Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.

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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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MALNUTRITION, SEPSIS AND TUMOR LYSIS SYNDROME ARE ASSOCIATED WITH INCREASED RATE OF ACUTE MORTALITY IN MATURE B CELL NON-HODGKIN LYMPHOMA IN PEDIATRIC POPULATION- STUDY FROM TERTIARY CARE HOSPITAL IN PAKISTAN

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2019.043 ◽

2019 ◽

Vol 11 (1) ◽

pp. 02019043

Author(s):

Raheela Mansoor

Keyword(s):

Risk Factors ◽

Fungal Infection ◽

B Cell ◽

Pediatric Population ◽

Tertiary Care ◽

Tumor Lysis Syndrome ◽

Significant Risk ◽

Early Death ◽

Care Hospital ◽

Tumor Lysis

Background: Outcomes of pediatric mature B cell NHL in resource challenged countries are negatively affected by increased rate of early and toxic deaths. Aim of this study is to assess rate of acute mortality and define significant risk factors present in children with mature B Cell NHL. Methods: A retrospective analysis was done of patients with B cell NHL from January 2012 till December 2016. Risk factors studied for acute mortality were malnutrition, stage, prior surgery with open laparotomy, LDH levels, tumor lysis syndrome, sepsis and fungal infection Results: Total 233 patients were enrolled in the study. Eighty five (36.4%) were below 15th percentile. Treatment was started in 226 patients. Eighty eight percent children showed 20% response after COP pre-phase. Tumor lysis syndrome was developed in 20.6 % (n = 48) children and 42.9% (n = 100) patients had sepsis, 71/100 patients had culture proven sepsis. 19.7% (n = 46) patients developed fungal infection. There was 19.7% (n = 46) acute mortality. Most common cause of death was sepsis (n = 22, 47.8%) followed by acute renal failure secondary to tumor lysis syndrome. On multivariate analysis, three independent variables found significant for early death are malnutrition, sepsis and tumor lysis syndrome. Conclusion: Rate of acute mortality in B cell NHL is high in our set up and significant risk factors are tumor lysis syndrome, sepsis and malnourishment at time of presentation.

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Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

Journal of Laboratory Physicians ◽

10.4103/0974-2727.98670 ◽

2012 ◽

Vol 4 (01) ◽

pp. 039-042 ◽

Cited By ~ 12

Author(s):

Simit H Kumar ◽

Anuradha S De ◽

Sujata M Baveja ◽

Madhuri A Gore

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Tertiary Care ◽

Significant Risk ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Resistance Mechanisms ◽

Care Hospital ◽

Acinetobacter Species ◽

Carbapenem Resistant

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

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Methicillin Resistance and Risk Factors for Embolism inStaphylococcus aureusInfective Endocarditis

Infection Control and Hospital Epidemiology ◽

10.1086/518727 ◽

2007 ◽

Vol 28 (7) ◽

pp. 860-866 ◽

Cited By ~ 11

Author(s):

Ron-Bin Hsu ◽

Fang-Yue Lin

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Methicillin Resistance ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Neurological Involvement ◽

Hospital Death ◽

Care Hospital ◽

Methicillin Resistant ◽

Independent Risk Factors

Objective.Infective endocarditis caused byStaphylococcus aureusis an ominous prognosis associated with a high prevalence of embolic episodes and neurological involvement. Whether methicillin resistance decreases the risk of embolism in infective endocarditis is unclear. We sought to assess the association between methicillin resistance and risk factors for embolism in S.aureusinfective endocarditis.Design.Retrospective chart review. Data from patients with infective endocarditis due to methicillin-resistantS. aureus werecompared with data from patients with endocarditis due to methicillin-susceptibleS. aureus.Logistic regression was used to identify independent risk factors for embolism.Setting.A 2,000-bed, university-affiliated tertiary care hospital.Patients.Between 1995 and 2005, 123 patients withS. aureusinfective endocarditis were included in the study. There were 74 male patients and 49 female patients, with a median age of 54 years (range, 0-89 years).Results.Of 123 infections, 30 (24%) were nosocomial infections, and 14 (11%) were prosthetic valve infections. Of 123S. aureusisolates, 48 (39%) were methicillin resistant. In total, embolism occurred in 45 (37%) of these patients: pulmonary embolism in 22 (18%), cerebral embolism in 21 (17%), and peripheral embolism in 6 (5%). The independent risk factors for an embolism were injection drug use, presence of a cardiac vegetation with a size of 10 mm or greater, and absence of nosocomial infection. For 83 patients with aortic or mitral infective endocarditis, independent risk factors for an embolism were the presence of a cardiac vegetation with a size of 10 mm or greater and endocarditis due to methicillin-susceptibleS. aureus.Overall, in-hospital death occurred for 32 (26%) of 123 Patients. Methicillin-resistant infection was not an independent risk factor for death.Conclusions.Methicillin-resistant S.aureusinfection was associated with decreased risk of embolism in left-side endocarditis, but was not associated with in-hospital death.

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Sex differences in clinical presentation in acute MI

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20173176 ◽

2017 ◽

Vol 4 (4) ◽

pp. 940

Author(s):

Ashwin Kodliwadmath ◽

Naren V. Nimbal

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Chest Pain ◽

Clinical Presentation ◽

Tertiary Care ◽

Significant Risk ◽

Significant Risk Factor ◽

Control Group ◽

Care Hospital ◽

Acute Mi

Background: Acute myocardial infarction differs in women and men with respect to risk factors and clinical presentation. There are studies carried out worldwide on this issue but few from India. This study was done to study the sex based differences in the risk factors and clinical features of acute MI in patients with Indian ethnicity.Methods: Comparative prospective study consisting of 100 women as study group and 100 men as control group with acute MI, who were admitted in a tertiary care hospital, from December 2016 to June 2017.Results: Chest pain was the main complaint in majority of the women (82%) and men (88%). Radiation of chest pain (87%) and sweating (90%) were significantly present in men compared to women (65% and 62% respectively), while breathlessness was significantly present in women (78%) compared to men (64%) and fatigue in women (76%) significantly more than men (55%). Smoking was a significant risk factor in men (69%) compared to women (5%), while diabetes mellitus was a significant risk factor in women (62%) compared to men (39%).Conclusions: Women with acute MI had more atypical presentation of symptoms, similar risk factors, compared to men except for smoking which was more significant in men and diabetes more common in women.

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Evaluating Vancomycin Use at a Pediatric Hospital: New Approaches and Insights

Infection Control and Hospital Epidemiology ◽

10.1086/502486 ◽

2005 ◽

Vol 26 (1) ◽

pp. 47-55 ◽

Cited By ~ 20

Author(s):

Maureen K. Bolon ◽

Alana D. Arnold ◽

Henry A. Feldman ◽

David H. Rehkopf ◽

Emily F. Strong ◽

...

Keyword(s):

Risk Factors ◽

Factor Analysis ◽

Risk Factor ◽

Tertiary Care ◽

Significant Risk ◽

Risk Factor Analysis ◽

Cell Transplant ◽

Care Hospital ◽

Inappropriate Use ◽

Tertiary Care Medical Center

AbstractObjectives:To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use.Design:Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multi-variable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use.Setting:A pediatric tertiary-care medical center.Patients:Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001.Results:Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use.Conclusions:Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.

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FREQUENCY OF DIABETIC RETINOPATHY IN TYPE 2 DIABETES MELLITUS WITH REFERENCE TO RISK FACTORS IN A TERTIARY CARE HOSPITAL IN SOUTH WESTERN MAHARASHTRA

10.36106/ijsr/6106189 ◽

2020 ◽

pp. 75-77

Author(s):

Satish Desai ◽

Priyanka A. Mahendrakar

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Tertiary Care ◽

Positive Family History ◽

Significant Risk ◽

Care Hospital

AIM: To estimate the frequency of Diabetic Retinopathy and the possible risk factors associated with Diabetic Retinopathy. MATERIALS AND METHODS: All patients of diagnosed type 2 Diabetes Mellitus attending Ophthalmology Outpatient Department in Government Medical College and Hospital, Miraj during the study period were included. History was taken and a complete ophthalmic examination was done. Diabetic Retinopathy was graded according to ETDRS classification. Data was analyzed using SPSS 22 version software. RESULT: A total of 275 patients with diagnosed Diabetes Mellitus were examined. Frequency of diabetic retinopathy in the study was 30.91%. Significant association was found with male gender (p=0.008), duration of Diabetes Mellitus more than 10 years (p<0.001), positive family history (p<0.001), use of insulin (p<0.001), raised systolic and diastolic blood pressure (p<0.001), fasting and post prandial blood sugar levels (p<0.001). Age, smoking status and body mass index were not found to be significant risk factors for the development of diabetic retinopathy.

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Risk factors for unfavorable clinical outcomes in patients with brain abscess in South Korea

PLoS ONE ◽

10.1371/journal.pone.0257541 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257541

Author(s):

Yun Suk Cho ◽

Yu Jin Sohn ◽

Jong Hoon Hyun ◽

Yae Jee Baek ◽

Moo Hyun Kim ◽

...

Keyword(s):

Risk Factors ◽

South Korea ◽

Clinical Outcomes ◽

Brain Abscess ◽

Charlson Comorbidity Index ◽

Tertiary Care ◽

Significant Risk ◽

Neurological Deficits ◽

Care Hospital ◽

Comorbidity Index

Background Brain abscess can be life-threatening and manifest various neurological findings, although the mortality rate has decreased recently. We investigated the risk factors for unfavorable outcomes of patients with brain abscess. Methods A retrospective cohort study examined patients with brain abscess seen from May 2005 to December 2018 in a tertiary care hospital in Seoul, South Korea. We reviewed the medical records for clinical findings, therapeutic modalities, and prognostic factors of brain abscess. Unfavorable clinical outcomes were defined as death, moderate to severe disability with neurological deficits, or vegetative state at 1 year or at the time of discharge from outpatient follow-up. Results The study enrolled 135 patients: 65.2% were males; the mean age was 56 years. 35.6% had unfavorable outcomes. In multivariate analysis, higher Sequential Organ Failure Assessment (SOFA) (p < 0.001), pre-existing hemiplegia (p = 0.049), and higher Charlson comorbidity index (CCI) (p = 0.028) were independently associated with unfavorable outcomes. Conclusions Higher SOFA, pre-existing hemiplegia and higher Charlson comorbidity index were significant risk factors for unfavorable clinical outcomes in patients with brain abscess.

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Risk Factors for Clostridium Difficile Infection in a Tertiary Care Hospital

Internal Medicine And Medical Investigation Journal ◽

10.24200/imminv.v2i4.151 ◽

2018 ◽

Vol 3 (3) ◽

pp. 124

Author(s):

Muralidhar Varma ◽

Neha Agrawal ◽

Pallavi Uppal ◽

Rahul Singh ◽

Karunya Jayasimha ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Case Control Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Significant Risk ◽

Care Hospital ◽

The Past ◽

Appropriate Treatment ◽

Control Study

Introduction: Clostridium difficile infections have had significant morbidity and mortality in the last decade leading to high healthcare costs. Our prospective case-control study from October 2013 to May 2015 in a tertiary care hospital in rural India aimed to evaluate the risk factors, treatment, outcome, and complications of Clostridium difficile infections in hospitalized patients.Materials and Methods: The study involved a total of 183 patients, of which 61 were cases, and 122 were controls. Data was analyzed using multivariate logistic regression.Results: Antibiotic intake in the past four weeks (p=0.003), hypoalbuminemia (p=0.001) and duration of hospital stay before the onset of diarrhea (p<0.001) were proven to have significant risk. We subdivided cases into severe and non-severe cases, and we found that complications were statistically higher in severe cases (OR= 1.685, <0.001).Conclusion: Identifying severe cases and administering timely and appropriate treatment is prudent.

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Surgical site infections at a Saudi hospital: The need for a national surveillance program

International Surgery ◽

10.9738/intsurg-d-16-00199.1 ◽

2017 ◽

Author(s):

Saeed Ali Alsareii

Keyword(s):

Risk Factors ◽

Developing Countries ◽

Surgical Site Infection ◽

Tertiary Care ◽

Significant Risk ◽

Surveillance Program ◽

Care Hospital ◽

National Surveillance ◽

Site Infection ◽

Acinetobacter Spp

ABSTRACT Background: Surgical site infection (SSI) continues to be a global health problem that causes increased morbidity and mortality, especially in developing countries. Objective: This study aimed to determine the prevalence of SSI, the microbial pathogens and their resistance patterns, as well as to identify risk factors associated with this infection at a Saudi tertiary care hospital. Methods: This cross-sectional observational study involved all patients who had surgery and who stayed in the hospital for at least 48 h during a one-year period. SSI was diagnosed using the guidelines of the Centers for Disease Control and Prevention. Results: A total of 2160 patients were included and the overall SSI rate was 10.2%. Malignancy (OR = 1.63), duration of operation (OR = 1.41), high ASA score (OR = 1.8), and clean-contaminated (OR = 1.5) and contaminated operations (OR = 3.2) were found to be statistically significant risk factors for SSI. The most frequently isolated microorganisms were Acinetobacter spp. (31.5%), E. coli (25.5%) and Pseudomonas spp. (17.9%). Conclusions: This study further illustrates the burden of SSI in a typical hospital situation in developing countries. Our findings highlight the urgent need to develop a consistent national surveillance program for SSI with accurate feedback of appropriate data to help surgeons control and reduce the SSI rates in developing countries. Keywords: Surgical site infection - surveillance - contaminated wounds - Acinetobacter spp.

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