scholarly journals Antimicrobial Resistance Profile of MDR & Non-MDR Meropenem-Resistant Pseudomonas aeruginosa Isolates of Patients in Intensive Care Unit of Tertiary Hospital

2021 ◽  
Vol 9 (3) ◽  
pp. 152
Author(s):  
Imaculata Sonia Vidaryo Lameng ◽  
Ni Nyoman Sri Budayanti ◽  
Luh Inta Prilandari ◽  
I Ketut Agus Indra Adhiputra
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Empirical Therapy ◽  
Tertiary Hospital ◽  
Clinical Microbiology Laboratory ◽  
Cross Sectional ◽  
Resistance Profile ◽  
Control Programs

Pseudomonas aeruginosa is one of the gram-negative bacteria that causes infection in the Intensive Care Unit (ICU) which is easily resistant. Patients infected with carbapenem-resistant P. aeruginosa are predicted to have a poor prognosis. This study aims to know the resistance profile of meropenem-resistant P. aeruginosa in the ICU. The results of this study can be used as a measure on the success of antimicrobial resistance control, infection control programs and become a reference for empirical therapy in the ICU. This study used a cross-sectional retrospective descriptive research method and was carried out at the Clinical Microbiology Laboratory of Sanglah Hospital Denpasar for three years, from 2018 to 2020. The results showed 38 of the 93 isolates of P. aeruginosa in the ICU were resistant to meropenem and were derived from sputum and urine. The percentage of meropenem-resistant P. aeruginosa isolates was higher in the multi-drug-resistant group and mostly came from sputum specimens. In 2018, Non-MDR meropenem-resistant P. aeruginosa isolates was that 100% sensitive to all other antibiotics used to treat P. aeruginosa infections, including; ceftazidime, cefepime, ciprofloxacin, gentamicin, amikacin, and piperacillin-tazobactam. In 2019 no meropenem-resistant P. aeruginosa isolates were found. In 2020, its sensitivity to antibiotics ceftazidime and piperacillin-tazobactam was 20.0%, ciprofloxacin 60.0% and to antibiotics gentamicin and amikacin 100%. MDR meropenem-resistant P. aeruginosa isolates in 2018 were still sensitive to ceftazidime (15.4%) and amikacin (69.2%) antibiotics, while in 2019 they were only sensitive to amikacin (37.5%). In 2020, P. aeruginosa isolates were sensitive to the antibiotics ceftazidime and cefepime (11.1%), piperacillin-tazobactam (22.2%), and amikacin (88.9%). Amikacin may be the choice of treatment for MDR meropenem-resistant P. aeruginosa.

scholarly journals A Combination Antibiogram Evaluation for Pseudomonas aeruginosa in Respiratory and Blood Sources from Intensive Care Unit (ICU) and Non-ICU Settings in U.S. Hospitals

2019 ◽  
Vol 63 (4) ◽  
Author(s):  
Laura Puzniak ◽  
Daryl D. DePestel ◽  
Arjun Srinivasan ◽  
Gang Ye ◽  
John Murray ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Single Agent ◽  
Empirical Therapy ◽  
New Drugs ◽  
Research Database ◽  
Cross Sectional ◽  
Content Type

ABSTRACT Pseudomonas aeruginosa is an important pathogen associated with significant morbidity and mortality. U.S. guidelines for the treatment of hospital-acquired and ventilator-associated pneumonia recommend the use of two antipseudomonal drugs for high-risk patients to ensure that ≥95% of patients receive active empirical therapy. We evaluated the utility of combination antibiograms in identifying optimal anti-P. aeruginosa drug regimens. We conducted a retrospective cross-sectional analysis of the antimicrobial susceptibility of all nonduplicate P. aeruginosa blood and respiratory isolates collected between 1 October 2016 and 30 September 2017 from 304 U.S. hospitals in the BD Insights Research Database. Combination antibiograms were used to determine in vitro rates of susceptibility to potential anti-P. aeruginosa combination regimens consisting of a backbone antibiotic (an extended-spectrum cephalosporin, carbapenem, or piperacillin-tazobactam) plus an aminoglycoside or fluoroquinolone. Single-agent susceptibility rates for the 11,701 nonduplicate P. aeruginosa isolates ranged from 72.7% for fluoroquinolones to 85.0% for piperacillin-tazobactam. Susceptibility rates were higher for blood isolates than for respiratory isolates (P < 0.05). Antibiotic combinations resulted in increased susceptibility rates but did not achieve the goal of 95% antibiotic coverage. Adding an aminoglycoside resulted in higher susceptibility rates than adding a fluoroquinolone; piperacillin-tazobactam plus an aminoglycoside resulted in the highest susceptibility rate (93.3%). Intensive care unit (ICU) isolates generally had lower susceptibility rates than non-ICU isolates. Commonly used antipseudomonal drugs, either alone or in combination, did not achieve 95% coverage against U.S. hospital P. aeruginosa isolates, suggesting that new drugs are needed to attain this goal. Local institutional use of combination antibiograms has the potential to optimize empirical therapy of infections caused by difficult-to-treat pathogens.

scholarly journals Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results

2018 ◽  
Vol 16 (2) ◽  
Author(s):  
Ana Carolina de Souza e Silva ◽  
Domingos Sávio de Carvalho Sousa ◽  
Eunice Bobô de Carvalho Perraud ◽  
Fátima Rosane de Almeida Oliveira ◽  
Bruna Cristina Cardoso Martins
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Pharmacist ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Respiratory Intensive Care Unit ◽  
The Impact

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

scholarly journals Incidence of Hospital-Acquired Bacterial Pneumonia and Its Resistance Profiles in Patients Admitted to Intensive Care Unit

2016 ◽  
Vol 9 (3) ◽  
pp. 73 ◽  
Author(s):  
Vahid Boostani ◽  
Farzaneh Dehghan ◽  
Afsaneh Karmostaji ◽  
Nader Zolghadri ◽  
Afsaneh Shafii
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Bacterial Pneumonia ◽  
Clinical Signs ◽  
Resistance Rate ◽  
Gram Negative Bacteria ◽  
Cross Sectional ◽  
Gram Negative ◽  
Hospital Acquired

<p>Hospital-acquired bacterial pneumonia (HABP) is one of the most important causes of morbidity, mortality and economic problems especially for patients admitted in the intensive care unit (ICU) ward. The aim of this study was to determine the incidence of nosocomial pneumonia in ICU, identify the causative bacteria and their resistance profiles. This cross sectional study was performed on 214 patients who were admitted in the ICU ward of a general hospital requiring mechanical ventilation for at least 48 h. Identification of HABP was based on the clinical signs manifested 48 h or more after admission, new chest X-ray infiltrates and microbiologic examination of endo tracheal secretion. Data were analyzed using SPSS 21 to perform the descriptive statistics. The isolated gram negative bacteria were <em>Klebsiella pneumoniae</em> (50%), <em>Staphylococcus aureus</em> (18.7%), <em>Acinetobacter baumannii</em> (12.5%), <em>Escherichia coli</em> (12.5%) and <em>Pseudomonas aeroginosa</em> (6.3%). The maximum antimicrobial resistance of gram negative bacteria was to Cefazolin (100%) and Ampicillin (84.6%), while antimicrobial resistance to Clindamycin, Azithromycin, Amoxycillin+clavulanate, Trimethoprim+sulfamethoxazole and Ciprofloxacin was 33.3%. No resistance was seen towards carbapenems.The most frequent gram negative isolated bacterium was <em>K. pneumoniae, </em>and maximum antimicrobial resistance rate was observed for Cefazolin and Ampicillin, which is due to betalactamase production.</p>

scholarly journals Proton pump inhibitor indications in a Brazilian tertiary hospital

2020 ◽  
Vol 66 (7) ◽  
pp. 913-917
Author(s):  
Abadia Gilda Buso Matoso ◽  
Fernanda Arantes Mendonça Toledo Almeida ◽  
Lígia Paiva ◽  
Patrícia Munhoz Margonari ◽  
Tainá Mendes Bertolin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Medical Records ◽  
Tertiary Hospital ◽  
Patient Records ◽  
Cross Sectional ◽  
Main Motivation ◽  
Assistant Physician

SUMMARY OBJECTIVES To evaluate the frequency of prescription of proton pump inhibitors (PPIs) and their indications in patients hospitalized at the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU). METHODS This is a quantitative cross-sectional observational study that analyzes data obtained from patient records on prescriptions of PPIs for patients hospitalized at the HC-UFU and from a questionnaire applied to assistant physicians on the indications of the drug in each case and evaluates the indication based on literature data. RESULTS On a pre-determined day, of a total of 462 inpatients, there was a prescription of PPI for 183 (39.3%), with a higher frequency (73.5%) in the Intensive Care Unit (ICU), followed by the infirmaries and the Emergency Room. The assistant physician was located in 116 cases, and the main motivation referred to prescription was prophylaxis of digestive hemorrhage (77%). However, after reviewing medical records, it was noticed that in 50.8% of the cases, the prescription was not supported by the literature. CONCLUSION The frequency of PPI prescriptions for inpatients in the HC-UFU is among the lowest described in the literature, but there are still unnecessary prescriptions. Instruction and awareness of the assisting team can minimize these numbers.

scholarly journals Hand Colonization with Gram-Negative Organisms of Healthcare Workers Accessing the Cardiac Intensive Care Unit: A Cross-Sectional Study at the Uganda Heart Institute

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Lameck Ssemogerere ◽  
Cornelius Sendagire ◽  
Ceaser Mbabazi ◽  
Yvonne Namungoma ◽  
Anna Noland Oketayot ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Healthcare Workers ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Gram Negative ◽  
Heart Institute ◽  
Cardiac Intensive Care ◽  
Gram Negative Organisms

Background. Hands of healthcare workers (HCWs) are vehicles for pathogens responsible for healthcare-associated infections (HAIs). Following the identification of Gram-negative organisms (GNOs) in all cases of HAIs in the cardiac intensive care unit (ICU), we sought to determine the burden of hand colonization with GNOs among healthcare workers who access the cardiac ICU. Methods. We retrospectively reviewed results from surveillance cultures of fingertip imprints of HCWs who access the cardiac ICU at the Uganda Heart Institute. We collected data on staff category, isolates, and susceptibility to antibiotics. We analyzed the data using Microsoft Excel, and the results are summarized in proportions and percentages and presented in charts and tables. Results. Fifty-six healthcare workers participated in the surveillance. 21 were ICU clinicians, 21 non-ICU clinicians, and 14 nonclinicians. GNOs were cultured in 19 (33.9%) HCWs, in which 8/19 (42.1%) were non-ICU clinicians, 6/19 (31.2%) ICU clinicians, and 5/19 (26.3%) nonclinicians. 32 isolates were identified, of which 47%, 28%, and 25% were cultured from non-ICU clinicians, nonclinicians, and ICU clinicians, respectively. Predominant isolates were Acinetobacter (34%), Citrobacter (21.9%), and Pseudomonas (21.9%). Antimicrobial resistance ranged from 4% to 90%. 9/28 (32.1%) isolates, predominantly Acinetobacter species (spp), were carbapenem resistant. 8/28 (28.6%) isolates, predominantly Citrobacter spp, were multidrug resistant. Resistance to ciprofloxacin and cefepime was low at 3.6% and 4.4%, respectively. Conclusion. Gram-negative organisms, predominantly Acinetobacter, Citrobacter, and Pseudomonas spp, were prevalent on the hands of HCWs who access the cardiac ICU irrespective of the staff category. Antimicrobial resistance was high, with multidrug resistance and carbapenem resistance common among Citrobacter spp and Acinetobacter spp, respectively. Resistance to cefepime and ciprofloxacin was low.

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