scholarly journals 150. Improved Susceptibility of Pseudomonas aeruginosa to Cefepime (CEF) at a Veterans Tertiary Care Hospital, over a 7-Year Period (2011-2017): The Impact of Antibiotic Rotation/Cycling and Reversal of Drug Resistance in P. aeruginosa

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S187-S187
Author(s):  
Ryan Kuhn ◽  
Oscar Martinez ◽  
Chris Ross ◽  
Lauren Touleyrou ◽  
Suganthini Krishnan Natesan
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Resistance ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
Laboratory Data ◽  
High Morbidity ◽  
Care Hospital ◽  
Drug Shortage ◽  
Antibiotic Cycling ◽  
The Impact

Abstract Background Background: Pseudomonas aeruginosa continues to be an important cause of nosocomial infections associated with a high morbidity and mortality. Despite the availability of ceftazidime-avibactam (CAZ-AVI) and ceftolozone-tazobactam (CFT-TAZO), CEF continues to be an empiric agent of choice in several institutions. Aim: To evaluate the prevalence and trend in susceptibilities of P. aeruginosa to CEF over a 7-year period, identify possible correlation with the use of CAZ, AZT, PTZ, CIP, and CAR, (DOT/1000 patient days), as a quality improvement (QI) measure for optimizing CEF use, introduce antibiotic cycling as a tool to avoid emergence of drug-resistance in P. aeuriginosa. Methods A retrospective review of antimicrobial susceptibility data of all isolates of P. aeruginosa, (inpatient and outpatient) at the Detroit VAMC pre and post implementation of antibiotic cycling, over a 7-year period (2011-2017) was performed. Susceptibility testing was performed by reference broth micro-dilution methods in a central laboratory. Data analysis was performed using Pearson correlation coefficient score. Being a QI project, clinical data were not reviewed. Results A total of 977 isolates were identified during the study period. (drug usage are in DOT/1000 PD); CAZ and AZT use surged during 2013-14 from 5 to 8 dropping in 2015-17 to < 3; PTZ usage increased to 100 during 2011-14 but dropped to 38 in 2015-17 (drug shortage); CAR use averaged at 10 until 2016 and dropped to 8 in 2017; CIP use dropped by 50% from 30 in 2012 to 15 in 2017; P. aeruginosa susceptible to CEF decreased from 88% in 2012 to 81% in 2014 mirroring the increased use of CEF, AZT, CAZ, and CIP; AG use was very low at < 5. With restrictions on the use of AZT, CAZ, and CIP, from 2014-15, CEF susceptibility increased significantly to 95.5% in 2015. Drug shortage of PTZ in 2015 and increased use of CEF from 2015-17 led to a drop in susceptibility to (82%); P. aeruginosa susceptible to CAR and AG averaged at 88% and 97% respectively (2011-17). However, reintroduction PTZ, resulted in improved susceptibility of P. aeuruginosa to CEF by 40% within a year. Conclusion Judicious antimicrobial use and antibiotic rotation play a significant role in reversing drug resistance in P. aeuruginosa. Disclosures All Authors: No reported disclosures

scholarly journals Drug Resistance and Biofilm Production among Pseudomonas aeruginosa Clinical Isolates in a Tertiary Care Hospital of Nepal

2019 ◽  
Vol 21 (2) ◽  
pp. 110-116
Author(s):  
Rajani Shrestha ◽  
N. Nayak ◽  
D.R. Bhatta ◽  
D. Hamal ◽  
S.H. Subramanya ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Resistance ◽  
Biofilm Formation ◽  
Tertiary Care ◽  
Clinical Problem ◽  
Multidrug Resistant ◽  
Clinical Isolates ◽  
Diffusion Method ◽  
Care Hospital ◽  
Microbiological Methods

Clinical isolates of Pseudomonas aeruginosa often exhibit multidrug resistance due to their inherent ability to form biofilms. Drug resistance in Ps. aeruginosa is a major clinical problem, especially in the management of patients with nosocomial infections and those admitted to ICUs with indwelling medical devices. To evaluate the biofilm forming abilities of the clinical isolates of Ps. aeruginosa and to correlate biofilm formation with antibiotic resistance. A total of 90 consecutive isolates of Ps. aeruginosa obtained from various specimens collected from patients visiting the Manipal Teaching Hospital, Pokhara, Nepal between January 2018 - October 2018 were studied. Isolates were identified by standard microbiological methods. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method. All the isolates were tested for their biofilm forming abilities by employing the tissue culture plate assay. Of the 90 Ps. aeruginosa isolates, maximum i.e 42 (46.6%) were from patients in the age group of > 50 years. Majority (30; 33.3%) of the isolates were obtained from sputum samples. However, percentage isolation from other specimens like urine, endotracheal tube (ETT), pus, eye specimens and blood were 18.9%, 16.7%, 16.7%, 7.8% and 6.7% respectively. All the isolates were sensitive to polymixin B and colistin, 91.1% of the organisms were sensitive to imipenem, and more than 80% to aminoglycosides (80% to gentamicin, 83.3% to amikacin). A total of 29 (32.2%) organisms were biofilm producers. Maximum numbers of biofilm producing strains were obtained from ETT (8 of 15; 53.3%), pus (8 of 15; 53.3%) and blood (2 of 6; 33.3%) i.e from all invasive sites. None of the isolates from noninvasive specimens such as conjunctival swabs were biofilm positive. Significantly higher numbers of biofilm producers (23 of 29; 79.3%) were found to be multidrug resistant as compared to non-biofilm (6 of 61; 9.8%) producers (p=0.000). Ps. aeruginosa colonization leading to biofilm formation in deep seated tissues and on indwelling devices is a therapeutic challenge as majority of the isolates would be recalcitrant to commonly used antipseudomonal drugs. Effective monitoring of drug resistance patterns in all Pseudomonas clinical isolates should be a prerequisite for successful patient management.

scholarly journals Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

2011 ◽  
Vol 55 (12) ◽  
pp. 5597-5601 ◽  
Author(s):  
Paul P. Cook ◽  
Michael Gooch ◽  
Shemra Rizzo
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Formulary ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Group 2

ABSTRACTWe examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomialPseudomonas aeruginosato group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility ofPseudomonas aeruginosato group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage ofPseudomonas aeruginosaisolates resistant to the group 2 carbapenems (P= 0.003). Group 2 carbapenem use and the number of carbapenem-resistantPseudomonas aeruginosaisolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P= 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems (ρ = 0.47,P= 0.002). We suspect that the improvement in susceptibility ofPseudomonas aeruginosato group 2 carbapenems was related to a decrease in ciprofloxacin use.

scholarly journals Beta-lactamase Profile and Biofilm Production of Pseudomonas aeruginosa Isolated from a Tertiary Care Hospital in Kolkata, India

2020 ◽  
Author(s):  
Soma Sarkar ◽  
Shanta Dutta ◽  
Anjum Namhata ◽  
Chayanika Banerjee ◽  
Mallika Sengupta ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Health Concern ◽  
Care Hospital ◽  
Sensitivity Testing ◽  
Automated Method ◽  
Biofilm Production ◽  
Carbapenemase Gene

Introduction: Nosocomial infections caused by Multidrug Resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) have become a major clinical and public health concern. Moreover, the biofilm production protects the bacteria from antibiotics and thereby makes the drugs ineffective. Aim: To find out the β-lactamases profile of antimicrobial resistance and biofilm production of P. aeruginosa isolated from different clinical specimens of patients attending a tertiary care hospital of Kolkata, West Bengal, India. Materials and Methods: A total of 394 consecutive, non-duplicate isolates of P. aeruginosa were identified from 3559 Gram negative bacilli over a period of two years from July 2016 to June 2018. Identification of the isolates and antibiotic sensitivity testing was performed by using automated method and interpreted. Extended Spectrum β-Lactamases (ESBLs), Amp-C β-lactamase (AmpC) and Metallo-β-Lactamases (MBLs) were phenotypically detected by disk synergy test and MBL-encoding genes were detected by multiplex Polymerase Chain Reaction (PCR). Biofilm production was done by tissue culture plate assay. Laboratory data and test results were statistically analysed in counts and percentages using MS Excel 2010 version. Results: Out of 394 strains of P. aeruginosa 288 (73.10%) were isolated from male patients whereas 106 (26.90%) were isolated from female patients. Maximum number of cases (67.26%) were from adult populations. The resistance pattern showed 72.33% resistance to ticarcillin-clavulanic acid followed by ciprofloxacin (53.80%), levofloxacin (50.25%), gentamicin (51.52%), ceftazidime (CAZ) (45.93%), cefoperazone-sulbactam (40.1%), aztreonam (34.77%), imipenem (33.5%), piperacillin/tazobactum (30.96%) and Meropenem (MRP) (29.18%). Out of 394 Pseudomonas spp. isolates, 204 (51.77%) were MDR. Overall, ESBLs, AmpC and carbapenemase (MBL) production was detected in 145 (36.80%), 51 (12.94%) and 49 (12.43%) isolates by phenotypic methods. By genotypic method 53.34% were carbapenemase producing and blaNDM-1 (68.75%) was the most prevalent carbapenemase gene detected followed by blaVIM (18.75%) and co-production of blaNDM-1+ blaVIM was 12.5%. Biofilm production was observed in 158 (40.10%) isolates. Conclusion: Early detection of these β-lactamases production is crucial not only for epidemiological study and effective infection control practices to limit the spread of infection but also for planning appropriate therapy according to the resistance mechanisms of the MDR strains.

scholarly journals Quality of life in epilepsy

2017 ◽  
Vol 5 (2) ◽  
pp. 452 ◽  
Author(s):  
Prem Singh ◽  
Achyut Kumar Pandey
Keyword(s):  
Quality Of Life ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Lower Education Level ◽  
One Year ◽  
Patients With Epilepsy ◽  
The Impact

Background: The quality of life (QOL) evaluation is a relatively new measure to evaluate the outcome of epilepsy. Many factors influence the quality of life of people with epilepsy, including seizure severity, stigma, fear, and the presence of cognitive or psychiatric problems. QOL is influenced by biological factors as well as cultural, social and religious beliefs and values. This study was planned to find out the impact of epilepsy on quality of life of epileptic patients.Methods: The study was conducted in the epilepsy clinic of department of neurology at a tertiary care hospital over a period of one year.101 patients were included after fulfilling the inclusion criteria. All the patients seeking treatment in the OPD were screened, assessed and then all procedures were fully explained to them. History regarding name, age sex, socio-demographic profile and detailed history regarding seizure disorder was taken from both the patient and the reliable informant. Bengali version of QOLIE-9 was used to assess the quality of life.Results: One hundred and one patients with epilepsy consisting of 70 men (69.3%) and 31 women (30.7%) were included. Their ages ranged from 15 to 52, the mean age being 26.17 (SD = 7.84). Out of the 101 patients, 65 patients (64.4%) were suffering from partial epilepsies and 36 patients (35.6%) were suffering from generalized epilepsies. Mean QOLIE-9 total scores were 16.66, 19.74, 20.13 and 24.00 in married, widows, unmarried and separated individuals respectively. The differences in the means were statistically significant on ANOVA (p value 0.002). Mean QOLIE-9 total scores were 27.75, 19.64, 19.65, 18.14 and 18.00 in primary, secondary, higher secondary, graduate and postgraduate individuals respectively. The differences were highly significant statistically on ANOVA (p value<0.001). Frequency of seizures per month was positively correlated with QOLIE-9 total scores (Pearson Correlation 0.622) and was highly statistically significant (p value<0.001).Conclusions: Frequent seizures, lower education level and single status are associated with lower quality of life in persons with epilepsy.

Pseudomonas Aeruginosa: Evaluation Of Pathogen Burden And Drug-resistance Trends In A Tertiary Care Hospital

2018 ◽  
Vol 27 (4) ◽  
pp. 279-283
Author(s):  
Muhammad Saeed ◽  
Farhan Rasheed ◽  
Raja Kamran Afzal ◽  
Shahida Hussain ◽  
Saba Riaz ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Pathogen Burden

scholarly journals Antibiotic profiling of Pseudomonas aeruginosa isolates from pus sample of rural tertiary care hospital of Western Maharashtra, Loni, India

2017 ◽  
Vol 5 (7) ◽  
pp. 3076 ◽  
Author(s):  
Namita A., Raytekar, ◽  
Meghna R. Choudhari ◽  
Sonali Das
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Resistance ◽  
Antibiotic Resistance ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Opportunistic Pathogen ◽  
Multi Drug Resistance ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Medical College

Background: Pseudomonas aeruginosa (P. aeruginosa) considered as an opportunistic pathogen which can be isolated from various kinds of infection. The risk of emergence of antibiotic resistance is based on different antibiotic treatments. Antibiotic resistance and flexibility to adapt changing environment renders the pathogens a matter of concern in hospital acquired infections. Changing pattern of antimicrobial resistance pose challenge in treating pyogenic infections, hence periodical monitoring of bacterial profile and their antibiotic susceptibility pattern is important. This study deals with the infectious and drug resistance nature of P. aeruginosa with effectiveness of antimicrobial agents against it.Methods: Present study was conducted in Centre for Biotechnology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India. A total of 763 pus samples were received in the bacteriology section of department of microbiology, rural medical college, Loni from the various wards of Pravara Rural Hospital. The colonial morphology and identification was done as per standard microbiology procedures. Antibiogram testing was done as per Kirby Bauer disc diffusion method.Results: Out of 763 pus samples 154 were Pseudomonas aeruginosa thus showing 20.19% prevalence. In this study, it was observed that isolates were sensitive to Ciprofloxacin (76.63%) followed by Amikacin. However, showed 90.90 % resistant to Cefazolin followed by Co-trimoxazole 75.97% was observed. Multi drug resistance (MDR) strain 68.83% (N=106) was detected from 154 isolates strains of Pseudomonas aeruginosa. Prevalent resistance pattern was found to be GENr, AKr, CAZr, CZr, COTr for 10 (9.43%) isolates followed by GENr, CAZr, CZr, MRPr, COTr, CIPr for 9 (8.49%) isolates.Conclusions: Present study focused on antibiotic resistance pattern of P. aeruginosa from pus sample. This study contributes in understanding the emergence of MDR strains which can be considered for judicial usage of antibiotics in hospital settings. 

scholarly journals Pseudomonas aeruginosa bacteraemia: independent risk factors for mortality and impact of resistance on outcome

2014 ◽  
Vol 63 (12) ◽  
pp. 1679-1687 ◽  
Author(s):  
Raquel Cavalcanti Dantas ◽  
Melina Lorraine Ferreira ◽  
Paulo Pinto Gontijo-Filho ◽  
Rosineide Marques Ribas
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Underlying Disease ◽  
First Episode ◽  
Clinical Consequence ◽  
Care Hospital ◽  
Inappropriate Therapy ◽  
Independent Risk Factors ◽  
The Impact

The rates of multidrug-resistant, extensively drug-resistant and pandrug-resistant isolates amongst non-fermenting Gram-negative bacilli, particularly Pseudomonas aeruginosa, have risen worldwide. The clinical consequence of resistance and the impact of adverse treatment on the outcome of patients with P. aeruginosa bacteraemia remain unclear. To better understand the predictors of mortality, the clinical consequence of resistance and the impact of inappropriate therapy on patient outcomes, we analysed the first episode of P. aeruginosa bacteraemia in patients from a Brazilian tertiary-care hospital during the period from May 2009 to August 2011. Antimicrobial susceptibility testing was conducted; phenotypic detection of metallo-β-lactamase (MBL) and PCR of MBL genes were performed on carbapenem-resistant strains. Amongst the 120 P. aeruginosa isolates, 45.8 % were resistant to carbapenem and 36 strains were tested for MBL detection. A total of 30 % were phenotypically positive and, of these, 77.8 % expressed an MBL gene, bla SPM-1 (57 %) and bla VIM-type (43 %). The resistance rates to ceftazidime, cefepime, piperacillin/tazobactam, carbapenem, fluoroquinolone and aminoglycoside were 55, 42.5, 35, 45.8, 44 and 44 %, respectively. Previous antibiotic use, length of a hospital stay ≥30 days prior to P. aeruginosa, haemodialysis, tracheostomy, pulmonary source of bacteraemia and Intensive Care Unit admission were common independent risk factors for antimicrobial resistance. Cefepime resistance, multidrug resistance and extensive drug resistance were independently associated with inappropriate therapy, which was an important predictor of mortality, being synergistic with the severity of the underlying disease.

IMPACT OF SOCIO-DEMOGRAPHIC VARIABLES AND MORBID CONDITIONS ON PERCEIVED MENTAL HEALTH COMPONENTS USING SF-36 QUESTIONNAIRE

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
S. K. Sharma ◽  
V. P. Shrotriya ◽  
D. Imtiaz ◽  
S. B. Gupta
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Social Functioning ◽  
Tertiary Care ◽  
Perceived Health ◽  
Subjective Assessment ◽  
Care Hospital ◽  
Sf 36 ◽  
The Social ◽  
The Impact

<bold>Introduction:</bold> Perceived Health is a subjective assessment of the physical as well as mental health and includes so many aspects as mentioned in SF-36 form that are difficult to capture clinically such as incipient disease, physiological, psychological reserves and social functions. To assess the impact of Diabetes Mellitus, Hypertension and other socio-demographic factors on the Social Functioning component of mental health of the patients attending a tertiary care hospital in Bareilly. <bold>Material and Methods:</bold> Perceived health status of the patients was assessed by the Social Functioning dimension of the Mental Component Summary (MCS) using the SF-36 form. <bold>Results:</bold> The presence of both Diabetes Mellitus and Hypertension was associated with lower Social Functioning scores compared to those with diabetes (p = 0.013) and hypertension alone. Age was negatively related with Social Functioning scores (p<0.001) but male gender (p>0.000) and higher income (p<0.424) were all associated with higher Social Functioning scores. Rural subjects were found to have better SF score compared to urban. <bold>Conclusion:</bold> Age, gender and morbidity was found to have profound influence on Social Functioning scoring of the subjects. However, the results should be interpreted in terms of the study’s limitations.

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