scholarly journals Resistance pattern of infected chronic wound isolates and factors associated with bacterial resistance to third generation cephalosporins at Mbarara Regional Referral Hospital, Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261264
Author(s):  
Wangoye Khalim ◽  
James Mwesigye ◽  
Martin Tungotyo ◽  
Silvano Samba Twinomujuni
Keyword(s):  
Logistic Regression ◽  
Bacterial Resistance ◽  
Chronic Wounds ◽  
Third Generation ◽  
Bacterial Isolates ◽  
Factors Associated ◽  
The Third ◽  
Surgical Ward ◽  
Complete Resistance ◽  
Third Generation Cephalosporins

Background The objectives of this study were; (I) to determine the proportion of pathogens isolated from patients with infected chronic wounds in the surgical ward of MRRH that are resistant to the third-generation cephalosporins and (II) to determine the factors associated with resistance to third-generation cephalosporins in the surgical ward of MRRH. Method(s) This study was a descriptive analytical survey of bacterial isolates from infected chronic wounds among patients admitted in the surgical ward of MRRH, Uganda. Seventy five (75) study participants were recruited in the study using convenient sampling technique. Bacterial culture and identification was performed using standard microbiology laboratory procedures whereas broth microdilution method was used to establish the susceptibility of the identified pathogens. Data for objective one (1) was summarized as proportions while the categorized variables were analyzed using logistic regression to determine whether they were associated with the resistance patterns. The level of significance was preset at 5% and p-values less than 0.05 were considered statistically significant. Results Generally, all isolates had complete susceptibility (100%) to Cefoperazone+Sulbactam 2g except 7.1% of proteus spp that were resistant. Of all the bacterial isolates studied, Staphylococcus aureus, Enterobacter agglomerans, providencia spp and pseudomonas earuginosa had complete resistance (100%) to Cefopodoxime 200mg while providencia spp and pseudomomas earuginosa had complete resistance (100%) to Cefixime 400mg and cefotaxime 1g. Finally, higher odds of bacterial resistance to more 2 brands of the third generation cephalosporins were observed among participants who had prior exposure to the third generation cephalosporins (OR, 2.22, 95% CI, 0.80–6.14), comorbidities (OR, 1.76, 95% CI, 0.62–4.96) and those who had more than two hospitalizations in a year (OR, 1.39, 95% CI 0.46–4.25). However, multivariate logistic regression was not performed since no factor was significantly associated with resistance to more than two brands of third generation cephalosporins (p >0.05). Conclusion This study found that cefixime and cefpodoixme had high rates of resistance and should not be used in routine management of infected chronic wounds. In addition, the factors investigated in this study were not significantly associated with bacterial resistance to more than two brands of third generation cephalosporins.

scholarly journals Prevalence of infected chronic wound isolates and their Minimum inhibitory concentrations against third generation cephalosporins at Mbarara Regional Referral Hospital, Uganda

2021 ◽  
Author(s):  
Wangoye Khalim ◽  
Mwesigye James ◽  
Tungotyo Martin ◽  
Twinomujuni Silvano Samba
Keyword(s):  
Staphylococcus Aureus ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Referral Hospital ◽  
Third Generation ◽  
Regional Referral Hospital ◽  
Surgical Ward ◽  
Broth Microdilution Method ◽  
Third Generation Cephalosporins ◽  
Klebsiella Spp

Abstract Background: Globally, the burden of infected chronic wounds is likely to increase due to the rising levels of bacterial resistance to antibiotics and non-communicable diseases such as Diabetes mellitus and cancer. Furthermore, the burden of antibiotic resistant strains in infected chronic wounds is likely to increase especially in resource constrained areas like Mbarara regional referral Hospital where the selection of antibiotic therapy does not usually depend on known antibiotic susceptibilities. Therefore the objectives of this study were; (I) to determine the prevalence of infected chronic wounds isolates from patients admitted in the surgical ward of MRRH, Uganda and (II) to determine the MIC of infected chronic wound isolates against the third generation cephalosporins.Method(s): This study was a descriptive analytical survey of bacterial isolates from infected chronic wounds among patients admitted in the surgical ward of MRRH, Uganda. Seventy five (75) study participants were recruited in the study using convenient sampling technique. Wound swabs were aseptically collected, registered in the laboratory register and depending on the nature of samples; each specimen was inoculated on chocolate, blood, mannitol salt sugar, xylose lysine decarboxylated agar, and MacConkey Agar and incubated at 350C-370C in the incubator. Broth microdilution method was used to test for MIC.The collected data was entered into Microsoft Excel and exported to STATA version 15.0 for statistical analysis. Chi square/Fishers’s Exact test and analysis of variance (ANOVA) tests were used to analyse data for objective 1 and 2 respectively.Results: The most prevalent pathogens isolated were staphylococcus aureus (40.6%,) and Klebsiella spp (29%,) while the least prevalent pathogens were Providencia spp(1.4%, n=1/69) and Enterobacter agglomerans(2.9%, n=2/29). Generally, staphylococcus aureus exhibited the lowest MIC against cefoperazone+sulbactum 2g (Sulcef®) and ceftriaxone 1g (Epicephin®) (4.33±8.41µ/ml and 15.77±23.32µ/ml respectively). However, the differences in mean MIC observed across various groups were not statistically significant (P >0.05).Conclusion: The most prevalent pathogens isolated from patients with infected chronic wounds at the surgical ward of MRRH were Staphylococcus aureus, Klebsiella spp and proteus spp and the most effective third generation cephalosporins were cefoprazone+sulbactam 2g and ceftriaxone 1g (Epicephin®) while the most ineffective antibiotics were cefpodoxime 200mg and cefixime 400mg.

Third-Generation and Investigational Cephalosporins: I. Structure-Activity Relationships and Pharmacokinetic Review

1983 ◽  
Vol 17 (7-8) ◽  
pp. 507-515 ◽  
Author(s):  
Pamela Garzone ◽  
James Lyon ◽  
Victor L. Yu
Keyword(s):  
Classification Scheme ◽  
Third Generation ◽  
Serum Concentrations ◽  
New Agents ◽  
The Third ◽  
Structure Activity ◽  
Pharmacokinetic Properties ◽  
Fluid Penetration ◽  
Third Generation Cephalosporins ◽  
Antibacterial Spectrum

The structure-relationships and pharmacokinetic properties of the new second- and third-generation cephalosporins are reviewed. The new second-generation cephalosporins include ceforanide, cefotiam, and cefuroxime. The third-generation cephalosporins include cefmenoxime, cefoperazone, cefotaxime, cefsulodin, ceftazidime, ceftizoxime, ceftriaxone, and moxalactam. These new cephalosporins are semisynthetic analogs with different chemical substitutions on a 7-aminocephalosporanic nucleus. As a result of these chemical modifications, improvements in the antibacterial spectrum as well as pharmacokinetic properties have occurred. In general, the new cephalosporins have longer half-lives, higher and prolonged serum concentrations, and increased cerebrospinal fluid penetration. Selected cephalosporins also have increased biliary tract concentrations. A classification scheme for these new agents, based on generation and susceptibility to Pseudomonas aeruginosa, is presented.

scholarly journals Risk Factors for and Outcomes Associated with Clinical Isolates ofEscherichia coliandKlebsiellaSpecies Resistant to Extended-Spectrum Cephalosporins among Patients Admitted to Canadian Hospitals

2009 ◽  
Vol 20 (3) ◽  
pp. e43-e48 ◽  
Author(s):  
Marianna Ofner-Agostini ◽  
Andrew Simor ◽  
Michael Mulvey ◽  
Alison McGeer ◽  
Zahir Hirji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Care Facility ◽  
P Value ◽  
Third Generation ◽  
Multivariate Logistic Regression ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

BACKGROUND: Clinical features associated with Gram-negative bacterial isolates with extended-spectrum beta-lactamase (ESBL)- and AmpC-mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL- or AmpC-mediated resistant organisms in Canadian hospitals.METHODS: Patients with clinical cultures ofEscherichia coliorKlebsiellaspecies were matched with patients with a similar organism but susceptible to third-generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.RESULTS: Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P-value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first-generation cephalosporins (OR 2.38, P=0.02) or third-generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).CONCLUSION: The importance of patient medical history, present admission and antibiotic use should be considered for allE coliorKlebsiellaspecies patients pending susceptibility testing results.

Intrathecal Administration of Amikacin for Treatment of Meningitis Secondary to Cephalosporin-Resistant Escherichia Coli

1993 ◽  
Vol 27 (7-8) ◽  
pp. 870-873 ◽  
Author(s):  
Sandra L. Preston ◽  
Laurie L. Briceland
Keyword(s):  
Escherichia Coli ◽  
Bacterial Resistance ◽  
Generation Cephalosporin ◽  
Intrathecal Administration ◽  
Neurosurgical Procedures ◽  
Third Generation ◽  
E Coli ◽  
Efficacious Treatment ◽  
Clonic Seizures ◽  
Third Generation Cephalosporins

OBJECTIVE: To report a case of gram-negative bacillary meningitis (GNBM) secondary to cephalosporin-resistant Escherichia coli that was treated with intrathecal and intravenous amikacin and intravenous imipenem/cilastatin (I/C). CASE SUMMARY: A patient who had undergone two recent neurosurgical procedures developed GNBM and bacteremia. He was treated empirically with ceftazidime. Both bloodstream and cerebrospinal fluid isolates were identified as E. coli, resistant to third-generation cephalosporins, penicillins, tobramycin, and gentamicin. The patient was subsequently treated with intravenous and intrathecal amikacin plus intravenous I/C He experienced subjective and objective improvement on days 2–4 of antimicrobial therapy; two generalized tonic-clonic seizures occurred on days 7 and 12. Intrathecal amikacin was discontinued after 6 days, and intravenous amikacin and I/C were discontinued after 23 and 27 days, respectively. The patient's mental status did not completely return to premeningitis baseline. DISCUSSION: Third-generation cephalosporins are the treatment of choice for GNBM. In the case reported herein, bacterial resistance to these agents prompted the use of a therapy that has not been well studied and is also considered to be less safe and perhaps less efficacious. Treatment of GNBM with an intrathecally administered aminoglycoside or with intravenous I/C plus an aminoglycoside is reviewed. CONCLUSIONS: Patients with GNBM secondary to third-generation cephalosporin-resistant organisms may require therapies that may be less effective and more toxic. Further study of alternative agents is warranted.

scholarly journals Fatores de Risco Associados à Recusa de Notas de Transferência e Vales Cirurgia: O Caso da Região Centro em Portugal

2022 ◽  
Vol 35 (13) ◽  
Author(s):  
Salomé Cruz ◽  
Carlota Quintal ◽  
Patrícia Antunes
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
General Surgery ◽  
Waiting Times ◽  
Positive Association ◽  
Waiting List ◽  
Multiple Logistic Regression ◽  
Third Trimester ◽  
Factors Associated ◽  
The Third

Introduction: In Portugal, the rate of refusals regarding transfer between hospitals through surgery vouchers is high, which makes it difficult to meet maximum waiting times for elective surgeries. The objectives of this study are to examine how many vouchers were issued and refused between the third quarter of 2016 and the fourth quarter of 2019 and the risk factors associated with their refusal, in Central PortugalMaterial and Methods: Data was obtained in the database of cancelled vouchers and the waiting list for surgery on the 31st December 2019. Multiple logistic regression was used to investigate risk factors.Results: The number of issued vouchers increased after 2018 and the rate of refusals has been above 55% since the 3rd quarter of 2018. Refusal was more likely for individuals aged 55 years or above (OR = 1.136; CI = 1.041 – 1.240; OR = 1.095; CI = 1.005 – 1.194; OR = 1.098; CI = 1.002 – 1.203, for the age bands 55 - 64, 65 - 74 and 75 - 84, respectively), for inpatient surgery when compared to ambulatory (OR = 2.498; CI = 2.343 – 2.663) and for Orthopaedics when compared to General Surgery (OR = 1.123; CI = 1.037 – 1.217). The odds of refusal also varied across hospitals (for example OR = 3.853; CI = 3.610 – 4.113; OR = 3.600; CI = 3.171 – 4.087; OR = 2.751; CI =3.383 – 3.175 e OR = 1.337; CI = 1.092 – 1.637, for hospitals identified as HO_2, HO_7, HO_4 and HO_6, respectively).Conclusion: In this study, we have confirmed that the number of issued surgery vouchers increased after the administrative reduction of maximum waiting times in 2018 and that the rate of transfer refusals has been increasing since 2016 and has remained above 55% from the third trimester of 2018 onwards. Some of the factors for which we obtained a positive association with refusal are age, inpatient surgery (compared to ambulatory) and Orthopaedics (compared to General Surgery).

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