumin levels) or symptomatic hypocalcemia. Univariate analysis was performed with a 2-sample t test and chi-square test, while multivariate analysis was performed with logistic regression analysis to determine whether perioperative 25(OH)D level is a predictor of postoperative hypocalcemia. Results A total of 517 subjects were included in the study, 15.7% (n = 81) of whom experienced postoperative hypocalcemia with a mean ± SD serum calcium level of 7.6 ± 0.5 mg/dL as compared with 8.9 ± 0.5 mg/dL in the normocalcemic population ( P < .01). The mean 25(OH)D level for patients with hypocalcemia was 24.4 ± 12.0 ng/mL as compared with 27.5 ± 12.2 ng/mL in patients with normocalcemia ( P = .038). Subjects who were hypocalcemic experienced a significantly longer hospital stay (2.9 ± 2.5 vs 1.4 ± 1.1 days, P < .01). After adjusting for preoperative calcium, age, and performance of a neck dissection, subjects with a 25(OH)D level <30 ng/mL were significantly associated with postoperative hypocalcemia (odds ratio, 1.9; P = .041; 95% CI, 1.0-3.3). Conclusion Using a single-center retrospective study design, we demonstrated that 25(OH)D level is a significant predictor of postoperative hypocalcemia after thyroidectomy.

Rates of nosocomial infection associated with interhospital transfer of patients receiving extracorporeal membrane oxygenation

2021 ◽  
pp. 1-6
Author(s):  
Joseph E. Marcus ◽  
Valerie G. Sams ◽  
James K. Aden ◽  
Andriy Batchinsky ◽  
Michal J. Sobieszczyk ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Extracorporeal Membrane Oxygenation ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Subsequent Development ◽  
High Risk Population ◽  
Care Hospital ◽  
Membrane Oxygenation ◽  
Interhospital Transfer ◽  
Increased Risk

Abstract Objectives: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently require interhospital transfer to a center that has ECMO capabilities. Patients receiving ECMO were evaluated to determine whether interhospital transfer was a risk factor for subsequent development of a nosocomial infection. Design: Retrospective cohort study. Setting: A 425-bed academic tertiary-care hospital. Patients: All adult patients who received ECMO for >48 hours between May 2012 and May 2020. Methods: The rate of nosocomial infections for patients receiving ECMO was compared between patients who were cannulated at the ECMO center and patients who were cannulated at a hospital without ECMO capabilities and transported to the ECMO center for further care. Additionally, time to infection, organisms responsible for infection, and site of infection were compared. Results: In total, 123 patients were included in analysis. For the primary outcome of nosocomial infection, there was no difference in number of infections per 1,000 ECMO days (25.4 vs 29.4; P = .03) by univariate analysis. By Cox proportional hazard analysis, transport was not significantly associated with increased infections (hazard ratio, 1.7; 95% confidence interval, 0.8–4.2; P = .20). Conclusion: In this study, we did not identify an increased risk of nosocomial infection during subsequent hospitalization. Further studies are needed to identify sources of nosocomial infection in this high-risk population.

scholarly journals Fetomaternal outcome in fibroid complicating pregnancy: a retrospective study

2021 ◽  
Author(s):  
Suneela Mullakkal Sankaran ◽  
Jayasree Sukumara Pillai
Keyword(s):  
Retrospective Study ◽  
Gestational Age ◽  
Mode Of Delivery ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Reproductive Age ◽  
Ultra Sound ◽  
Government Medical College ◽  
Medical College ◽  
Increased Risk

Background: Fibroids are the commonest benign tumour arising from the smooth muscle from uterus. Effects of fibroids on pregnancy and the effects of pregnancy on fibroids are a frequent clinical concern since these tumors are common in women of reproductive age. Most pregnant women with fibroids do not have any complications during pregnancy related to the fibroids. Pain is the most common problem and there may be a slightly increased risk of obstetrical complications like miscarriage, preterm labor and delivery, malpresentation and placental abruption.Methods: A retrospective study was carried out to study the fetomaternal complications in fibroid complicating pregnancies. Duration of study period was one year. Study was from 1 January 2019 to 31 December 2019 in government medical college, Kozhikode. Patients beyond 28 weeks of gestational age with fibroid complicating pregnancies were included. Case records were reviewed from medical records library government medical college, Kozhikode. Detailed review of patients including history, examination and ultrasound scan reports, mode of delivery, antepartum, intrapartum, postpartum complications and details of babies were also taken.Results: During the study period a total of 112 cases of fibroid complicating pregnancies were included in the study out of 15875 total number of deliveries. Majority of patients belonged to age group between 30 to 35 years (40.17%) and 28.1% belonged to between 35 and40 years. 63.39% of patients were multies. In most of the cases fibroid was diagnosed by the first trimester ultra sound itself. Size of uterus remained corresponding to gestational age in more than half of cases (56.25%). There was increased incidence of caesarean delivery (56.25%), preterm delivery (7.2%) and placenta praevia (2.8%) postpartum haemorrhage (10.71%) in the studied cases.Conclusions: Fibriod complicating pregnancies are associated with higher incidence of obstetric complications during all the phases of pregnancy. Proper antenatal care and assessment can reduce the adverse outcomes to a greater extent.

Sign in / Sign up

Export Citation Format

Share Document