scholarly journals CARBAPENEM-RESISTANT ENTEROBACTERIACEAE: NEW MENACE TO OUR ANTIBIOTIC ARMAMENTARIUM!

2017 ◽  
Vol 10 (9) ◽  
pp. 335
Author(s):  
Ankita Porwal ◽  
Sevitha Bhat
Keyword(s):  
Risk Factors ◽  
Polymyxin B ◽  
Isolation Rate ◽  
Chi Square ◽  
Carbapenem Resistant ◽  
Chi Square Test ◽  
Vitek 2 ◽  
The Common ◽  
Common Infection ◽  
Carbapenem Resistant Enterobacteriaceae

  Objective: To study the risk factors, clinical characteristics, and outcome in patients with infections due to CRE infections.Methods: Retrospective study was carried out in a microbiology laboratory for 6 months. 152 CRE isolates identified by the Vitek 2 compact system were included in the study. The risk factors, antibiotic treatment and clinical outcome were studied from the case sheets, Chi-square test was used for statistical analysis.Results: Of the 2520 positive cultures for Enterobacteriaceae, isolation rate of CRE was 152 (6%). 76 (50%) belonged to exudates, 22 (14.1%) blood culture, 90 (59.2%) urine. The common infection was UTI. The risk factors were prior exposure to antimicrobials, admission to intensive care unit, indwelling devices and prior hospitalization. The effective antibiotic was colistin, polymyxin B, tigecycline, cefoperazone-sulbactum, piperacillin-tazobactum. The mortality was 19.7%.Conclusion: We have demonstrated the value of understanding local epidemiology to help modify our risk-based screening as a strategy to limit the spread of CRE.

scholarly journals 1591. Antibiotic Utilization Trends in Veterans Affairs (VA) Patients with Carbapenem Resistant Enterobacteriaceae (CRE) Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S792-S792
Author(s):  
Alfredo Traversa ◽  
Linda Poggensee ◽  
Geneva M Wilson ◽  
Katie J Suda ◽  
Charlesnika T Evans ◽  
...  
Keyword(s):  
Treatment Options ◽  
Blood Stream ◽  
Chi Square ◽  
Blood Stream Infections ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Extended Spectrum ◽  
New Antibiotics ◽  
Chi Square Test ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are classified as an “urgent threat” to public health. Historically, colistin and tigecycline had been considered the drugs of choice for CRE infections, while other agents such as aminoglycosides and carbapenems had been used as adjunctive therapy. However, the FDA approval of ceftazidime-avibactam in 2015, meropenem-vaborbactam in 2017, and plazomicin in 2018 has expanded treatment options. Our purpose was to assess trends in CRE treatment for “new” antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) as compared with other antibiotics with CRE activity. Methods This was a retrospective cohort study describing treatment of CRE blood stream infections (BSI) across 134 VA facilities from 2012-2018. Patients were censored at their first positive blood culture with CRE. Categorical data was assessed with a Fisher’s exact test or chi-square test. Trends test and logistic regression were used to describe changes in CRE treatment over time. Results 724 patients with positive blood cultures for CRE were identified during the study period. Most patients were male (94%), white (32%) or Hispanic (38%), and the mean age was 71.5+11.9. Of those patients that received antibiotics (N=697), 53.4% carbapenems, 40.3% received aminoglycosides, 39.3% received polymyxins, 32.9% penicillins, 32.6% extended spectrum cephalosporins, 26.1% fluoroquinolones, 11.6% ceftazidime/avibactam, and 0.4% ceftolazone/tazobactam. Over the study period, there was decreased utilization of aminoglycosides (P < 0.0026) and colistin (P< 0.002) and increases in extended spectrum cephalosporins (P < 0.001) and ceftazidime/avibactam (P < 0.001). Conclusion Utilization of “older” agents such as aminoglycosides and polymyxins for the treatment of CRE blood stream infections is decreasing in the VA. Treating CRE with ceftazidime/avibactam, a newly approved antibiotic, and extended spectrum cephalosporins are increasing. Disclosures All Authors: No reported disclosures

scholarly journals Clinical and Demographic Predictors of Mortality due to COVID-19 Pandemic: A Retrospective Study

2021 ◽  
Vol 11 (5) ◽  
pp. 74-81
Author(s):  
Ayushi Rajkumar Jain ◽  
Doss Prakash ◽  
Sheetal Swamy
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Early Stage ◽  
Major Complication ◽  
Respiratory Arrest ◽  
Chi Square ◽  
High Risk Factors ◽  
Demographic Predictors ◽  
Chi Square Test ◽  
The Common

The alarming statistics of COVID-19 surges up in 2021 throwing an enormous burden on the healthcare system across the world. According to WHO reports on 14th April 2021, globally 136,996,364 confirmed COVID-19 cases are reported across the continents, including 2,951,832 deaths. The state of Maharashtra reported the maximum number of cases of India including high mortality rate. This study was conducted to identify and describe the relation of different predictors (Age, gender, duration of hospital stay, presence of co morbidities) of mortality among the COVID-19 deceased patients by retrospectively analyzing the medical case records of 121 patients from a dedicated COVID hospital at Aurangabad from July 2020 to December 2020. Chi-square test was performed to assess the association between causes of death with different cluster of variables and their significance. This study helps us to identify risk factors that show association between various predictors and mortality rate in COVID-19 patients. Out of 121 deaths, 96 (79%) were male, 61 (49.6%) were in age group between 60-79 years, ARDS was one of the major complication in the deceased patients accounting 29.8% and cardio respiratory arrest was the common cause of death among the deceased patients with 85%. It was also observed that mortality rate was very higher in the initial five days of hospitalization with critical care support. Our result findings provide clinical inferences for physicians to identify high-risk factors with COVID-19 at a very early stage. Key words: COVID-19, Mortality rate, Demographic predictors, Co-morbidities, Cardio respiratory arrest.

scholarly journals Phenotypic Detection of Carbapenemase Production in Carbapenem-Resistant Enterobacteriaceae by Modified Hodge Test and Modified Strip Carba NP Test

2021 ◽  
Author(s):  
Nisha Patidar ◽  
Nitya Vyas ◽  
Shanoo Sharma ◽  
Babita Sharma
Keyword(s):  
Carbapenem Resistance ◽  
Nonparametric Test ◽  
Multidrug Resistant ◽  
Clinical Samples ◽  
Chi Square ◽  
Carbapenem Resistant ◽  
The Social ◽  
Significant Difference ◽  
High Degree ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Objective Carbapenems are last resort antibiotics for multidrug-resistant Enterobacteriaceae. However, resistance to carbapenem is increasing at an alarming rate worldwide leading to major therapeutic failures and increased mortality rate. Early and effective detection of carbapenemase producing carbapenem-resistant Enterobacteriaceae (CRE) is therefore key to control dissemination of carbapenem resistance in nosocomial as well as community-acquired infection. The aim of present study was to evaluate efficacy of Modified strip Carba NP (CNP) test against Modified Hodge test (MHT) for early detection of carbapenemase producing Enterobacteriaceae (CPE). Material and Methods Enterobacteriaceae isolated from various clinical samples were screened for carbapenem resistance. A total of 107 CRE were subjected to MHT and Modified strip CNP test for the detection of CPE. Statistical Analysis It was done on Statistical Package for the Social Sciences (SPSS) software, IBM India; version V26. Nonparametric test chi-square and Z-test were used to analyze the results within a 95% level of confidence. Results Out of 107 CRE, 94 (88%) were phenotypically confirmed as carbapenemase producer by Modified strip CNP test and 46 (43%) were confirmed by Modified Hodge Test (MHT). Thirty-eight (36%) isolates showed carbapenemase production by both MHT and CNP test, 56 isolates (52%) were CNP test positive but MHT negative, eight (7%) isolates were MHT positive but CNP test negative and five (5%) isolates were both MHT and CNP test negative. There is statistically significant difference in efficiency of Modified CNP test and MHT (p < 0.05). Conclusion Modified strip CNP test is simple and inexpensive test which is easy to perform and interpret and gives rapid results in less than 5 minutes. It has high degree of sensitivity and specificity. Modified strip CNP test shows significantly higher detection capacity for carbapenemase producers as compared with MHT.

scholarly journals Prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults

2008 ◽  
Vol 19 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Carlos Estrela ◽  
Cláudio Rodrigues Leles ◽  
Augusto César Braz Hollanda ◽  
Marcelo Sampaio Moura ◽  
Jesus Djalma Pécora
Keyword(s):  
Risk Factors ◽  
Confidence Intervals ◽  
Odds Ratio ◽  
Apical Periodontitis ◽  
Endodontic Treatment ◽  
Technical Quality ◽  
Endodontically Treated Teeth ◽  
Chi Square ◽  
Chi Square Test

The aim of this study was to assess the prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults. A total of 1,372 periapical radiographs of endodontically treated teeth were analyzed based on the quality of root filling, status of coronal restoration and presence of posts associated with apical periodontitis (AP). Data were analyzed statistically using odds ratio, confidence intervals and chi-square test. The prevalence of AP with adequate endodontic treatment was low (16.5%). This percentage dropped to 12.1% in cases with adequate root filling and adequate coronal restoration. Teeth with adequate endodontic treatment and poor coronal restoration had an AP prevalence of 27.9%. AP increased to 71.7% in teeth with poor endodontic treatment associated with poor coronal restoration. When poor endodontic treatment was combined with adequate coronal restoration, AP prevalence was 61.8%. The prevalence of AP was low when associated with high technical quality of root canal treatment. Poor coronal restoration increased the risk of AP even when endodontic treatment was adequate (OR=2.80; 95%CI=1.87-4.22). The presence of intracanal posts had no influence on AP prevalence.

scholarly journals Bacteriological Safety of Blood Collected for Transfusion at University of Gondar Hospital Blood Bank, Northwest Ethiopia

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Hailegebriel Wondimu ◽  
Zelalem Addis ◽  
Feleke Moges ◽  
Yitayal Shiferaw
Keyword(s):  
Risk Factors ◽  
Bacterial Contamination ◽  
Standard Procedure ◽  
Cross Sectional Study ◽  
Northwest Ethiopia ◽  
Blood Bank ◽  
Bacterial Isolation ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test

Background. Transfusion associated bacterial infection has remained more frequent with a sever risk of morbidity and mortality. This study assessed the bacteriological safety of blood collected for transfusion. Method. A cross-sectional study was conducted at University of Gondar hospital blood bank from December 2011 to June 2012. Bacterial isolation, identification, and antimicrobial susceptibility tests were done as per the standard procedure. Chi-square test and P value were used to assess associations between risk factors and the bacterial isolation rate. Results. Twenty-one (15.33%) blood units were found contaminated with bacteria, and 95.24% contamination was due to external sources. The commonly isolated bacteria were Staphylococcus aureus, Coagulase negative Staphylococci, Escherichia coli, Klebsiella species, Streptococci species, Enterobacter species, and Citrobacter species. All of the bacteria isolated were 100% sensitive to Gentamicin, Chloramphenicol, Amoxicillin, and Doxycycline. Multiple antimicrobial resistances were observed in 66.7% of the isolates. Not using glove by phlebotomist, touching disinfected phlebotomy site and double puncture at the same hand or both hands of a donor were found to be risk factors for bacterial contamination. Conclusion. Bacterial contamination of blood to be transfused is a common problem in the hospital. So attention should be given to activities performed at the blood bank for safe transfusion practices.

Social assessment of children dental health and its determining factors

2021 ◽  
Vol 21 (2) ◽  
pp. 123-131
Author(s):  
T. G. Svetlichnaya ◽  
A. S. Mityagina ◽  
T. M. Burkova ◽  
N. M. Ogorelkova
Keyword(s):  
Risk Factors ◽  
Oral Hygiene ◽  
Primary Teeth ◽  
Dental Health ◽  
Tooth Decay ◽  
Chi Square ◽  
Significance Level ◽  
Pediatric Dentist ◽  
Chi Square Test ◽  
Decay Risk

Relevance. The high prevalence of tooth decay requires investigation of its risk factors. The aim was to study tooth decay risk factors among six-year-old children according to the level of dental health (based on parents’ assessment).Materials and methods. The research evaluated the dental health of six-year-olds and factors defining their oral health; The study surveyed 515 parents of six-year-old children from 7 kindergartens in Arkhangelsk. Pearson chi-square test assessed the differences in the frequency of tooth decay factors among six-year-old children according to the level of dental health. The accepted significance level was 0.05.Results. The Arkhangelsk parents evaluated the dental health of their six-year-olds as relatively favourable: good (41.2%) and satisfactory (46.6%). Only 9.5% of children had poor health. Children generally had good oral hygiene skills: 86.8% liked brushing their teeth; 60.2% squeezed the optimal amount of toothpaste on the toothbrush; 56.7% brushed their teeth twice a day. The dental literacy of parents was satisfactory: 67.0% purchased toothpaste for children; 90.8% considered necessary to treat primary teeth; 69.2% replaced toothbrush every three months; 59.7% visited a pediatric dentist twice a year. The children with poor dental health had insufficient oral hygiene skills: 46.9% did not like teeth cleaning; 51.1% brushed their teeth once a day. Their diet was not healthy: 100.0% did not eat hard food; 65.3% frequently consumed sweets. The parents  of children with poor dental health had low medical literacy and poor oral hygiene: 46.9% did not know that treatment of primary teeth was necessary; 42.9% considered the treatment of primary teeth as unnecessary; 32.6% purchased whatever toothpaste. The general negative trend is to use toothpaste without fluoride (68.1%).Conclusions. The results of the study demonstrated a significantly higher frequency of cariogenic factors in children with poor dental health.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

Risk Factors for Typhoid Fever Occurrence and Recurrence in Gombe Metropolis, Gombe State, Nigeria

2021 ◽  
Vol 23 (11) ◽  
pp. 381-401
Author(s):  
Umar Abdullahi Tawfiq ◽  
◽  
Shohaimi Shamarina ◽  
Syafinaz Amin Nordin ◽  
Mohd Noor Hisham Mohd Nadzir ◽  
...  
Keyword(s):  
Risk Factors ◽  
Epidemiological Data ◽  
Simple Random Sampling ◽  
Chi Square ◽  
Long Time ◽  
Chi Square Test ◽  
The Government ◽  
Set Up ◽  
Associated Risk Factors ◽  
At Home

Typhoid is a life-threatening disease that has remained endemic in parts of Africa and Asia where its burden is elevated by the inefficiency of control efforts which have been hampered by lack of epidemiological data, among others. In Nigeria, such data is absent in most of the States like Gombe where the disease has been rife for a long time, hence, to bridge that knowledge gap, this study was set up to determine the host-associated risk factors for typhoid occurrence and recurrence in Gombe. A questionnaire that was designed and validated for this location was used to obtain data from 663 respondents using simple random sampling and analyzed using the Chi-square test for association and binomial logistic regression to obtain risk factors for typhoid occurrence and recurrence, respectively. The study revealed that occurrences were statistically significantly associated with the variables for vaccination (χ2 = 39.729, p < 0.01), having houseboy/girl (χ2 = 16.909, p < 0.01), typhoid patient at home (χ2 = 13.393, p < 0.01), hand washing before handling food (χ2 = 22.856, p < 0.01), consuming iced/frozen items (χ2 = 16.805, p < 0.01), boiling drinking water (χ2 = 49.633, p < 0.01), and eating commercially available foods/drinks (χ2 = 27.864, p < 0.01), while recurrences were statistically significantly predicted by „not sure of been vaccinated‟ (OR = 2.962, CI = 1.290 to 6.802, p < 0.01), „not having another typhoid patient at home‟ (OR = 1.799, CI = 0.998 to 3.244, p < 0.01), and „drinking unboiled water sometimes‟ (OR = 2.130, CI = 1.023 to 4.434, p < 0.01). It is believed that these findings will guide efforts by the Government for health interventions against typhoid in the study area, thus improving the quality of life for the population.

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