Experience in the implementation of the early warning sign system in obstetric patients (Maternal Early Warning Criteria, MEWC) during early postpartum. A prospective observational study.

Objective: To evaluate the implementation of an early warning system in obstetric patients (MEWC) during the first two hours after delivery in a single tertiary-care hospital. Methods: The MEWC system implementation was carried out from 15th March to 15th September 2018, over 1166 patients. The parameters collected were systolic and diastolic blood pressure, heart rate, oxygen saturation, diuresis, uterine involution, and bleeding. If a parameter was not within defined limits, an obstetrician first examined the patient, determining the need to call the anesthesiologist. We carried out a sensitivity-specificity study of the trigger and multivariate analysis of the factors involved in developing potentially fatal disorders (PFD), reintervention, critical care admission, and stay. Results: The protocol was triggered in 75 patients (6.43%). The leading cause of alarm activation was the altered systolic blood pressure (32 [42.7%] patients), and eleven developed PFD. Twenty-eight patients were false-negatives. Sensitivity and specificity of MEWC protocol were 0.28 (0.15, 0.45) and 0.94 (0.93, 0.96), respectively. Multivariate analysis showed a relationship between alarm activation and PFD. Conclusion: Our MEWC protocol presented low sensitivity and high specificity, having a significant number of false-negative patients.

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Implementation of a maternal early warning system during early postpartum. A prospective observational study

PLoS ONE ◽

10.1371/journal.pone.0252446 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252446

Author(s):

Cristina Ibáñez-Lorente ◽

Rubén Casans-Francés ◽

Soledad Bellas-Cotán ◽

Luis E. Muñoz-Alameda

Keyword(s):

Blood Pressure ◽

Multivariate Analysis ◽

Early Warning ◽

Early Warning System ◽

Warning System ◽

High Specificity ◽

False Negatives ◽

Critical Care Admission ◽

Low Sensitivity ◽

Sensitivity Specificity

Objective To evaluate the implementation of a maternal early warning system (MEWS) for monitoring patients during the first two hours after delivery in a tertiary level hospital. Methods Implementation of the criteria between 15 March and 15 September 2018 was evaluated in 1166 patients. The parameters collected were systolic and diastolic blood pressure, heart rate, oxygen saturation, urine output, uterine involution, and bleeding. Out-of-range values of any of these parameters triggered a warning, and an obstetrician was called to examine the patient. The obstetrician then decided whether to call the anesthesiologist. We carried out a sensitivity-specificity study of triggers and a multivariate analysis of the factors involved in developing potentially fatal disorders (PFD), reintervention, critical care admission, and stay. Results The MEWS was triggered in 75 patients (6.43%). Leading trigger was altered systolic blood pressure in 32 patients (42.7%), and 11 patients had a PFD. Twenty-eight triggers were false-negatives. Sensitivity and specificity of the system was 0.28 (0.15, 0.45) and 0.94 (0.93, 0.96), respectively. The multivariate analysis showed a correlation between trigger activation and PFD. Conclusion Our MEWS presented low sensitivity and high specificity, with a significant number of false-negatives.

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Implementation and adherence to the Bedside Paediatric Early Warning System (BedsidePEWS) in a pediatric tertiary care hospital

10.21203/rs.3.rs-23140/v1 ◽

2020 ◽

Author(s):

Orsola Gawronski ◽

Federico Ferro ◽

Corrado Cecchetti ◽

Marta Luisa Ciofi Degli Atti ◽

Immacolata Dall'oglio ◽

...

Keyword(s):

Early Warning ◽

Early Warning System ◽

Tertiary Care ◽

Vital Signs ◽

Warning System ◽

Hospital Inpatient ◽

Care Hospital ◽

Clinical Records ◽

Hospital Wards ◽

Score Range

Abstract BackgroundClinical deterioration in children admitted to hospital wards often manifests through signs of increasing illness severity that may lead to unplanned Pediatric Intensive Care Unit admissions or cardiac arrest, if undetected. The Bedside Pediatric Early Warning System (BedsidePEWS) is a validated Canadian scoring system used at a large tertiary care children’ hospital to prevent critical illness and standardize the response to deteriorating children on the wards.MethodsA 6-month audit was performed to evaluate the use of the BedsidePEWS, escalation of patient observations, monitoring and medical reviews on the wards in 2018.Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P <0.05 considered as significant).ResultsA total of 522 Vital Signs (VS) and score calculations on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of VS and score documentation occurred <3 times per day in 33% of the observations. Adherence to the VS documentation frequency according to the hospital protocol was observed in 54% for all patients; for children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47%, P=0.006). The BedsidePEWS score was correctly calculated and documented in 84% of the observed VS documentation events. Systolic blood Pressure was recorded in 79% and Temperature in 91% of the VS recording events. Patients within a 0-2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50% of the patients in the 5-6 score range were reviewed within 4 hours and 42% of the patients with a score ≥7 within 2 hours. Transcutaneous Oxygen Saturation continuous monitoring was applied to 60% of the children at higher risk (BedsidePEWS ≥5).ConclusionsEscalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

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Adherence to the bedside paediatric early warning system (BedsidePEWS) in a pediatric tertiary care hospital

BMC Health Services Research ◽

10.1186/s12913-021-06809-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Orsola Gawronski ◽

Federico Ferro ◽

Corrado Cecchetti ◽

Marta Ciofi Degli Atti ◽

Immacolata Dall’Oglio ◽

...

Keyword(s):

Early Warning ◽

Early Warning System ◽

Tertiary Care ◽

Vital Signs ◽

Warning System ◽

Hospital Inpatient ◽

Care Hospital ◽

Clinical Records ◽

Hospital Wards ◽

Score Range

Abstract Background The aim of this study is to describe the adherence to the Bedside Pediatric Early Warning System (BedsidePEWS) escalation protocol in children admitted to hospital wards in a large tertiary care children’s hospital in Italy. Methods This is a retrospective observational chart review. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded. Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P < 0.05 considered as significant). Results A total of 522 Vital Signs (VS) and score calculations [BedsidePEWS documentation events, (DE)] on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of BedsidePEWS DE occurred < 3 times per day in 33 % of the observations. Adherence to the BedsidePEWS documentation frequency according to the hospital protocol was observed in 54 % of all patients; in children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47 % vs. 69 %, P = 0.006). The BedsidePEWS score was correctly calculated and documented in 84 % of the BedsidePEWS DE. Patients in a 0–2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50 % of the patients in the 5–6 score range were reviewed within 4 h and 42 % of the patients with a score ≥ 7 within 2 h. Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

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FC 096THE EFFECT OF INCREMENTAL START OF HAEMODIALYSIS ON BLOOD PRESSURE AND INTERDIALYTIC WEIGHT GAIN: PRELIMINARY FINDINGS FROM THE ENDURE STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab128.004 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Adil Hazara ◽

Victoria Allgar ◽

Maureen Twiddy ◽

Sunil Bhandari

Keyword(s):

Blood Pressure ◽

Propensity Scores ◽

Phase 1 ◽

Tertiary Care ◽

Residual Renal Function ◽

Care Hospital ◽

Interdialytic Weight Gain ◽

Matching Criteria ◽

The Impact

Abstract Background and Aims Mortality rates are high in patients starting haemodialysis/haemodiafiltration (HD) therapy. Incremental HD may help reduce this risk by reducing the burden of early treatment whilst patients are still adapting to long-term HD therapy. A feasibility study (ENDURE study – Clinical trials ID: NCT04268264) is being conducted with the primary objectives of evaluating the acceptability and tolerance of a new incremental HD regime. Its secondary aims are to evaluate the impact of this form of incremental HD on indicators of patient safety and wellbeing. These indicators include blood pressure (BP) control and interdialytic weight gains (IDWG) which are independently associated with adverse cardiovascular outcomes in patients on long-term HD. We present preliminary findings from the study related to systolic BP and IDWG. Method The ENDURE study is being carried out at a tertiary care hospital in the United Kingdom. Patients aged > 18 years known to renal services for at least 90 days, referred for start of HD, were eligible for participation. Following approved consenting procedures, they are started on a new regime of incremental HD starting dialysis twice weekly with progressive increases in the duration and frequency of sessions over 15 weeks. This period is split in to four phases; phase 1 representing the first two days of dialysis (baseline) whereas phases 2 – 4 representing the pre-specified incremental steps. Propensity scores were calculated to match each participant (incremental HD group) with two controls from a database of patients who previously started HD at our centres using the standard protocol of 3 times weekly, 4hr long sessions. The matching criteria accounted for 14 key demographic, clinical and laboratory characteristics. Results were analysed as intention to treat. In comparing BP and IDWG between the two groups, only readings taken pre-dialysis at the first session of the week was considered. This study has been approved by the West of Scotland Research Ethics committee-4 (Ref: 19/WS/0019). Results Baseline characteristics of the first 15 participants (target 20) and their matched controls are presented in table 1. The proportion of females and duration of previous specialist input was higher in the incremental HD group. Conclusion The ENDURE study tests the feasibility of starting patients on a novel incremental HD regime. Early data suggest that control of systolic BP and IDWG are comparable to patients who start dialysis at 3 times weekly. Further work is needed to understand the impact of reducing dialysis frequency on BP control correlating the findings with changes residual renal function and objective measures of fluid overload.

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SOCIOECONOMIC STATUS EFFECT ON MANAGEMENT OF HYPERTENSION IN COMMUNITY PHARMACY IN SOUTH- SOUTH ZONE IN NIGERIA

Universal Journal of Pharmaceutical Research ◽

10.22270/ujpr.v6i5.670 ◽

2021 ◽

Author(s):

Mgbahurike AA ◽

Oduogu SO ◽

Bagbi BM

Keyword(s):

Blood Pressure ◽

Socioeconomic Status ◽

Alcohol Consumption ◽

Peer Review ◽

Tertiary Care ◽

Research Centre ◽

Community Pharmacies ◽

Care Hospital ◽

Co Morbidity ◽

Significant Difference

Background to study: Effective management of hypertension is influenced by several factors that center on social and economic status of the patient. Identification of these factors will enable informed intervention in the management of hypertensive patients. Objective: The study aimed to determine possible association between blood pressure control and socioeconomic status of patients who are managed in community pharmacies in Rivers State. Method: A descriptive cross-sectional survey of thirty-nine community pharmacies was conducted between July and December 2018. A total of 195 respondents participated in the study. Every patient’s consent was obtained. Further information on patients’ demographics were extracted from pharmacists’ documentation files. Such include age, medication patient is on, duration of hypertension, co-morbidity, income/ social status, and habits like smoking, alcohol consumption, educational status, and mean blood pressure over the study period. The outcome measure taken as controlled blood pressure was mean BP ≤140/90 mm Hg for the general population and BP 130/80 mmHg for patients with diabetes as co-morbidity. BP >140/90 mm Hg was considered as uncontrolled blood pressure. Result: A total of 195 respondents participated in the study, of which 105(53.8%) were male and 90(46.2%) were female. Out of this number 75(38.5%) were below 40yrs of age, 105(53.8%) were between 41–50yrs of age and only 15(7.7%) were 60yrs and above. More female had BP control compared to the male (OR 1.89, 95% CI (1.16 - 3.0), P=0.009. Patients within ages 41 - 59yrs had more controlled BP compared to older age, 60yrs and above, OR 1.48, 95% CI (0.84 - 2.42) p 0.18. Uncontrolled BP was found more among employed patients and patients with highest monthly income, OR 1.05 95% CI (0.58 - 2.00); OR 1.16 95% CI (0.49 - 2.78) P, 0.36 respectively. Exercise activities have significant impact on BP control as alcohol consumption increased OR of BP control with no significant difference in OR on amount of monthly expenditure on medications. Conclusion: Male gender, employment, and high income earning have negative effect on BP control while exercise is associated with BP control. Peer Review History: Received: 4 September 2021; Revised: 10 October; Accepted: 21 October, Available online: 15 November 2021 Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622, Giza, Egypt, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Muhammad Zahid Iqbal, AIMST University, Malaysia, [email protected] Dr. Vanina Doris Edo’o, University of Yaounde I, Yaounde, Cameroun, [email protected] Similar Articles: PRESCRIPTION PATTERN OF ANTI-HYPERTENSIVE DRUGS IN A TERTIARY CARE HOSPITAL IN KERALA AND ADHERENCE TO JNC-8 GUIDELINES

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To Determine the Correlation between Anthropometric Variables of Obesity and Hypertension at NGMC: A Tertiary Care Hospital

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v14i2.21544 ◽

2018 ◽

Vol 14 (2) ◽

pp. 70-74

Author(s):

Bhawana Neupane Pant ◽

Manoj Pant ◽

Rajesh Kumar Goit ◽

Ashish Neupane ◽

Ganesh Prasad Neupane ◽

...

Keyword(s):

Blood Pressure ◽

Tertiary Care ◽

Morbidity And Mortality ◽

Care Hospital ◽

Hip Circumference ◽

Specific Population ◽

Anthropometric Indices ◽

Arterial Blood ◽

Skin Fold ◽

Scientific Validation

Aim: Obesity is associated with the metabolic risk factors such as high blood pressure, body fat abnormality, and glucose intolerance which may influence the morbidity and mortality due to cardiovascular diseases. The present study is to determine the correlation of common anthropometric indices of obesity with blood pressure among population in mid-western region of Nepal. The result will provide us insight on relevant anthropometric indices for predicting hypertension based on linear correlation calculated from our data. Methods: We screened 500 healthy subjects to study the correlation between anthropometric indices and blood pressure.Result: Our result showed strong correlation between Sum of Skin fold, waist circumference, and waist hip ratio with blood pressure (systolic blood pressure, diastolic blood pressure and mean arterial blood pressure). However some of the anthropometric indices like hip circumference and body mass index did not have significant correlation with blood pressure. Conclusion: Provided obesity related morbidity and mortality is burgeoning in our society it is imperative to identify right indicators of cardiovascular disease for specific population. Relevant anthropometric indices can serve as excellent indicators if used based of scientific validation. JNGMC, Vol. 14 No. 2 December 2016, Page:70-74

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Hysteroscopy is Gold standard in Uterine evaluation for Infertility, but HSG still has a place

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i4.35199 ◽

2021 ◽

Vol 12 (4) ◽

pp. 98-104

Author(s):

Manisha Bajaj ◽

Rajib Roy ◽

Motiur Rahman ◽

Joydeb Roychowdhury

Keyword(s):

Predictive Value ◽

False Negative ◽

Screening Method ◽

Uterine Cavity ◽

High Specificity ◽

Filling Defect ◽

Endometrial Polyp ◽

Care Hospital ◽

Saline Infusion Sonography ◽

First Choice

Background: Uterine abnormalities, congenital or acquired are implicated as causal factor in 10%-15% of infertile couplesreporting for treatment. Hysteroscopy, hysterosalpingography (HSG), saline-infusion-sonography and USG are available for evaluation of uterine cavity. HSG helps in initial evaluation of a sub-fertile woman, but hysteroscopy is gold standardas itallows direct visualisation ofintrauterine pathology and treatment in same-setting, if required. Aims and Objective: To describe hysteroscopic findings of infertile patients and compare the observations with their respective HSG findings. Materials and Methods: It’s a prospective analysis of 105 women with infertility who attendedtertiary-care hospital during 18 monthsfulfilling pre-defined inclusion and exclusion criteria. All cases were evaluated with both HSG and hysteroscopy, observations were recorded and co-related with each other. Results: Among 105 cases, maximum (76.19%) were 25-35 years of age. The primary infertility accounted for 68.57% cases.Abnormal HSG findings observed in 19 cases (20%), most common being filling-defect.Hysteroscopy detected abnormalities in 39 cases (37.14%), commonest being endometrial polyp. Out of 39 cases of abnormal uterine cavity detected on hysteroscopy only 19 were picked-up by HSG, rest 20 cases failed to be identified. The strength of agreement between hysteroscopy and HSG calculated is moderate (Kappa=0.505). Conclusion: As HSG hadlow false positivity (03%), high positive-predictive-value (90.48%) and negative-predictive-value (76.19%) and high specificity (96.96%) it is still considered as a first-choice screening method of uterine cavity. However, high false-negative-value (51.28%)of HSG makes Hysteroscopy a better diagnostic test. HSG couldn’t differentiate endometrial polyp, adhesions and submucous fibroid, shown them as filling defect only.

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Detection of Serum Vascular Endothelial Growth Factors (VEGF) And Soluble Vascular Endothelial Growth Factors (sVEGF / sflt-1) of Pregnancy Induced Hypertension Mothers (PIH) With pathological changes of Placenta In a Tertiary Care Hospital of West Bengal.

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v2i1.21 ◽

2018 ◽

Vol 2 (1) ◽

pp. 25

Author(s):

Sulekha Ghosh ◽

Kabayashree Jana ◽

Pratima Mandal ◽

Trithankar Chakrabarty ◽

Debasis Bhattacharya ◽

...

Keyword(s):

Blood Pressure ◽

Growth Factors ◽

Tertiary Care ◽

Vascular Endothelial Growth Factors ◽

Vascular Endothelial ◽

Care Hospital ◽

Angiogenic Growth Factors ◽

Serum Free ◽

Induced Hypertension ◽

Endothelial Growth Factors

Introduction:Pregnancy Induced Hypertension (PIH) results from imbalance between pro-angiogenic factors (VEGF & PIGF) and antiangiogenic factors (sVEGFR-1/sflt- 1)Subjects and methodology: A mixed random study comprising of random cases of different gestational ages 28-36 wks of PIH mothers along with control cases till completion of pregnancy after delivery. Age of enrolled mothers and their gestational age, blood pressure, serum free VEGF and sVEGFR-1(sflt1) were compared in both groups (control n=36, PIH n=36). Blood pressure of both control and PIH mothers just before and after delivery showed significant correlation (p<0.0001). Serum levels of free VEGF were lower among PIH mothers at 28-36 wks (p <0.0001) and just before delivery (JBD) (p <0.0001) than normal control antenatal mothers and more or less similar in both groups at just after delivery (p <0.390). Serum sflt1 level (6459.81 ±1811.07 pg/ml) of PIH mothers showed higher value than control mothers (1062.19 ± 165.98 pg/ml) at the time of presentation and also just before delivery(JBD) & after delivery(JAD) and was highly significant ( p < 0.0001). Serum free VEGF level of PIH mothers was negatively correlated with systolic r= - 0.247, p = 0.147) and diastolic (r =-0.220, p =0.197) blood pressure. The increased serum sflt1 level of PIH mothers was positively correlated with systolic (r = 0.299, p = 0.07) and diastolic (r = 0.309, p = 0.067) blood pressure. Semi quantitative expression of VEGF R1 and PCNA LI of placenta showed increased (3+) expression of VEGF R1 of 13 (43.33%) and > 50% PCNA LI expression of 12 (40%) cases than control.Discussion &Conclusion:The elevated levels of systolic and diastolic blood pressure along with alteration of proangiogenic and angiogenic growth factors among PIH mothers than normotensive control may help to identify PIH mothers as early as possible and referring them to higher/tertiary centers for better management and prevention of its grave complications of PIH.International Journal of Human and Health Sciences Vol. 02 No. 01 Jan’18. Page : 25-30

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Retrospective analysis of the most common cause of rejection of donors for blood donation

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20210604 ◽

2021 ◽

Vol 8 (3) ◽

pp. 444

Author(s):

Garima Vijayvergiya ◽

Parag Fulzele ◽

Naveen Vairyamoorthy

Keyword(s):

Blood Pressure ◽

Blood Donor ◽

Blood Donation ◽

Tertiary Care ◽

Geographical Area ◽

Rejection Rate ◽

Developed Countries ◽

Care Hospital ◽

Systemic Examination ◽

Safe Blood

Background: A significant imbalance in access to safe blood is seen between the developing and developed countries. Donor selection has a pivotal role in preventing transfusion related complications and provide safety to the recipients. In this study, we aimed to find out rate and causes of blood donor rejection in our hospital. Methods: A retrospective study conducted in a tertiary care hospital involving both the voluntary and replacement donors during the period September 2017 to December 2018. We included all those donors who were considered unfit for blood donation. All those who came for blood donation at our hospital were asked to fill up an enrolment form for a blood donor. A general and systemic examination were done. We calculated the rejection rate, listed the reasons for donor rejection, and analyzed the data.Results: Among 150 rejected blood donors, most were males [129 (86%)], and the rest were females [21 (14%)]. The rejection rate in our study was 3.29%. We found that the rejection rate of donors was different among voluntary and replacement donors. It showed that the most common reason for the temporary rejection of blood donation was low hemoglobin level, followed by abnormal blood pressure. Conclusions: A vast majority of donors were rejected temporarily [132 (88%)], while the rest of them were rejected permanently [18 (12%)]. Low Hb in females and abnormal blood pressure in males were the commonest causes of blood donor rejection. Many factors affect the similarities and variations between the most typical causes of blood donor rejection, such as geographical area, cultural, socio-economic, and educational factors.

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Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.163123 ◽

2015 ◽

Vol 7 (02) ◽

pp. 108-111 ◽

Cited By ~ 1

Author(s):

Tuhina Banerjee ◽

Shampa Anupurba ◽

Joel Filgona ◽

Dinesh K Singh

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Tertiary Care ◽

Significant Risk ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Hospitalized Patients ◽

University Hospital ◽

North India ◽

Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

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