scholarly journals Effect of the Increasing Use of Piperacillin/Tazobactam on the Incidence of Vancomycin-Resistant Enterococci in Four Academic Medical Centers

2004 ◽  
Vol 25 (5) ◽  
pp. 380-383 ◽  
Author(s):  
Usha Stiefel ◽  
David L. Paterson ◽  
Nicole J. Pultz ◽  
Steven M. Gordon ◽  
David C. Aron ◽  
...  
Keyword(s):  
Academic Medical Centers ◽  
Effective Control ◽  
Third Generation ◽  
Beta Lactam ◽  
Medical Centers ◽  
Vancomycin Resistant Enterococci ◽  
Defined Daily Doses ◽  
Academic Medical ◽  
Vancomycin Resistant ◽  
Third Generation Cephalosporins

AbstractBackground:The substitution of piperacillin/tazobactam, ampicillin/sulbactam, or both for third-generation cephalosporins has been associated with reduced vancomycin-resistant enterococci (VRE). However, piperacillin/tazobactam came into widespread use during a period in which the prevalence of VRE increased. We hypothesized that the increasing use of piperacillin/tazobactam and other agents with relatively enhanced anti-enterococcal activity (ie, piperacillin, ampicillin/sulbactam, and ampicillin) has been associated with increased or unchanged rates of VRE in some hospitals.Design:We retrospectively evaluated the correlation between hospital antibiotic use (defined daily doses per 10,000 patient-days of care) and incidence of stool or non-stool VRE isolation. We assessed whether a high or increasing proportion of use of beta-lactam agents with relatively enhanced versus minimal (ie, third-generation cephalosporins and ticarcillin/clavulanate) anti-enterococcal activity would prevent increased VRE.Setting:Four academic medical centers.Results:With the increasing use of piperacillin/tazobactam, the use of beta-lactam agents with enhanced activity against enterococci surpassed the combined use of third-generation cephalosporins and ticarcillin/clavulanate in each hospital. In one hospital, the incidence of VRE was positively correlated with the use of piperacillin/tazobactam or beta-lactam agents with enhanced anti-enterococcal activity (P< .0001). The incidence of VRE rose steadily in another hospital despite relatively high use of beta-lactam agents with enhanced versus minimal anti-enterococcal activity. A negative correlation between VRE and piperacillin/tazobactam or beta-lactam agents with enhanced anti-enterococcal activity was observed in one hospital, but this correlation was not statistically significant.Conclusion:Increasing the hospital use of piperacillin/tazobactam and other beta-lactams with relatively enhanced anti-enterococcal activity may not be an effective control measure for VRE.

scholarly journals The Threat of the Emergence of Antimicrobial-Resistant Gram-Positive Pathogens in Canada

1994 ◽  
Vol 5 (suppl c) ◽  
pp. 9C-14C ◽  
Author(s):  
Donald E Low ◽  
Barbara M Willey ◽  
Allison J McGeer
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
The United States ◽  
Multiple Resistance ◽  
Third Generation ◽  
Gram Positive ◽  
Gram Negative ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Third Generation Cephalosporins

Since the early 1980s, much attention has been focused on the emergence or resistance in nosocomially acquired Gram-negative pathogens. However, in the 1990s we are witnessing in North America the development and spread or multiple resistance in Gram-positive pathogens in the hospital selling as well as in the community. Methicillin resistant Staphylococcus aureus and vancomycin-resistant enterococci are now endemic in many urban centres in the United States, although less so in Canada. In some states, penicillin -resistant Streptococcus pneumoniae in the community selling has gone from rates of less than 5% in 1988 to 50% in 1994, including: resistance to third-generation cephalosporins and carbapenems. Although these same pathogens have now been identified in Canada, we may still be in a position to limit or prevent their spread.

Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty

Hand ◽  
2020 ◽  
pp. 155894471989881 ◽  
Author(s):  
Taylor M. Pong ◽  
Wouter F. van Leeuwen ◽  
Kamil Oflazoglu ◽  
Philip E. Blazar ◽  
Neal Chen
Keyword(s):  
Risk Factors ◽  
Implant Removal ◽  
Academic Medical Centers ◽  
Implant Design ◽  
Factors Associated ◽  
Medical Centers ◽  
Total Wrist Arthroplasty ◽  
Academic Medical ◽  
Related Risk ◽  
Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed ( P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.

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