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%.

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.

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.

Extended-Spectrum β-Lactamase–ProducingEscherichia coliandKlebsiellaSpecies: Risk Factors for Colonization and Impact of Antimicrobial Formulary Interventions on Colonization Prevalence

2002 ◽  
Vol 23 (5) ◽  
pp. 254-260 ◽  
Author(s):  
Gregory Bisson ◽  
Neil O. Fishman ◽  
Jean Baldus Patel ◽  
Paul H. Edelstein ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
System A ◽  
Extended Spectrum ◽  
Tertiary Care Medical Center ◽  
Duration Of Hospitalization ◽  
Third Generation Cephalosporins ◽  
Control Study

Objective:The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producingEscherichia coliand Klebsiella species(ESβL-EK) remain unclear, as do methods to control their further emergence.Design:Case–control study.Setting:Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.Patients:Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.Results:Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a singleK. oxytocaclone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P= .51).Conclusions:ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

Epidemiology of Methicillin-ResistantStaphylococcus aureusat a University Hospital in the Canary Islands

2003 ◽  
Vol 24 (9) ◽  
pp. 667-672 ◽  
Author(s):  
Isabel Montesinos ◽  
Eduardo Salido ◽  
Teresa Delgado ◽  
Maria Lecuona ◽  
Antonio Sierra
Keyword(s):  
Canary Islands ◽  
Tertiary Care ◽  
Control Measures ◽  
University Hospital ◽  
Pfge Type ◽  
Staff Members ◽  
Surveillance Cultures ◽  
Underlying Illness ◽  
Hospital Stays ◽  
Prolonged Hospital

AbstractObjectives:To describe the epidemiology of methicillin-resistantStaphylococcus aureus(MRSA) at a university hospital in Tenerife, Canary Islands, during a 40-month period and to evaluate the effectiveness of the application of control measures.Design:Laboratory-based surveillance, medical charts and microbiological records review, and characterization of strains by pulsed-field gel electrophoresis (PFGE) were used to describe the epidemiology. Infection control practices were introduced as an intervention.Setting:A 650-bed, tertiary-care university hospital.Subjects:Patients with clinical and nasal isolates of MRSA and colonized staff members.Results:The rate of nosocomial MRSA infections was 32.5% for 1997, 17.9% for 1998, 14.5% for 1999, and 25.6% during the first 4 months of 2000. The major sites of isolation for nosocomial MRSA infection included surgical wounds (25%) and the lower respiratory tract (24%). Intensive care units and surgical specialties had more frequent MRSA cases. Characteristics associated with nosocomial MRSA isolates included prior use of intensive antibiotic therapy, prolonged hospital stays, major underlying illness, invasive procedures, and older age. PFGE type A (subtype A1) was the strain most frequently found and the only PFGE type involved in clusters.Conclusions:Surveillance cultures and contact droplet precautions were followed by decreased rates for 2 years. Nevertheless, the spread of PFGE subtype Al to many different areas of the hospital and the increase in incidence during the first third of 2000 indicates either that surveillance cultures were not used widely enough or that compliance with isolation measures was suboptimal.

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.

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.

Increased Rate of Tuberculin Skin Test Conversion Among Workers at a University Hospital

1992 ◽  
Vol 13 (10) ◽  
pp. 579-581 ◽  
Author(s):  
Julio A. Ramirez ◽  
Pamela Anderson ◽  
Sharon Herp ◽  
Martin J. Raff
Keyword(s):  
Tuberculin Skin Test ◽  
Skin Test ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Control Measures ◽  
University Hospital ◽  
Skin Tests ◽  
Tuberculin Skin Test Conversion ◽  
Cdc Guidelines ◽  
Hospital Patients

AbstractObjectives:To summarize the results of an investigation of increased rates of tuberculin skin test conversion in employees at a university hospital.Design:The results of annual tuberculin skin tests performed on all 1,845 hospital employees from 1986 to 1991 were reviewed.Setting:A 450-bed acute tertiary care university hospital.Results:The rate of tuberculin skin test conversion was 0.35% (standard deviation ± 0.15) from 1986 to 1989 and increased to 1.7% during 1991. Investigation revealed deviations from the Centers for Disease Control (CDC) guidelines for tuberculosis control, which included the failure to consider tuberculosis as a probable cause of community-acquired pneumonia and the failure to initiate isolation precautions when tuberculosis was suspected.Conclusions:The epidemic appeared to be secondary to delays in diagnosis and isolation of patients with pulmonary tuberculosis. Future control measures should include isolation of all hospital patients admitted with pneumonia until tuberculosis has been excluded.

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