Methicillin Resistance and Risk Factors for Embolism inStaphylococcus aureusInfective Endocarditis

Objective.Infective endocarditis caused byStaphylococcus aureusis an ominous prognosis associated with a high prevalence of embolic episodes and neurological involvement. Whether methicillin resistance decreases the risk of embolism in infective endocarditis is unclear. We sought to assess the association between methicillin resistance and risk factors for embolism in S.aureusinfective endocarditis.Design.Retrospective chart review. Data from patients with infective endocarditis due to methicillin-resistantS. aureus werecompared with data from patients with endocarditis due to methicillin-susceptibleS. aureus.Logistic regression was used to identify independent risk factors for embolism.Setting.A 2,000-bed, university-affiliated tertiary care hospital.Patients.Between 1995 and 2005, 123 patients withS. aureusinfective endocarditis were included in the study. There were 74 male patients and 49 female patients, with a median age of 54 years (range, 0-89 years).Results.Of 123 infections, 30 (24%) were nosocomial infections, and 14 (11%) were prosthetic valve infections. Of 123S. aureusisolates, 48 (39%) were methicillin resistant. In total, embolism occurred in 45 (37%) of these patients: pulmonary embolism in 22 (18%), cerebral embolism in 21 (17%), and peripheral embolism in 6 (5%). The independent risk factors for an embolism were injection drug use, presence of a cardiac vegetation with a size of 10 mm or greater, and absence of nosocomial infection. For 83 patients with aortic or mitral infective endocarditis, independent risk factors for an embolism were the presence of a cardiac vegetation with a size of 10 mm or greater and endocarditis due to methicillin-susceptibleS. aureus.Overall, in-hospital death occurred for 32 (26%) of 123 Patients. Methicillin-resistant infection was not an independent risk factor for death.Conclusions.Methicillin-resistant S.aureusinfection was associated with decreased risk of embolism in left-side endocarditis, but was not associated with in-hospital death.

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Risk Factors for Nosocomial Infective Endocarditis in Patients with Methicillin-Resistant Staphylococcus Aureus Bacteremia

Infection Control and Hospital Epidemiology ◽

10.1086/502597 ◽

2005 ◽

Vol 26 (7) ◽

pp. 654-657 ◽

Cited By ~ 13

Author(s):

Ron-Bin Hsu

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Liver Disease ◽

Infective Endocarditis ◽

Chronic Liver Disease ◽

Tertiary Care ◽

Chronic Liver ◽

Control Group ◽

Care Hospital ◽

Methicillin Resistant

AbstractBackground and Objective:Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasing. Only a few studies of MRSA infective endocarditis have been conducted, and none have reported its risk factors. We sought to determine the host-related risk factors for infective endocarditis in patients with nosocomial MRSA bacteremia.Setting:A 2,000-bed, university-affiliated, tertiary-care hospital.Patients:Thirty-one patients with nosocomial MRSA infective endocarditis between October 1996 and May 2003.Design:A retrospective chart review was conducted. Data were compared with those from a control group of patients with nosocomial MRSA bacteremia. Logistic regression was used to identify independent risk factors for nosocomial infective endocarditis.Results:Compared with patients who had nosocomial MRSA bacteremia and no infective endocarditis, patients who had infective endocarditis had a higher incidence of chronic liver disease and a lower incidence of immunodeficiency. The risk of developing infective endocarditis was approximately 10% for patients with nosocomial MRSA bacteremia.Conclusion:Patients with MRSA bacteremia and underlying chronic liver disease were prone to infective endocarditis. (Infect Control Hosp Epidemiol 2005;26:654-657)

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Distribution of MR-CoNS in the clinical staffs of tertiary care hospital

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2021.022 ◽

2021 ◽

Vol 7 (2) ◽

pp. 100-102

Author(s):

Sonu S. Ahirwar ◽

Prabhat Jatav ◽

Kirti Kushwaha

Keyword(s):

Low Income ◽

Nasal Swab ◽

Tertiary Care Hospital ◽

Methicillin Resistance ◽

Tertiary Care ◽

Automated System ◽

Diffusion Method ◽

Care Hospital ◽

Methicillin Resistant ◽

Vitek 2

Methicillin-resistant coagulase-negative staphylococci (MR-CoNS) associated infection is a growing concern in healthcare settings now a day. MR-CoNS are the main infectious agents of the hospital acquired infection. Clinical staffs to patients transmission of resistant strains have caused a rapid increase in the prevalence of antimicrobial resistance in recent years. Growing rate of antimicrobial resistant against available antibiotics of MR-CoNS is a developing problem in low income or lower middle income counties. This study was conducted to determine the occurrence MR-CoNS isolated from different clinical staffs of tertiary care hospital. This prospective study conducted in clinical staffs, nasal swab were collected from all the participants. Screening of CoNS were done on the basis of cultural, morphological and biochemical tests, identification and AST analysis done by VITEK-2 automated system. Methicillin resistance pattern was checked by VITEK-2 and Kirby-Bauer disc diffusion method according to CLSI guideline. A total of 129 nasal swab samples were collected from clinical staffs, of which n=81 isolates (85.6%) were CoNS. Among n=81 CoNS, (48.12%) , (41.97%) , (7.4%) and (2.4%) were reported. Out of n=81 CoNS isolates, n=26 were conformed as MR-CoNS. Maximum methicillin resistance were reported in 53.48% (14/26), 42.30% (11/26), 3.84% (1/26) and 0% (0/26). Theoccurrence rate of MR-CoNS are higher (20.6%) in the healthcare workers and most of the methicillin resistant-CoNS isolates shows high level of resistance against widely used antibiotics but all the isolates susceptible against vancomycin.

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Incidence and Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

10.20944/preprints201912.0205.v2 ◽

2020 ◽

Author(s):

Abhishek Sharma ◽

Aditya Mathur ◽

Cecilia Stålsby Lundborg ◽

Ashish Pathak

Keyword(s):

Risk Factors ◽

Tertiary Care ◽

World Health ◽

Respiratory Pattern ◽

Care Hospital ◽

Severe Dehydration ◽

Cross Sectional ◽

Oral Rehydration ◽

History Of ◽

Independent Risk Factors

Diarrhoea contributes significantly in the under-five childhood morality and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having “some dehydration” and “dehydration” according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine output, and abnormal respiratory pattern. A questionnaire was administered to identify risk factors for severe dehydration, which was the primary outcome. Multivariate logistic regression modeling was used to detect independent risk factors for severe dehydration. The study included 332 children, with mean ± standard deviation age of 25.62 ± 31.85 months; out of which, 70%(95% confidence interval [CI] 65 to 75) were diagnosed to have severe dehydration. The independent risk factors for severe dehydration were: child not exclusive breast fed in the first six months of life (AOR 5.67, 95%CI 2.51 to 12.78; p<0.001), history of not receiving oral rehydration solution before hospitalization (AOR 1.34, 95%CI 1.01 to 1.78; p=0.038), history of not receiving oral zinc before hospitalization (AOR 2.66, 95%CI 1.68 to 4.21; p<0.001) and living in overcrowded conditions (AOR 5.52, 95%CI 2.19 to 13.93; p<0.001). The study identified many risk factors associated with severe childhood dehydration; many of them are modifiable though known and effective public health interventions.

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Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080202200306 ◽

2002 ◽

Vol 22 (3) ◽

pp. 335-338 ◽

Cited By ~ 14

Author(s):

Robert E. Ariano ◽

Christine Franczuk ◽

Adrian Fine ◽

Godfrey K.M. Harding ◽

Sheryl A. Zelenitsky

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Staphylococcus Epidermidis ◽

Methicillin Resistance ◽

Tertiary Care ◽

Significant Risk ◽

Response Rates ◽

Care Hospital ◽

Clinical Failure ◽

Empiric Treatment

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.

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Risk Factors and Reasons for Treatment Abandonment for Patients With Esophageal Atresia: A Study From a Tertiary Care Hospital in Beijing, China

Frontiers in Pediatrics ◽

10.3389/fped.2021.634573 ◽

2021 ◽

Vol 9 ◽

Author(s):

Shen Yang ◽

Junmin Liao ◽

Siqi Li ◽

Kaiyun Hua ◽

Peize Wang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Surgical Repair ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Unplanned Admission ◽

Independent Risk Factors ◽

Treatment Abandonment

Background: This study aims to identify the risk factors and reasons for treatment abandonment for patients with esophageal atresia (EA) in a tertiary care hospital in China.Methods: A retrospective study was conducted on 360 patients with EA admitted to Beijing Children's Hospital between January 1, 2007 and June 1, 2020. Medical records for treatment abandonment and non-treatment abandonment patients were compared. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for treatment abandonment.Results: After the diagnosis of EA, parents of 107 patients refused surgical repair and discharged against medical advice, and 253 patients underwent surgical repair. Among these 253 patients, parents of 59 patients abandoned treatment after surgery; 52 patients were discharged in an unstable condition, and parents of seven patients abandoned resuscitation leading to death in the hospital. By comparing clinical characteristics between treatment abandonment before surgery (n = 107) and non-treatment abandonment (n = 253) groups, we found that mother's parity >1, unplanned admission to intensive care unit before surgery, associated anomalies, and Gross type A/B were significant independent risk factors for treatment abandonment before surgery. Furthermore, birth weight <2,545 g, being discharged from neonatal center/intensive care unit and other departments, unplanned admission to intensive care unit after surgery, operative time >133 min, admission before 2016, pneumothorax, and anastomotic leakage were significant independent risk factors for treatment abandonment after surgery. The reasons for treatment abandonment included financial difficulties, multiple malformations with poor prognosis, belief of incurability and concerns about the prognosis of the diseases, postoperative complications, and extensive length of intensive care unit stay.Conclusions: Treatment abandonment of children with EA/TEF is still a common and serious problem in China. This study showed that EA/TEF patients in critical conditions, with associated anomalies, Gross type A/B, and who had occurrence of complications had high-risk for treatment abandonment.

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Detection of Oxacillin (Methicillin)-resistant Staphylococcus aureus Isolated from a Tertiary-care Hospital, Georgetown, Guyana

Microbiology Research Journal International ◽

10.9734/mrji/2019/v29i630182 ◽

2020 ◽

pp. 1-7

Author(s):

Paul Cheddie ◽

Drovashti Seepersaud ◽

Tereasia Ramlochan

Keyword(s):

Staphylococcus Aureus ◽

Tertiary Care Hospital ◽

Methicillin Resistance ◽

Tertiary Care ◽

Hospital Setting ◽

Tertiary Hospital ◽

Care Hospital ◽

Prevalence Survey ◽

Methicillin Resistant ◽

Broth Microdilution Method

Background and Aim: Methicillin-resistant Staphylocccus aureus (MRSA) continues to be a major problem globally. Previous data had suggested that the prevalence of MRSA infections in the tertiary hospital setting was 51%. The aim of this study was to conduct a point prevalence survey of MRSA infections occurring at a tertiary-care hospital in Georgetown, Guyana, and to determine to what extent methicillin-resistance was occurring among Staphylococcus aureus isolates utilising the minimum inhibitory concentration (MIC) data. Study Design: This study was based on a prospective, analytical design. Place and Duration of Study: Microbiology department, Georgetown Public Hospital Corporation (GPHC), and Department of Medical Technology, University of Guyana, between May 2019 and July 2019. Methodology: A total of 101 consecutive, non-repetitive, laboratory-identified MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) isolates were tested using an oxacillin broth microdilution method. Results: We found that 65.4% of Staphylococcus aureus were oxacillin (methicillin) resistant with a majority of the isolates being high level oxacillin resistant strains (i.e., MICs > 256 μg/ml) (84.85%). Most of the resistant isolates were collected from patients admitted to medical and surgical wards. Conclusion: Methicillin-resistance continues to be a major problem in the hospital setting and conventional techniques are unlikely to identify all of the potentially resistant isolates.

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Prevalence of Methicillin-resistant Staphylococcus Aureus (MRSA) in a Tertiary Care Hospital in Northern India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.72154 ◽

2010 ◽

Vol 2 (02) ◽

pp. 078-081 ◽

Cited By ~ 14

Author(s):

Shilpa Arora ◽

Pushpa Devi ◽

Usha Arora ◽

Bimla Devi

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Susceptibility ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Tertiary Care ◽

Antibiotic Sensitivity ◽

Diffusion Method ◽

Care Hospital ◽

Methicillin Resistant ◽

Sensitivity Pattern

ABSTRACT Aim: The emergence of Methicillin-resistant Staphylococcus aureus (MRSA) has posed a serious therapeutic challenge. We report the prevalence and antibiotic susceptibility pattern of MRSA in the hospitals attached to GMC, Amritsar, Punjab. Materials and Methods: The study comprised of 250 coagulase-positive staphylococci (COPS) isolated from a total of 6743 clinical specimens (like pus, blood, urine, high vaginal swab, sputum, etc.) of patients admitted in hospitals attached to Government Medical College, Amritsar from January 2008−February 2009. Routine antibiotic susceptibility testing was performed and interpreted as per standard guidelines. Methicillin resistance was detected using oxacillin and cefoxitin disc diffusion method, oxacillin screen agar method, and minimum inhibitory concentration using broth macrodilution method. Results: A total of 115 (46%) strains were found to be methicillin resistant. Multidrug resistance was observed in 73% MRSA strains. However, no strain was resistant to vancomycin. Conclusion: Regular surveillance of hospital-associated infection and monitoring of antibiotic sensitivity pattern is required to reduce MRSA prevalence.

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Incidence and Risk Factors of Ocular Infection Caused by Staphylococcus aureus Bacteremia

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02651-15 ◽

2016 ◽

Vol 60 (4) ◽

pp. 2012-2017 ◽

Cited By ~ 8

Author(s):

Jiwon Jung ◽

Junyeop Lee ◽

Shi Nae Yu ◽

Yong Kyun Kim ◽

Ju Young Lee ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Tertiary Care ◽

Ocular Infection ◽

Ocular Involvement ◽

Care Hospital ◽

Content Type ◽

Ocular Infections ◽

Metastatic Infection

ABSTRACTStaphylococcus aureusbacteremia (SAB) often leads to ocular infections, including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcomes of ocular infections complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infections as endophthalmitis or chorioretinitis. During the 5-year study period, 1,109 patients had SAB, and data for 612 (55%) who underwent ophthalmic examinations within 14 days after SAB onset were analyzed. Of those 612 patients, 56 (9% [95% confidence interval [CI], 7 to 12%]) had ocular involvement, including 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In a multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74 [95% CI, 2.25 to 14.64]) and metastatic infection (aOR, 2.38 [95% CI, 1.29 to 4.39]) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbances. Two-thirds of the patients with endophthalmitis (10/15 patients) were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all of the patients with chorioretinitis were treated only with systemic antibiotics. No patients became blind. Among 42 patients for whom follow-up assessments were available, the ocular lesions improved in 29 (69%) but remained the same in the others. Ocular involvement was independently associated with death within 30 days after SAB onset. Ocular involvement is not uncommon among patients with SAB. Routine ophthalmic examinations should be considered for patients with infective endocarditis or metastatic infections caused by SAB.

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