scholarly journals A Review of 11 Years ofStenotrophomonas maltophiliaBlood Isolates at a Tertiary Care Institute in Canada

2012 ◽  
Vol 23 (4) ◽  
pp. 165-169 ◽  
Author(s):  
Prenilla Naidu ◽  
Stephanie Smith
Keyword(s):  
Infection Control ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Surveillance Program ◽  
Tertiary Care Centre ◽  
Alberta Hospital ◽  
University Of Alberta ◽  
Drug Of Choice

BACKGROUND:Stenotrophomonas maltophiliahas emerged as a significant nosocomial pathogen with increasing resistance to trimethoprim/sulphamethoxazole (TMP/SMX), the current drug of choice for treatment.OBJECTIVES: To describe the microbiological and clinical characteristics ofS maltophiliabloodstream infections (BSIs) over an 11-year period at a tertiary care centre in Canada.METHODS: All adultS maltophiliaBSIs from 1999 to 2009 in a 750-bed tertiary care teaching hospital (University of Alberta Hospital, Edmonton, Alberta) were identified through the infection control nosocomial infection surveillance program. Demographic and clinical data were extracted from the infection control database and from patient charts. Microbiological data were confirmed through the laboratory information system.RESULTS: Twenty-five episodes ofS maltophiliaBSI (0.9% of all BSIs) involving 24 patients were identified between 1999 and 2009. The patient age range was 18 to 83 years (average 45.7 years). The majority were men (14 of 24 [58.3%]). The mean length of hospital stay was 83.3 days (range eight to 310 days). The rate ofS maltophiliaBSIs per 1000 admissions ranged from 0.04 to 0.22 (average 0.09). Greater than one-half of the episodes (13 of 25 [52%]) were admitted to the intensive care unit before BSI onset. Laboratory data were available for 24 of the 25 isolates. Polymicrobial infections were present in 11 of 24 (45.8%) patients. Resistance to TMP/SMX occurred in 8.3% of all infections. Fifteen per cent of isolates were resistant to ticarcillin/clavulanate. Mortality attributed to bacteremia was 16.7%.CONCLUSIONS: In the University of Alberta Hospital, the rate ofS maltophiliaBSI remains low and constant, and TMP/SMX remains the drug of choice for treatment.

Nosocomial Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus AureusPrimary Bacteremia: At What Costs?

1999 ◽  
Vol 20 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Murray A. Abramson ◽  
Daniel J. Sexton
Keyword(s):  
Hospital Stay ◽  
Medical Center ◽  
A Priori ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Tertiary Care Medical Center ◽  
Matching Criteria ◽  
Nested Case Control

Objective:To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).Design:Pairwise-matched (1:1) nested case-control study.Setting:University-based tertiary-care medical center.Patients:Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.Measurements:Length of hospital stay and total and variable direct costs of hospitalization.Results:The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).Conclusion:Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.

Abstract 13123: Early Mobilization of Older Adults in the Cardiac Intensive Care Unit

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Goldfarb ◽  
Koorosh Semsar-kazerooni ◽  
Jose Morais ◽  
Diana Dima
Keyword(s):  
Older Adults ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Hospital Death ◽  
Healthcare Team ◽  
Tertiary Care Centre ◽  
Discharge Home

Background: Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home. Results: There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90. Conclusion: EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

Survey of Infection Control Practices in Hemodialysis Units: Preventing Vascular Access–Associated Bloodstream Infections

2014 ◽  
Vol 35 (7) ◽  
pp. 833-838 ◽  
Author(s):  
Pascale Trépanier ◽  
Caroline Quach ◽  
Milagros Gonzales ◽  
Élise Fortin ◽  
Mohammed Kaouache ◽  
...  
Keyword(s):  
Infection Control ◽  
Vascular Access ◽  
Practice Guidelines ◽  
Online Survey ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Control Measures ◽  
Face Validity ◽  
Surveillance Program ◽  
Skin Disinfection

ObjectiveDespite surveillance, the Quebec Healthcare-Associated Infections Surveillance Program saw no improvement in vascular access–associated bloodstream infections in hemodialysis (HD). We aimed to determine the infection control measures recommended and implemented in Quebec’s HD units, compliance of local protocols to infection control practice guidelines, and reasons behind the low prevalence of arteriovenous fistulas.MethodsAn online survey was elaborated on the basis of the Centers for Disease Control and Prevention (CDC) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. The questionnaire was validated (construct, content, face validity, and reliability) and sent to all HD units in Quebec (n = 40). Results were analyzed using descriptive statistics, linear regression, and Poisson regression.ResultsThirty-seven (93%) of 40 HD units participated. Thirty (94%) of the 32 centers where central catheters are inserted have written insertion protocols. Compliance with practice guidelines is good, except for full-body draping during catheter insertion (79%) and ointment use at insertion site (3%). Prevention measures for catheter maintenance are in accordance with guidelines, except for skin disinfection with at least 0.5% chlorhexidine and 70% alcohol (67% compliance) and regular antiseptic ointment use at the insertion site (3%). Before fistula cannulation, skin preparation is suboptimal; forearm hygiene is performed in only 61% of cases. Several factors explain the low rate of fistulas, including patient preference (69%) and lack of surgical resources (39%; P = .01).ConclusionsImprovement in standardization of care according to practice guidelines is necessary. Fistula rate could be increased by improving access to surgical resources and patient education. Strategies are now being elaborated to address these findings.

Spontaneous pneumomediastinum: ten years of our experience in diagnosis and outcome

Open Medicine ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. 642-647
Author(s):  
Sanja Hromis ◽  
Biljana Zvezdin ◽  
Ivan Kopitovic ◽  
Senka Milutinov ◽  
Violeta Kolarov ◽  
...  
Keyword(s):  
Chest Pain ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Sudden Onset ◽  
Recurrent Event ◽  
First Episode ◽  
Close Monitoring ◽  
Tertiary Care Centre ◽  
Benign Condition ◽  
Spontaneous Pneumomediastinum

AbstractSpontaneous pneumomediastinum (SPM) is a rare clinical condition that may be mild but also dramatic with sudden onset of chest pain and dyspnea accompanied by swelling and subcutaneous crepitations. The objective of this study was to analyze the clinical presentation and outcome of SPM in a specialized pulmonary tertiary care centre over a 10 years year period. In subsequent followup, we received information related to recurrence episodes of SPM by patients or their GPs physicians. Eighteen patients, 15 (83%) men, mean age 24 years (SD ±7.86) were diagnosed with SPM. Predominant symptoms were chest pain and cough (n=11) then dyspnea (n=9). Asthma was the most common predisposing condition (n=12). Pneumomediastinum was present on chest radiograph in 17 cases (94%), and in one case it was detected only by computed tomography. The mean length of hospital stay was 7 days (SD ±4.4 days). All our patients recovered and there were no complications. Recurrent event occurred in one asthma patient, 2 years after the first episode. Although, SPM is usually a self-limiting and benign condition, close monitoring is necessary. Recurrence is rare, but possible, with no evidence that routine monitoring of those patients is needed.

scholarly journals A study on the bacterial isolates from blood cultures of a tertiary care hospital

2021 ◽  
Vol 7 (3) ◽  
pp. 171-174
Author(s):  
KMS Mohamed Ali ◽  
K Girija
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Bacterial Isolates ◽  
Tertiary Care Centre ◽  
Sensitivity Testing ◽  
Cross Sectional ◽  
Blood Samples

Blood stream infections are the most important and common cause of morbidity and mortality in tertiary care hospitals. Since the results are usually not available promptly a knowledge of epidemiologic and antimicrobial susceptibility pattern of blood pathogens is life saving and very useful for early treatment and recovery of patients. The aim of this study is to describe the epidemiological, bacterial profile and antimicrobial resistance pattern of bloodstream infections in a tertiary care centre.A prospective cross-sectional study was done on seven hundred and eight blood samples collected over a period of six months in the Microbiology laboratory. Blood samples collected under aseptic conditions were cultured by aerobic culture method. Identification of bacterial isolates were done using standard bacteriologic and biochemical testing methods and antibiotic sensitivity testing done by Kirby - Bauer disc diffusion method.Bacteria was isolated in 201 (28.3%) samples with highest rates among newborns 84(41.8%). The most frequent isolates were 111 (55.2%) followed by 49 (24.4%). Results showed high susceptibilities of CoNS 111 (100%) to Vancomycin, Linezolid and 51 (98%) to Meropenem. This study highlights the common prevalent bacteriological agents in bacteremia, their antibiotic susceptibility & resistance patterns. and multi drug resistant were the leading causes of septicaemia in our hospital with Vancomycin, Linezolid and Carbapenems the effective antibiotics against these pathogens respectively.

Determining the Clinical Significance of Coagulase-Negative Staphylococci Isolated From Blood Cultures

2005 ◽  
Vol 26 (6) ◽  
pp. 559-566 ◽  
Author(s):  
Susan E. Beekmann ◽  
Daniel J. Diekema ◽  
Gary V. Doern
Keyword(s):  
Clinical Significance ◽  
Clinical Evidence ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Bloodstream Infections ◽  
Sepsis Syndrome ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Inappropriate Use

AbstractBackground and Objective:Coagulase-negative staphylococci are both an important cause of nosocomial bloodstream infections and the most common contaminants of blood cultures. Judging the clinical significance of coagulase-negative staphylococci is vital but often difficult and can have a profound impact on an institution's bloodstream infection rates. Our objective was to develop an algorithm to assist in determining the clinical significance of coagulase-negative staphylococci.Design:A single experienced reviewer examined the medical records of 960 consecutive patients with positive blood cultures in a tertiary-care referral teaching hospital. Four hundred five of the cultures contained coagulase-negative staphylococci. A determination of clinical significance was made and the performances of various published algorithms that contained readily available clinical and laboratory data were compared.Results:Eighty-nine (22%) of the episodes were considered significant, whereas 316 were contaminants. Patients with bacteremia were significantly more likely to be neutropenic and exhibit signs of sepsis syndrome. The algorithm with the best combined sensitivity (62%) and specificity (91%) for determining the clinical significance of coagulase-negative staphylococci was defined as at least two blood cultures positive for coagulase-negative staphylococci within 5 days, or one positive blood culture plus clinical evidence of infection, which includes abnormal white blood cell count and temperature or blood pressure.Conclusion:Use of this algorithm could potentially reduce misclassification of nosocomial bloodstream infections and inappropriate use of vancomycin for positive blood cultures likely to represent contamination (Infect Control Hosp Epidemiol2005;26:559-566).

scholarly journals Clinico-pathological spectrum and novel karyotypic findings in myelodysplastic syndrome: Experience of tertiary care centre in India

2017 ◽  
Vol 9 (1) ◽  
pp. e2017048 ◽  
Author(s):  
Ruchi Gupta ◽  
Khaliqur Rahman ◽  
Khaliqur Rahman ◽  
Manish Kumar Singh ◽  
Manish Kumar Singh ◽  
...  
Keyword(s):  
High Risk ◽  
Myelodysplastic Syndrome ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Risk Groups ◽  
Limited Data ◽  
Tertiary Care Centre ◽  
Prognostic Group ◽  
Cytogenetic Profile ◽  
High Disease Burden

Background: Myelodysplastic syndrome (MDS) is a heterogeneous disorder characterized clinically by presence of cytopenia/s. Limited data is available pertaining to the morphological spectrum and cytogenetic profile of Indian MDS patients. The aim of the study was to ascertain the clinco pathological, morphological and cytogenetic spectrum of Indian MDS patients. Material and methods: A retrospective analysis of all patients diagnosed as MDS from June 2012-December 2016 was performed. Their clinical and laboratory data was collated and reviewed.Results: A total of 150 patients of as primary MDS were evaluated with M: F ratio of 1.6:1 and median age of 55.5 years. 64% patients presented with pancytopenia, with thrombocytopenia alone was seen in only 2 cases. There were 66 (44%) cases of MDS-MLD, 33 (22%) MDS-EB 2, 32 (21.3%) MDS–EB 1, 13 (8.6%) cases MDS-SLD and two cases each of MDS-SLD-RS, MDS-MLD-RS and RCC. Cytogenetic data was available in 86/150 patients, 50% of which were abnormal. Complex karyotype was observed to be the commonest abnormality (27.5%). Novel translocations like t(9;22)(q11.2;q34.2) in addition to other abnormalities (n=3), t(2;4)(p25;q23),t(1;5)(p22;q33), t(1;12)(p34;p11.2) and t(5;7;9;)(q13;q32;p22) were observed.Conclusion: The median age of patients in India is almost a decade younger than the western population. Moreover, majority of the patients belonged to the high risk IPSS-R prognostic group (31.4%), followed by intermediate (29%) and very high risk groups (24.4%) in our cohort of patients. Seventy percent individuals, < 40 years belonged to the high prognostic categories, indicating that Indian MDS patients have high disease burden and in turn more likelihood for leukemic transformation.

Prevalence of Nosocomial Infection and Antibiotic Use at a University Medical Center in Malaysia

2005 ◽  
Vol 26 (1) ◽  
pp. 100-104 ◽  
Author(s):  
Andrew J. Hughes ◽  
Norliza Ariffin ◽  
Tan Lien Huat ◽  
Habibah Abdul Molok ◽  
Salbiah Hashim ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Medical Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Developed Countries ◽  
High Rate ◽  
Antibiotic Prescribing ◽  
Tract Infections

AbstractBackground and Objective:Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We exMnined the rate of N1 in our institution.Methods:A point-prevalence study of N1 and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for N1, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication.Setting:Tertiary-care referral center in Malaysia.Patients:All inpatients during the time of the study.Results:Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.29-6), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%).Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. N1 treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for N1 treatment was estimated to be approximately 2 million per year (Malaysian dollars).Conclusion:Whereas the rate of N1 is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.

scholarly journals Vascular comorbidities worsen prognosis of patients with heart failure hospitalised with COVID-19

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001668
Author(s):  
Jacob Mok ◽  
Juan Carlos Malpartida ◽  
Kimberly O'Dell ◽  
Joshua Davis ◽  
Cuilan Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Ischaemic Stroke ◽  
Tertiary Care ◽  
Vascular Diseases ◽  
Length Of Hospital Stay ◽  
Arterial Disease ◽  
Tertiary Care Centre ◽  
Peripheral Arterial

BackgroundPrior diagnosis of heart failure (HF) is associated with increased length of hospital stay (LOS) and mortality from COVID-19. Associations between substance use, venous thromboembolism (VTE) or peripheral arterial disease (PAD) and its effects on LOS or mortality in patients with HF hospitalised with COVID-19 remain unknown.ObjectiveThis study identified risk factors associated with poor in-hospital outcomes among patients with HF hospitalised with COVID-19.MethodsCase–control study was conducted of patients with prior diagnosis of HF hospitalised with COVID-19 at an academic tertiary care centre from 1 January 2020 to 28 February 2021. Patients with HF hospitalised with COVID-19 with risk factors were compared with those without risk factors for clinical characteristics, LOS and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF hospitalised with COVID-19.ResultsTotal of 211 patients with HF were hospitalised with COVID-19. Women had longer LOS than men (9 days vs 7 days; p<0.001). Compared with patients without PAD or ischaemic stroke, patients with PAD or ischaemic stroke had longer LOS (7 days vs 9 days; p=0.012 and 7 days vs 11 days, p<0.001, respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared with younger patients (adjusted OR: 1.04; 95% CI 1.00 to 1.07; p=0.036). Prior diagnosis of VTE increased mortality more than threefold in patients with HF hospitalised with COVID-19 (adjusted OR: 3.33; 95% CI 1.29 to 8.43; p=0.011).ConclusionVascular diseases increase LOS and mortality in patients with HF hospitalised with COVID-19.

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