A hospital-wide outbreak of IMI-17-producing Enterobacter ludwigii in an Israeli hospital

Absract Background To describe the course and intervention of an hospital-wide IMI-Producing Enterobacter ludwigii outbreak. Methods This was an outbreak interventional study, done at a tertiary care center in Tel-Aviv, Israel. Data was collected on the course of the outbreak and the demographic and clinical characteristics of all patients involved in the outbreak. The intervention measures included patients’ cohorting, contact isolation precautions, environmental cleaning and screening of contacts. The molecular features and phylogeny of outbreak-related isolates were studied by whole-genome based analysis. Results The outbreak included 34 patients that were colonized by IMI-Producing E. ludwigii and were identified in 24 wards throughout the hospital. Colonization was identified in the first 72 h of admission in 13/34 patients (38.2%). Most patients (91.2%) were admitted from home and had relatively low level of comorbidities. The majority of them (88%) had no recent use of invasive catheters and none had previous carriage of other multi-drug resistant bacteria. All available isolates harbored the blaIMI-17 allele and belonged to Sequence-Type 385. With the exception of two isolates, all isolates were closely related with less than a 20-SNP difference between them. Conclusions This outbreak had most likely originated in the community and subsequently disseminated inside our institution. More studies are required in order to elucidate the epidemiology of IMI-Producing E. ludwigii and the possible role of environmental sources in its dissemination.

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An Outbreak of Heterogeneous Glycopeptide-IntermediateStaphylococcus aureusRelated to a Device Source in an Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/663703 ◽

2012 ◽

Vol 33 (2) ◽

pp. 167-174 ◽

Cited By ~ 10

Author(s):

Sylvie Parer ◽

Anne Lotthé ◽

Patrick Chardon ◽

Rosie Poncet ◽

Hélène Jean-Pierre ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care ◽

Normal Activity ◽

University Hospital ◽

Surface Sampling ◽

Environmental Cleaning ◽

Environmental Investigation ◽

Contact Isolation

Objective.The emergence ofStaphylococcus aureuswith reduced susceptibility to glycopeptides (glycopeptide-intermediateS. aureus[GISA] and heterogeneous GISA [h-GISA]) leads to intensive care unit (ICU) outbreaks that frequently result in ward closure. We investigated the role of hospital hygiene in the transmission and eradication of an h-GISA outbreak.Design.The study is a description of an original environmental investigation around a series of 12 cases.Setting and Patients.The outbreak occurred in a 20-bed polyvalent/trauma ICU in a 2,800-bed tertiary care university hospital in France.Interventions.Specimens were obtained for surveillance and diagnostic cultures from all patients in the unit. Surface sampling was also performed. Geographic cohorting, contact isolation, emphasis on adherence to infection control practices, and environmental cleaning were implemented.Results.Twelve patients with h-GISA infection (n= 5) or colonization (n= 7) were identified. The mean interval between admission and h-GISA detection was 23.6 days (range, 10–89 days), with a median of 16.5 days. Environmental investigation identified an unexpected reservoir, namely, SpO2sensors. The outbreak was controlled by a combination of measures, including eradication of this reservoir, avoiding total ward closure.Conclusions.Targeted surface sampling helps to secure the environment through active investigation of various reservoirs while maintaining normal activity on the ward. In our study, this method led to the detection of an unsuspected reservoir, the eradication of which helped control the h-GISA epidemic. Further applications of this original investigative procedure should allow confirmation of its relevance and efficiency.Infect Control Hosp Epidemiol2012;33(2):167-174

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VASCULAR COMPLICATIONS OF CHRONIC PANCREATITIS AND ROLE OF EUS IN MANAGEMENT: EXPERIENCE FROM TERTIARY CARE CENTER IN NORTHWESTERN INDIA

10.1055/s-0040-1704545 ◽

2020 ◽

Author(s):

V Goel ◽

A Jhajharia ◽

V Chauhan ◽

M Ameta ◽

V Agarwal

Keyword(s):

Chronic Pancreatitis ◽

Care Center ◽

Tertiary Care ◽

Vascular Complications ◽

Tertiary Care Center ◽

Northwestern India ◽

Management Experience

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Defining the role of the pediatric critical care nurse practitioner in a tertiary care center

Critical Care Medicine ◽

10.1097/00003246-200007000-00074 ◽

2000 ◽

Vol 28 (7) ◽

pp. 2626-2630 ◽

Cited By ~ 28

Author(s):

Shari L. Derengowski ◽

Sharon Y. Irving ◽

Pamela V. Koogle ◽

Robert M. Englander

Keyword(s):

Critical Care ◽

Nurse Practitioner ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Pediatric Critical Care ◽

Care Nurse ◽

Critical Care Nurse

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Predictive Value of Combination of D-dimer and Fibrinogen in Diagnosing Acute CVST

Annals of Neurosciences ◽

10.1177/09727531211063138 ◽

2021 ◽

pp. 097275312110631

Author(s):

Abhishek Pathak ◽

Varun Kumar Singh ◽

Anand Kumar ◽

Vijaya Nath Mishra ◽

Deepika Joshi ◽

...

Keyword(s):

Early Diagnosis ◽

Predictive Value ◽

Sinus Thrombosis ◽

Care Center ◽

Tertiary Care ◽

Cerebral Venous Sinus Thrombosis ◽

Latex Agglutination ◽

D Dimer ◽

Latex Agglutination Assay

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke, and the role of D-dimer and fibrinogen in early diagnosis of CVST has been studied with varying results. The present study aims to study the role of the combination of D-dimer and fibrinogen in early diagnosis of acute CVST. Methods: Forty consecutive confirmed acute CVST cases admitted at a tertiary care center were recruited for the study. D-dimer and fibrinogen were assessed by a rapid semiquantitative latex agglutination assay. Results: Out of the 40 CVST patients, 21 (52.50%) were females. The mean age of the patients was 37.58 years ± 19.17 years. Common clinical features were headache ( N = 38 [95%]), papilloedema ( N = 15 [37.5%]), and seizures ( N = 12 [30%]). Although the sensitivity (75%) of the combination of D-dimer and fibrinogen assay was lower than that of D-dimer or fibrinogen alone, the specificity and positive predictive value (75% each) was higher. Conclusions: The combination of D-dimer and fibrinogen testing may aid in an early diagnosis of acute CVST and in better management.

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Role of Office-Based Vaginoscopy in a Tertiary Care Center

Urology Practice ◽

10.1097/upj.0000000000000266 ◽

2021 ◽

Author(s):

Rahul S. Patel ◽

Alana L. Christie ◽

Philippe E. Zimmern

Keyword(s):

Care Center ◽

Tertiary Care ◽

Tertiary Care Center

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Abstract 19134: Elevated Troponin T is Associated with Adverse Outcomes After Aortic Valve Replacement

Circulation ◽

10.1161/circ.130.suppl_2.19134 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ashwat Dhillon ◽

Kanhaiya Poddar ◽

Murat Tuzcu ◽

Eric Roselli ◽

Lars Svensson ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Troponin T ◽

Coronary Revascularization ◽

Care Center ◽

Tertiary Care ◽

Adverse Outcomes ◽

Post Procedure

Background: Data regarding association of elevated cardiac enzymes and adverse outcomes in patients who undergo aortic valve replacement (AVR) has been inconclusive. Role of coronary revascularization prior to AVR remains uncertain. We sought to understand prognostic implication of post procedure troponin T (TnT) elevation in patients undergoing AVR. Hypothesis: We hypothesized that patients with significantly elevated TnT after AVR will have worse outcomes representing important coronary circulation which is not revascularized. Methods: We retrospectively studied 4648 consecutive patients who underwent AVR at a single tertiary care center between January 2007 and December 2013. These were divided into surgical AVR (SAVR) and transcatheter AVR (TAVR). Median post procedure peak TnT was identified in the SAVR and TAVR groups. Patients were divided into quartiles based on median TnT level. Results: Of 4648 patients who underwent AVR, 4200 (66% male) were SAVR and 448 (59% male) were TAVR. Median post procedure peak TnT values in the TAVR and SAVR group were 0.19 [0.08-0.39] & 0.36 [0.22-0.64] respectively (p<0.001). 6 month mortality was 1.5% (65/4200) in SAVR cases and 2.7% (12/448) in TAVR cases (p=0.08). In patients with TnT less than 50 th percentile, 6 month mortality was 0.7% & 1.8% after SAVR & TAVR respectively (p=0.1). In patients with TnT higher than 50 th percentile, 6 month mortality was 2.4% & 3.6% after SAVR & TAVR respectively (p=0.26). In the SAVR group, mortality was 0.7% in patients with TnT levels less than 50 th percentile & 2.4% in patients with TnT higher than 50 th percentile (p<0.001). See Figure. Conclusion: Peak troponin T was significantly higher after SAVR as compared to TAVR. Higher post procedure peak TnT is associated with increased 6 month mortality. These results are highly significant in the SAVR group. The mechanism and significance of these findings requires further studies.

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Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420953963 ◽

2020 ◽

pp. 247412642095396

Author(s):

Cason B. Robbins ◽

Henry L. Feng ◽

Divakar Gupta ◽

Sharon Fekrat

Keyword(s):

Initial Treatment ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Light Perception ◽

Initial Management ◽

Pars Plana ◽

Line Loss

Purpose: Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. Methods: A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Results: Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). Conclusions: BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

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