Microbiology of Surgical Site Infections and Associated Antimicrobial Use Among Vietnamese Orthopedic and Neurosurgical Patients

Objectives. To determine the pathogens associated with surgical site infections (SSIs) and describe patterns of antimicrobial use and resistance in orthopedic and neurosurgical patients in a large university hospital in Vietnam. Design. Prospective cohort study. Setting. Cho Ray Hospital, Ho Chi Minh City, Vietnam. Patients. All patients who had operations during a 5-week study period. Results. Of 702 surgical patients, 80 (11.4%) developed an SSI. The incidence of SSI among orthopedic patients was 15.2% (48 of 315), and among neurosurgical patients it was 8.3% (32 of 387). Postoperative bacterial cultures of samples from the surgical sites were performed for 55 (68.8%) of the 80 patients with SSI; 68 wound swab specimens and 10 cerebrospinal fluid samples were cultured. Of these 78 cultures, 60 (76.9%) were positive for a pathogen, and 15 (25%) of those 60 cultures yielded multiple pathogens. The 3 most frequently isolated pathogens were Pseudomonas aeruginosa (29.5% of isolates), Staphylococcus aureus (11.5% of isolates), and Escherichia coli (10.3% of isolates). Ninety percent of S. aureus isolates were methicillin resistant, 91% of P. aeruginosa isolates were ceftazidime resistant, and 38% of E. coli isolates were cefotaxime resistant. All but 1 of the 702 patients received antimicrobial therapy after surgery, and the median duration of antimicrobial therapy was 11 days. Commonly used antimicrobials included aminopenicillins and second- and third-generation cephalosporins. Two or, more agents were given to 634 (90%) of the patients, and most combination drug regimens (86%) included an aminoglycoside. Conclusions. Our data indicate that the incidence of SSI is high in our study population, that the main pathogens causing SSI are gram-negative bacteria and are often resistant to commonly used antimicrobials, that the use of broad-spectrum antimicrobials after surgery is widespread, and that implementation of interventions aimed at promoting appropriate and evidence-based use of antimicrobials are needed in Vietnam.

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The clinical management of cesarean section-acquired Mycobacterium abscessus surgical site infections

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3821 ◽

2014 ◽

Vol 8 (02) ◽

pp. 184-192 ◽

Cited By ~ 3

Author(s):

Shih-Ming Tsao ◽

Keh-Sen Liu ◽

Hsien-Hua Liao ◽

Tian-Lin Huang ◽

Gwan-Han Shen ◽

...

Keyword(s):

Cesarean Delivery ◽

Antimicrobial Therapy ◽

Clinical Management ◽

Rflp Analysis ◽

Surgical Site Infections ◽

Mycobacterium Abscessus ◽

University Hospital ◽

Pcr Rflp ◽

Dna Restriction Fragments ◽

Healthcare Associated

Introduction: Rapidly growing mycobacteria (RGM) can cause a broad spectrum of both community and healthcare-associated infections in humans. The aim of this study was to report the clinical management and outcomes of successive patients following cesarean delivery with healthcare-associated surgical site infections (SSIs) caused by RGM. Methodology: Patients who were admitted to Chung Shan Medical University Hospital, Taichung, Taiwan, between September 2006 and July 2008, and who developed SSIs following cesarean delivery at an obstetrics hospital and were then referred to our hospital, were enrolled. Demographic characteristics of the patients and clinical isolates were obtained retrospectively and an environmental investigation was performed. PCR-restriction fragment length polymorphism (PCR-RFLP) analysis of the hsp65gene and pulsed-field gel electrophoresis (PFGE) of large genomic DNA restriction fragments were applied to differentiate Mycobacterium species. Results: Seventeen patients were diagnosed with RGM infections by microbiology and/or histopathology. Mycobacterial isolates by PCR-RFLP analysis from 15 patients revealed Mycobacterium abscessus (M. abscessus) and M. lentiflavum. Most of the patients received surgical debridement and combination antimicrobial therapy and were eventually cured. Conclusions: Our study demonstrates the potential that RGM infections have in causing healthcare-associated SSIs. Surgery plus prolonged combination antimicrobial therapy seemed to be an effective option for the management of M. abscessus infections.

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Reduction in Surgical Site Infections in Neurosurgical Patients Associated With a Bedside Hand Hygiene Program in Vietnam

Infection Control and Hospital Epidemiology ◽

10.1086/516661 ◽

2007 ◽

Vol 28 (05) ◽

pp. 583-588 ◽

Cited By ~ 36

Author(s):

Le Thi Arm Thu ◽

Michael J. Dibley ◽

Vo Van Nho ◽

Lennox Archibald ◽

William R. Jarvis ◽

...

Keyword(s):

Length Of Stay ◽

Hand Hygiene ◽

Surgical Site Infections ◽

Control Group ◽

Antimicrobial Use ◽

Hand Sanitizer ◽

Neurosurgical Patients ◽

Quasi Experimental ◽

Postoperative Length ◽

The Impact

Objective. We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam. Design. A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention). A hand sanitizer with 70% isopropyl alcohol and 0.5% Chlorhexidine gluconate was introduced, and healthcare workers were trained in its use on ward A in September 2000. No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used. Patient SSI data were collected on standardized forms and were analyzed using Stata software (Stata). Results. A total of 786 patients were enrolled: 377 in the period before intervention (156 in ward A and 221 in ward B) and 409 in the period after intervention (159 in ward A and 250 in ward B). On ward A after the intervention, the SSI rate was reduced by 54% (from 8.3% to 3.8%; P = .09), and more than half of superficial SSIs were eliminated (7 of 13 vs 0 of 6 in ward B; P = .007). On ward B, the SSI rate increased by 22% (from 7.2% to 9.2%; P = .8). In patients without SSI, the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A (both from 8 to 6 days; P <.001) but not on ward B. Conclusions. Our study demonstrates that introduction of a hand sanitizer can both reduce SSI rates in neurosurgical patients, with particular impact on superficial SSIs, and reduce the overall postoperative length of stay and the duration of antimicrobial use. Hand hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes.

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Incidence and root causes of surgical site infections after gastrointestinal surgery at a public teaching hospital in Sudan

Patient Safety in Surgery ◽

10.1186/s13037-020-00272-4 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Rawan Sharaf Eldein Elamein Hassan ◽

Sarah Osman Sayed Osman ◽

Mohamed Abdulmonem Salih Aabdeen ◽

Walid Elhaj Abdelrahim Mohamed ◽

Razan Sharaf Eldein Elamein Hassan ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Associated Factors ◽

Financial Burden ◽

Gastrointestinal Surgery ◽

Operation Time ◽

Surgical Site Infections ◽

University Hospital ◽

Categorical Variables ◽

E Coli ◽

Surgical Unit

Abstract Background Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries. Methods A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between 1st September and 31st December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05. Results A total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%). Conclusions The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

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Antimicrobial related problems in patients undergoing renal dialysis in a university hospital

Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde ◽

10.30968/rbfhss.2019.104.0340 ◽

2020 ◽

Vol 10 (4) ◽

pp. 0340

Author(s):

Cristiane C. Santos ◽

Elza A. Domingues

Keyword(s):

Antimicrobial Therapy ◽

Renal Dialysis ◽

University Hospital ◽

Antimicrobial Use ◽

Prescription Error ◽

Antimicrobial Drugs ◽

Multiprofessional Team ◽

Team Working ◽

Stewardship Program ◽

Main Class

Objective: To detect antimicrobial drug-related problems (DRP) in adult patients undergoing renal dialysis in a university hospital. Methods: This is an observational and retrospective study in which were included patients hospitalized in antimicrobial therapy and submitted to renal replacement therapy (RRT) from January to August 2017. The study variables were collected on the first day that antimicrobial was administraded and hemodialysis was done. The Dáder Methodology was used to detect and classify the DRP and probable negative outcomes associated with medications (NOMs). Results: 85 patients were included, 62.4% (n=53) male, mean age 61.2 ± 15.2 years. An average of 2.6 ± 1.6 different antimicrobials prescribed per patient was observed, being the main class carbapenems (13.7%) and the main reason for antimicrobial use was sepsis (34.1%). The main DRPs found were: prescription error (45.1%), Y incompatibility (14.0%) and inadequate dosage (12.1%), median 6.0 (4-11) DRP per patient, minimum:1 and maximum:32. Regarding NOMs, the most frequent were quantitative insecurity (50.6%), non-quantitative insecurity (19.9%) and quantitative ineffectiveness (19.0%). Conclusions: All patients undergoing dialysis and antimicrobial therapy included in this study had at least one problem related to antimicrobial drugs and, therefore, one probable NOM. It was verified the need of a multiprofessional team working on the detection and prevention of avoidable problems, through the implantation of computerized systems, continuing education program, protocols and routines, allied with an institutional antimicrobial stewardship program.

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Surgical Sites Infection After Gastrointestinal Surgeries in a Public Teaching Hospital in Sudan

10.21203/rs.3.rs-59531/v1 ◽

2020 ◽

Author(s):

Rawan Sharaf Eldein Elamein Hassan ◽

Sarah Osman Sayed Osman ◽

Mohamed Abdulmonem Salih Aabdeen ◽

Walid Elhaj Abdelrahim Mohamed ◽

Razan Sharaf Eldein Elamein Hassan ◽

...

Keyword(s):

Associated Factors ◽

Financial Burden ◽

Operation Time ◽

Surgical Site Infections ◽

University Hospital ◽

Categorical Variables ◽

Cross Sectional ◽

Significance Level ◽

Surgical Interventions ◽

E Coli

Abstract Background: Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract (GIT) procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing GIT surgeries.Methods: A hospital based, cross-sectional study conducted at Soba University Hospital (SUH) in Khartoum, Sudan. We included all patients from all age groups attending the GIT surgical unit at SUH between September-December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. Data analysis was done using the SPSS software version 20 (SPSS Inc., Chicago, IL, USA). A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05.Results: A total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p =.013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).Conclusion: The results showed a high prevalence of SSIs among patients attending the GIT unit in SUH and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

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URINARY INFECTION AT DEPARTMENT OF UROLOGY OF HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.3.16 ◽

2018 ◽

pp. 100-108

Author(s):

Dinh Khanh Le ◽

Dinh Dam Le ◽

Khoa Hung Nguyen ◽

Xuan My Nguyen ◽

Minh Nhat Vo ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Urine Culture ◽

Clinical Manifestations ◽

University Hospital ◽

E Coli ◽

Positive Urine ◽

Tract Infections

Objectives: To investigate clinical characteristics, bacterial characteristics, drug resistance status in patients with urinary tract infections treated at Department of Urology, Hue University Hospital. Materials and Method: The study was conducted in 474 patients with urological disease treated at Department of Urology, Hue Universiry Hospital from July 2017 to April 2018. Urine culture was done in the patients with urine > 25 Leu/ul who have symptoms of urinary tract disease or infection symptoms. Patients with positive urine cultures were analyzed for clinical and bacterial characteristics. Results: 187/474 (39.5%) patients had symptoms associated with urinary tract infections. 85/474 (17.9%) patients were diagnosed with urinary tract infection. The positive urine culture rate was 45.5%. Symptoms of UTI were varied, and no prominent symptoms. E. coli accounts for the highest proportion (46.67%), followed by, Staphycoccus aureus (10.67%), Pseudomonas aeruginsa (8,0%), Streptococcus faecali and Proteus (2.67%). ESBL - producing E. coli was 69.23%, ESBL producing Enterobacter spp was 33.33%. Gram-negative bacteria are susceptible to meropenem, imipenem, amikacin while gram positive are vancomycin-sensitive. Conclusions: Clinical manifestations of urinary tract infections varied and its typical symptoms are unclear. E.coli is a common bacterium (46.67%). Isolated bacteria have a high rate of resistance to some common antibiotics especially the third generation cephalosporins and quinolones. Most bacteria are resistant to multiple antibiotics at the same time. Gram (+) bacteria are susceptible to vancomycin, and gram (-) bacteria are susceptible to cefoxitin, amikacin, and carbapenem. Key words: urinary tract infection

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Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽

10.3390/antibiotics10010005 ◽

2020 ◽

Vol 10 (1) ◽

pp. 5

Author(s):

Sílvia Simó ◽

Eneritz Velasco-Arnaiz ◽

María Ríos-Barnés ◽

María Goretti López-Ramos ◽

Manuel Monsonís ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Case Fatality ◽

University Hospital ◽

Antimicrobial Use ◽

Stewardship Program ◽

Days Of Therapy ◽

Length Of Therapy ◽

Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

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Resistome Profiles, Plasmid Typing, and Whole-Genome Phylogenetic Tree Analyses of BlaNDM-9 and Mcr-1 Co-Harboring Escherichia coli ST617 from a Patient without a History of Farm Exposure in Korea

Pathogens ◽

10.3390/pathogens8040212 ◽

2019 ◽

Vol 8 (4) ◽

pp. 212 ◽

Cited By ~ 3

Author(s):

Le Phuong Nguyen ◽

Naina Adren Pinto ◽

Thao Nguyen Vu ◽

Hung Mai ◽

An HT Pham ◽

...

Keyword(s):

Rectal Swab ◽

Asymptomatic Carrier ◽

University Hospital ◽

Surveillance Culture ◽

Whole Genome ◽

E Coli ◽

Carbapenem Resistant ◽

Plasmid Replicon ◽

Donor Cells ◽

History Of

Recently, a blaNDM-9 and mcr-1 co-harboring E. coli ST 617 isolate was identified from an asymptomatic carrier in Korea. An 81-year-old female was admitted to a university hospital for aortic cardiac valve repair surgery. Following surgery, she was admitted to the intensive care unit (ICU) for three days, and carbapenem-resistant E. coli YMC/2017/02/MS631 was isolated from a surveillance culture (rectal swab). Antimicrobial susceptibility testing (AST) for colistin was not performed at that time. Upon retrospective study, further AST revealed resistance to all tested antibiotics, including meropenem, imipenem, ceftazidime-avibactam, amikacin, gentamicin, ciprofloxacin, trimethoprim-sulfamethoxazole, and colistin, with the exception of tigecycline. Whole genome sequencing analyses showed that this strain belonged to the ST617 serotype O89/162: H10 and harbored three β-lactamase genes (blaTEM-1B, blaCTX-M-55, blaNDM-9), mcr-1, and 14 other resistance genes. Seven plasmid replicon types (IncB, IncFII, IncI2, IncN, IncY, IncR, IncX1) were identified. Horizontal transfer of blaNDM-9 and mcr-1 from donor cells to the recipient E. coli J53 has been observed. blaNDM-9 and mcr-1 were carried by IncB and IncI2 plasmids, respectively. To speculate on the incidence of this strain, routine rectal swab screening to identify asymptomatic carriers might be warranted, in addition to the screening of ICU patients.

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3124 Early Electrographic Seizure Detection by Neuro ICU Nurses via Bedside Real-Time Quantitative EEG

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.93 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 38-38

Author(s):

Safa Kaleem ◽

Christa B. Swisher

Keyword(s):

Positive Predictive Value ◽

Real Time ◽

Predictive Value ◽

Quantitative Eeg ◽

University Hospital ◽

Duke University ◽

Study Population ◽

Time To Detection ◽

Sensitivity Specificity ◽

Improve Patient

OBJECTIVES/SPECIFIC AIMS: 1. Determine positive predictive value, negative predictive value, sensitivity, and specificity of Neuro ICU nurse interpretation of real-time bedside qEEG. 2. Determine difference in time to detection of first seizure between Neuro ICU nurse qEEG interpretation and EEG fellow reads of cEEG. 3. Determine what qualities of seizures make detection by neuro ICU nurses more or less likely – e.g. duration of seizures, type of seizures, spatial extent of seizures. METHODS/STUDY POPULATION: Recruit neuro ICU nurses taking care of 150 patients admitted to the Neuro ICU at Duke University Hospital who are initiated on cEEG monitoring. Nurses will be consented for their participation in the study. Neuro ICU nurses will evaluate the qEE RESULTS/ANTICIPATED RESULTS: From literature estimates of a 20% seizure prevalence in critical care settings, we hope to have 30 patients with seizures and 120 without. Based on prior study in the Duke Neuro ICU, we hypothesize that Neuro ICU nurses will have sensitivity and DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first prospective study of neuro ICU nurse interpretation of real-time bedside qEEG in patients with unknown NCSE/NCS presence. If nurse sensitivity, specificity, and positive predictive value are clinically useful, which we deem would be so at a sensitivity of 70% or greater, with acceptable false alarm rate, nurse readings of qEEG could significantly decrease the time to treatment of seizures in the Neuro ICU patient population, and perhaps could improve patient outcomes.

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