scholarly journals 269. A Review of Gram Negative Endogenous Endophthalmitis at University Hospital in Newark

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S241-S241
Author(s):  
Hernando Salazar ◽  
Catherine Ye ◽  
Brian Schott ◽  
Kristin R Riddle ◽  
Diana Finkel
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Hepatobiliary Disease ◽  
University Hospital ◽  
Endogenous Endophthalmitis ◽  
Gram Negative ◽  
Ocular Symptoms ◽  
Sources Of Infection ◽  
Tract Infections ◽  
Anatomical Success

Abstract Background Endophthalmitis (EO) is an ocular emergency characterized by intraocular inflammation, usually in response to infection. While most cases are exogenous, gram negative (GN) EO account for 10-24% of all cases, and endogenous EO (EEO) account for 2-8% of all cases. Risk factors for EEO include diabetes mellitus (DM), IV drug use, and indwelling catheters. Major sources of infection are urinary tract infections (UTI), liver abscesses, pneumonia, and bacteremia. Common pathogens include K. pneumoniae, P. aeruginosa, and H. influenzae. Outcomes are poor, with only 20% of patients achieving improved visual acuity, and 30-40% requiring enucleation. Methods Retrospective analysis was performed on patients diagnosed with EO (n=89) at University Hospital in Newark from January 2016 to December 2020 using ICD-10 codes H44.0-H44.009, H44.1, and H44.19. Patients included were 18 years of age or older with culture proven GN endogenous EO (GNEEO) (n=7). Outcomes included anatomical success, functional success, and mortality at 28 days and 3 months. Results 7 of 89 patients met criteria for GNEEO (median age 67, 4 males, 71.4% Hispanic/Latino). Comorbidities included hepatobiliary disease (57.1%) and DM (42.9%). All 7 patients presented with ocular symptoms and 3 had non-ocular symptoms. Primary sources of infection included UTI, prostate abscess, and pneumonia/empyema. Eye cultures identified Pseudomonas in 4 patients and Klebsiella in 3 patients. Mean antibiotic length was 17.7 days with 6 patients receiving intravitreal antibiotics. Enucleation was performed in 3 patients. 2 patients had functional success and 4 had anatomical success, with 0 mortality at 28 days and 3 months. Table 1. Ocular symptoms on presentation of cases of gram negative endogenous endophthalmitis Table 2. Positives cultures obtained from cases of gram negative endogenous endophthalmitis Conclusion Although rare, GNEEO causes significant morbidity, with only 2 recovering visual acuity and 3 requiring enucleation. Risk factors, sources of infection, and microbes were all consistent with those in previous reports. Hepatobiliary disease and DM were the most prominent risk factors while sources of infection included UTI and empyema. Eye cultures were positive for K. pneumoniae and P. aeruginosa, two common pathogens previously identified. This case series highlights the importance of prompt recognition and initial treatment of GNEEO with empiric coverage that includes vancomycin and ceftazidime. Disclosures All Authors: No reported disclosures

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Analysis of Clinical Characteristics of 19 Patients with Endophthalmitis Caused by Liver Abscess

2021 ◽  
Author(s):  
guangsen liu ◽  
Yue Li ◽  
Wei Wang ◽  
Lei Gao
Keyword(s):  
Visual Acuity ◽  
Liver Abscess ◽  
Diagnosis And Treatment ◽  
Endogenous Endophthalmitis ◽  
Klebsiella Pneumonia ◽  
Microbial Culture ◽  
Poor Vision ◽  
Ocular Symptoms ◽  
History Of ◽  
First Time

Abstract Objective: To analyze the clinical features, treatment, and prognosis of endophthalmitis caused by a liver abscess.Methods: All cases of endogenous endophthalmitis caused by a liver abscess in our hospital in the past 7 years were analyzed retrospectively. The data collected included age, sex, history of diabetes, initial and final vision, pathogen, course of the disease, treatment, and prognosis.Results: 21 eyes of 19 patients were complicated with liver abscess. The average age was 55.9 ±9.8 years old, including 10 males (52.6%) and 9 females (44.4%), 13 patients complicated with diabetes (71.4%), 14 patients (66.7%) first went to the ophthalmology department for diagnosis and treatment and 5 with hepatobiliary surgery (33.3%). 14 patients had a fever before onset, with an average fever time of 5.8 days. Before treatment, the duration of ocular symptoms was 7.71 ±6.68 days, 5.71 ±1.25 days for patients who go to ophthalmology for diagnosis and treatment for the first time, and 12.2 ±3.58 days for patients who go to other departments. After treatment, the average visual acuity of 21 eyes was 0.013, and the average best-corrected visual acuity was 0.79. In the 21 eyes, vitreous fluid culture was positive in 7 eyes (33.3%), all of which were Klebsiella pneumonia. Among the 14 patients with fever during hospitalization, 5 cases were positive for blood microbial culture, all of which were Klebsiella pneumonia. After vitrectomy, the average visual acuity was improved by 4.90 ±2.47 letters and that of patients without vitrectomy was-0.25±0.16letters. The visual acuity of patients who underwent postoperative visual was significantly better than that of patients without postoperative visual (P＜0.096). The visual acuity of patients without vitrectomy was significantly higher than that of patients without vitrectomy (P ＜0.01). 3 eyes (33.3%) of 9 eyes in the IVI group were removed because of uncontrolled inflammation, and 1 eye of 12 eyes in the PPV group was removed because of inflammation recurrence.Conclusion: The prognosis of endogenous endophthalmitis caused by liver abscess is generally poor, but early treatment can save part of the vision. The first visit non-ophthalmology department will delay the early diagnosis of the disease. Diabetes is an important risk factor for endogenous endophthalmitis and poor vision in patients with liver abscess. Klebsiella pneumonia is the main pathogen of intraocular infection. Vitrectomy combined with vitreous injection of antibiotics can improve the prognosis. A systematic and thorough treatment of a liver abscess is of great significance to prevent the recurrence of endophthalmitis in a liver abscess.

scholarly journals Complete Genome Sequence of Escherichia coli GW-AmxH19, Isolated from Hospital Wastewater in Greifswald, Germany

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Dominik Schneider ◽  
Daniela Zühlke ◽  
Tabea Petscheleit ◽  
Anja Poehlein ◽  
Katharina Riedel ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
University Hospital ◽  
Hospital Wastewater ◽  
Circular Chromosome ◽  
Protein Coding ◽  
Gram Negative ◽  
Content Type ◽  
Protein Coding Genes ◽  
Potential Association ◽  
Tract Infections

ABSTRACT The Gram-negative and rod-shaped Escherichia coli strain GW-AmxH19 was isolated from university hospital wastewater in Greifswald, Germany. The genome consists of two replicons, including one circular chromosome (5.04 Mb) and a circular plasmid (126.96 kb). The genome harbors 4,694 protein-coding genes, comprising multidrug resistance and a potential association with urogenital tract infections.

scholarly journals Bacteria of Nosocomial Urinary Tract Infections at a University Hospital in Egypt: Identification and Associated Risk Factors

2004 ◽  
Vol 25 (11) ◽  
pp. 895-897 ◽  
Author(s):  
Fatma A. Amer ◽  
Heba A. Mohtady ◽  
Iman M. El-Behedy ◽  
Salem Khalil ◽  
Yasser A. El-Hendy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
University Hospital ◽  
Associated Risk Factors ◽  
Tract Infections

scholarly journals Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens: a study of prevalence, risk factors and molecular mechanisms of resistance (ARGUS) in Zimbabwe – a study protocol

2020 ◽  
Vol 5 ◽  
pp. 140
Author(s):  
Ioana D. Olaru ◽  
Shunmay Yeung ◽  
Rashida A. Ferrand ◽  
Richard Stabler ◽  
Prosper Chonzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Molecular Mechanisms ◽  
Outpatient Setting ◽  
Sub Saharan Africa ◽  
Gram Negative ◽  
Sub Saharan ◽  
Few Data ◽  
Tract Infections

Antimicrobial resistance (AMR) is compromising our ability to successfully treat infections. There are few data on gram-negative AMR prevalence in sub-Saharan Africa especially from the outpatient setting. This study aims to investigate the prevalence of and underlying molecular mechanisms for AMR in gram-negative bacilli causing urinary tract infections (UTIs) in Zimbabwe. Risk factors for AMR and how AMR impacts on clinical outcomes will also be investigated. Adults presenting with UTI symptoms at primary health clinics in Harare will be included. A questionnaire will be administered, and urine samples will be collected for culture. Participants with positive urine cultures will be followed up at 7-14 days post-enrolment. All participants will also be followed by telephone at 28 days to determine clinical outcomes. Bacterial identification and antibiotic susceptibility testing will be performed on positive cultures. The results from this study will be used to inform policy and development of treatment recommendations. Whole genome sequencing results will provide a better understanding of the prevalent resistance genes in Zimbabwe, of the spread of successful clones, and potentially will contribute to developing strategies to tackle AMR.

scholarly journals Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic

2021 ◽  
Vol 58 ◽  
pp. 004695802110679
Author(s):  
Hela Ghali ◽  
Asma Ben Cheikh ◽  
Sana Bhiri ◽  
Selwa Khefacha ◽  
Houyem Said Latiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Protective Factor ◽  
Bloodstream Infections ◽  
Point Prevalence ◽  
University Hospital ◽  
Healthcare Associated Infection ◽  
Tract Infections ◽  
Healthcare Associated ◽  
The Impact

Background Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. Aim To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. Methods The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. Results Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% ( P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). Conclusion Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

scholarly journals An evaluation of six-year Stenotrophomonas maltophilia infections in a university hospital

2020 ◽  
Vol 20 (3) ◽  
pp. 1118-1123
Author(s):  
Nevin Ince ◽  
Dilek Yekenkurul ◽  
Ayşe Danış ◽  
Emel Çalışkan ◽  
İdris Akkaş
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Stenotrophomonas Maltophilia ◽  
Bloodstream Infections ◽  
University Hospital ◽  
Invasive Procedures ◽  
Tract Infections ◽  
Rational Use Of Antibiotics ◽  
Resistance Rates ◽  
Hospital Acquired

Background: Stenotrophomonas maltophilia is a Gram-negative bacillus and opportunistic emergent pathogen causing hospi- tal-acquired infections (HAIs). Due to risk factors such as prolonged intensive care unit stay and invasive procedures, it has become one of the leading causes of HAIs. Objective: The aim of this study was to evaluate the epidemiology of S.maltophilia infections over a six-year period at Düzce University Hospital, Turkey. Methods: The incidence, clinical characteristics, antimicrobial susceptibility and outcomes of nosocomial S. maltophilia in- fections during this period were retrospectively analyzed. Results: During the study period, 67 samples obtained from 61 patients were identified. Pneumonias (82%) were the most common HAIs, followed by bloodstream infections (10.5%), urinary tract infections (3%), skin and soft tissue infections (3%) and surgical site infection (1.5%). Admission to intensive care, hospitalization exceeding 30 days, and previous use of broad-spectrum antibiotics constituted risk factors. Resistance to cotrimoxazole (6%) was lower than that to levofloxacin (18%). Conclusion: The most important risk factors for S.maltophilia infection in patients are previous exposure to antibiotics, pro- longed hospitalization and invasive procedures such as mechanic ventilation. Discharging patients as early as possible with the rational use of antibiotics may be effective in reducing S. maltophilia infections and resistance rates. Keywords: Stenotrophomonas maltophilia; hospital-acquired infections; epidemiology; risk factors.

scholarly journals Optimizing Empiric Antibiotic Therapy in Patients with Severe β-Lactam Allergy

2013 ◽  
Vol 57 (12) ◽  
pp. 5918-5923 ◽  
Author(s):  
Lindsey P. Koliscak ◽  
James W. Johnson ◽  
James R. Beardsley ◽  
David P. Miller ◽  
John C. Williamson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Single Agent ◽  
Empirical Therapy ◽  
Patient Characteristics ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative ◽  
Resistance Risk ◽  
Susceptibility Data ◽  
Empirical Antibiotics ◽  
Tract Infections

ABSTRACTAntibiotic selection is challenging in patients with severe β-lactam allergy due to declining reliability of alternate antibiotics. Organisms isolated from these patients may exhibit unique resistance phenotypes. The objective of this study was to determine which alternate antibiotics or combinations provide adequate empirical therapy for patients with β-lactam allergy who develop Gram-negative infections at our institution. We further sought to determine the effects of risk factors for drug resistance on empirical adequacy. A retrospective analysis was conducted for adult patients hospitalized from September 2009 to May 2010 who had a severe β-lactam allergy and a urine, blood, or respiratory culture positive for a Gram-negative organism and who met predefined criteria for infection. Patient characteristics, culture and susceptibility data, and predefined risk factors for antibiotic resistance were collected. Adequacies of β-lactam and alternate antibiotics were compared for all infections and selected subsets. The primary outcome was adequacy of each alternate antibiotic or combination for all infections. One hundred sixteen infections (40 pneumonias, 67 urinary tract infections, and 9 bacteremias) were identified. Single alternate agents were adequate less frequently than β-lactams and combination regimens. Only in cases without risk factors for resistance did single-agent regimens demonstrate acceptable adequacy rates; each factor conferred a doubling of risk for resistance. Resistance risk factors should be considered in selecting empirical antibiotics for Gram-negative pathogens in patients unable to take β-lactams due to severe allergy.

scholarly journals Relative Frequency of Nosocomial Microorganisms at Unicamp University Hospital from 1987 to 1994

1997 ◽  
Vol 39 (6) ◽  
pp. 333-336 ◽  
Author(s):  
Antonia Teresinha TRESOLDI ◽  
Maria Luíza Moretti BRANCHINI ◽  
Djalma de Carvalho MOREIRA FILHO ◽  
Maria Clara PADOVEZE ◽  
Sonia P. Evangelista DANTAS ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Relative Frequency ◽  
Gradual Increase ◽  
Bloodstream Infections ◽  
University Hospital ◽  
Surgical Wound ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Candida Sp ◽  
Tract Infections

The frequency of microorganisms identified in nosocomial infections at Unicamp University Hospital from 1987 to 1994 was analysed. The most common microorganism was S. aureus (20.9%), which was found in surgical wound, bloodstream and arterial-venous infections. In urinary tract infections (UTI), gram-negative rods (56.5%) and yeasts (9%) predominated. A. baumannii isolates were observed to have increased in the last three years. There was a gradual increase in the frequency of coagulase-negative staphylococci and A. baumannii in bloodstream infections but there wasn’t any change in Candida sp

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