scholarly journals Burns infection profile of Singapore: prevalence of multidrug-resistant Acinetobacter baumannii and the role of blood cultures

2016 ◽  
Vol 4 ◽  
pp. 1-9 ◽  
Author(s):  
Christopher Tam Song ◽  
Jolie Hwee ◽  
Colin Song ◽  
Bien Keem Tan ◽  
Si Jack Chong
Keyword(s):  
Hospital Stay ◽  
Acinetobacter Baumannii ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Burn Patients ◽  
Perioperative Antibiotics ◽  
Infection Profile

Abstract Background With various changes implemented such as perioperative antibiotics for tangential excision, this retrospective study reviews the infection profile of burn patients at Singapore’s only centralized burns unit. Worldwide, the appearance of multidrug-resistant (MDR) strains of Acinetobacter baumannii (A. baumannii) continues to worsen patient outcomes. This study also surveys the role of blood cultures in burns at our unit. Methods Four hundred fifty-two burn patients admitted to the unit between 2011 and 2013, and with cultures performed, were included in the study. The yields of various cultures were evaluated and 2684 samples were amassed, of which 984 (36.7 %) were positive. Patient variables for predictors of MDR A. baumannii infection acquisition and bacteremia were evaluated through multivariate analyses. Results Pseuodomonas aeruginosa (P. aeruginosa) (67 patients) was the most common organism in those with total body surface area (TBSA) burn <20 % while MDR A. baumannii (39 patients) was most prevalent in those with TBSA burn ≥20 %. We found a yield of 1.1 % positive blood cultures for TBSA burn <20 % and a yield of 18.6 % positive cultures in TBSA burn ≥20 %. The median time between surgery and bacteremia was 6.5 days (range -18 to 68 days, interquartile range 4.5); 2.9 and 8.8 % of bacteremic episodes occurred within 24 and 48 h, respectively. This is a decrease from a predeceasing study (45.3 % for 24 h and 60 % for 48 h). Multivariate analysis revealed that length of hospital stay and TBSA burn ≥20 % were predictors of MDR A. baumannii infection and positive blood cultures. Conclusions MDR A. baumannii infection burdens patient management, especially in those with TBSA burn ≥20 % and longer hospital stay. Prophylactic antibiotics may reduce perioperative bacteremia, but their role in MDR infections needs to be evaluated. The role of blood cultures in TBSA burn <20 % needs reconsideration.

scholarly journals BURN PATIENTS;

2013 ◽  
Vol 20 (06) ◽  
pp. 1042-1047
Author(s):  
FIRDOUS KHAN ◽  
ASIF SHAH ◽  
ABDUL AZIZ JANAN
Keyword(s):  
Hospital Stay ◽  
Plastic Surgery ◽  
Teaching Hospital ◽  
Burn Injury ◽  
Demographic Data ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Descriptive Study ◽  
Burn Patients ◽  
Key Factor

Aim: To determine major risk factors of mortality and causes of death in patients presented with burn injury. Study design:Prospective Descriptive Study. Setting and duration: Department of Burns and Plastic Surgery, Khyber Teaching Hospital, Peshawar,Pakistan from April 2008 and June 2012. Methodology: A prospective descriptive study was performed among the patients whoadmitted to the Department of Burns and Plastic Surgery, Khyber Teaching Hospital, Peshawar, Pakistan between April 2008 and June2012. All relative information was collected through a detailed proforma and patient’s treatment files. Patients of any age, any degree ofburns and burns exceeding 10% TBSA were included. Patients presenting after more than one week post burn or patients referred fromother hospitals were excluded. Within this period, demographic data, treatment, and outcomes of treatment were reviewed and analyzed.Survivors and non-survivors among burn patients were compared to define the predictive factors of mortality. Results: Between April2008 and June 2012, 1850 patients were admitted with burn injuries. There were 1150 male patients (62%) and 700 female patients(38%). Mean age was 36 years with range of 1-70 years. Inhalation injuries were present in 45 patients (2.40%). Causes were flameburns (65.0%), electrical burns (15%), scalds (13%) and chemical burns (7.0%). The total body surface area (TBSA) burn ranged from10- 100%, with a mean of 38% TBSA burn. Mean length of hospital stay was 12 days (ranging from 24 hours to 170 days). Mortality ratewas 11.2%. Higher age, larger burn area, wound infection, longer hospital stay and the presence of multi-system organ failuresignificantly predicted increased mortality. Conclusions: Prevention is a key factor in reducing the morbidity and mor tality associatedwith burn injury. A campaign to educate people that burns can be prevented will be important in our community. The prevention of multiorganfailure and septicemia are likely to be more effective than their treatment.

Clinical and Economic Impact of Multidrug Resistance in Nosocomial Acinetobacter baumannii Bacteremia

2007 ◽  
Vol 28 (6) ◽  
pp. 713-719 ◽  
Author(s):  
Nan-Yao Lee ◽  
Hsin-Chun Lee ◽  
Nai-Ying Ko ◽  
Chia-Ming Chang ◽  
Hsin-I Shih ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Acinetobacter Baumannii ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Economic Outcomes ◽  
University Teaching ◽  
Attributable Mortality ◽  
The Impact

Objective.To investigate the impact of antimicrobial resistance on clinical and economic outcomes among hospitalized patients with multidrug-resistant (MDR) Acinetobacter baumannii bacteremia.Design.A retrospective, matched-cohort study.Setting.A tertiary care university teaching hospitalMethods.A matched case-control (1:1) study was conducted to compare the differences in clinical and economic outcomes of patients with MDR A. baumannii bacteremia and patients with non-MDR A. baumannii bacteremia. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness, and length of hospital stay before onset of bacteremia.Results.Forty-six (95.8%) of 48 cases with MDR A. baumannii bacteremia were eligible for the study and matched with appropriate controls. The sepsis-related mortality rate was 34.8% among cases and 13.0% among controls, for an attributable mortality rate of 21.8% (adjusted odds ratio, 4.1 [95% confidence interval, 1.1-15.7]; P = .036). After the onset of bacteremia, cases and controls had a significantly different length of hospital stay (54.2 vs 34.1 days; P = .006), hospitalization cost (US$9,349 vs US$4,865; P = .001 ), and antibiotic therapy cost (US$2,257 vs US$1,610; P = .014). Thus, bacteremia due to MDR A. baumannii resulted in 13.4 days of additional hospitalization and US$3,758 of additional costs, compared with bacteremia due to non-MDR A. baumannii.Conclusions.Patients with MDR A. baumannii bacteremia had a higher mortality rate and incurred greater medical costs than patients with non-MDR A. baumannii bacteremia.

scholarly journals Elderly And Burn Injuries: A Ten-Year Analysis of 612 Patients

2021 ◽  
Author(s):  
Zahra Haghani Dogahe ◽  
Reza Zarei ◽  
Shahin Hallaj ◽  
Mohammadreza Mobayen
Keyword(s):  
Hospital Stay ◽  
Geriatric Medicine ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Prevention Programs ◽  
The Elderly ◽  
Burn Injuries ◽  
Anatomical Site ◽  
Burn Patients ◽  
The Mean

Abstract Background: With all the progress made in geriatric medicine, we expect to have a growing population of elderly soon. With burn injuries, as one of the most common unpredictable injuries to the elderly, it is essential to clarify the epidemiological pattern and factors related to worse outcomes in geriatric burn patients. We aimed to investigate burn characteristics in the elderly in Guilan province, IRAN, in ten years.Methods: This study conducted a retrospective analysis of burn patients aging 60yrs and over in Velayat Burn Center between 2010 and 2020. The data collected from the hospital information system included age, sex, marital state, occupation, residency, season and month of the incident, place of incident, total body surface area (TBSA), burn degree, cause of the burn, anatomical site of the injury, pre-injury morbidities, surgical managements, length of hospital stay and mortality.Results: Among 612 patients, the mean age was 72.20±8.94 years. The female to male ratio was 1.14:1 with a total of 53.3% female burn patients. 94.90% of patients lived with family members. 59.3% lived in urban areas. Most of the burn injuries happened during winter and summer. 82.5% happened indoors. The mean was 19.70±22.13%. The most common causes were flames (50.0%) and scalds (44.3%). The mean length of hospital stay (LOS) was 6.14±6.27 days. The overall mortality rate was 15%.Conclusion: We concluded that most burn injuries among the geriatric population happen indoors, during the first hours of the day, and on the first day of the week, making it essential to establish special prevention programs suiting these situations. On the other hand, with the increased life expectancy and the unpredictable nature of burn injuries, it is essential to identify risk factors and establish prevention programs for the elderly.

Advanced Endoscopic Tools

2021 ◽  
Author(s):  
Eleanor C. Fung
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Surgical Intervention ◽  
Length Of Hospital Stay ◽  
Therapeutic Endoscopy ◽  
Full Thickness ◽  
Evolution And Development ◽  
Improved Outcomes ◽  
Endoscopic Clips

AbstractThe advent and success of therapeutic endoscopy has expanded the utilization of endoscopy as an effective alternative to surgical intervention in some cases with decreased morbidity, improved outcomes, and shortened length of hospital stay. Gastrointestinal bleeding, perforations, leaks, fistulas, and strictures have become increasingly managed by endoscopy with the evolution and development of endoscopic tools for effective closure of full-thickness gastrointestinal defects, dilation, and hemostasis. This article reviews the characteristics and role of endoscopic clips, stents, dilation balloons, endoscopic knives, and suturing devices.

scholarly journals Colistin heteroresistance and the involvement of the PmrAB regulatory system in Acinetobacter baumannii

2018 ◽  
Author(s):  
Yannick Charretier ◽  
Seydina M. Diene ◽  
Damien Baud ◽  
Sonia Chatellier ◽  
Emmanuelle Santiago-Allexant ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Population Analysis ◽  
Regulatory System ◽  
Clinical Problem ◽  
Multidrug Resistant ◽  
Regulatory Pathway ◽  
Colistin Resistance ◽  
Bacterial Killing ◽  
One Step

AbstractMultidrug-resistant Acinetobacter baumannii infection has recently emerged as a worldwide clinical problem and colistin is increasingly being used as last resort therapy. Despite its favorable bacterial killing, resistance and heteroresistance to colistin have been described. Mutations in the PmrAB regulatory pathway have been already associated with colistin resistance whereas the mechanisms for heteroresistance remain largely unknown. The purpose of the present study is to investigate the role of PmrAB in laboratory-selected mutants representative of global epidemic strains. During brief colistin exposure, colistin resistant and colistin heteroresistant mutants were selected in a one-step strategy. Population Analysis Profiling (PAP) was performed to confirm the suspected phenotype. Upon withdrawal of selective pressure, compensatory mutations were evaluated in another one-step strategy. A trans-complementation assay was designed to delineate the involvement of the PmrAB regulatory system using qPCR and PAP. Mutations in the PmrAB regulatory pathway were associated with colistin resistance and colistin heteroresistance as well. The transcomplementation assay provides a proof for the role played by changes in the PmrAB regulatory pathway. The level of colistin resistance is correlated to the level of expression of pmrC. The resistance phenotype was partially restored since the complemented strain became heteroresistant. This report shows the role of different mutations in the PmrAB regulatory pathway and warns on the development of colistin heteroresistance that could be present but not easily detected with routine testing.

scholarly journals Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive cocci Infections: Effectiveness, Hospital Stay and Mortality

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1296
Author(s):  
Mar de Pablo-Miró ◽  
Sergi Pujol-Ruiz ◽  
Simona Iftimie ◽  
María del Mar Arenas-Miras ◽  
Inmaculada López-Montesinos ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Ambulatory Setting ◽  
Bivariate Analysis ◽  
Gram Positive ◽  
Healthcare Associated ◽  
Remarkable Reduction ◽  
Gram Positive Cocci ◽  
Control Study

Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (−12.05 days 95% CI [−17.00, −7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy.

scholarly journals Role of early enteral feeding in mild and moderate acute pancreatitis

2021 ◽  
Vol 8 (11) ◽  
pp. 3387
Author(s):  
Aswin George Roy ◽  
Haridas T. V.
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Enteral Feeding ◽  
Significant Risk ◽  
Length Of Hospital Stay ◽  
Advantages And Disadvantages ◽  
Early Enteral Feeding ◽  
Systemic Complication ◽  
Infective Complications

Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

scholarly journals Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4997
Author(s):  
Madelon Dijkstra ◽  
Sanne Nieuwenhuizen ◽  
Robbert S. Puijk ◽  
Florentine E. F. Timmer ◽  
Bart Geboers ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Hospital Stay ◽  
Colorectal Liver Metastases ◽  
Local Treatment ◽  
Length Of Hospital Stay ◽  
Progression Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Subgroup Analyses

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).

scholarly journals Characterization of RelA in Acinetobacter baumannii

2020 ◽  
Vol 202 (12) ◽  
Author(s):  
María Pérez-Varela ◽  
Aimee R. P. Tierney ◽  
Ju-Sim Kim ◽  
Andrés Vázquez-Torres ◽  
Philip Rather
Keyword(s):  
Acinetobacter Baumannii ◽  
Galleria Mellonella ◽  
Multidrug Resistant ◽  
Cell Physiology ◽  
Content Type ◽  
Content Model ◽  
Transposon Insertion ◽  
Downstream Effectors

ABSTRACT In response to nutrient depletion, the RelA and SpoT proteins generate the signaling molecule (p)ppGpp, which then controls a number of downstream effectors to modulate cell physiology. In Acinetobacter baumannii strain AB5075, a relA ortholog (ABUW_3302) was identified by a transposon insertion that conferred an unusual colony phenotype. An in-frame deletion in relA (ΔrelA) failed to produce detectable levels of ppGpp when amino acid starvation was induced with serine hydroxamate. The ΔrelA mutant was blocked from switching from the virulent opaque colony variant (VIR-O) to the avirulent translucent colony variant (AV-T), but the rate of AV-T to VIR-O switching was unchanged. In addition, the ΔrelA mutation resulted in a pronounced hypermotile phenotype on 0.35% agar plates. This hypermotility was dependent on the activation of a LysR regulator ABUW_1132, which was required for expression of AbaR, a LuxR family quorum-sensing regulator. In the ΔrelA mutant, ABUW_1132 was also required for the increased expression of an operon composed of the ABUW_3766-ABUW_3773 genes required for production of the surfactant-like lipopeptide acinetin 505. Additional phenotypes identified in the ΔrelA mutant included (i) cell elongation at high density, (ii) reduced formation of persister cells tolerant to colistin and rifampin, and (iii) decreased virulence in a Galleria mellonella model. IMPORTANCE Acinetobacter baumannii is a pathogen of worldwide importance. Due to the increasing prevalence of antibiotic resistance, these infections are becoming increasingly difficult to treat. New therapies are required to combat multidrug-resistant isolates. The role of RelA in A. baumannii is largely unknown. This study demonstrates that like in other bacteria, RelA controls a variety of functions, including virulence. Strategies to inhibit the activity of RelA and the resulting production of ppGpp could inhibit virulence and may represent a new therapeutic approach.

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