Evaluation of Hospital Room Assignment and Acquisition of Clostridium difficile Infection

2011 ◽  
Vol 32 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Megan K. Shaughnessy ◽  
Renee L. Micielli ◽  
Daryl D. DePestel ◽  
Jennifer Arndt ◽  
Cathy L. Strachan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clostridium Difficile ◽  
Tertiary Care ◽  
Significant Risk ◽  
Extended Period ◽  
Significant Risk Factor ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Icu Discharge

Background and Objective.Clostridium difficile spores persist in hospital environments for an extended period. We evaluated whether admission to a room previously occupied by a patient with C. difficile infection (CDI) increased the risk of acquiring CDI.Design.Retrospective cohort study.Setting.Medical intensive care unit (ICU) at a tertiary care hospital.Methods.Patients admitted from January 1, 2005, through June 30, 2006, were evaluated for a diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge. Medical, ICU, and pharmacy records were reviewed for other CDI risk factors. Admitted patients who did develop CDI were compared with admitted patients who did not.Results.Among 1,844 patients admitted to the ICU, 134 CDI cases were identified. After exclusions, 1,770 admitted patients remained for analysis. Of the patients who acquired CDI after admission to the ICU, 4.6% had a prior occupant without CDI, whereas 11.0% had a prior occupant with CDI (P = .002). The effect of room on CDI acquisition remained a significant risk factor (P = .008) when Kaplan-Meier curves were used. The prior occupant's CDI status remained significant (P = .01; hazard ratio, 2.35) when controlling for the current patient's age, Acute Physiology and Chronic Health Evaluation III score, exposure to proton pump inhibitors, and antibiotic use.Conclusions.A prior room occupant with CDI is a significant risk factor for CDI acquisition, independent of established CDI risk factors. These findings have implications for room placement and hospital design.

scholarly journals Sex differences in clinical presentation in acute MI

2017 ◽  
Vol 4 (4) ◽  
pp. 940
Author(s):  
Ashwin Kodliwadmath ◽  
Naren V. Nimbal
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Chest Pain ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Control Group ◽  
Care Hospital ◽  
Acute Mi

Background: Acute myocardial infarction differs in women and men with respect to risk factors and clinical presentation. There are studies carried out worldwide on this issue but few from India. This study was done to study the sex based differences in the risk factors and clinical features of acute MI in patients with Indian ethnicity.Methods: Comparative prospective study consisting of 100 women as study group and 100 men as control group with acute MI, who were admitted in a tertiary care hospital, from December 2016 to June 2017.Results: Chest pain was the main complaint in majority of the women (82%) and men (88%). Radiation of chest pain (87%) and sweating (90%) were significantly present in men compared to women (65% and 62% respectively), while breathlessness was significantly present in women (78%) compared to men (64%) and fatigue in women (76%) significantly more than men (55%). Smoking was a significant risk factor in men (69%) compared to women (5%), while diabetes mellitus was a significant risk factor in women (62%) compared to men (39%).Conclusions: Women with acute MI had more atypical presentation of symptoms, similar risk factors, compared to men except for smoking which was more significant in men and diabetes more common in women.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals Risk factors for Clostridium difficile infection in C. difficile colonized ICU patients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S403-S403
Author(s):  
Yuan Zhou ◽  
Larissa Lewis ◽  
Michelle McIntosh ◽  
Ferric C Fang ◽  
Ronald Pergamit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Disease Transmission ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Significant Risk Factor ◽  
Antibiotic Use ◽  
Research Support ◽  
Icu Patients

Abstract Background Clostridium difficile is a major cause of healthcare-associated infections leading to significant morbidity and mortality; however, data-driven interventions to decrease C. difficile infections (CDI) are lacking due to an incomplete understanding of disease transmission and risk factors. Asymptomatic C. difficile carriers may be an important source of nosocomial transmission and disease but few studies have examined colonized patients who later develop CDI. We describe risk factors for the development of CDI in a critical care population screened for C. difficile colonization. Methods All patients admitted to our medical or trauma ICUs were screened for toxigenic C. difficile by PCR via rectal swab. Colonized patients were placed in contact enteric precautions for their entire hospitalization and monitored for signs and symptoms of CDI. Retrospective chart review assessed risk factors associated with development of CDI. Results 868 rectal swabs were collected from 4/01/16 to 10/31/16. 40 patients were colonized with C. difficile on ICU admission and 20 developed symptomatic CDI (Table 1). Risk factors for CDI in colonized patients include enteral feeding and exposure to antibiotics (Table 2). Conclusion 50% of C. difficile colonized ICU patients progressed to symptomatic CDI during their hospitalization. Antibiotic use was a significant risk factor for CDI. C. difficile carriers may be a particularly vulnerable population for CDI, warranting further investigation for early identification of colonized patients and strategies for infection prevention. Disclosures F. C. Fang, BioFire: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research support and Speaker honorarium; Cepheid: Collaborator, Consultant and Scientific Advisor, Consulting fee, Educational grant, Research support and Speaker honorarium

scholarly journals Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

2012 ◽  
Vol 4 (01) ◽  
pp. 039-042 ◽  
Author(s):  
Simit H Kumar ◽  
Anuradha S De ◽  
Sujata M Baveja ◽  
Madhuri A Gore
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Care Hospital ◽  
Acinetobacter Species ◽  
Carbapenem Resistant

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

Evaluating Vancomycin Use at a Pediatric Hospital: New Approaches and Insights

2005 ◽  
Vol 26 (1) ◽  
pp. 47-55 ◽  
Author(s):  
Maureen K. Bolon ◽  
Alana D. Arnold ◽  
Henry A. Feldman ◽  
David H. Rehkopf ◽  
Emily F. Strong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Tertiary Care ◽  
Significant Risk ◽  
Risk Factor Analysis ◽  
Cell Transplant ◽  
Care Hospital ◽  
Inappropriate Use ◽  
Tertiary Care Medical Center

AbstractObjectives:To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use.Design:Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multi-variable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use.Setting:A pediatric tertiary-care medical center.Patients:Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001.Results:Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use.Conclusions:Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.

scholarly journals Use of carbapenems and glycopepdides is significant risk for multidrug resistant Acinetobacter baumannii infections

2018 ◽  
Vol 12 (02) ◽  
pp. 67-72
Author(s):  
Salih Hosoglu ◽  
Eyup Arslan ◽  
Emel Aslan ◽  
Özcan Deveci
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Acinetobacter Baumannii ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Control Group ◽  
Time Interval ◽  
And Control

Introduction: Multi-drug resistant Acinetobacter baumannii (MDR-Ab) infections are an important healthcare problem globally. The aim of this study was to evaluate risk factors associated with MDR-Ab infections in hospitalized patients in Turkey. Methodology: A case-control study was performed in a tertiary care 1,303-bed university hospital, among case patients with MDR-Ab infections. The hospital records of case and control patients were retrospectively evaluated over a year. Patients who were hospitalized in the same department and in the same time interval as the case patients, without MDR-Ab infection or colonization, were chosen for control group. Demographic characteristics, Acute Physiology And Chronic Health Evaluation II (APACHE II) scores, comorbid diseases, use of invasive tools and duration of usage, and duration of use of antibiotics were recorded for all patients. Comparisons between case and control groups for possible risk factors were performed. Results: In total, 95 cases and 95 controls were included in the study. Univariate analysis highlighted several variables as risk factors for MDR-Ab infections. Multivariate analysis showed that only antibiotic usage over seven days (OR = 2.38, CI = 1.18-4.83, p = 0.016) was found to be a significant risk factor. When antibiotic treatment patterns in both groups were compared, the use of carbapenems (p = 0.001) and glycopeptide antibiotics (p=0.001) in patient treatment were found significantly higher in the MDR-Ab case group. Conclusion: This study showed us that previous antibiotic use is a significant risk factor for MDR-Ab infections. The use of carbapenems and glycopeptides should be considered as primary risk factors for developing MDR-Ab infection.

scholarly journals Risk Factors for Clostridium Difficile Infection in a Tertiary Care Hospital

2018 ◽  
Vol 3 (3) ◽  
pp. 124
Author(s):  
Muralidhar Varma ◽  
Neha Agrawal ◽  
Pallavi Uppal ◽  
Rahul Singh ◽  
Karunya Jayasimha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Case Control Study ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Significant Risk ◽  
Care Hospital ◽  
The Past ◽  
Appropriate Treatment ◽  
Control Study

Introduction: Clostridium difficile infections have had significant morbidity and mortality in the last decade leading to high healthcare costs. Our prospective case-control study from October 2013 to May 2015 in a tertiary care hospital in rural India aimed to evaluate the risk factors, treatment, outcome, and complications of Clostridium difficile infections in hospitalized patients.Materials and Methods: The study involved a total of 183 patients, of which 61 were cases, and 122 were controls. Data was analyzed using multivariate logistic regression.Results: Antibiotic intake in the past four weeks (p=0.003), hypoalbuminemia (p=0.001) and duration of hospital stay before the onset of diarrhea (p<0.001) were proven to have significant risk. We subdivided cases into severe and non-severe cases, and we found that complications were statistically higher in severe cases (OR= 1.685, <0.001).Conclusion: Identifying severe cases and administering timely and appropriate treatment is prudent.

scholarly journals Risk Factors for Acquisition of Clostridium difficile–Associated Diarrhea among Outpatients at a Cancer Hospital

2005 ◽  
Vol 26 (8) ◽  
pp. 680-684 ◽  
Author(s):  
Tara N. Palmore ◽  
SeJean Sohn ◽  
Sharp F. Malak ◽  
Janet Eagan ◽  
Kent A Sepkowitz
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Case Control Study ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Case Control ◽  
Cancer Center ◽  
Care Hospital ◽  
Control Study

AbstractBackground:Clostridium difficile-associated diarrhea (CDAD) is an important infection in hospital settings. Its impact on outpatient care has not been well defined.Objective:To examine risk factors of ambulatory cancer patients with CDAD.Design:Case-control study.Setting:Memorial Sloan-Kettering Cancer Center, a tertiary-care hospital.Methods:Cases of CDAD among oncology outpatients from January 1999 through December 2000 were identified via positive C. difficile toxin assay results on stool specimens sent from clinics or the emergency department. A 1:3 matched case-control study examined exposures associated with CDAD.Results:Forty-eight episodes of CDAD were identified in cancer outpatients. The mean age was 51 years; 44% were female. Forty-one (85%) had received antibiotics within 60 days of diagnosis, completing courses a median of 16.5 days prior to diagnosis. Case-patients received longer courses of first-generation cephalosporins (4.8 vs 3.2 days; P = .03) and fluoroquinolones (23.6 vs 8 days; P < .01) than did control-patients. Those receiving clindamycin were 3.9-fold more likely to develop CDAD (P < .01). For each additional day of clindamycin or third-generation cephalosporin exposure, patients were 1.29- and 1.26-fold more likely to develop CDAD (P < .01 and .04, respectively). The 38 CDAD patients hospitalized during the risk period (79.2%) spent more time as inpatients than did control-patients (19.3 vs 9.7 days; P <. 001).Conclusions:Antibiotic use, especially with cephalosporins and clindamycin, and prolonged hospitalization contributed to the development of CDAD. Outpatient CDAD appears to be most strongly related to inpatient exposures; reasons for the delayed development of symptoms are unknown.

scholarly journals Acute bilirubin encephalopathy and its associated risk factors in a tertiary care hospital, Pakistan

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Munir Ahmad ◽  
Abdur Rehman ◽  
Mudasser Adnan ◽  
Muhammad Khalil Surani
Keyword(s):  
Risk Factors ◽  
Serum Bilirubin ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Total Serum ◽  
Care Hospital ◽  
Bilirubin Encephalopathy ◽  
Associated Risk Factors

Objective: To determine the incidence of acute bilirubin encephalopathy (ABE) and its risk factors in neonates presenting with hyperbilirubinemia in a tertiary care children hospital. Methods: This descriptive observational study was conducted from June 2018 to June 2019. A total of 300 infants who were admitted in neonatal ICU with diagnosis of hyperbilirubinemia in The Children’s Hospital & The Institute of Child Health, Multan, Pakistan were included in this period. Incidence of ABE was noted. ABE was divided into two categories on the basis of severity of symptoms; mild ABE and moderate to severe ABE. Total serum bilirubin (TSB) in all neonates was measured in all patients in hospital laboratory using colorimetric method. ABO incompatibility and Rh factor incompatibility was also noted for each neonate. Results: Out of 300 neonates who presented with hyperbilirubinemia, ABE was diagnosed in only 42 (14.0%) neonates (mild ABE in 17 (5.7%) and moderate in 25 (8.3%). Out of 42 neonates of ABE, total serum bilirubin levels were 20-29.9 mg/dL in 24 (40.5%) neonates, and >30 mg/dL in 18 (42.8%) neonates. Pre-term birth was a significant risk factor of ABE; 23.8% in ABE and 10.70% in non-ABE (p-value 0.01). During treatment, 02 (4.76%) neonates expired due to ABE. Conclusion: In present study, ABE was diagnosed in 14.0% neonates who presented with hyperbilirubinemia. We found pre-term delivery as a significant risk factor of ABE. doi: https://doi.org/10.12669/pjms.36.6.2222 How to cite this:Ahmad M, Rehman A, Adnan M, Surani MK. Acute bilirubin encephalopathy and its associated risk factors in a tertiary care hospital, Pakistan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2222 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Risk Factors for Acquisition and Loss of Clostridium difficile Colonization in Hospitalized Patients

2015 ◽  
Vol 59 (8) ◽  
pp. 4533-4543 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Sondra Seiler ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Content Acquisition ◽  
Stool Samples

ABSTRACTAsymptomatic colonization may contribute toClostridium difficiletransmission. Few data identify which patients are at risk for colonization. We performed a prospective cohort study ofC. difficilecolonization and risk factors forC. difficileacquisition and loss in hospitalized patients. Patients admitted to medical or surgical wards at a tertiary care hospital were enrolled; interviews and chart review were performed to determine patient demographics,C. difficileinfection (CDI) history, medications, and health care exposures. Stool samples/rectal swabs were collected at enrollment and discharge; stool samples from clinical laboratory tests were also included. Samples were cultured forC. difficile, and the isolates were tested for toxins A and B and ribotyped. Chi-square tests and univariate logistic regression were used for the analyses. Two hundred thirty-five patients were enrolled. Of the patients, 21% were colonized withC. difficile(toxigenic and nontoxigenic) at admission and 24% at discharge. Ribotype 027 accounted for 6% of the strains at admission and 12% at discharge. Of the patients colonized at admission, 78% were also colonized at discharge. Cephalosporin use was associated withC. difficileacquisition (47% of patients who acquiredC. difficileversus 25% of patients who did not;P= 0.03). β-lactam–β-lactamase inhibitor combinations were associated with a loss ofC. difficilecolonization (36% of patients who lostC. difficilecolonization versus 8% of patients colonized at both admission and discharge;P= 0.04), as was metronidazole (27% versus 3%;P= 0.03). Antibiotic use affects the epidemiology of asymptomaticC. difficilecolonization, including acquisition and loss, and it requires additional study.

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