Study of microbial growth on silicone tubes after transcanalicular laser-assisted dacryocystorhinostomy and correlation with patency

Introduction: Intubation in primary transcanalicular laser assisted dacryocystorhinostomy (TCLADCR) is performed to increase the success rates. However, the associated inflammation and infection can have adverse effects. Objective: To study the microbial infection and drug susceptibility of extubated silicone tubes and final anatomical patency in patients undergoing TCLADCR. Materials and methods: A non-randomised prospective interventional study was conducted in a tertiary care eye centre. The study included twenty consecutive adult patients with primary nasolacrimal duct obstruction. They underwent TCLADCR with bicanalicular silicone intubation. The stents were removed at 2 months and subjected to culture sensitivity, followed by administration of appropriate antimicrobial agents. Main outcome measures studied were the microbial spectrum on the cultured tubes, their sensitivity profile and its correlation with final anatomical patency. Results: A positive culture was obtained in 100% cases, comprising of normal commensals and pathogenic organisms. Of the total 24 isolates, 16 (66.6%) Gram positive bacteria (75% Staphylococcus aureus) and 8 (33.3%) Gram negative bacteria (commonest E.coli) were found, with 4 tubes having more than one isolate. No fungal growth was seen. Ninety percent success rate was achieved at one year following appropriate antimicrobial therapy except in 2 patients with gram negative isolates who had failed to take the prescribed antibiotics following sensitivity reports. There was no correlation between multiple infections and success rate. However, by using the Fisher exact test, a positive correlation was obtained between appropriate antibiotic treatment and the final anatomical patency (p<0.05). Conclusion: Silicone intubation predisposes to microbial growth, which if neglected, can lead to failure of TCLADCR.

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Once-Daily Intraperitoneal Gentamicin is Effective Therapy for Gram-Negative Capd Peritonitis

Peritoneal Dialysis International ◽

10.1177/089686089901900412 ◽

1999 ◽

Vol 19 (4) ◽

pp. 357-360 ◽

Cited By ~ 10

Author(s):

Wai-Choong Lye ◽

Jane C. Van Der Straaten ◽

See-Odd Leong ◽

Pary Sivaraman ◽

Seng-Ho Tan ◽

...

Keyword(s):

Antimicrobial Agents ◽

Treatment Success ◽

Tertiary Care ◽

Empirical Therapy ◽

Success Rates ◽

Once Daily ◽

Gram Negative ◽

Tertiary Care Institution ◽

Acinetobacter Spp ◽

Gram Negative Organisms

Objective To report our 3-year experience with the use of once-daily intraperitoneal (IP) gentamicin in the treatment of gram-negative continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Design A prospective cohort study in prevalent CAPD patients. Setting A tertiary care institution. Patients All CAPD patients who presented with new episodes of peritonitis were studied. At presentation with peritonitis, IP vancomycin and gentamicin were administered as empirical therapy. IP gentamicin was given at a single daily dose of 40 mg/2 L in the overnight bag. The antimicrobial agents were reviewed when the culture results became available. Intraperitoneal ceftazidime was added for the treatment of pseudomonas peritonitis. Main Outcome Measures Results of microbiological cultures and clinical outcomes of peritonitis were analyzed. Results Over a 36-month period, 190 episodes of peritonitis were recorded, of which 62/190 episodes (32.6%) isolated gram-negative organisms. The gram-negative organisms isolated were Escherichia coli, 15/62 episodes (24.1%); Pseudomonas aeruginosa, 12/62 episodes (19.4%); Acinetobacter spp, 12/62 episodes (19.4%); Klebsiella spp, 10/62 episodes (16.1%); and others, 13/62 episodes (21.0%). The overall treatment success rate was 66.1%. The treatment success rates were 74.0% if pseudomonas infections were excluded, 76.1% if gentamicin-resistant pathogens were excluded, and 80.5% if both pseudomonas infections and gentamicin-resistant pathogens were excluded. Conclusions Once-daily IP gentamicin appears to be effective in the treatment of gram-negative CAPD peritonitis.

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Complications and Success Rate of Percutaneous Nephrolithotomy in Renal Stone: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.4723 ◽

2019 ◽

Vol 57 (220) ◽

Author(s):

Robin Joshi

Keyword(s):

Success Rate ◽

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Tertiary Care ◽

Cross Sectional Study ◽

Point Estimate ◽

Care Hospital ◽

Success Rates ◽

Sectional Study ◽

Cross Sectional

Introduction: Renal stone disease has been affecting people for centuries. Percutaneous nephrolithotomy is one of the five interventions offered to a patient with renal stone. With the continuous development of noninvasive or minimally invasive techniques, these surgical procedures have been refined over time. This study was conducted to find the success rate of percutaneous nephrolithotomy in renal stone using Guy’s score and complication by Modified Clavien score. Methods: This descriptive cross-sectional study was done among 114 patients who underwent percutaneous nephrolithotomy in a tertiary care hospital, from September 2016 to December 2018 after receiving ethical approval from the Institutional Review Committee. Convenient sampling was done. All patients were informed about the potential benefits and risks of the percutaneous nephrolithotomy procedure and patients signed an informed written consent form. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion. Statistical analysis was done by using Statistical Package for Social Sciences version 22.2. Results: Forty-six (40.3%) patients had Guy’s stone score I, 43 (37.71%) patients had a score of II, 15 (13.6%) patients had a score of III and 10 (8.77%) patients had a score of IV. The success rates of stone clearance were 97.8 %, 95.3%, 80% and 50% for Guy’s stone score 1, 2, 3 and 4 respectively. A total of 114 patients were enrolled in the study out of which 66 were male and 48 were female. Eighteen patients experienced some form of complications out of which 3 patients needed surgical intervention with Modified Clavien score of III. Conclusions: Using Guy’s scoring system for percutaneous nephrolithotomy we evaluated the success rate. It is reproducible, easy and proves to be a useful tool to counsel patients about stonefree rate and prognosis for the surgical procedure. Modified Clavien score was helpful in evaluating complication rate.

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The Success Rate of Endotracheal Intubation in the Emergency Department of Tertiary Care Hospital in Ethiopia, One-Year Retrospective Study

Emergency Medicine International ◽

10.1155/2021/9590859 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Ayalew Zewdie ◽

Dejene Tagesse ◽

Selam Alemayehu ◽

Tesfaye Getachew ◽

Menbeu Sultan

Keyword(s):

Emergency Department ◽

Success Rate ◽

Endotracheal Intubation ◽

Addis Ababa ◽

Tertiary Care ◽

Tertiary Hospital ◽

Rapid Sequence Intubation ◽

Care Hospital ◽

Success Rates ◽

First Pass

Background. Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective. This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result. Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion. The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.

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OXA-48 Carbapenemase-Encoding Transferable Plasmids of Klebsiella pneumoniae Recovered from Egyptian Patients Suffering from Complicated Urinary Tract Infections

Biology ◽

10.3390/biology10090889 ◽

2021 ◽

Vol 10 (9) ◽

pp. 889

Author(s):

Ann A. Elshamy ◽

Sarra E. Saleh ◽

Mohammad Y. Alshahrani ◽

Khaled M. Aboshanab ◽

Mohammad M. Aboulwafa ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Antimicrobial Agents ◽

Bacterial Species ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Clinical Isolates ◽

Gram Negative ◽

E Coli ◽

Tract Infections

Gram-negative bacteria are common causes of urinary tract infections (UTIs). Such pathogens can acquire genes encoding multiple mechanisms of antimicrobial resistance, including carbapenem resistance. The aim of this study was to detect the carbapenemase-producing ability of some Gram-negative bacterial isolates from urine specimens of patients suffering from complicated UTIs at two vital tertiary care hospitals in Cairo, Egypt; to determine the prevalence of carbapenemase genes among plasmid-bearing isolates; and explore the possibility of horizontal gene transfer to other bacterial species. The collected isolates were subjected to antimicrobial susceptibility testing, phenotypic analysis of carbapenemase production, and molecular detection of plasmid-borne carbapenemase genes, then the extracted plasmids were transformed into competent E. coli DH5α. A total of 256 Gram-negative bacterial clinical isolates were collected, 65 (25.4%) isolates showed carbapenem resistance of which 36 (55.4%) were carbapenemase-producers, and of these 31 (47.7%) harbored plasmids. The extracted plasmids were used as templates for PCR amplification of blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP carbapenemase genes. The blaOXA-48 gene was detected in 24 (77.4%) of the tested isolates while blaVIM gene was detected in 8 (25.8%), both blaKPC and blaNDM genes were co-present in 1 (3.2%) isolate. Plasmids carrying the blaOXA-48 gene from 4 K. pneumoniae clinical isolates were successfully transformed into competent E. coli DH5α. The transformants were carbapenemase-producers and acquired resistance to some of the tested antimicrobial agents as compared to untransformed E. coli DH5α. The study concluded that the rate of carbapenem resistance among Gram-negative bacterial uropathogens in Cairo, Egypt is relatively high and can be transferred horizontally to other bacterial host(s).

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Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates

Acta Endocrinologica ◽

10.1530/eje-11-0287 ◽

2011 ◽

Vol 165 (2) ◽

pp. 301-306 ◽

Cited By ~ 54

Author(s):

Matthias J Betz ◽

Christoph Degenhart ◽

Evelyn Fischer ◽

Anna Pallauf ◽

Volker Brand ◽

...

Keyword(s):

Success Rate ◽

Primary Aldosteronism ◽

Femoral Vein ◽

Tertiary Care ◽

Control Period ◽

Retrospective Chart Review ◽

University Hospital ◽

Adrenal Vein ◽

Success Rates ◽

Adrenal Vein Sampling

ObjectiveAdrenal vein sampling (AVS) is considered the gold standard in the differential diagnosis of primary aldosteronism (PA), but success rates vary between centers. We hypothesized that rapid (intraprocedure) cortisol measurement can improve performance in a center with initially low AVS success rate.DesignWe analyzed 46 patients with confirmed PA studied between 2008 and 2010. Forty-seven PA patients studied between 2004 and 2008 identified by retrospective chart review served as controls. All patients were treated at a single tertiary care university hospital.MethodsStarting in 2008, rapid cortisol assays (RCA) were performed in all patients during the AVS procedure. A cortisol gradient of ≥2.0 between adrenal vein and a femoral vein sample was used as success criterion. Up to two repeat samples were drawn if adrenal vein cortisol was below this threshold.ResultsDuring the control period 26 of 47 AVS were successful (55%). After introduction of RCA, 39 out of 46 AVS (85%) were successful (P=0.003). In 21 of the 46 cases (46%) a resampling was necessary. The increase in overall success was due to an increase in successful right AVS (85 vs 62% before introduction of RCA; P=0.02) and a training effect (P=0.024 for trend).ConclusionRCA during AVS are useful in centers with an initially low AVS success rate.

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Isolates and their Antibiogram in Different Samples from a Tertiary Care Hospital, Kathmandu.

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v14i1.14831 ◽

2016 ◽

Vol 14 (1) ◽

pp. 1-8

Author(s):

Bibek Bhatta ◽

Roshina Thapa ◽

Sanjay Shahi ◽

Sushil Karki ◽

Yogesh Bhatta ◽

...

Keyword(s):

Antimicrobial Agents ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Laboratory Data ◽

Care Hospital ◽

Gram Positive ◽

Gram Negative ◽

Appropriate Prescribing ◽

A Prospective Study ◽

Klebsiella Spp

Introduction: The emergence and spread of antimicrobial resistance constitutes a major risk for human health by limiting the success of these agents in the therapy. The widespread uses of antibiotics, together with the length of time over which they have been available, have led to major problems of resistant organisms contributing to morbidity and mortality. Knowledge of etiological agent and its sensitivities to available drugs is of immense value to the rational selection and use of antimicrobial agents and to the development of appropriate prescribing policies. The aim of this study was to prepare a local antibiogram of the commonly isolated organism at a tertiary care hospital.Methods: A prospective study was conducted at KMC Teaching Hospital, from April 14th to 17th September 2014. Laboratory data of culture and sensitivity were collected from hospital Microbiology Laboratory and analyzed using SPSS software.Results: In our study most of the isolates were Gram negative with Klebsiella Spp. and Escherichia coli being predominant with many MDR isolates. The isolates were found to be resistant to different groups of drugs. We found least resistance to Chloramphenicol, Imepenem and Amikacin. Most of the resistance was found against Amoxicillin and Erythromycin. Among gram positive S. aureus was predominant with 64.7% MRSA and 23.1% VRSA isolates.Conclusions: The most sensitive drug for gram positive was Chloramphenicol, Cephotaxim and Norfloxacine. The only drug which was 100% sensitive to Gram Negative organism was Chloramphenicol.

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Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1617439 ◽

2018 ◽

Vol 79 (05) ◽

pp. 451-457 ◽

Cited By ~ 8

Author(s):

Enrique Perez ◽

Daniel Carlton ◽

Matthew Alfarano ◽

Eric Smouha

Keyword(s):

Cerebrospinal Fluid ◽

Length Of Stay ◽

Skull Base ◽

Success Rate ◽

Average Length ◽

Tertiary Care ◽

Success Rates ◽

Base Thickness ◽

Transmastoid Approach ◽

Csf Leaks

Objective Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population. Method We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case. Results We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness (R 2 = 0.00011). Conclusion The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.

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Peripherally Inserted Central Catheters in the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/088506669601100107 ◽

1996 ◽

Vol 11 (1) ◽

pp. 49-54 ◽

Cited By ~ 33

Author(s):

Philip K. Ng ◽

Mark J. Ault ◽

Lawrence S. Maldonado

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Success Rate ◽

Complication Rate ◽

Central Venous Access ◽

Tertiary Care ◽

Venous Access ◽

Success Rates ◽

Peripherally Inserted Central Catheters ◽

Central Catheters

We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians requested a PICC service consultation were included. Main outcome measurements included (1) the success rate for initial PICC placement, (2) the placement complication rate, and (3) the overall success and complication rate. Of the 91 consecutive attempts at PICC placement, 89 (97.8%) were successful: of the 89 successful placements, 25 (28%) required cutdown procedures. There were 20 complications of initial placement and 8 delayed complications, which occurred in 19 PICCs. Complications included recatheterization after first attempt was unsuccessful (10), catheter malposition (7), palpitations or catheter clotting (3 each), heavy bleeding or mechanical phlebitis (2 each), and arterial puncture (1). The overall success rate for completion of therapy using the PICC was 74.7%. The most frequent reasons for failure to complete therapy were catheter dislodgment in 8 patients and “infection” in 9 patients. Of these 9 patients with “infections,” 8 catheters were discontinued due to potential infection, and only 1 was removed due to confirmed infection. The confirmed infection rate was 6/10,000 patient days. The PICC appears to be a reasonable alternative to other approaches to peripheral and central venous access. The initial and overall success rates from this preliminary study justify' further evaluation of the PICC in critically ill patients.

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Alarming Pattern of Antimicrobial Resistance in Neonatal Sepsis Observed in Neonatal Intensive Care Unit of a Tertiary Care Hospital in Bangladesh

KYAMC Journal ◽

10.3329/kyamcj.v12i1.53359 ◽

2021 ◽

Vol 12 (1) ◽

pp. 3-7

Author(s):

Tania Rahman ◽

Sharmeen Sultana ◽

Taslima Akber Happy ◽

Kamrunnahar Alo ◽

Momtaz Begum

Keyword(s):

Antimicrobial Resistance ◽

Neonatal Sepsis ◽

Antimicrobial Agents ◽

Tertiary Care ◽

Diffusion Method ◽

Gram Negative Bacteria ◽

Care Hospital ◽

Isolation And Identification ◽

Gram Positive ◽

Gram Negative

Background: Resistance of micro-organisms to multiple broad-spectrum antimicrobial agents is a major problem in treating neonatal sepsis. It is a matter of utmost importance to have knowledge of trends in changing pattern of antimicrobial resistance. Objective: This study was done to observe antimicrobial resistance of gram-positive and gram-negative bacteria isolated from cases of neonatal sepsis Material and Methods: This cross sectional descriptive study was conducted in Department of Microbiology in collaboration with Department of Neonatology, Dhaka Medical College Hospital, Dhaka. Antimicrobial resistance of all the isolated bacteria was performed by Modified Kirby-bauer disk diffusion method following standard guideline after isolation and identification of bacteria from blood samples of suspected septicemic neonates by automated blood culture and standard microbiological protocol. Results: All of the isolated Staphylococcus aureus, Coagulase negative Staphylococcus, Group-B Streptococcus and Micrococcus showed 100% resistance to ceftriaxone, cefotaxime and ceftazidime. Among the isolated gram-negative bacteria, all of Enterobacter spp., Pseudomonas aeruginosa and Citrobacter spp. showed 100% resistance to amoxiclav, amikacin, ceftriaxone, cefixime, ceftazidime. Conclusion: Majority of the gram-positive and gram-negative bacteria are developing resistance to multiple antimicrobial agents and surveillance is necessary to tackle this alarming situation. KYAMC Journal.2021;12(01): 03-07

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Phenotypic detection of carbapenem resistance in gram negative bacilli from various clinical specimens of a tertiary care hospital in Western Uttar Pradesh

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173552 ◽

2017 ◽

Vol 5 (8) ◽

pp. 3511 ◽

Cited By ~ 1

Author(s):

Jyoti Diwakar ◽

Rajesh K. Verma ◽

Dharmendra P. Singh ◽

Amit Singh ◽

Sunita Kumari

Keyword(s):

Antimicrobial Agents ◽

Tertiary Care ◽

Uttar Pradesh ◽

Carbapenem Resistance ◽

Diffusion Method ◽

Public Health Issue ◽

Care Hospital ◽

Beta Lactam ◽

Disk Diffusion Method ◽

Gram Negative

Background: Carbapenemase producing multidrug-resistant organisms (i.e., MDROs) is a critical medical and public health issue globally. These bacteria are often resistant to all beta-lactam agents and are also co-resistant to other multiple classes of antimicrobial agents, leaving very few antimicrobial options.Methods: This study was carried out at UP University of medical sciences Saifai, Etawah, Uttar Pradesh, India, from January 2015 to June 2016. 110 isolates were found resistant by the Kirby Bauer’s disc diffusion method according to the CLSI guidelines. Modified Hodge test and combined disk test were performed for resistant isolates.Results: A total of 800-gram negative isolate were included in the study. 110 isolates were found resistant to imipenem by disk diffusion method. Out of these 90 (81.81%) were positive for carbapenemase production by modified Hodge test.Conclusions: We conclude that the modified Hodge test is a useful method for detection of carbapenemase production. Combined disc method is useful to detect metallo beta lactamase production.

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