Microbial Patterns and Antimicrobial Susceptibility on Pediatric Patients with Pressure Ulcers

Background: A pressure ulcer (PU) is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with sharp surface. Several studies have found that PU is also a common problem in the pediatric population. Infection at PU sites is the most common complication, where PU can host resistant microorganisms and can turn into a local infection that is a source of bacteremia in hospital patients. This study aims to determine the most common bacteria and antimicrobial susceptibility at the site of PU in pediatric patients that serve as baseline data in Haji Adam Malik Hospital.Materials and Methods: A cross-sectional study was carried out in July-December 2017, involving 30 PU pediatric patients. For each subject, swab from ulcers were cultured in microbial laboratory to determine the microbial pattern and antimicrobial susceptibility.Results: The most common age group was 0-3 (53.3%), the highest gender was male (60%), the most common type was type 2 (46.7%), the main location was occipital (30%) and the most common undelying diseases were hydrocephalus (16.6%). The most common microbial pattern in PU pediatric patients is Acinetobacter baumannii (40%). The highest sensitivity is vancomycine for gram positive bacteria and amikacine for gram negative bacteria.Conclusion: The most common microbial pattern in PU pediatric patients in Haji Adam Malik Hospital is Acinetobacter baumannii (40%). The highest sensitivity is vancomycine for gram positive bacteria and amikacine for gram negative bacteria.Keywords: pressure ulcer, pediatric, microbial pattern, antimicrobial susceptibility

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Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study

Children ◽

10.3390/children8060436 ◽

2021 ◽

Vol 8 (6) ◽

pp. 436

Author(s):

Giovanni Parente ◽

Tommaso Gargano ◽

Stefania Pavia ◽

Chiara Cordola ◽

Marzia Vastano ◽

...

Keyword(s):

Escherichia Coli ◽

Retrospective Study ◽

Success Rate ◽

Pediatric Population ◽

Gram Negative Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Significant Difference ◽

Klebsiella Spp

Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life–3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were Escherichia coli (97%), Proteus mirabilis (2%), and Klebsiella spp. (1%). The only Gram-positive bacteria isolated was an Enterococcus faecalis. As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life–11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1–5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were Pseudomonas aeruginosa (44%), Escherichia coli (27%), and Klebsiella spp. (12%), while Enterococcus spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found (p = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested.

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Difference of Procalcitonin Levels in Gram-Positive and Gram-Negative Bacterial Sepsis Patients of Indonesia Army Central Hospital Gatot Soebroto in 2016

JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga ◽

10.20473/juxta.v13i12022.38-41 ◽

2022 ◽

Vol 13 (1) ◽

pp. 38

Author(s):

Nindy Handayani ◽

Soroy Lardo ◽

Nunuk Nugrohowati

Keyword(s):

Mean Difference ◽

P Value ◽

Central Hospital ◽

Bacterial Sepsis ◽

Gram Positive ◽

Cross Sectional ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Significant Difference ◽

The Mean

Introduction: Procalcitonin is known as a marker of infection and indicator for severity of infections. In sepsis, elevated procalcitonin levels in blood have a significant value that can be used as a sepsis biomarker. The aim of this study was to determine the mean difference of procalcitonin levels in Gram-positive and Gram-negative bacterial sepsis patients.Methods: This study used quantitative method with cross sectional approach. The sample of this study were bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 which were divided into two groups: Gram-positive and Gram-negative bacterial sepsis patients with the number of each group was 30 samples. The data were analyzed by using independent t test.Results: This study showed that mean levels of procalcitonin in Gram-positive bacterial sepsis patients was 6.47 ng/ml and Gram-negative was 66.04 ng/ml. There was a significant difference between mean levels of procalcitonin in Gram-positive and Gram-negative bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 with p value = 0.000 (p < 0.05).Conclusion: The mean difference of procalcitonin levels in Gram-negative bacterial sepsis patients were higher than Gram-positive bacterial sepsis patients, because Gram-negative bacteria have lipopolysaccharide which is a strong immunostimulator and increases TNF-α production higher than Gram-positive bacteria.

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Re-thinking antimicrobial resistance transmission dynamics: a meta-analysis of cross-sectional studies at referral hospitals in Uganda

F1000Research ◽

10.12688/f1000research.24638.1 ◽

2020 ◽

Vol 9 ◽

pp. 878

Author(s):

Gerald Mboowa ◽

Ivan Sserwadda ◽

Dickson Aruhomukama

Keyword(s):

Antimicrobial Resistance ◽

Transmission Dynamics ◽

Gram Positive ◽

Cross Sectional ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Extended Spectrum ◽

Hospital Environments ◽

Referral Hospitals ◽

Cross Sectional Studies

Background: Antimicrobial resistance threatens the achievements of modern medicine as well as the sustainability of effective global public health responses to the threat posed by infectious diseases. Extended-spectrum β-lactamase production in bacteria provides the main mechanism of resistance in gram-negative bacteria, particularly those belonging to the Enterobacteriaceae family as well as gram-positive bacteria. This study hence aimed at providing insights into the potential role of in-patients, their immediate hospital environments, out-patients, and their communities in the transmission of antimicrobial resistance via identifying gram-negative and gram-positive bacteria commonly isolated in samples collected from each of these patients/sites as well as their antimicrobial susceptibility profiles using extended-spectrum β-lactamase production in the same as the basis. Methods: Our study reviewed four cross-sectional studies conducted at national and regional referral hospitals in Uganda. Data on bacterial aetiology and antimicrobial susceptibility testing retrieved from the studies was imported into Microsoft Excel, cleaned, sand then exported to IBM SPSS statistics (version 16) for statistical analysis. The databases used were PubMed and Embase. Results: We report that; Escherichia coli and Klebsiella pneumoniae are the most prevalent Enterobacteriaceae species in the samples that were collected in the studies reviewed; these species account for the highest proportions of extended-spectrum β-lactamase producers; Staphylococcus aureus is the most prevalent of the gram-positive bacteria isolated from the same samples, and accounts for the highest proportions of extended-spectrum β-lactamase producers in the gram-positive bacteria isolated, and similar Enterobacteriaceae species and gram-positive bacteria, are predominant in samples from in-patients, their immediate hospital environments, and out-patients. Conclusion: The insights provided indicate antimicrobial resistance transmission dynamics be re-thought and more comprehensive studies aimed at investigating the same be done to ascertain the source and transmission routes of antimicrobial-resistant bacteria in clinical settings.

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Incidence and Bacterial Etiologies of Surgical Site Infections in a Public Hospital, Addis Ababa, Ethiopia

The Open Microbiology Journal ◽

10.2174/1874285801913010301 ◽

2019 ◽

Vol 13 (1) ◽

pp. 301-307

Author(s):

Alem A. Kalayu ◽

Ketema Diriba ◽

Chuchu Girma ◽

Eman Abdella

Keyword(s):

Drug Resistance ◽

Addis Ababa ◽

Surgical Site Infections ◽

Resistant Bacteria ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Cross Sectional ◽

Gram Negative ◽

Clinical Criteria ◽

Gram Positive Bacteria

Background: Surgical Site Infections (SSIs) are among the frequently reported healthcare-acquired infections worldwide. Successful treatment of SSIs is affected by the continuous evolvement of drug-resistant microbes. This study investigated the incidence of SSIs, identifying the major etiologic agents and their drug resistance patterns in Yekatit 12 Hospital, Ethiopia. Methods: A cross-sectional study was conducted on 649 patients who underwent surgery at Yekatit 12 hospital from April 2016 to April 2017. Socio-demographic and clinical data were collected from each patient on admission. After surgery, they were followed for SSI occurrence. SSI was initially diagnosed by a senior surgeon based on standard clinical criteria and then confirmed by culture. Isolates were tested for drug resistance according to the clinical and laboratory standards institute guideline. Results: Of the 649 study participants, 56% were females. Their age ranged from 9 months to 88 years with a median age of 37 years. The incidence of culture-confirmed SSI was 10.2% (66/649) where 73 isolates were recovered. About two-third of the isolates were Gram-positive bacteria. Staphylococcus aureus was the most frequently isolated (27/73, 37%) followed by Coagulase-negative staphylococci (18/73, 24.7%), Escherichia coli (11/73, 15.1%) and Klebsiella species (10/73, 13.7%). About 89% and 44% of S. aureus isolates were resistant to penicillin and trimethoprim-sulfamethoxazole, respectively. MRSA constituted 11% of the S. aureus isolates. All the Gram-negative isolates were resistant to ampicillin and trimethoprim-sulfamethoxazole but susceptible to amikacin and meropenem. Klebsiella species showed 70-100% resistance to ceftazidime, cefuroxime, augmentin, chloramphenicol, ciprofloxacin, cefepime and gentamicin. About 82% of E. coli isolates were resistant for chloramphenicol, cefepime, ceftazidime, augmentin, cefuroxime and 64% for gentamicin and ciprofloxacin. Conclusion: The incidence of surgical site infection in Yekatit 12 hospital is 10.2%. Most of the SSIs were due to Gram-positive bacteria. Gram-negative isolates showed high resistance to the most commonly prescribed drugs. No resistance was found for meropenem indicating the absence of carbapenem-resistant bacteria. SSI treatments should be guided by culture and drug resistance test. Better infection prevention practices and continuous surveillance of antimicrobial resistance in the hospital are recommended for better patient care.

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TREATMENT OF UNSTABLE THORACOLUMBAR FRACTURES IN PEDIATRIC PATIENTS

Coluna/Columna ◽

10.1590/s1808-185120151403152473 ◽

2015 ◽

Vol 14 (3) ◽

pp. 227-229 ◽

Cited By ~ 1

Author(s):

Roberto Chapa Sosa ◽

Edgar Rubén Urrutia Vega

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Cross Sectional Study ◽

Thoracolumbar Fracture ◽

Anatomical Site ◽

Thoracolumbar Fractures ◽

Sectional Study ◽

Neurological Damage ◽

Cross Sectional ◽

Common Cause

Objective:To analyze the characteristics of unstable thoracolumbar fractures in the pediatric population.Methods:A retrospective cross-sectional study was conducted with pediatric patients (0 to 15 years) who presented with unstable thoracolumbar fracture with or without neurological damage. Twenty-four operated patients were analyzed: 13 male and 11 female.Results:Falls from height are the most common cause, being the thoracolumbar junction the anatomical site most frequently injured.Conclusion:The thoracolumbar fractures are rare in the pediatric population, as well as post-surgical instrumentation structural deformities.

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A Prospective Evaluation of Two Rapid Phenotypical Antimicrobial Susceptibility Technologies for the Diagnostic Stewardship of Sepsis

BioMed Research International ◽

10.1155/2018/6976923 ◽

2018 ◽

Vol 2018 ◽

pp. 1-13 ◽

Cited By ~ 15

Author(s):

Cesira Giordano ◽

Elena Piccoli ◽

Veronica Brucculeri ◽

Simona Barnini

Keyword(s):

Antimicrobial Susceptibility ◽

Multidrug Resistant ◽

Rapid Identification ◽

Blood Cultures ◽

Gram Positive ◽

Gram Negative ◽

Maldi Tof Ms ◽

Gram Positive Bacteria ◽

Maldi Tof ◽

Tof Ms

Rapid identification of bloodstream pathogens by MALDI-TOF MS and the recently introduced rapid antimicrobial susceptibility testing (rAST) directly from positive blood cultures allow clinicians to promptly achieve a targeted therapy, especially for multidrug resistant microorganisms. In the present study, we propose a comparison between phenotypical rASTs performed in light-scattering technology (Alfred 60AST, Alifax®) and fluorescencein situhybridization (Pheno™, Accelerate) directly from positive blood cultures, providing results in 4–7 hours. Blood samples from 67 patients admitted to the Azienda Ospedaliero-Universitaria Pisana were analyzed. After the direct MALDI-TOF MS identification, the rAST was performed at the same time both on Alfred 60AST and Pheno. Alfred 60AST provided qualitative results, interpreted in terms of clinical categories (SIR). Pheno provided identification and MIC values for each antibiotic tested. Results were compared to the broth microdilution assay (SensiTitre™, Thermo Fisher Scientific), according to EUCAST rules. Using Alfred 60AST, an agreement was reached, 91.1% for Gram-negative and 95.7% for Gram-positive bacteria, while using Pheno, the agreement was 90.6% for Gram-negative and 100% for Gram-positive bacteria. Both methods provided reliable results; Alfred 60AST combined with MALDI-TOF MS proved itself faster and cheaper. Pheno provided identification and MIC determination in a single test and, although more expensive, may be useful whenever MIC value is necessary and where MALDI-TOF MS is not present.

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Microbiological Profile and Antibiotic Sensitivity Pattern of Bacteria in Diabetic Foot Ulcers in a Tertiary Care Hospital

Journal of Advanced Research in Medicine ◽

10.24321/2349.7181.202101 ◽

2021 ◽

Vol 08 (01) ◽

pp. 1-8

Author(s):

Gajender Singh Ranga ◽

Keyword(s):

Diabetic Foot ◽

Tertiary Care ◽

Klebsiella Pneumonia ◽

Care Hospital ◽

Gram Positive ◽

Cross Sectional ◽

Gram Negative ◽

E Coli ◽

Gram Positive Bacteria ◽

Sensitivity Pattern

Introduction: Diabetic foot is any foot pathology due to diabetes or sequelae of diabetes mellitus. This study was conducted to identify the common microorganisms isolated from diabetic foot and to analyse the antibiotic susceptibility pattern of bacteria isolated from diabetic foot. Materials and Method: The study was a hospital based cross-sectional study where 146 foot ulcer samples (who had type 2 diabetes) were analysed. Swabs were collected from the edge and margins of ulcers, and organisms were identified by gram staining culture and biochemical reactions. Result:Out of 146 patients, 69 specimens showed growth of organisms. Total 84 aerobic organisms were isolated and out of them, 64 cases showed bacterial growth, in which 84 bacteria were isolated, which represented an average of 1.28 organisms per case. Among these organisms, 62 gram-negative and 22 gram-positive organisms were isolated. E. coli was the most common gram-negative isolate (23.81%), followed by Pseudomonas aeruginosa (21.4%), and Klebsiella pneumonia(8.33%), while among gram-positive bacteria, S. aureus was the most common isolate (22.6%). Conclusion: Incidence of growth was 47.2% in which E. coli (23.8%) was the most common isolate. Gram-negative bacteria were more common than gram-positive bacteria. Diabetic foot infections are polymicrobial in nature.

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PATHOGENS CAUSING BLOOD STREAM INFECTIONS

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.12.850 ◽

2015 ◽

Vol 22 (12) ◽

pp. 1617-1623

Author(s):

Muhammad Saeed ◽

Farhan Rasheed ◽

Fouzia Ashraf ◽

Shagufta Iram ◽

Shahida Hussain ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Cardiac Surgery ◽

Blood Culture ◽

Blood Stream ◽

Cross Sectional Study ◽

Blood Cultures ◽

Gram Positive ◽

Cross Sectional ◽

Blood Stream Infections ◽

Gram Negative

Blood stream infections (BSI) remain a major cause of debility and death aroundthe world. BSI accounts for 10-20% of all Nosocomial infections. Empirical antimicrobials arebased on the susceptibility pattern of the pathogens isolated in a specific institute from timeto time. We have conducted this study only on cardiac Patients over two & half years of studyduration. Study design: Cross sectional study. Settings: Microbiology Department, Allama IqbalMedical College/Jinnah Hospital, Lahore. Study Period: January 2013 to July 2015. Materials& Methods: A total of 5411 blood culture specimens were collected from cardiac patientsincluding patients admitted to cardiology ward, coronary care unit (CCU), pre-operative andpost-operative cardiac surgery patients. The bottles containing BHI broth were incubated andwere subcultured after 24 hours, 72 hours, 120 hours, and 168 hours on blood and MacConkeyagars. Isolates were further identified with the help of Gram staining, biochemical reactionsand rapid tests like catalase, oxidase, coagulase, Analytical Profile Index (API) 20E and API20NE. Antimicrobial susceptibility of the isolate was carried out on Mueller-Hinton agar byModified Kirby Bauer disc diffusion technique according to the isolate as per recommendationsof Clinical and Laboratory Standards Institute (CLSI) guidelines 2013. Results: Out of total 5411patients, 3958(73.14%) were male, 1453(26.85%) were females. Out of total 5411 Specimens,only 486 (8.98%) were positive for bacterial growth. Out of total 486 positive blood cultures,261 (53.71%) were Gram positive isolates and 225 (46.29%) were Gram negative isolates.Out 486 positive blood cultures, 96 (19.75%) were from cardiology ward, 67 (13.78%) werefrom CCU, 113 (23.25%) were from pre operative cardiac surgery ward, 210 (43.20%) werefrom post operative cardiac surgery ward. Among Gram positives, Staphylococcus Specieswere most common organism isolated from 246 (50.61%) blood culture specimens. AmongGram negatives, Pseudomonas aeruginosa and E.coli were predominant organisms, isolatedfrom 81(16.66%) and 72(14.81%) blood culture specimens respectively. Conclusion: GramPositive isolates were more common as compared to Gram negative isolates. Vancomycin andLinezolid were the most effective drugs among Gram positive isolates. Piperacillin-Tazobactamwas most potent antimicrobial against Pseudomonas aeruginosa. For coli forms Tigecyclinewas most effective drug.

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Bacterial etiology and antibiotic resistance pattern of neonatal sepsis: a study in a tertiary care hospital, in Bangladesh

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20193098 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1839

Author(s):

Mahfuza Shirin ◽

M. Monir Hossain ◽

Manifa Afrin ◽

Mohammad Abdullah Al Mamun

Keyword(s):

Neonatal Sepsis ◽

Tertiary Care ◽

Resistance Pattern ◽

Gram Negative Bacteria ◽

Care Hospital ◽

Gram Positive ◽

Cross Sectional ◽

Gram Negative ◽

Mortality And Morbidity ◽

Gram Positive Bacteria

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. The objective of the study was to detect causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns.Methods: This prospective cross-sectional study was conducted from July 2017 to June 2018 in the Department of Neonatal Medicine and NICU of Dhaka Shishu (Children) Hospital (DSH). Neonates diagnosed with probable sepsis were studied. After enrollment, 1 mL blood was taken and sent to Microbiology department of DSH for culture and sensitivity. With baseline characteristics, clinical examination findings and outcome, were also recorded.Results: Rate of isolation of single organism was 9.2% (84/913). Out of 84 isolates, gram negative bacteria were 77.4% with Klebsiella pneumonae being the commonest (35, 41.7%), gram positive bacteria were 11.9% with Staphylococcus aureus and Streptococcus were equal (5, 5.95% each) and the remaining (9, 10.7%) isolated organism was Candida. Most of the isolated gram-negative bacteria were resistant to ampicillin, gentamicin, and ceftazidime; but gram-positive bacteria preserved 20-80% sensitivity. Klebsiella was more resistant than Acinetobacter to amikacin, netilmicin, ciprofloxacin and levofloxacin. Around 45-65% of gram-negative bacteria were resistant to imipenem and meropenem but gram-positive bacteria showed lesser resistance. Among the gram-negative bacteria, Klebsiella and Acinetobacter were resistant to piperacillin as same as carbapenem group, but gram-positive bacteria were 100% sensitive to piperacillin. All the gram-negative bacteria showed more resistance to 4th generation cephalosporin, cefepime than carbapenem. Out of culture positive 84 neonates, 63 (75.0%) were cured but 21 (25.0%) died. Among the 21 expired neonates, 47.6% (10/21) were infected with Klebsiella.Conclusion: This study observed that gram-negative bacteria causing neonatal sepsis predominantly, with emergence of Candida. All the isolated gram-positive and gram-negative organisms were mostly resistant to available antibiotics

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Accuracy Score on Raja Isteri Pengiran Anak Saleha (RIPASA) and Pediatric Appendicitis (PAS) for Diagnosing Acute Appendicitis in Children

Sriwijaya Journal of Surgery ◽

10.37275/sjs.v2i2.32 ◽

2020 ◽

Vol 3 (2) ◽

pp. 102-111

Author(s):

Shalita Dastamuar ◽

M. Roby ◽

Sindu Saksono ◽

Erial Bahar

Keyword(s):

Acute Appendicitis ◽

Pediatric Patients ◽

Histopathological Examination ◽

Pediatric Population ◽

Cross Sectional Study ◽

Accuracy Score ◽

Cross Sectional ◽

Clinical Scoring ◽

Surgical Field ◽

Sensitivity Specificity

Abstract Introduction. Acute appendicitis is the most common case of acute abdomen. Diagnosis of acute appendicitis is still difficult and is one of the problems in the surgical field. The Clinical Scoring System (CSS) has been developed to help doctors classify risk categories. PAS has been widely evaluated in the pediatric population. In another study it was found that RIPASA had better sensitivity, specificity, and accuracy than PAS in pediatric patients. Methods. This study is a cross sectional study to assess the level of concordance between RIPASA and PAS scores in diagnosing acute appendicitis, with the gold standard of Histopathological examination. Samples were taken by consecutive method, in 30 patients aged <18 years for 1 year. Results. This study had an average age of 10.10 ± 3.745 years. Histopathologically early acute appendicitis 3.3%, acute suppurative appendicitis as much as 20%, acute gangrenous appendicitis 73.3% and others 3.3%. Using a cut-off point value of 9.5 for RIPASA and 7 for PAS, the sensitivity, Specificity, Accuracy of 82.75%, 100%, 80% for RIPASA, and 75.8%, 100%, 73.3% for PAS. Conclusion. The RIPASA score on the cut-off treshold 9.5 has better sensitivity and accuracy than PAS in diagnosing acute appendicitis in pediatric patients and can be used as CSS to assist in making decisions regarding the diagnosis of acute appendicitis in children.

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