Risk Factors and Outcomes of Bacteremia Caused by Carbapenem Resistant Enterobacterales Compared to Carbapenem Susceptible Enterobacterales

Abstract BackgroundDue to shrinking therapeutic options, infections due to Carbapenem-resistant Enterobacterales (CRE) are an urgent threat in healthcare systems. We compared the risk factors and outcomes of bacteremia secondary to CRE with bacteremia secondary to carbapenem susceptible Enterobacterales (CSE).MethodsWe conducted a retrospective cross-sectional study on patients admitted to a tertiary care hospital in Karachi, Pakistan between 2013 and 2016. Patients with CRE bacteremia were matched to those with CSE bacteremia while excluding those with polymicrobial cultures.ResultsA total of 131 patients were enrolled (65 CRE and 66 CSE) with the mean age of 51.8 years and 57.1 years in CRE and CSE groups respectively. Compared with CSE, CRE bacteremia was more likely to occur in patients with Diabetes Mellitus or those with a tracheostomy (P = 0.002 and 0.014, respectively). The most common source of CRE bacteremia was central line associated (24.6% of all cases) as opposed to urinary tract infections in those with CSE bacteremia (62.1% of all cases). Fewer patients with CRE bacteremia received appropriate antibiotics (72.3% vs. 81.8%). Mortality was significantly higher in the CRE group (41.5% vs. 12.1%, P = 0.001) even when adjusted for the severity of illness using the PITT-bacteremia score. Increased mortality was also associated with central venous catheterization in both groups. The median length of hospital stay was longer in patients with CRE (8 vs. 6 days, P = 0.021)ConclusionCRE bacteremia was associated with central lines and led to significantly higher mortality and length of stay.

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499. Carbapenem-resistant Enterobacteriaceae (CRE)-associated Infections and Prolonged Colonization among Hospitalized Patients Colonized by CRE

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.568 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S242-S243

Author(s):

Thana Khawcharoenporn ◽

Wipada Laichuthai

Keyword(s):

Risk Factors ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Carbapenem Resistance ◽

Central Line ◽

Care Hospital ◽

Central Line Insertion ◽

Carbapenem Resistant ◽

Study Population ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background This study aims to determine rates of subsequent carbapenem-resistance Enterobacteriaceae (CRE)-associated infections and prolonged colonization among patients colonized by CRE and to identify risk factors of such conditions. Methods This study was conducted among a cohort of hospitalized adult patients colonized by CRE at any sites from June 1, 2015 to December 31, 2018. The patients had been prospectively identified by the Infection Control (IC) Division of a Thai tertiary-care hospital. According to the hospital’s IC protocol, patients with CRE colonization/infections were isolated and underwent CRE cultured at the colonized/infected sites every week until the cultures have turned negative for 2 consecutive times. Prolonged colonization was defined as having CRE colonization more than 30 days. Results Of the 125 patients identified, 25 were excluded due to death, being transferred, or discharged within 48 hours of CRE colonization detected. The final cohort included 100 patients, the median age was 74 years, 48% were male, the most common colonized site was rectum (37%) and 20 patients (20%) developed subsequent CRE-associated infections. The median time from colonization to infection was 13 days and the most common site of infection was bloodstream (45%). Independent factors associated with subsequent CRE-associated infections were the number of colonization sites [adjusted odds ratio (aOR) 7.98, P < 0.001)], central line insertion during admission (aOR 7.97, P = 0.009) and receipt of vancomycin during admission (aOR 24.77, P = 0.02). Prolonged colonization was observed in 13 of 77 evaluable patients (17%). There were trends toward significance that the length of hospital stay and duration of antibiotic prior to colonization were associated with prolonged colonization (P < 0.10). Conclusion The findings suggest high rates of subsequent CRE-associated infections and prolonged colonization among the study population. Patients with risk factors for subsequent infections should be closely monitored and empirically-treated with antibiotics active against CRE while those with risk factors for prolonged colonization should receive continued surveillance and isolation to prevent CRE transmission. Disclosures All authors: No reported disclosures.

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Knowledge, Attitude and Practice on Prevention of Catheter-associated UTI among Nurses of a Tertiary Care Hospital

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v17i1.28543 ◽

2021 ◽

Vol 17 (1) ◽

pp. 61-68

Author(s):

Rashmi K.C. ◽

Binita Dhakal

Keyword(s):

Urinary Tract ◽

Bacterial Infections ◽

Urinary Catheter ◽

Tertiary Care ◽

Negative Attitude ◽

Length Of Hospital Stay ◽

Care Hospital ◽

Cross Sectional ◽

Level Of Knowledge ◽

Tract Infections

Introduction: Urinary tract infection (UTI) is among the common bacterial infections worldwide and approximately 80% are associated with a urinary catheter. Catheter-associated UTI (CAUTI) has been associated with increased mortality, morbidity, length of hospital stay and the best way of CAUTI prevention is to adhere to recommended guidelines on infection control in the use of a urinary catheter. Methods: A cross-sectional analytical study was conducted among the nurses of college of medical sciences. A total of 160 staff nurses were selected using a probability simple random sampling technique. Data was collected using a self-administered questionnaire for knowledge, Likert scale for attitude, and checklist for practice regarding the prevention of CAUTI. The data gathered was analyzed using both descriptive and inferential statistics in SPSS software. Results: Among the total of 160 participants, most of the nurses 59.37% had moderate knowledge and 16.25% had adequate knowledge towards the prevention of CAUTI. The positive attitude of nurses was 41.88% and the majority of nurses 64.38% had a good level of practice. Also, age (p=0.022), professional qualification (p=0.001), designation (p=0.001), current area of practice (p=0.030) and previous information towards CAUTI prevention (p=0.003) among all the socio-demographic variables were statistically significant with the level of knowledge regarding the prevention of CAUTI. Conclusion: Majority of nurses level of knowledge was not satisfactory and had a negative attitude regarding CAUTI prevention. This indicates that the implementation of an educational program is needed to enhance nurses' knowledge regarding catheter management to improve quality care. Keywords: attitude; catheter-associated urinary tract infections; CAUTI; practice; UTI

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Molecular detection of blaOXA-23gene and blaOXA-51 gene in carbapenem resistant strains of Acinetobacterbaumannii in patients with ventilator associated pneumonia at tertiary care hospital

Journal of the Pakistan Medical Association ◽

10.47391/jpma.01537 ◽

2021 ◽

Vol 71 (11) ◽

pp. 2576-2581

Author(s):

Saima Ishtiaq ◽

Sidrah Saleem ◽

Abdul Waheed ◽

Arslan Ahmed Alvi

Keyword(s):

Acinetobacter Baumannii ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Conventional Polymerase Chain Reaction ◽

Diffusion Method ◽

Military Hospital ◽

Care Hospital ◽

Acinetobacter Baumanii ◽

Cross Sectional ◽

Carbapenem Resistant

Objective: To evaluate carbapenem resistance and to detect blaOXA-23 and blaOXA-51 genes in carbapenem-resistant acinetobacter baumanii isolates recovered from patients having pneumonia secondry to ventilation. Methods: The cross-sectional study was conducted from July 2017 to June 2018 at the Department of Microbiology, University of Health Sciences, Lahore, Pakistan, and comprised endotracheal aspirates / tracheobroncheal lavage samples from patients irrespective of age and gender who developed pneumonia after being on the ventilator for 48 hrs at the Combined Military Hospital, and Jinnah Hospital, Lahore. The samples were inoculated on MacConkey and blood agar and aerobically incubated at a temperature of 370C for 18-24 hours. The isolated organisms were further assessed by standard morphological, cultural and biochemical profile. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method. Carbapenem-resistant acinetobacter baumannii were checked for carbapenemase production using Modified Hodge Test. Conventional polymerase chain reaction and agarose gel electrophoreses were performed to detect blaOXA-23 and blaOXA-51 genes. Data was analysed using SPSS 17. Results: Out of 157 samples, 92(58.6%) yielded growth of bacteria, and, among them, 39(42.4%) were identified as acinetobacter baumannii. All (100%) acinetobacter baumannii cases showed resistance to carbapenem, were producing carbapenemase enzyme, and were positive for blaOXA-51 gene. The blaOXA-23 gene was amplified in 38(97.4%) isolates. Conclusion: BlaOXA-23 gene appeared to be the major cause of carbapenem resistance. Continuous...

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A Review of Comparison of Complications of Vaginal Hysterectomy with and without Concomitant Surgery for SUI: A 5 Years’ Experience at a Tertiary Care Hospital of Pakistan

Obstetrics and Gynecology International ◽

10.1155/2013/540646 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Raheela Mohsin Rizvi ◽

Munnazza Akhtar ◽

Nadeem Faiyaz Zuberi

Keyword(s):

Vaginal Hysterectomy ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

International Classification Of Diseases ◽

Medical Intervention ◽

Uterovaginal Prolapse ◽

Care Hospital ◽

Cross Sectional ◽

Efficient Treatment ◽

Concomitant Surgery

Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery.Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence.Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH with repair alone. The basic characteristics like age, BMI, and degree of prolapse showed no statistical difference among two groups. The main comorbidities in both groups were hypertension, diabetes, and bronchial asthma. We observed no significant differences in intraoperative and postoperative complications except for cuff abscess, need for medical intervention, and readmission following discharge from hospital, which were higher in cases with vaginal hysterectomy with concomitant TVT.Conclusions. Vaginal hysterectomy is an efficient treatment for uterovaginal prolapse with a swift recovery, short length of hospital stay, and rare serious complications. The addition of surgery for USI does not appear to increase the morbidity.

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Incidence and Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

10.20944/preprints201912.0205.v2 ◽

2020 ◽

Author(s):

Abhishek Sharma ◽

Aditya Mathur ◽

Cecilia Stålsby Lundborg ◽

Ashish Pathak

Keyword(s):

Risk Factors ◽

Tertiary Care ◽

World Health ◽

Respiratory Pattern ◽

Care Hospital ◽

Severe Dehydration ◽

Cross Sectional ◽

Oral Rehydration ◽

History Of ◽

Independent Risk Factors

Diarrhoea contributes significantly in the under-five childhood morality and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having “some dehydration” and “dehydration” according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine output, and abnormal respiratory pattern. A questionnaire was administered to identify risk factors for severe dehydration, which was the primary outcome. Multivariate logistic regression modeling was used to detect independent risk factors for severe dehydration. The study included 332 children, with mean ± standard deviation age of 25.62 ± 31.85 months; out of which, 70%(95% confidence interval [CI] 65 to 75) were diagnosed to have severe dehydration. The independent risk factors for severe dehydration were: child not exclusive breast fed in the first six months of life (AOR 5.67, 95%CI 2.51 to 12.78; p<0.001), history of not receiving oral rehydration solution before hospitalization (AOR 1.34, 95%CI 1.01 to 1.78; p=0.038), history of not receiving oral zinc before hospitalization (AOR 2.66, 95%CI 1.68 to 4.21; p<0.001) and living in overcrowded conditions (AOR 5.52, 95%CI 2.19 to 13.93; p<0.001). The study identified many risk factors associated with severe childhood dehydration; many of them are modifiable though known and effective public health interventions.

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A study on length of stay and its predictors among dengue patients in a tertiary care institute in Lucknow

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20195071 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4870

Author(s):

Sandhya Mishra ◽

Deepak Chopra ◽

Nidhi Jauhari ◽

Ausaf Ahmad

Keyword(s):

Occupational Exposure ◽

Length Of Stay ◽

Hospital Admissions ◽

Tertiary Care ◽

Case Fatality ◽

Length Of Hospital Stay ◽

Care Hospital ◽

Age Group ◽

Cross Sectional ◽

Early Arrival

Background: Dengue virus infection is a growing health problem and is prevalent throughout India. Research focusing on length of hospital stay and its predictors is scarce from India. This is important considering the burden of the disease during epidemics and impact on hospital admissions. Hence the study was conducted with the objectives to find out the factors influencing the length of stay in hospital of dengue patients.Methods: A cross sectional retrospective observational study conducted at a tertiary care hospital from August 2016 to October 2016. Data was retrieved from case sheets at Medical Record Department of 350 lab confirmed adult dengue patients admitted in the hospital.Results: The majority of patients admitted were of economically productive age group of 18-45 years and males indicating the occupational exposure to the vector of dengue. The study found that majority had length of stay of less than a week and as age increases the length of stay also increases (statistically significant). The nil case fatality and lesser number of mean days of symptoms before admission possibly indicate that early arrival of patients to hospital can lead to very low fatality rates. Further research required to find out the other predictors of length of stay.Conclusions: The study concludes that the dengue affects the economically productive age group and more males thereby indicating occupational exposure to the vector. The age of the patient can be used as an indicator to the length of stay in the hospital.

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Cross-sectional Study on MyocardialInfarction in Young Adults in an EmergencyDepartment of a Rural Tertiary Care Hospital, Davanagere,Karnataka, India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49377.14903 ◽

2021 ◽

Author(s):

CH Karthik Reddy ◽

Mahesh Krishnamurthy ◽

Ashray Vasanthapuram ◽

Girish Narayan ◽

SS Narendra

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Young Adults ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Vessel Disease

Introduction: The incidence of Acute Coronary Syndrome (ACS) in the young has been increasing globally. Research in this population has been limited in developed countries or urban areas in developing countries. Identifying the various epidemiologic features in this age group is crucial to understand the disease. Aim: To describe the clinical characteristics of young adults presenting with ACS in a rural tertiary care hospital. Materials and Methods: This cross-sectional study included 50 patients diagnosed with ACS. Data were collected from consecutive patients between the ages of 18 to 45 years diagnosed with ACS between January 2014 to January 2015 in the Emergency Medicine Department of a tertiary care hospital in Davanagere, India. Data were collected on demographic characteristics, risk factors, laboratory tests, and angiographic findings. Range, mean and percentages were calculated for continuous and categorical variables, respectively. A 95% confidence intervals were calculated for all variables. Results: The mean age was 38.1±5.8 years with male preponderance 46 (92%). Risk factors were smoking 36 (72%), diabetes 17 (34%), hypertension 6 (12%) and Body Mass Index (BMI) >23 kg/m2, 36 (72%). Anterior Wall Myocardial Infarction (AWMI) was observed in 35 (70%) of subjects with angiography revealing Single Vessel Disease (SVD) 28 (56%), Double Vessel Disease (DVD) 5 (10%), Triple Vessel Disease (TVD) 3 (6%) and Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) 11 (22%). Three patients died during their course of treatment before initiating an interventional procedure. Conclusion: Smoking, diabetes mellitus and elevated BMI are associated with ACS among young patients. Interventions targeting these risk factors among younger individuals should be developed.

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Ischemic stroke: Observations and analysis of stroke patients admitted in a tertiary hospital of Kathmandu

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v8i2.28166 ◽

2019 ◽

Vol 8 (2) ◽

pp. 66-71

Author(s):

Dipesh Shakya ◽

Rabindra Shrestha ◽

Krishna Dhungana ◽

Raisha Kafle ◽

Sabnam Bhatta

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Carotid Artery ◽

Public Awareness ◽

Tertiary Care ◽

Care Hospital ◽

Stroke Patients ◽

Cross Sectional ◽

Carotid Artery Atherosclerosis ◽

Common Risk Factors

Background: Stroke is a disabling condition that has physical and mental impact on a patient’s life. Stroke is an important morbidity for low and middle income countries like Nepal. Hypertension, diabetes, smoking, and dyslipidemia are common risk factors in this regard and are inadequately controlled; mainly because of poor public awareness, inadequate infrastructure, lack of service and qualified manpower.Objectives: This study aims to provide insight into the epidemiology and risk factors in ischemic stroke patients.Methodology: A descriptive cross sectional study was conducted in 92 ischemic stroke patients at a tertiary care hospital Kathmandu Medical College and Teaching Hospital (KMCTH), Sinamangal, Nepal from December 2017 to June 2018. Consecutive sampling technique was used and data was collected from ischemic stroke patients above 14 years of age who were admitted in the Department of Neurology. Information regarding pre-morbid and morbid conditions, imaging findings as well as results was obtained from biochemical analysis of blood after taking consent from the patient or patient’s relative. Statistical Package for the Social Sciences Version 20 was used as a tool for statistical analysis.Results: Their mean age was 63.25 years with standard deviation of 16.45. Dyslipidemia was the most commonly found risk factor which was present in 77.2% of the subjects, followed by smoking (59.8%), presence of carotid artery atherosclerosis (59.8%), hypertension (50%), atrial fibrillation (26.1%) and diabetes mellitus(15.2%). Smoking was significant in males and heart disease was mostly seen in females.Conclusion: Dyslipidemia and smoking were the most common risk factors followed by carotid artery atherosclerosis. Patients with hypertension and dyslipidemia had higher incidence of stroke in both young and elderly group.

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Epidemiology of carbapenem-resistant Enterobacteriaceae in a Tertiary Care Center in the Kingdom of Bahrain

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_101_18 ◽

2019 ◽

Vol 11 (02) ◽

pp. 111-117 ◽

Cited By ~ 2

Author(s):

Nermin Kamal Saeed ◽

Safaa Alkhawaja ◽

Nashawa Fawzy Abd El Moez Azam ◽

Khalil Alaradi ◽

Mohammed Al-Biltagi

Keyword(s):

Control Measure ◽

Care Center ◽

Tertiary Care ◽

Laboratory Data ◽

Control Measures ◽

Clinical Samples ◽

Common Source ◽

Care Hospital ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Abstract PURPOSE: The purpose of the study is to estimate the rate of infection with carbapenem-resistant Enterobacteriaceae (CRE) in the main governmental tertiary care hospital in Bahrain. MATERIALS AND METHODS: All clinical samples with positive growth of CRE over 6-year period (January 2012–December 2017) were collected from the microbiology laboratory data. RESULTS: The CRE incidence was high in the first half of study period (2012–2014) and then decreased between 2015 and 2017, after implementation of intensified CRE control measure bundle. About 49.4% of CRE-positive samples were isolated from the elderly age group (above 65 years old), most of them were admitted in the intensive care unit (ICU). The most common isolated organisms were Klebsiella pneumoniae (87.0%), followed by Escherichia coli (7.9%). Isolates from deep tracheal aspirate and midstream urine specimens were the most common source of CRE isolates (27.3%) and (26.3%), respectively. Bacteremia was documented in 21.2% of cases. CRE isolates in the study showed high rates of resistance to aminoglycosides (72.2% resistant to amikacin and 67.3% to gentamicin). Alternatively, most isolates retained their susceptibility to colistin and tigecycline with sensitivity of 83.9% and 85.7%, respectively. Combined resistance to both colistin and tigecycline was observed in 0.06% of total isolates. CONCLUSION: Elderly population and ICU admission were important risk factors for CRE acquisition. Most of CRE isolates were sensitive to both colistin and tigecycline, which make them the best combination for empiric frontline therapy for suspected serious CRE infection in our facility. Implementing CRE-bundled infection control measures significantly reduced the incidence of CRE infection in our hospital.

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Phenotypic and genotypic characterization of multidrug-resistant isolates from patients with catheter-associated urinary tract infection in a tertiary care hospital

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_22_19 ◽

2019 ◽

Vol 11 (03) ◽

pp. 206-211

Author(s):

Jaison Jayakaran ◽

Nirupa Soundararajan ◽

Priyadarshini Shanmugam

Keyword(s):

Urinary Tract ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Diffusion Method ◽

Care Hospital ◽

Disk Diffusion Method ◽

Carbapenem Resistant ◽

Tract Infections

Abstract INTRODUCTION: Urinary tract infections (UTIs) remain as the most common infection. Catheter-associated (CA) UTI can lead to bacteremia and thereby is the leading cause of morbidity and mortality in hospitalized patients in our country. AIMS AND OBJECTIVES: This study aims to check the prevalence of CAUTI and study the phenotypic and genotypic characters of the multidrug-resistant organisms in a tertiary care hospital, with special reference to NDM-1 and OXA-23. MATERIALS AND METHODS: A total of 231 urine samples from patients with CA-UTI in different wards in a tertiary care hospital over a period of 3 months between June and August 2018 were collected and processed following the standard protocol. Antibiotic susceptibility tests were performed by disk-diffusion method. Modified Hodge test (MHT) was done to isolate carbapenem-resistant isolates, and polymerase chain reaction was done to detect NDM-1 and OXA-23. RESULTS: Out of 231 samples, 101 samples yielded significant growth. These 38 samples were Gram-negative bacilli which were resistant to carbapenems. Out of the 38 which showed carbapenem resistance, 23 were MHT positive. Out of the 23 MHT-positive isolates, 8 (21.05%) were positive for NDM-1 gene and only 1 (2.6%) was positive for the OXA-23 gene. CONCLUSION: This study has shown that carbapenem-resistant isolates from all the CA urinary tract-infected patients were 52.77% and most of them were Klebsiella. About 21% of them harbored the NDM-1 gene whereas only 2% had the OXA-23 gene. There has been an alarming increase in the spread of carbapenem resistance.

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