scholarly journals Increasing antibiotic susceptibility in Staphylococcus aureus in Boston, Massachusetts, 2000-2014: an observational study

2017 ◽  
Author(s):  
Sanjat Kanjilal ◽  
Mohamad R. Abdul Sater ◽  
Maile Thayer ◽  
Georgia Lagoudas ◽  
Soohong Kim ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Observational Study ◽  
Tertiary Care ◽  
Genetic Determinants ◽  
Genetic Lineages ◽  
Time Period ◽  
Large Tertiary Care ◽  
The Common ◽  
Tertiary Care Centers ◽  
Gains And Losses

ABSTRACTBackgroundMethicillin resistant S. aureus (MRSA) has been declining over the past decade, but changes in S. aureus overall and the implications for trends in antibiotic resistance remain unclear.ObjectiveTo determine whether the decline in rates of infection by MRSA has been accompanied by changes in rates of infection by methicillin susceptible, penicillin resistant S. aureus (MSSA) and penicillin susceptible S. aureus (PSSA). We test if these dynamics are associated with specific genetic lineages and evaluate gains and losses of resistance at the strain level.MethodsWe conducted a 15 year retrospective observational study at two tertiary care institutions in Boston, MA of 31,589 adult inpatients with S. aureus infections. Surveillance swabs and duplicate specimens were excluded. We also sequenced a sample of contemporary isolates (n = 180) obtained between January 2016 and July 2016. We determined changes in the annual rates of infection per 1,000 inpatient admissions by S. aureus subtype and in the annual mean antibiotic resistance by subtype. We performed phylogenetic analysis to generate a population structure and infer gain and loss of the genetic determinants of resistance.ResultsOf the 43,954 S. aureus infections over the study period, 21,779 were MRSA, 17,565 MSSA and 4,610 PSSA. After multivariate adjustment, annual rates of infection by S. aureus declined from 2003 to 2014 by 2.9% (95% CI, 1.6%-4.3%), attributable to an annual decline in MRSA of 9.1% (95% CI, 6.3%-11.9%) and in MSSA by 2.2% (95% CI, 0.4%-4.0%). PSSA increased over this time period by 4.6% (95% CI, 3.0%-6.3%) annually. Resistance in S. aureus decreased from 2000 to 2014 by 0.86 antibiotics (95% CI, 0.81-0.91). By phylogenetic inference, 5/35 MSSA and 2/20 PSSA isolates in the common MRSA lineages ST5/USA100 and ST8/USA300 arose from the loss of genes conferring resistance.Conclusions and relevanceAt two large tertiary care centers in Boston, MA, S. aureus infections have decreased in rate and have become more susceptible to antibiotics, with a rise in PSSA making penicillin an increasingly viable and important treatment option.

scholarly journals Analysis of Management Approach to Newborn Care of Infants Delivered to COVID-19 Positive Mothers at Five Tertiary Care Centers in the UAE over a 7 Month Period 

2021 ◽  
Author(s):  
Monika Kaushal ◽  
Yamuna Tulasi ◽  
Ayush Kaushal ◽  
Aditya Rakhecha ◽  
Rafiq Memon ◽  
...  
Keyword(s):  
Observational Study ◽  
Tertiary Care ◽  
Newborn Care ◽  
Retrospective Observational Study ◽  
Management Approach ◽  
Post Discharge ◽  
Formula Milk ◽  
Increased Risk ◽  
Care Practices ◽  
Tertiary Care Centers

Abstract ObjectivesTo assess newborn care practices, clinical characters and risks of mother to child transmission during rooming in and breastfeeding in infants born to mothers with COVID-19.DesignRetrospective observational study.Participants5 Tertiary care centers located in the UAE. Infants born to mothers diagnosed with COVID-19 at the time of delivery, born between April 1st and October 30th 2020.MethodsIn this retrospective observational study, we analyzed the newborn care practices in various tertiary care hospitals and the rate of transmission of SARS-CoV-2 from mother to infant (vertical or horizontal) while rooming in, breastfeeding and post discharge. Results40 infants were born to mothers with COVID-19 at the time of delivery. One infant tested positive for SARS-CoV-2 after birth and had respiratory symptoms and fever. 23 of the well infants were roomed in during their hospital stay and were breastfed. In 8 cases, the mother and baby were separated and isolated from the time of birth till discharge. 95% of the discharged infants were rooming in with mothers, 45% of the infants were exclusively breastfed and 55% were on mixed feeding (breast milk and formula milk) at the follow-up. None of the infants developed significant health issues or symptoms attributable to SARS-CoV-2.ConclusionThe risk of mother to infant transmission of COVID-19 in the perinatal period is very low. Our study reaffirms the AAP guidelines that rooming in and breastfeeding of newborns born to COVID-19 positive mothers is safe without an increased risk of transmission by following mandated safety precautions.

scholarly journals Real-World Experience With Acute Infusion Reactions to Ustekinumab at 2 Large Tertiary Care Centers

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Elizabeth A Spencer ◽  
Jami Kinnucan ◽  
Julie Wang ◽  
Marla C Dubinsky
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Real World ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Infusion Reaction ◽  
Large Tertiary Care ◽  
Infusion Reactions ◽  
Tertiary Care Centers

Abstract Background Ustekinumab is approved for Crohn’s disease and Ulcerative colitis with acute infusion reactions reported at a rate of 0.9%–4.5%. Methods A retrospective chart review was conducted on inflammatory bowel disease (IBD) patients experiencing an acute infusion reaction to ustekinumab at 2 large institutions. Results Acute ustekinumab infusion reactions occurred in 16 patients with Crohn’s disease (CD) and Ulcerative colitis (UC), at a rate of 0.8%–3%. Patients were all naïve to ustekinumab, receiving their initial IV induction. Ninety-three percent subsequently tolerated the injection without issues. Conclusions In this large, real-world study of acute infusion reactions to ustekinumab, the rate was similar to that seen in clinical trials—0.8%–3%.

Hospital-Wide Reduction in Central Line–Associated Bloodstream Infections: A Tale of Two Small Community Hospitals

2011 ◽  
Vol 32 (6) ◽  
pp. 619-622 ◽  
Author(s):  
Aysegul Gozu ◽  
Colleen Clay ◽  
Faheem Younus
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Small Community ◽  
Community Hospitals ◽  
Central Line Insertion ◽  
Line Insertion ◽  
Large Tertiary Care ◽  
Tertiary Care Centers ◽  
General Wards

Despite increasing awareness of central line-associated bloodstream infections (CLABSIs) in general wards, published strategies come from intensive care units (ICUs) of large tertiary care centers. After implementing a central line insertion checklist, two community hospitals experienced an 86% reduction in CLABSI rates in ICUs and a 57% reduction in non-ICU settings over 36 months.

scholarly journals An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study (Preprint)

2021 ◽  
Author(s):  
Hashaam Akhtar ◽  
Samar Akhtar ◽  
Fazal-Ul Rahman ◽  
Maham Afridi ◽  
Sundas Khalid ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Drug Discovery ◽  
Observational Study ◽  
Treatment Options ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Retrospective Observational Study ◽  
Immunocompromised Patients ◽  
First Line ◽  
Tertiary Care Hospitals

BACKGROUND Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll. OBJECTIVE The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan. METHODS A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020). RESULTS Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%). CONCLUSIONS Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19.

scholarly journals AN OBSERVATIONAL STUDY OF MEDICATION ERRORS AMONG PSYCHIATRIC PATIENTS IN A TERTIARY CARE HOSPITAL

2018 ◽  
Vol 11 (11) ◽  
pp. 340
Author(s):  
Reenu Jose ◽  
Krishnaveni K ◽  
Jesna Maria ◽  
Shanmuga Sundaram R ◽  
Sambathkumar R
Keyword(s):  
Observational Study ◽  
Psychiatric Patients ◽  
Demographic Data ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Male Patients ◽  
The Common ◽  
Psychiatric Department

Objective: The objective of this study is to evaluate the common medication error (ME), and its causes, category, and severity by using suitable questionnaire.Methods: A prospective observational study was carried out for 6 months in a psychiatric department. Demographic data, clinical history, and complete prescription were noted.Results: A total of 120 psychiatric cases were collected, among that 116 MEs were identified in which male patients were 64 (55%) and females 52 (44.8%). The number of MEs occurred due to physician was 67 (57.7%), due to nurses was 15 (12.9%), and combined was 38 (32.7%). Incomplete prescription was the main type of error that we found. About 43.1% of the error we identified was informed to the staff and and no specific action was needed for 37.1% of errors. In our study, we found that majority of 54 (46.5%) errors were categorized under category B, but there was no harm to the patient.Conclusion: The present study concluded that most of the patients admitted in the psychiatry department would experience MEs. Clinical pharmacist can play a major role in the early detection and prevention of MEs and thus can improve the quality of care to the patients.

Acquired Hemophilia in Patients With Hematologic Malignancies

2000 ◽  
Vol 124 (5) ◽  
pp. 730-734 ◽  
Author(s):  
Sabah Sallah ◽  
Nam P. Nguyen ◽  
Jorge M. Abdallah ◽  
L. Robert Hanrahan
Keyword(s):  
Factor Viii ◽  
Tertiary Care ◽  
Hematologic Malignancies ◽  
Response To Treatment ◽  
Acquired Hemophilia ◽  
Design Data ◽  
Large Tertiary Care ◽  
Underlying Illness ◽  
Tertiary Care Centers ◽  
Inhibitor Titer

Abstract Objectives.—To evaluate the occurrence of acquired hemophilia in patients with hematologic malignancies and to assess their response to treatment. Design.—Data on 8 patients with hematologic neoplastic disorders and inhibitor against factor VIII were analyzed retrospectively. Setting.—Three large tertiary-care centers. Results.—All 8 patients presented with spontaneous or posttraumatic hemorrhages. The mean inhibitor titer at the time of diagnosis was 79 Bethesda units (BU), and residual factor VIII activity was detectable in 3 patients. The inhibitor disappeared in 5 patients after a mean of 92 days, but persisted in the 3 other patients. The patients who achieved complete resolution of their circulating anticoagulant had lower mean inhibitor titers at the time of diagnosis than those who had persistent inhibitor (27 BU vs 167 BU, respectively). Two patients died as a result of major hemorrhages that did not respond to treatment. Conclusions.—Antibodies against factor VIII may be responsible for some bleeding episodes in patients with lymphoid or myeloid malignancies. Acquired hemophilia in this setting should be differentiated from other causes of bleeding because the approach to treatment is different. No conclusion can be drawn regarding the association between the activity of the underlying illness and the inhibitor titer, although it appears that at least in some patients such a relationship may exist. The underlying pathogenetic mechanisms responsible for the production of autoantibodies against factor VIII remain unclear, but we provide a few explanations in this article.

scholarly journals A Observational Study on Hypopigmented \ Depigmented Macules in Geriatric Population Attending Dermatology OPD in a Tertiary Care Centre

2021 ◽  
pp. 195-198
Author(s):  
B. Shea Sharma ◽  
Jayakar Thomas
Keyword(s):  
Observational Study ◽  
Tertiary Care ◽  
Care Centre ◽  
Inclusion Criteria ◽  
Tertiary Care Centre ◽  
Geriatric Population ◽  
Psychosocial Impairment ◽  
Aesthetic Appearance ◽  
The Common ◽  
Larger Sample

This article lays out the common hypopigmented \depigmented lesions in geriatric population encountered in dermatology OPD in a tertiary care centre in India. Hypopigmented/depigmented lesions is commonly encountered in a dermatology OPD on a day to day basis. This study is an observational study carried out on 100 patients in dermatology OPD in a tertiary care centre who satisfied the inclusion criteria of age more than 60 years with hypopigmented or depigmented lesions. Hypopigmented/depigmented lesions have a great impact on patients aesthetic  appearance leading to psychosocial impairment. A further research with larger sample size and longer study duration can help us understand hypomelanosis in geriatric population better.

scholarly journals Endoscopic findings in uninvestigated dyspepsia patients

2019 ◽  
Vol 6 (4) ◽  
pp. 1051
Author(s):  
Thyagaraja K. ◽  
Venkatakrishna Bhat S. ◽  
Stephan Benny
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Outpatient Basis ◽  
Cross Sectional ◽  
Medical College ◽  
Endoscopic Findings ◽  
Resource Limited ◽  
Large Tertiary Care ◽  
The Common ◽  
H Pylori

Background: Dyspepsia is a frequent syndrome in our country where there are limitations for endoscopy and there is high burden of H. pylori infection. It is important to establish the causes of dyspepsia hence therapeutic approach will be easier. Aim of the study was to find out the common endoscopic findings in a patient with dyspepsia symptoms large tertiary care hospital.Methods: A cross-sectional study was conducted on 184 patients either admitted or seen on outpatient basis at the Basaveswara medical college and research institute, Chitradurga with the upper GI symptom dyspepsia and the data was analysed using appropriate statistical methods.Results: Out of 184 patients who underwent Esophagogastroduodenoscopy (EGD scopy) 62% were male and 61% were 31-59year old. The common pathological findings in dyspeptic patients were gastritis and esophagitis.Conclusions: The following insights/observations were made during the course of this study→ dyspepsia is usually caused by H. pylori gastritis, eradication of which relieves the symptom in this observation. Many a times dyspepsia found to have normal study. Hence wise referral for endoscopy is a key in resource limited setup.

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