scholarly journals 2288. Role of Β Lactam-Β Lactamase Inhibitors in Indian Tertiary Care Hospitals: Results from a Nationwide Survey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S784-S784
Author(s):  
Shweta Kamat ◽  
Pankaj Gupta ◽  
Akshata Mane
Keyword(s):  
Clinical Experience ◽  
Online Survey ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Nationwide Survey ◽  
Third Generation ◽  
Tract Infections ◽  
Abdominal Infections ◽  
Tertiary Care Hospitals ◽  
Third Generation Cephalosporins

Abstract Background Broad-spectrum antibiotics, particularly third-generation cephalosporins, are routinely used in the treatment of nosocomial infections. The emergence of Extended Spectrum Β-Lactamase (ESBL)-producing pathogens in Indian tertiary care hospitals warrants the need to reassess β-lactam–β-lactamase inhibitors (BL-BLIs) as better alternative treatments. Methods An online survey was conducted by Pfizer India to understand the usage of BL-BLIs across Indian hospitals. The survey was administered to 334 clinicians across multiple specialties out of which 195 were from tertiary care hospitals. Results were analyzed using MS-Excel statistical tools. Results One-hundred ninety-five (195) clinicians from tertiary care hospitals completed the survey. About 78% of HCPs revealed the resistance to third-generation cephalosporins (e.g., ceftriaxone, ceftazidime) to be between 10–60% in their clinical settings. BL-BLIs were mostly preferred for treatment based on hospital antibiograms (64%) and used as first-line options for hospitalized adults with mild-moderate severe infections caused by ESBL-producing organisms (71%) and in mild-moderate infections caused by susceptible Gram-negative bacteria such as Enterobacteriaceae (54%). The average duration of IV BL-BLI treatment was 5–7 days (66%). The HCPs considerations while choosing BL-BLIs were mainly based on anti-microbial spectrum (81%), and rationality of BL/BLI combination (63%) and clinical experience with the BL-BLI molecule (63%). Cefoperazone-Sulbactam (CS) and Piperacillin–tazobactam (PT) were most commonly prescribed BL-BLIs and HCPs preferred the latter for pneumonia (67%), skin and soft-tissue infections (57%), bloodstream infections (67%) and cancer-associated febrile neutropenia (64%); while they preferred former for urinary tract infections (64%). CS and PT were preferred for intra-abdominal infections (57% and 64% respectively) and post-surgical infections (56% and 53% respectively). Conclusion CS and PT were the most commonly prescribed BL-BLIs probably due to their wide antimicrobial spectrum, rationality of the BL/BLI combination and the clinical experience with the molecules. BL-BLIs are still a mainstay of treatment for infections due to ESBL producing organisms. Disclosures All authors: No reported disclosures.

Burden of healthcare-associated infections at six tertiary-care hospitals in Saudi Arabia: A point prevalence survey

2019 ◽  
Vol 40 (3) ◽  
pp. 355-357 ◽  
Author(s):  
Majid M. Alshamrani ◽  
Aiman El-Saed ◽  
Asim Alsaedi ◽  
Ayman El Gammal ◽  
Wafa Al Nasser ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Point Prevalence ◽  
Healthcare Associated Infections ◽  
Prevalence Survey ◽  
Point Prevalence Survey ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Tertiary Care Hospitals

AbstractA point prevalence survey was conducted on May 11, 2017, among inpatients at 6 hospitals in Saudi Arabia. The overall point prevalence was 6.8% (114 of 1,666). The most common types of infections were pneumonia (27.2%), urinary tract infections (20.2%), and bloodstream infections (10.5%). Approximately 19.2% of healthcare-associated infections were device associated.

scholarly journals Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

2020 ◽  
Vol 41 (S1) ◽  
pp. s199-s200
Author(s):  
Matthew Linam ◽  
Dorian Hoskins ◽  
Preeti Jaggi ◽  
Mark Gonzalez ◽  
Renee Watson ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Contact Precautions ◽  
Stewardship Program ◽  
Tract Infections ◽  
The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

scholarly journals Clinical and laboratory differences between extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative bacteria in febrile urinary tract infection in pediatrics

2021 ◽  
Vol 11 (1) ◽  
pp. e2-e2
Author(s):  
Manijeh Kahbazi ◽  
Parsa Yousefichaijan ◽  
Danial Habibi ◽  
Somaie Nejabat ◽  
Amirreza Najmi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Recurrence Rate ◽  
Urine Analysis ◽  
Third Generation ◽  
Extended Spectrum ◽  
First Choice ◽  
Febrile Uti ◽  
History Of ◽  
Tract Infections ◽  
Third Generation Cephalosporins

Introduction: The prevalence of urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL)-producing bacteria is rising, which needs more potent antibiotics, such as carbapenems. Objectives: To evaluate the clinical and laboratory differences between ESBL-positive and ESBL-negative bacteria in febrile UTI in children between one month to seven years to indicate prognostic parameters for ESBL+ UTI and to suggest appropriate antibiotic treatment. Patients and Methods: This cross-sectional study investigated 282 patients diagnosed with the first febrile UTI. The participants were assigned to ESBL-positive and ESBL-negative UTI groups. The groups were compared based on their clinical and laboratory characteristics and outcomes; the infant group was assessed separately (with the onset age of <3 months). Results: The ESBL UTI was detected in 10.2% of the cases with a history of more frequent hospitalization (P=0.002), longer hospitalization (P=0.04), higher recurrence rate (P=0.003), and more red blood cell count in urine analysis findings (P=0.02). In the antimicrobial susceptibility assay, the ESBL-positive UTI group indicated resistance to third-generation cephalosporins; nevertheless, 93.1% of the cases responded clinically. The infant group showed 13% of the patients with ESBL-positive UTI that was correlated with a history of longer preonset hospital stay (P=0.001), elevated C-reactive protein (CRP) concentration (P=0.002), and elevated recurrence rate (P=0.03), compared to the older group. Conclusion: The ESBL UTI should be further considered due to the resulted recurrence rate. The antimicrobial sensitivity assay indicated resistance to third-generation cephalosporins; however, these drugs are applied as the first choice due to the high response rate. Aminoglycosides are applicable as second choice drugs prior to initiating the use of carbapenems, if third-generation cephalosporins did not indicate bactericidal impacts on ESBL UTI.

Pattern of antibiotic prescriptions for outpatients with acute respiratory tract infections in Japan, 2013–15: a retrospective observational study

2018 ◽  
Vol 36 (4) ◽  
pp. 402-409 ◽  
Author(s):  
Yusuke Teratani ◽  
Hideharu Hagiya ◽  
Toshihiro Koyama ◽  
Mayu Adachi ◽  
Ayako Ohshima ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Oral Antibiotic ◽  
Third Generation ◽  
Acute Respiratory Tract Infections ◽  
Inappropriate Use ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Tract Infections ◽  
Third Generation Cephalosporins

Abstract Background In this age of antimicrobial resistance, unnecessary use of antibiotics to treat non-bacterial acute respiratory tract infections (ARTIs) and inappropriate use of antibiotics in treating bacterial ARTIs are public health concerns. Purpose Our aim is to identify the pattern of oral antibiotic prescriptions for outpatients with ARTIs in Japan. Methods We analysed health insurance claims data of patients (aged ≤74 years) from 2013 to 2015, to determine the pattern of antibiotic prescriptions for outpatient ARTIs and calculated the proportion of each antibiotic. Results Data on 4.6 million antibiotic prescriptions among 1559394 outpatients with ARTIs were analysed. The most commonly prescribed classes of antibiotics included cephalosporins (41.9%), macrolides (32.8%) and fluoroquinolones (14.7%). The proportion of first-, second- and third-generation cephalosporins was 1.0%, 1.7% and 97.3%, respectively. Fluoroquinolones accounted for a quarter of the prescriptions for ARTIs in patients aged >20 years. In contrast, penicillins accounted for just 8.0% of the total number of antibiotic prescriptions for ARTIs. Conclusions According to clinical guidelines, penicillins are first-line antibiotics against ARTIs. However, third-generation cephalosporins, macrolides and fluoroquinolones are more frequently prescribed in Japan. Although we could not assess the extent to which appropriate antibiotics are selected, our results support the necessity of improving antibiotic choices in the treatment of ARTIs.

scholarly journals Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals

PLoS ONE ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. e97325 ◽  
Author(s):  
Dora E. Corzo-Leon ◽  
Tito Alvarado-Matute ◽  
Arnaldo L. Colombo ◽  
Patricia Cornejo-Juarez ◽  
Jorge Cortes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Candida Spp ◽  
Epidemiological Trends ◽  
Tertiary Care Hospitals

scholarly journals Third-Generation Cephalosporin-Resistant Spontaneous Bacterial Peritonitis: A single-Centre Experience and Summary of Existing Studies

2014 ◽  
Vol 28 (2) ◽  
pp. 83-88 ◽  
Author(s):  
Jennifer Chaulk ◽  
Michelle Carbonneau ◽  
Hina Qamar ◽  
Adam Keough ◽  
Hsiu-Ju Chang ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Care Hospital ◽  
Third Generation ◽  
Bacterial Peritonitis ◽  
Common Diagnosis ◽  
Cephalosporin Resistance ◽  
Third Generation Cephalosporins ◽  
Culture Positive

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.OBJECTIVE: To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.METHODS: SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.RESULTS: In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.CONCLUSIONS: Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.

scholarly journals Community acquired urinary tract infection: etiology and bacterial susceptibility

2003 ◽  
Vol 18 (suppl 5) ◽  
pp. 33-36 ◽  
Author(s):  
José Anastácio Dias Neto ◽  
Antonio Carlos Pereira Martins ◽  
Leonardo Dias Magalhães da Silva ◽  
Ricardo Brianezi Tiraboschi ◽  
André Luis Alonso Domingos ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Severe Disease ◽  
Antibacterial Drug ◽  
Third Generation ◽  
Antibacterial Susceptibility ◽  
Tract Infections ◽  
Epidemiological Characteristics ◽  
Third Generation Cephalosporins

PURPOSE: Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed. UTI account for a large proportion of antibacterial drug consumption and have large socio-economic impacts. Since the majority of the treatments begins or is done completely empirically, the knowledge of the organisms, their epidemiological characteristics and their antibacterial susceptibility that may vary with time is mandatory. OBJECTIVE: The aim of this study was to report the prevalence of uropathogens and their antibiotic susceptibility of the community acquired UTI diagnosed in our institution and to provide a national data. METHODS: We analyzed retrospectively the results of urine cultures of 402 patients that had community acquired urinary tract infection in the year of 2003. RESULTS: The mean age of the patients in this study was 45.34 ± 23.56 (SD) years. There were 242 (60.2%) females and 160 (39.8%) males. The most commonly isolated organism was Escherichia coli (58%). Klebsiella sp. (8.4%) and Enterococcus sp.(7.9%) were reported as the next most common organisms. Of all bacteria isolated from community acquired UTI, only 37% were sensitive to ampicillin, 51% to cefalothin and 52% to trimethoprim/sulfamethoxazole. The highest levels of susceptibility were to imipenem (96%), ceftriaxone (90%), amikacin (90%), gentamicin (88%), levofloxacin (86%), ciprofloxacin (73%), nitrofurantoin (77%) and norfloxacin (75%). CONCLUSION: Gram-negative agents are the most common cause of UTI. Fluoroquinolones remains the choice among the orally administered antibiotics, followed by nitrofurantoin, second and third generation cephalosporins. For severe disease that require parenteral antibiotics the choice should be aminoglycosides, third generation cephalosporins, fluoroquinolones or imipenem, which were the most effective.

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