scholarly journals Bacterial and fungal growth in sputum cultures from 165 COVID-19 pneumonia patients requiring intubation: evidence for antimicrobial resistance development and analysis of risk factors

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hans H. Liu ◽  
David Yaron ◽  
Amanda Stahl Piraino ◽  
Luciano Kapelusznik
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Nursing Home Residents ◽  
Total Mortality ◽  
Fungal Growth ◽  
Resistance Development ◽  
Hospital System ◽  
Oral Flora ◽  
Significance Level ◽  
Overall Mortality

Abstract Background Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial coinfection superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. Methods Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05. Results Average patient age was 68.7 years and LOS 19.9 days. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall did not suggest acute bacterial or fungal infection in 73 (45%) of 165 individuals sampled within 24 h of intubation. Cultures ≥ 1 week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus. Conclusions In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum prior to/around the time of intubation correlated with no culture growth or recovery of normal oral flora ± yeast. Discontinuation of empiric antibacterials should be considered in these patients aided by other clinical findings, history of prior antimicrobials, laboratory testing, and overall clinical course. Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance. Trial registration: Not applicable as this was a retrospective chart review study without interventional arm.

scholarly journals Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

2020 ◽  
Author(s):  
Hans H Liu ◽  
David Yaron ◽  
Amanda Stahl Piraino ◽  
Luciano Kapelusznik
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Nursing Home Residents ◽  
Total Mortality ◽  
Fungal Growth ◽  
Severe Pneumonia ◽  
Resistance Development ◽  
Hospital System ◽  
Significance Level ◽  
Overall Mortality

Abstract Background: Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. Methods: Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1,058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05.Results: Average patient age was 68.7 years. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall were evaluated and did not suggest acute bacterial or fungal infection in 89 (54%) of 165 individuals sampled within 24 hours of intubation. Cultures > one week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus.Conclusions: In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum suggest antibacterials are not needed. Discontinuation of empiric antibacterials should be considered after 48 hours in absence of sputum to culture or results reported "without growth" or "normal flora." Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance.Trial registration: Not applicable as this was a retrospective chart review study without interventional arm.

scholarly journals Cardiovascular diseases burden in Italy, 1990–2017: the Global Burden of Disease Study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Fornari ◽  
P A Cortesi ◽  
F Madotto ◽  
S Conti ◽  
G Crotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Diseases ◽  
National Health ◽  
Population Aging ◽  
National Health System ◽  
Total Mortality ◽  
Premature Death ◽  
Global Burden ◽  
High Systolic Blood Pressure ◽  
Life Years

Abstract Background Cardiovascular diseases (CVDs) are still the leading cause of mortality, morbidity and disability in Europe. Consequently, an exhaustive estimation of CVDs burden and cardiovascular risk factors impact is crucial for healthcare planning and resource allocation. In Italy, data on CVDs burden are sparse. This study aims to assess the global Italian CVDs burden and to analyze time changes from 1990 to 2017 within the country and in comparison to other European states. Methods We used data from the 2017 Global Burden of Diseases (GBD) study to estimate CVDs prevalence, mortality and disability-adjusted life-years (DALYs) in Italy from 1990 to 2017. We also analyzed burden attributable to CVDs-related risk factors. Finally, Italian estimations were compared to those of the other 28 European Union countries. Results CVDs were still the first cause of death (34.8% of total mortality) in Italy in 2017. A significant decrease in CVDs burden was observed since 1990: age-standardized prevalence (-12.7%), mortality rate (-53.75%), and DALYs rate (-55.54%) all decreased. Similar patterns were observed also in the majority of European countries. Despite these trends, all-ages CVDs prevalent cases increased from 5.75 million to 7.49 million. More than 80% of CVDs burden could be attributed to known modifiable risk factors such as high systolic blood pressure, dietary risks, high LDL cholesterol, and impaired kidney function. Conclusions Data showed a decline in cardiovascular mortality and DALYs, which reflects the success in terms of reducing disability, premature death and early incidence of CVDs. However, the burden of CVDs is still high, as population aging and the increased prevalent cases require more access to care and generate more years lived with disability, which in turn leads to higher costs for the National Health Service and society. More efficient prevention strategies at community and individual level are needed. Key messages Despite decreasing trends in CVDs mortality and DALYs, the burden of CVDs is still high in Italy. A joined approach of the National Health System stakeholders is needed to keep reducing the CVDs burden.

scholarly journals Risk factors for antibiotic resistance development in healthcare settings in China: A systematic review

2021 ◽  
pp. 1-30
Author(s):  
Qi Chen ◽  
Duguang Li ◽  
Claudia Beiersmann ◽  
Florian Neuhann ◽  
Babak Moazen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Antibiotic Resistance ◽  
Resistance Development ◽  
Healthcare Settings

scholarly journals Dietary Factors of blaNDM Carriage in Health Community Population: A Cross-Sectional Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5959
Author(s):  
Shuangfang Hu ◽  
Ziquan Lv ◽  
Qiumei Xiang ◽  
Yang Wang ◽  
Jianzhong Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Cross Sectional Study ◽  
Dietary Factors ◽  
Coarse Grain ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Community ◽  
Health Communities ◽  
Tuber Crops

Aim: There is an ongoing debate as to what extent antimicrobial resistance (AMR) can be transmitted from dietary to humans via the consumption of food products. We investigated this association between dietary and global spreading carbapenem-resistant gene blaNDM Methods: We did a cross-sectional study to assess the risk factors for carrier of blaNDM in health community. Healthy adults were recruited from the residents attending Community Healthcare Service in Shenzhen City (Guangdong Province, China), through 1February 2018 to 31December 2019, and 718 pre-participants were included in this study. Questionnaire were obtained and the qualitative food frequency questionnaire (Q-FFQ) were used to assess dietary intake. qPCR was applied to confirm the carrier of blaNDM in participants’fecal samples. Multivariable logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of each outcome according to each dietary factor before and after prosperity score matching (PSM). Results: we showed that a high intake of coarse grain (OR 1.003; 95% CI 1.001–1.005, p < 0.01) and root and tuber crops (OR 1.003; 95% CI 1.001–1.004, p < 0.05) were independent risk factor for blaNDM carrier in health communities, suggesting a possible transfer of AMRbetweendietary andhumans. Surprisingly, we also showed an association between a higher intake of poultry as a protective, which may be explained by the beneficial effects on the gut microbiota. Conclusion: Dietary factors such as intake of coarse grain, root and tuber crops and poultry were associated with blaNDM carrier in health communities. The influence of dietary factorson blaNDM carrier in the present study provides insights for the tangible dietary advice with guidelines to the routine of people with the risk of blaNDM carrier. This demonstrates the role of dietary intake in the prevention of blaNDM carrier, since prevention is the best way to control modifiable risk factors. A lower carrier rate of blaNDM is helpful to reduce the possibility of transmission and pathogenicity. Further studies on food, microbiota and antimicrobial resistance are necessary to confirm this possible association and unravel underlying mechanisms.

scholarly journals Potential of nanoparticles encapsulated drugs for possible inhibition of the antimicrobial resistance development

2021 ◽  
Vol 141 ◽  
pp. 111943
Author(s):  
Ramendra Pati Pandey ◽  
Riya Mukherjee ◽  
Anjali Priyadarshini ◽  
Archana Gupta ◽  
Arpana Vibhuti ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Resistance Development

scholarly journals Association between antimicrobial usage and resistance in Salmonella from poultry farms in Nigeria

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Abdurrahman Hassan Jibril ◽  
Iruka N. Okeke ◽  
Anders Dalsgaard ◽  
John Elmerdahl Olsen
Keyword(s):  
Treatment Outcome ◽  
Antimicrobial Resistance ◽  
Global Health ◽  
Human Medicine ◽  
Antimicrobial Use ◽  
Resistance Development ◽  
Use Patterns ◽  
Antimicrobial Usage ◽  
Poultry Farms ◽  
Reduction Strategies

Abstract Background Antimicrobial resistance (AMR) is a global health threat affecting treatment outcome in animals and humans. A pre-requisite for development of AMR reduction strategies is knowledge of antimicrobial use patterns, and how these affect resistance development. The aim of this study was to determine antimicrobial usage (AMU) and whether such usage was associated with AMR in Salmonella from poultry farms in Northwest Nigeria. Results Fifteen (37%) of antimicrobial products observed contained compounds that are of highest priority and critically important for human medicine. Broilers chicken consumed higher (28 ± 14 mg/kg active ingredients) amounts of antimicrobials compared to layers (13 ± 8 mg/kg) per week (p = 0.0009). Surprisingly, chickens raised under backyard system consumed higher amounts of antimicrobials (34 ± 7 mg/kg) than poultry in other systems (p = 0.02). High levels of resistance to tetracycline (58%), sulphonamides (65%), ciprofloxacin (46%) and gentamicin (42%) correlated with high farm level usage of these antimicrobials, and there was a strong correlation (r = 0.9) between farm usage and resistance of isolates to the same antimicrobials (p = 0.03). Conclusion High AMU, including use of highest priority critically important antimicrobials was observed at poultry farms in Northwest Nigeria. AMU correlated with high levels of resistance. Communication of prudent use of antimicrobials to farmers and regulation to obtain reduction in AMU should be a priority.

scholarly journals Advanced cognitive impairment among older nursing home residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tadeja Gracner ◽  
Patricia W. Stone ◽  
Mansi Agarwal ◽  
Mark Sorbero ◽  
Susan L Mitchell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Cognitive Impairment ◽  
Mortality Risk ◽  
Advanced Disease ◽  
Nursing Home Residents ◽  
Functional Score ◽  
Data Set

Abstract Background Though work has been done studying nursing home (NH) residents with either advanced Alzheimer’s disease (AD) or Alzheimer’s disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. Methods This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011–2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. Results Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p < 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). Conclusions There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care.

Social assessment of children dental health and its determining factors

2021 ◽  
Vol 21 (2) ◽  
pp. 123-131
Author(s):  
T. G. Svetlichnaya ◽  
A. S. Mityagina ◽  
T. M. Burkova ◽  
N. M. Ogorelkova
Keyword(s):  
Risk Factors ◽  
Oral Hygiene ◽  
Primary Teeth ◽  
Dental Health ◽  
Tooth Decay ◽  
Chi Square ◽  
Significance Level ◽  
Pediatric Dentist ◽  
Chi Square Test ◽  
Decay Risk

Relevance. The high prevalence of tooth decay requires investigation of its risk factors. The aim was to study tooth decay risk factors among six-year-old children according to the level of dental health (based on parents’ assessment).Materials and methods. The research evaluated the dental health of six-year-olds and factors defining their oral health; The study surveyed 515 parents of six-year-old children from 7 kindergartens in Arkhangelsk. Pearson chi-square test assessed the differences in the frequency of tooth decay factors among six-year-old children according to the level of dental health. The accepted significance level was 0.05.Results. The Arkhangelsk parents evaluated the dental health of their six-year-olds as relatively favourable: good (41.2%) and satisfactory (46.6%). Only 9.5% of children had poor health. Children generally had good oral hygiene skills: 86.8% liked brushing their teeth; 60.2% squeezed the optimal amount of toothpaste on the toothbrush; 56.7% brushed their teeth twice a day. The dental literacy of parents was satisfactory: 67.0% purchased toothpaste for children; 90.8% considered necessary to treat primary teeth; 69.2% replaced toothbrush every three months; 59.7% visited a pediatric dentist twice a year. The children with poor dental health had insufficient oral hygiene skills: 46.9% did not like teeth cleaning; 51.1% brushed their teeth once a day. Their diet was not healthy: 100.0% did not eat hard food; 65.3% frequently consumed sweets. The parents  of children with poor dental health had low medical literacy and poor oral hygiene: 46.9% did not know that treatment of primary teeth was necessary; 42.9% considered the treatment of primary teeth as unnecessary; 32.6% purchased whatever toothpaste. The general negative trend is to use toothpaste without fluoride (68.1%).Conclusions. The results of the study demonstrated a significantly higher frequency of cariogenic factors in children with poor dental health.

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