scholarly journals 684. Diagnostic Yield of Echocardiography in Coagulase Negative Staphylococcus Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S444-S445
Author(s):  
Sandhya Nagarakanti ◽  
Eliahu Bishburg ◽  
Alexis Okoh ◽  
Sagy Grinberg ◽  
Madhu Suryadevara
Keyword(s):  
Tertiary Care Hospital ◽  
Diagnostic Yield ◽  
Medical Center ◽  
Tertiary Care ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Assist Device ◽  
Cardiac Device ◽  
Ventricular Assist ◽  
Common Clinical Finding

Abstract Background Coagulase negative Staphylococcus (CoNS) bacteremia is a common clinical finding, but is less commonly associated with infective endocarditis (IE). Echocardiography (Echo) is utilized when clinicians suspect the diagnosis of IE. We sought to evaluate the utilization and yield of Echo in patients who had 1 or ≥ 2 (+) blood cultures (BC) for CoNS, and correlate Echo results with a diagnosis of IE. Methods A retrospective review in a tertiary care hospital between 2013-2020. Patients with or without cardiac device, who had either 1 or ≥ 2 BC positive for CoNS and who underwent Echo were included. Modified Duke’s (MDC) criteria was used for the diagnosis of IE. Logistic regression was used to examine the association between BC positivity, device existence and the presence of a vegetation on Echo. Results We included 116 patients, median age 58 (41-70) years, 64 (55%) women. Cardiac device was present in 69 (59%): Automated implantable cardioverter defibrillator in 49 (71%), pacemaker in 11(16%), ventricular assist device in four (6%), intra-aortic balloon pump in five (7%). CoNS isolated from 1 BC in 53(46%) patients and from ≥ 2 in 63(54%) patients. Trans- thoracic Echo (TTE) was performed in 42(36%), trans- esophageal Echo (TEE) in 39 patients (33.6%). Sequential Echo (TEE after TTE) was performed in 34 patients (29%). “Definite” IE was diagnosed in none, “possible” IE in 30 (26%), the diagnosis was “rejected” in 86 (74%). Vegetations were noted on device lead in 13(43%) and on valves in 17(57%). Overall yield in patients classified as “possible” IE (n=30) was similar in patients with device (n=26) to those without a device (n=4) (22% vs. 3%; p=0.149). For patients with 1 BC positive for CONS, the presence of a device was not associated with a positive Echo yield (OR, 95% C.I: 1.8 (0.3, 12.9); p=0.474). Patients who had ≥ 2 BC for CoNS had the same Echo yield with or without a cardiac device (15% vs. 24% p=0.243). Conclusion In our medical center, patients with CoNS bacteremia, no patients had a “definite” diagnosis of IE. Yield of Echo was similar in patients with either one or ≥ 2 positive BC and there was no significant association with the presence of a device. Disclosures All Authors: No reported disclosures

Diagnostic yield of Archer FusionPlex PanHeme and solid panels: two-year experience from a pediatric tertiary care hospital

2021 ◽  
Vol 132 ◽  
pp. S39-S40
Author(s):  
Kathleen Schieffer ◽  
Eileen Stonerock ◽  
Vijayakumar Jayaraman ◽  
Heather Jenkins ◽  
Tim Peterson ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
Care Hospital

scholarly journals The Prevalence and Antimicrobial Susceptibility Pattern of Gram-Positive Pathogens: Three-Year Study at a Private Tertiary Care Hospital in Mumbai, India

2021 ◽  
Author(s):  
Sweta Shah ◽  
Ritika Rampal ◽  
Pooja Thakkar ◽  
Sushima Poojary ◽  
Shweta Ladi
Keyword(s):  
Antimicrobial Susceptibility ◽  
Tertiary Care Hospital ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Resistance Pattern ◽  
Steady Increase ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Gram Positive ◽  
Tract Infections

Abstract Introduction The growing resistance pattern of the gram-positive pathogens along with a steady increase in minimum inhibitory concentration of the currently available antibiotics have led to an increase in morbidity and mortality rates in India. This study aims to access the shifting antibiotic susceptibility paradigm of the gram-positive pathogens in various infections at a tertiary care center. Methods This is a 3-year retrospective observational study which was performed from January 2016 to December 2018 at a tertiary care hospital in Mumbai. All clinically significant gram-positive cocci isolated from a variety of clinical specimens were studied for their prevalence and antimicrobial susceptibility. Results Out of 4,428 gram-positive isolates, Staphylococcus aureus (35.3%) was the commonly encountered pathogen, followed by Enterococcus spp. (32.1%) and coagulase-negative Staphylococcus (CoNS) (25.7%). S. aureus was majorly isolated from skin and soft tissue infections (60.3%), followed by patients with respiratory tract infections (18.2%) and blood stream infections (13%). Among S. aureus, particularly methicillin-resistant S.aureus (MRSA), prevalence increased from 29.5% in 2016 to 35.1% in 2018, with an overall prevalence of 33.6%. All S. aureus isolates were 100% sensitive toward vancomycin, linezolid, tigecycline, and teicoplanin. However, the CoNS isolates showed a higher resistance rate with reduced susceptibility toward linezolid and teicoplanin. High prevalence of resistance was observed across gram-positive isolates with commonly used antibiotics such as ciprofloxacin, levofloxacin, and erythromycin. While the prevalence of linezolid-resistant enterococcus (LRE) was 3.6%, vancomycin (VRE) and teicoplanin resistance among the enterococcus species was as high as 7.7% and 7.5%, respectively. Conclusion Rising methicillin resistance among the Staphylococcal species (MRSA and MR-CoNS) along with reduced susceptibility toward currently available anti-MRSA agents is a matter of serious concern as it limits the therapeutic options for treating multidrug resistant (MDR) gram-positive infections.

scholarly journals ASSIST DEVICES IN CARDIAC SURGERY

2018 ◽  
Vol 25 (12) ◽  
pp. 1796-1804
Author(s):  
Saad B. Zakai ◽  
Iqbal Hussain Pathan ◽  
Sohail K Bangash ◽  
Tariq A. Siddiqi ◽  
Fazle Rabbi
Keyword(s):  
Cardiac Surgery ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Balloon Catheter ◽  
Care Hospital ◽  
Assist Device ◽  
Balloon Catheters ◽  
The Poor ◽  
The Mean ◽  
Hospital Study

Objectives: IABP is the most frequently used assist device in cardiac surgery. However, due to the poor socioeconomic status in our country, it is not always possible to use a brand new IABP when required. In these circumstances we use re-sterilized IABP catheters. Our aim was to compare the outcome of re-sterilized versus new IABP catheters in the set of patients who were provided surgery for IHD free of cost in a tertiary care hospital. Study Design: Retrospective study. Period: January 2007 to December 2013. Setting: National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Methods: 3560 CABG procedures were performed. Those patients who could not afford a new IABP catheter were provided with the resterilized balloon catheters, free of cost. Total IABP usage was 286(8%) patients, of which the new balloon catheter was used in 214patients [74.8% (groupI)]. Re-sterilized catheters were used in 72patients [25.2% (groupII)]. All patients were screened for HIV, Hepatitis- B and Hepatitis-C.12(16.6%) of the balloon catheters were resterilized more than once and 3(4.1%) of these on three occasions. Results: The mean age of the patients was 52.59±13.32 years. 69 (24.1%) of the patients were female. The mode of insertion (sheath less versus with sheath) was found tobe an independent risk factor for the development of complications. The overall incidence of complications (p=0.29) was 6.9%. The incidence of balloon catheter related complications was 1.75%. When the two groups were compared with regard to morbidity and mortality, the resultswere found to be statistically insignificant. Conclusion: Use of re-sterilized IABP catheters is safe. However, strict guidelines should be instituted and followed for this purpose. 

Platelet Utilization In a Tertiary Care Hospital: An Opportunity for Reduced Transfusion?

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2575-2575
Author(s):  
Vipra Sharma ◽  
Maya Shah ◽  
Ravi Pullela ◽  
Alice J. Cohen
Keyword(s):  
Disease Transmission ◽  
Tertiary Care Hospital ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Tertiary Care ◽  
Invasive Procedure ◽  
Care Hospital ◽  
Tertiary Care Medical Center ◽  
The Mean ◽  
Transfusion Guidelines

Abstract Abstract 2575 Background: Use of platelet (plt) transfusions to treat and prevent bleeding varies widely between hospitals and by medical and surgical services. Standard indications include active bleeding with thrombocytopenia or plt dysfunction, pre or peri-invasive procedure, and prophylaxis for low plt counts. Rising demand for plt transfusions and donor shortage, coupled with the risks of transfusion (including infectious disease transmission and alloimmunization) are concerns which often lead to strict regulation of plt transfusion in hospitals. In order to evaluate appropriate use of plt transfusion based on Newark Beth Israel Medical Center transfusion guidelines, a review of plt use was undertaken at this tertiary care hospital. Design: A retrospective review was performed of plt utilization over a 3 month period from October to December 2009. All charts of hospitalized and outpatient patients receiving plt transfusions were reviewed to determine reasons for plt transfusion. Pre-transfusion plt values, site/service ordering plt transfusions, number of units transfused and cost were determined. Results: 421 plt units were transfused to 125 patients (51.6% female), mean age 44 years (yrs.) (range 0–89). All plt transfusions were single donor units. The mean plt count prior to transfusion for all procedures was 127,000, well above hospital guidelines. The majority of plt utilized were by cardiothoracic (CT) surgery (168/421, 40%) with the highest cost (Table 1). 124/421(29%) of transfusions occurred pre- or peri- invasive procedure, with 88/124 (71%) of those transfusions occurring prior or peri- cardio-thoracic procedure. 83/421 (20%) of transfusions had no clear indication based on hospital guidelines, predominately ordered by CT surgery and occurring post-op for asymptomatic thrombocytopenia (cost $45, 650). The mean plt count at which transfusion was found to have no indication was 55,000 (range 25,000–105,000). 136/421(32%) of the cases were prophylactic transfusions with a plt count < 20,000, with 121/136 (89%) in the oncology patients, and the rest in the medical pts due to sepsis. 114/421(27%) of the transfusions were for bleeding. Only 5 patients, 3 in the CT group, and 2 in neonate group had plt dysfunction as the indication for transfusion prior to procedure. The lowest incidence of plt transfusions without an indication was in the adult oncology department. Conclusion: Platelet utilization varied by departments. CT surgery followed by neonatal and pediatric oncology are the principal users of plt in our tertiary care medical center. CT surgery, general surgery, and neonatal services had the highest pre-transfusion plt counts. As 20% of all transfusions had no clinical reason for plt use (no bleeding, invasive procedure, or severely low plt count) the opportunities may exist for lower platelet usage by educating physicians about compliance to transfusion guidelines in order to decrease the risks associated with transfusion and resultant complications. Disclosure: No relevant conflicts of interest to declare.

Molecular Characterization of Methicillin-ResistantStaphylococcus aureusSpread by Neonates Transferred From Primary Obstetrics Clinics to a Tertiary Care Hospital in Korea

2006 ◽  
Vol 27 (6) ◽  
pp. 593-597 ◽  
Author(s):  
Kwan Soo Ko ◽  
Sulhee Park ◽  
Kyong Ran Peck ◽  
Eun Jung Shin ◽  
Won Sup Oh ◽  
...  
Keyword(s):  
Primary Care ◽  
Multilocus Sequence Typing ◽  
Clonal Complex ◽  
Tertiary Care Hospital ◽  
Medical Center ◽  
Tertiary Care ◽  
Sequence Type ◽  
Care Hospital ◽  
Mrsa Strains ◽  
Genotypic Characteristics

Objective.To investigate the characteristics and origins of methicillin-resistantStaphylococcus aureus(MRSA) strains isolated from neonatal patients admitted to a tertiary care hospital from local and primary care obstetrics clinics.Design.Molecular typing study.Setting.A 1,278-bed tertiary care hospital (Samsung Medical Center) and 2 primary obstetrics clinics in Seoul, Korea.Patients.The genotypic characteristics of 12 MRSA samples isolated from 11 neonatal patients transferred from 2 primary care obstetrics clinics to a tertiary care hospital were investigated by means of multilocus sequence typing,spa(staphylococcal protein A) typing, andSCCmectyping. Ten MRSA strains isolated from workers and environments in the associated obstetrics clinics were also investigated.Results.Although the antibiograms of isolates from 2 obstetrics clinics differed, no strain showed multidrug resistance to antimicrobials. Multilocus sequence typing analysis showed that all 22 MRSA isolates analyzed in this study had sequence type 1 (with the allelic profile 1-1-1-1-1-1-1), sequence type 493 (62-1-1-1-1-1-1), or a novel sequence type (25-1-1-1-1-1-1) and that all belonged to a single clonal complex (clonal complex 1). Moreover, they all containedSCCmectype IVA and the identicalspatype (UJEBKBP). These genotypic characteristics are similar to those of typical community-associated MRSA strains rather than the hospital-acquired MRSA strains common in Korea.Conclusion.The findings of this study suggest that community-acquired MRSA strains can spread in primary care clinics and be imported into tertiary care settings.

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