Nosocomial Infection With Cephalosporin-ResistantKlebsiella pneumoniaeIs Not Associated With Increased Mortality

2006 ◽  
Vol 27 (9) ◽  
pp. 907-912 ◽  
Author(s):  
Cristiana C. Gomes ◽  
Evangelina Vormittag ◽  
Cleide R. Santos ◽  
Anna S. Levin
Keyword(s):  
Odds Ratio ◽  
Demographic Data ◽  
Tertiary Care ◽  
Study Drug ◽  
Underlying Disease ◽  
University Hospital ◽  
Third Generation ◽  
Anatomic Site ◽  
Irreversible Damage ◽  
Third Generation Cephalosporins

Objective.To evaluate whether resistance to third-generation cephalosporins and/or aztreonam was associated with a higher mortality rate among patients with nosocomialKlebsiella pneumoniaeinfections.Design.Retrospective cohort study.Setting.Tertiary care university hospital.Methods.A total of 143 patients with nosocomial infections due toK. pneumoniaewere evaluated. Death within 21 days after diagnosis of infection was the outcome. Demographic data, invasive procedures, presence and severity of underlying conditions, infection diagnosis, anatomic site of isolation, and treatment of infection, as well as resistance to third-generation cephalosporins and/or aztreonam, were evaluated for association with the outcome.Results.The mortality associated with nosocomialK. pneumoniaeinfections was 22% in our study. Drug resistance was found in isolates from 48% of case patients. Multivariate analysis demonstrated that the severity of the patient's underlying condition (odds ratio, 12.50;P<.01) and isolation of the microorganism from the blood or from another usually sterile site (odds ratio, 2.94;P= .03) were associated with death. On the other hand, the presence of resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. When only the severe cases of infection were analyzed, the results were unchanged.Conclusions.Resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. The reasons for this are not clear. It is possible that the severity of the underlying disease and the patient's condition have a larger role than theK. pneumoniaeinfection in determining the outcome, and initially inadequate treatment may not have an impact sufficient to cause irreversible damage, allowing treatment to be changed to an effective drug.

Risk Factors forClostridium difficileToxin-Associated Diarrhea

1990 ◽  
Vol 11 (6) ◽  
pp. 283-290 ◽  
Author(s):  
Elizabeth Brown ◽  
George H. Talbot ◽  
Peter Axelrod ◽  
Mary Provencher ◽  
Cindy Hoegg
Keyword(s):  
Attack Rate ◽  
Tertiary Care ◽  
Control Measures ◽  
University Hospital ◽  
Third Generation ◽  
Underlying Malignancy ◽  
Usage Patterns ◽  
Duration Of Hospitalization ◽  
Anaerobic Infections ◽  
Third Generation Cephalosporins

AbstractThe hospital-wide attack rate forClostridium difficile-associateddiarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. Thirty-seven cases selected for study were older than 37 control patients, more likely to have an underlying malignancy and less likely hospitalized on the obstetrics/gynecology service. Their mean duration of hospitalization prior to diagnosis was 21 days, versus a mean total length of stay of eight days for controls. All cases received antibiotics, compared to 24 of the controls. Cases were given more antibiotics for longer periods, and more often received clindamycin, third-generation cephalosporins, aminoglycosides and vancomycin. Gender, race, duration of hospitalization, prior surgery and antiulcer therapy were not significant by logistic regression analysis. Epidemiologic variables with significantly different adjusted odds ratios (95% confidence intervals) were age greater than 65 years (14.1, 1.4-141), intensive care unit residence (39.2, 2.2-713), gastrointestinal procedure (23.2, 2.1-255) and more than ten antibiotic days (summation of days of each antibiotic administered) (16.1, 2.2-117). Control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronidazole for therapy of anaerobic infections. By the second half of 1988, the attack rate had dropped progressively to0.74%.

scholarly journals 2288. Role of Β Lactam-Β Lactamase Inhibitors in Indian Tertiary Care Hospitals: Results from a Nationwide Survey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S784-S784
Author(s):  
Shweta Kamat ◽  
Pankaj Gupta ◽  
Akshata Mane
Keyword(s):  
Clinical Experience ◽  
Online Survey ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Nationwide Survey ◽  
Third Generation ◽  
Tract Infections ◽  
Abdominal Infections ◽  
Tertiary Care Hospitals ◽  
Third Generation Cephalosporins

Abstract Background Broad-spectrum antibiotics, particularly third-generation cephalosporins, are routinely used in the treatment of nosocomial infections. The emergence of Extended Spectrum Β-Lactamase (ESBL)-producing pathogens in Indian tertiary care hospitals warrants the need to reassess β-lactam–β-lactamase inhibitors (BL-BLIs) as better alternative treatments. Methods An online survey was conducted by Pfizer India to understand the usage of BL-BLIs across Indian hospitals. The survey was administered to 334 clinicians across multiple specialties out of which 195 were from tertiary care hospitals. Results were analyzed using MS-Excel statistical tools. Results One-hundred ninety-five (195) clinicians from tertiary care hospitals completed the survey. About 78% of HCPs revealed the resistance to third-generation cephalosporins (e.g., ceftriaxone, ceftazidime) to be between 10–60% in their clinical settings. BL-BLIs were mostly preferred for treatment based on hospital antibiograms (64%) and used as first-line options for hospitalized adults with mild-moderate severe infections caused by ESBL-producing organisms (71%) and in mild-moderate infections caused by susceptible Gram-negative bacteria such as Enterobacteriaceae (54%). The average duration of IV BL-BLI treatment was 5–7 days (66%). The HCPs considerations while choosing BL-BLIs were mainly based on anti-microbial spectrum (81%), and rationality of BL/BLI combination (63%) and clinical experience with the BL-BLI molecule (63%). Cefoperazone-Sulbactam (CS) and Piperacillin–tazobactam (PT) were most commonly prescribed BL-BLIs and HCPs preferred the latter for pneumonia (67%), skin and soft-tissue infections (57%), bloodstream infections (67%) and cancer-associated febrile neutropenia (64%); while they preferred former for urinary tract infections (64%). CS and PT were preferred for intra-abdominal infections (57% and 64% respectively) and post-surgical infections (56% and 53% respectively). Conclusion CS and PT were the most commonly prescribed BL-BLIs probably due to their wide antimicrobial spectrum, rationality of the BL/BLI combination and the clinical experience with the molecules. BL-BLIs are still a mainstay of treatment for infections due to ESBL producing organisms. Disclosures All authors: No reported disclosures.

Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study

2019 ◽  
Vol 75 (3) ◽  
pp. 747-755
Author(s):  
Pierre-Marie Roger ◽  
Ingrid Peyraud ◽  
Michel Vitris ◽  
Valérie Romain ◽  
Laura Bestman ◽  
...  
Keyword(s):  
Clavulanic Acid ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Third Generation ◽  
Therapeutic Guidelines ◽  
Amoxicillin Clavulanic Acid ◽  
The Impact ◽  
Third Generation Cephalosporins

Abstract Objectives We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. Methods Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. Results We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82–5.92 and 2.18, 95% CI 1.38–3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06–0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34–0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was −16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). Conclusions STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.

scholarly journals Third-Generation Cephalosporin-Resistant Spontaneous Bacterial Peritonitis: A single-Centre Experience and Summary of Existing Studies

2014 ◽  
Vol 28 (2) ◽  
pp. 83-88 ◽  
Author(s):  
Jennifer Chaulk ◽  
Michelle Carbonneau ◽  
Hina Qamar ◽  
Adam Keough ◽  
Hsiu-Ju Chang ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Care Hospital ◽  
Third Generation ◽  
Bacterial Peritonitis ◽  
Common Diagnosis ◽  
Cephalosporin Resistance ◽  
Third Generation Cephalosporins ◽  
Culture Positive

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.OBJECTIVE: To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.METHODS: SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.RESULTS: In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.CONCLUSIONS: Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.

scholarly journals PNEUMONIA

2018 ◽  
Vol 25 (05) ◽  
pp. 744-748
Author(s):  
Anwar Hussain Abbasi ◽  
Shahab Abid ◽  
Shahab Abid
Keyword(s):  
Acute Stroke ◽  
Economic Transition ◽  
Demographic Data ◽  
Tertiary Care ◽  
Chronic Atrial Fibrillation ◽  
University Hospital ◽  
Care Hospital ◽  
Medical Department ◽  
Risk Of Death ◽  
Number Of Patients

Introduction: Stroke is a major cause of death and disability globally, with anexpected rise in number of patients with ageing and economic transition of developing countries.Pneumonia is one of the major complications after stroke. Stroke associated pneumoniaincreases risk of death by three fold and is the major cause of morbidity and mortality afterthe stroke. Objective: To determine the frequency and factors leading to stroke associatedpneumonia in all acute stroke patients admitted at a tertiary care hospital. Study Design: Caseseries. Setting: Medical Department, Aga Khan University Hospital (AKUH), Karachi. Period:six months and extended from 1st July 2015 to 31st December 2015. Material and methods:All adult patients (age 14 years and above) admitted through emergency room in the medicalward of Aga khan university hospital Karachi with the diagnosis of acute stroke on the basis ofMRI findings were enrolled after taking informed consent through Non purposive consecutivesampling technique. Demographic data like age and sex were recorded. Diagnosis of strokeassociated pneumonia was made on basis of CDC criteria for pneumonia. All analyses wasconducted by using the Statistical package for social science SPSS (Release 19.0, standardversion, copyright © SPSS; 1989-02). Results: A total of 157 patients admitted with a mean ageof the inducted patients were 61.75 ± 13.91 years. According to this stratification, 23 patients(14.65%) were aged less than 45 years and remaining 134 subjects (85.35%) were above theage of 45 years among them 110 were males (70.1 %) and 47 were females (29.9 %). Strokeassociated pneumonia was found in 33 (21%) out of 157 patients. Out of 33 patients havingstroke associated pneumonia; 14 (42.4%) patients had Diabetes mellitus. Out of 33 patientshaving stroke associated pneumonia; 28 (84.8%) patients had hypertension. Out of 33 patientshaving stroke associated pneumonia; 2 (6%) had COPD. Out of 33 patients having strokeassociated pneumonia; 2(6%) had Chronic Atrial Fibrillation. Out of 33 patients having strokeassociated pneumonia; 21 (63.6%) patients had impaired swallowing. Conclusion: Strokeassociated pneumonia is the common and serious complication after stroke. All the effortsshould be taken to control various factors leading to stroke associated pneumonia like DM,hypertension, and impaired swallowing to improve stroke outcome.

scholarly journals Delay in diagnosis of patients with head-and-neck cancer in Canada: impact of patient and provider delay

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
S. Kassirian ◽  
A. Dzioba ◽  
S. Hamel ◽  
K. Patel ◽  
D.A. Palma ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck ◽  
Demographic Data ◽  
Tertiary Care ◽  
Wait Time ◽  
Late Presentation ◽  
Initial Symptom ◽  
Anatomic Site ◽  
Delay In Diagnosis ◽  
First Time

Background Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting. Methods Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients. Results The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1–7). No significant differences in time to presentation were found based on stage at presentation or anatomic site. Conclusions At our tertiary care cancer centre, a patient’s clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.

Reduced Use of Third-Generation Cephalosporins Decreases the Acquisition of Extended-Spectrum Beta-Lactamase-ProducingKlebsiella pneumoniae

2004 ◽  
Vol 25 (10) ◽  
pp. 832-837 ◽  
Author(s):  
Sang-Oh Lee ◽  
Eun Sun Lee ◽  
Shin Young Park ◽  
Sue-Yun Kim ◽  
Yiel-Hae Seo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Tertiary Care ◽  
Prior Exposure ◽  
Third Generation ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

AbstractObjectives:To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producingKlebsiella pneumoniaeamong patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures.Design:Nested case-control and intervention study.Setting:A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU.Methods:Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producingK. pneumoniaewas isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producingK. pneumoniae.After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producingK. pneumoniaebefore (October 2002 to February 2003) and after (April to August 2003) the intervention.Results:Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI95, 1.9 to 18.6;P= .002) was an independent risk factor of ESBL-producingK. pneumoniaeacquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producingK. pneumoniaeper 1,000 patient-days (13.5 [CI95, 8.9 to 18.1] vs 2.7 [CI95, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 ± 5.0 vs 17.3 ± 2.6;P< .001) decreased significantly after the intervention.Conclusion:Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producingK. pneumoniae,and less use of TGCs was associated with a decrease in acquisition.

scholarly journals The Outcome of Agitation in Poisoned Patients in an Iranian Tertiary Care University Hospital

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Ali Mohammad Sabzghabaee ◽  
Ahmad Yaraghi ◽  
Elham Khalilidehkordi ◽  
Seyyed Mohammad Mahdy Mirhosseini ◽  
Elham Beheshtian ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Demographic Data ◽  
Tertiary Care ◽  
Previous History ◽  
University Hospital ◽  
Richmond Agitation Sedation Scale ◽  
Alcohol Abusers ◽  
History Of ◽  
Acute Agitation ◽  
Time Of Admission

Introduction. This study was conducted to evaluate and document the frequency and causes of agitation, the symptoms accompanying this condition in intoxications, relationship between agitation score on admission and different variables, and the outcome of therapy in a tertiary care referral poisoning center in Iran.Methods. In this prospective observational study which was done in 2012, 3010 patients were screened for agitation at the time of admission using the Richmond Agitation Sedation Scale. Demographic data including age, gender, and the drug ingested were also recorded. The patients’ outcome was categorized as recovery without complications, recovery with complications (hyperthermia, renal failure, and other causes), and death.Results. Agitation was observed in 56 patients (males,n=41), mostly aged 19–40 years (n=38) and more frequently in illegal substance (stimulants, opioids and also alcohol) abusers. Agitation score was not significantly related to the age, gender, and previous history of psychiatric disorders. Forty nine patients had recovery without any complication. The need for mechanical ventilation was the most frequent complication. None of the patients died.Conclusion. Drug abuse seems to be a must-to-consider etiology for patients presenting with acute agitation and its morbidity and mortality could be low in agitated poisoning cases if prompt supportive care is performed.

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