scholarly journals 253. Is Echocardiogram always indicated in Bacteremia?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S126-S126
Author(s):  
Sagy Grinberg ◽  
Sandhya Nagarakanti ◽  
Audai Ibrahim Ma’ayah ◽  
Yee Tchao ◽  
Eliahu Bishburg
Keyword(s):  
Tertiary Care ◽  
Blood Cultures ◽  
Streptococcus Viridans ◽  
Care Hospital ◽  
Indwelling Catheter ◽  
Indwelling Catheters ◽  
History Of ◽  
Unidentified Source ◽  
Staphylococcus Spp ◽  
Implanted Devices

Abstract Background Echocardiography (ECHO) is a commonly used test; and is part of the Duke’s criteria for diagnosing endocarditis (IE). Our objectives were to analyze utilization and results of ECHO in pts with bacteremia growing organisms not typically associated with IE, and to evaluate whether ECHO contributed to a diagnosis of IE. Methods A retrospective review in a 680-bed tertiary care hospital from 2013–2019. Adult pts with bacteremia with at least 2 positive blood cultures for an organism not typically associated with IE such as Streptococcus viridans, Staphylococcus spp. and enterococcus, and who underwent ECHO were included. Data was collected on demographics, blood cultures, timing of ECHO and its’ findings. Modified Duke’s criteria was used to diagnose IE. Results Ninety four pts were included. Mean age 62 yrs. (range 23-91yrs). 50 (53%) were men. DM noted in 49(52%), CAD in 37(39%), CHF in 54 (57%), chronic kidney disease in 22(23%), hemodialysis in 19(20%), history of IE in 9 (10%). Transthoracic ECHO in 34 (36%), transesophageal ECHO in 28(30%), 32(34%) had both. Identifiable sources of bacteremia were urinary tract infection in 9 (10%), pneumonia 5 (5%), PICC line 5 (5%), wound/tissue infection 3 (3%).Clinicians did not specify the indication for ECHO in any of the cases. Unidentified source of bacteremia noted in 72(77%). Bacteremia was community acquired in 70(74%). Mean days of positive blood cultures 5.6 days (range 1–34 days). Gram (-) organism isolated in 44(47%), Gram (+) in 50(53%), of these, 50 (54%) had an implanted devices/indwelling catheter: 39 cardiac implantable device, 12 indwelling/tunneled catheter. The overall yield of ECHO in bacteremia was 11/94 (12%). ECHO in Gram (-) bacteremia had yield of 9% (4/44 pts) of them only 1 met possible IE by Duke’s criteria. Gram (+) bacteremia had an ECHO yield of 14% (7/50pts); of them 4 met possible IE Duke’s criteria. None of the cases met definite criteria for IE. Conclusion Yield of ECHO for the diagnosis of IE in pts with bacteremia with organisms other than Streptococcus viridans, staphylococci or enterococci was low even in the presence of implanted devices or indwelling catheters. Better criteria for ECHO utilization will reduce its use and potentially increase its yield. Disclosures All Authors: No reported disclosures

scholarly journals 650. Clinical Performance Evaluation of Virtuo Blood Culture System in a Tertiary Care Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S383-S383
Author(s):  
Miguel A Chavez ◽  
Satish Munigala ◽  
Carey-Ann Burnham ◽  
Melanie L Yarbrough ◽  
David K Warren
Keyword(s):  
Blood Culture ◽  
Recovery Rate ◽  
Culture System ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Care Hospital ◽  
Blood Culture System ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Staphylococcus Spp

Abstract Background Bloodstream infections are a major cause of morbidity and mortality. BACT/ALERT VIRTUO (VIRTUO) blood culture system is an automated, closed system used with resin-containing media which may enhance the growth of microorganisms. Our objective was to assess the real-world performance of the VIRTUO system. Methods We retrospectively reviewed all blood cultures performed between January-December 2018 (VersaTREK) and January-December 2019 (VIRTUO) at a 1250-bed academic medical center. Blood culture positivity rates, contamination rates, and time from collection to arrival in the laboratory were compared pre- versus post-VIRTUO implementation. Contamination was defined as a single blood culture with common skin microbiota. Results A total of 101803 blood cultures were performed during the study period: 48969 (48.1%) were processed with VersaTREK system and 52834 (51.9%) with VIRTUO system. A decreased median time from collection until arrival to the laboratory was seen post-implementation (2.0 pre- vs. 0.8 hours post-implementation, p< 0.001). The positivity rate increased from 3987 (8.1%) pre-implementation to 6141 (11.6%) post-implementation (p < 0.001) (Table and Figure). Staphylococcus aureus was the most frequently isolated species for both periods and had higher recovery rate with the VIRTUO system (717 (1.5%) pre- vs. 1764 (3.3%) post-implementation, p< 0.001). Higher recovery rate was also noted for other Staphylococcus spp. in the post-implementation period (985 (2.0%) pre- vs. 1644 (3.1%) post-implementation, p< 0.001). No difference in the organism recovery rate was noted for Streptococcus spp., Enterococcus faecium, E. faecalis, Pseudomonas aeruginosa, Enterobacterales, and Candida spp. The inpatient contamination rate was higher post-implementation (1.5% pre- vs. 1.9% post-implementation, p < 0.001). Comparison of blood culture positivity rate pre- vs. post-implementation, by culture location Daily positivity rate for blood cultures processed at BJH during the study period Conclusion The VIRTUO system showed a higher rate of positive blood cultures compared to the VersaTREK system primarily from a higher detection of Staphylococcus spp. Further studies are needed to assess whether an increased rate of positive blood cultures is associated with changes in management and clinical outcomes. Disclosures All Authors: No reported disclosures

Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: A Blinded Study to Establish Baseline Acquisition Rates

2003 ◽  
Vol 24 (6) ◽  
pp. 415-421 ◽  
Author(s):  
Joel T. Fishbain ◽  
Joseph C. Lee ◽  
Honghung D. Nguyen ◽  
Jeffery A. Mikita ◽  
Cecilia P. Mikita ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Transmission Rate ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Nosocomial Transmission ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Average Hospital ◽  
Methicillin Resistant ◽  
History Of

AbstractObjective:To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.Design:A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA Risk factors associated with the likelihood of MRSA colonization on admission were investigated.Setting:Tertiary-care military medical facility.Participants:All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.Results:Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.Conclusions:Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.

COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

2021 ◽  
pp. 70-72
Author(s):  
Gaurav Santosh Nemade ◽  
Sumit Nitin Dhus ◽  
Arushi Ramesh Shetty ◽  
Neha Dhananjay Firake
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary Tuberculosis ◽  
Younger Age ◽  
Tobacco Addiction ◽  
History Of ◽  
Early Case ◽  
Male To Female ◽  
Clinical Characteristic

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (<25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

Pattern of Congenital Heart Diseases and Associated Risk Factors among Children at a Tertiary Care Hospital

2021 ◽  
Vol 15 (9) ◽  
pp. 2451-2453
Author(s):  
Shahid Iqbal ◽  
Muhammad Fareed Khan ◽  
Raja Imtiaz Ahmed ◽  
Shahab Saidullah ◽  
Nisar Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Folic Acid ◽  
Congenital Heart ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Care Hospital ◽  
Younger Age ◽  
History Of ◽  
Associated Risk Factors

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

PREVALENCE OF NAFLD AMONG HEALTHY LIVER DONORS

2021 ◽  
pp. 46-48
Author(s):  
Muzaffer Rashid Shawl ◽  
Fahad ul Islam Mir ◽  
Saad Abdul Rahman ◽  
Anil C Anand ◽  
Manav Wadhawan ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Western World ◽  
Care Hospital ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
History Of ◽  
Healthy Liver ◽  
Liver Donors

NAFLD is hepatic pandemic of the twenty rst century, being leading cause of chronic hepatic disease in western world. We did a cross sectional study to nd out prevalence of NAFLD among prospective healthy liver donors at a tertiary care hospital at New Delhi, India over a period from June 2014 to March 2016. 124 apparently healthy prospective liver donors were selected. Exclusion criteria were set to exclude all those who had signicant history of alcohol intake (dened as greater than 30g/day for men and greater than 20g/day for women over last two years), Hepatitis B or C infection, severe surgical weight loss or emaciation, Obstructive Sleep Apnea, Celiac disease, history of drug intake known to cause hepatic steatosis. Out of 124 prospective liver donors included in this study, 29 (23%) donors were found to have fatty liver on USG abdomen; 38 (31%) donors had fatty liver on unenhanced CTof the abdomen (LAI of ≤ 5 HU); 61 (49%) donors had fatty liver on magnetic resonance.

scholarly journals A comparative study of impact on cognitive function between diabetic and non-diabetic patients in a tertiary care hospital

2018 ◽  
Vol 7 (8) ◽  
pp. 1547
Author(s):  
Dharnaben A. Patel ◽  
Dhruv J. Patel ◽  
N. D. Kantharia
Keyword(s):  
Cognitive Function ◽  
Cognitive Decline ◽  
Tertiary Care ◽  
The Body ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Proper Understanding ◽  
History Of ◽  
Control Of Diabetes ◽  
The Brain

Background: Diabetes Mellitus is a chronic metabolic disorder characterized by hyperglycemia, polyuria, hyperlipidemia etc, resulting from defects in insulin secretion, insulin action or both. It affects various organs of the body including the brain. Cognitive function is the thinking process of the brain. In any chronic disease evaluation of cognitive function is justified as it may affect various common day to day activities.Methods: It is a prospective, observational and non-interventional study. Thirty diabetic patients who were recently started on insulin i.e. within 7 days were enrolled in the study based on inclusion and exclusion criteria. Thirty non diabetic healthy individuals served as a control. Cognitive function was accessed by Adenbrooke’s Cognitive Examination (ACE III) at the time of enrollment.Results: The results were analysed using paired t-test. Attention, Memory and Visiospatial ability was significantly reduced in diabetic patients compared to control. Verbal fluency and language was also reduced but the change was not significant. Total ACE III score was significantly reduced in diabetic patients compared to control.Conclusions: Cognitive function is significantly reduced in Diabetic patients recently started on insulin. Hyperglycemia could be the possible reason of cognitive decline. Proper understanding of the natural history of Diabetes and the pathogenesis of cognitive decline as well as control of Diabetes can help to prevent development of cognitive dysfunction.

scholarly journals The clinical study of dermatophytosis in a tertiary care hospital of konkan region, Maharashtra

2021 ◽  
Vol 7 (4) ◽  
pp. 315-319
Author(s):  
U Ketan Raju ◽  
Hanamant G Bobade ◽  
Anil Mishra
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Hair Shaft ◽  
Care Hospital ◽  
Common Site ◽  
Tinea Cruris ◽  
Nail Changes ◽  
Male Preponderance ◽  
History Of ◽  
Epidemiological Characteristics

Dermatophytes are aerobic fungi that produce proteases that digest keratin and allows colonization, invasion and infection of the stratum corneum of the skin, the hair shaft, and the nail. This study was an attempt on the part of the author to find out the incidence and various clinico-epidemiological characteristics of Dermatophytosis in skin OPD of Tertiary care Hospital, B.K.L.W.R.M.C., Dervan. The study was carried on 2444 patients of Dermatophytosis attending the OPD, out of which 49.79% of the cases were Tinea Cruris (TC). The age group of 11-20 years showed maximum prevalence of Dermatophytosis (22.17%). 58% of the patients had diffuse lesions. Body involvement was seen in 87% of cases. Itching was the most common condition associated with Dermatophytosis. 35% of the patients reported with family history of Tinea Cruris.Circumscribed variety of TC was found to be most common variant mostly observed in 2and 4 decade, with a male preponderance. Groin was the most common site with multiple lesions. Nail changes was most commonly associated with TC.

scholarly journals Prevalence and the risk factors for the carriage of beta-haemolytic streptococci among women visiting a tertiary care hospital in South India

2021 ◽  
Vol 8 (4) ◽  
pp. 308-312
Author(s):  
Pendru Raghunath ◽  
LN Rao Sadanand
Keyword(s):  
Risk Factors ◽  
Teaching Hospital ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Latex Agglutination ◽  
Research Centre ◽  
Care Hospital ◽  
Microbiological Techniques ◽  
History Of ◽  
Group B

Streptococci are gram positive cocci arranged in chains and are part of normal flora of humans and animals. The present study is carried out to determine the prevalence and risk factors for the carriage of beta-haemolytic streptococci (BHS) among women visiting Dr. VRK Women’s Teaching Hospital & Research Centre, Hyderabad. Vaginal swabs were collected from 250 patients attending outpatient department (OPD) of Dr. VRK Women’s Teaching hospital. Swabs were inoculated onto 5% sheep blood agar plates and incubated for 24 h at 37°C in a candle jar. BHS isolates were phenotypically identified by standard microbiological techniques, all the isolates presumptively identified as BHS were tested for Bacitracin susceptibility. Sensitive isolates were presumptively identified as GAS and resistant isolates were identified as non-group A BHS (NGABHS). Presumptively identified GAS & NGABHS isolates were serogrouped by Lancefield grouping using a commercially available latex agglutination test. BHS were isolated from 12.4% of samples. As many as 12 BHS isolates were identified as GAS and 19 were identified as NGABHS. Ten of nineteen were identified as group B (GBS), 4 (12.9%) were identified as group C (GCS) and 5 (16.12%) were identified as group G (GGS). Among six clinical groups, the prevalence of GAS is highest i.e. 7.5% in female patients visiting Gynaecology OPD with history of white discharge. Prevalence of NGABHS was more among post insertion (18%) IUCD group compared to pre insertion (8%) IUCD group. GBS were isolated from 7% of samples from IUCD group and 4% of samples from prostitutes.This study reports the prevalence of BHS among women visiting a tertiary care hospital in Hyderabad. This study also identified certain risk factors such as IUCD usage and working as a FSW are associated with the increased prevalence of NGABHS especially GBS.

scholarly journals VAGINAL DISCHARGE

2011 ◽  
Vol 18 (04) ◽  
pp. 598-603
Author(s):  
SHAHIDA SHAIKH ◽  
SALEEM AKHTER SHAIKH ◽  
INAYAT MAGSI
Keyword(s):  
Vaginal Discharge ◽  
Tertiary Care ◽  
Care Hospital ◽  
College Hospital ◽  
Internally Displaced ◽  
Syndromic Management ◽  
Sexually Transmitted ◽  
Medical College ◽  
Abnormal Growth ◽  
History Of

Objective: To observe the results of syndromic management in women living in IDPs camps complaining of chronic vaginal discharge. Design: Descriptive study. Setting: Medical Camps at Larkana set by Chandka Medical College Hospital for Internally Displaced Persons (IDPs) due to floods. Period: 1st September 2010 to 31st December 2010. Material and Methods: Total 200 symptomatic patients aged from 20 to 50 years suffering from chronic vaginal discharge having history of more than 6 months duration were included in the study. Asymptomatic as well as pregnant women and patients with abnormal cervix and having abnormal growth on cervix were excluded from the study. A detailed history and examination (including speculum and vaginal) was done and a proforma was filled. All these patients were given empirical treatment recommended by WHO as syndromic management consisting of stat doses of antifungal along with antibiotics, where no laboratory tests are required before treatment. Results: Next to vaginal discharge which was main symptom in all patients, the other symptoms like dusparunia, dysuria, itching ,lower abdomen pain and low backache was reported 9%, 16%, 20%, 24% and 31% respectively. Also 8% patients reported post coital bleeding. All patients were married and the mean age of the patients was 28+0.2 years and 15% of them were over 40 years. Mean parity was 4±1.Vaginal infection improved in 65% of the patients excellently with a first line single course of antibiotic and percentage raised up to 88% with second course. 19(9.5%) patients couldn’t be followed as they left that camp and 5(2.5%) patients who did not improve with two courses of antibiotics had big cervical erosions, referred to nearby tertiary care hospital for further management. Conclusions: IDPs live in poor conditions in camps without basic facilities and where it is difficult to perform bedside tests like microscopy, Potassium Hydroxide, wet mount films and tests for Sexually transmitted diseases like Chlamydia and gonorrhea are not available, syndromic management there is a rational way of treating cases of chronic vaginal discharge to get quicker response in such desperate women. 

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