Pattern of acquisition of hospital-associated pathogens in the ICU of an academic tertiary care hospital

2022 ◽  
Author(s):  
Shazia Damji ◽  
Jerrold Perrott ◽  
Salomeh Shajari ◽  
Jennifer Grant ◽  
Titus Wong ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Median Time ◽  
Broad Spectrum ◽  
Health Authority ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Primary Objective ◽  
Solid Organ ◽  
Care Hospital ◽  
Broad Spectrum Antibiotics

BACKGROUND: Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital. METHODS: Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded. RESULTS: In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8–15.6 days). CONCLUSIONS: Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.

scholarly journals Radiological Parameters for Conservative Management of Solid Organ Injuries in a Tertiary Care Hospital

2020 ◽  
Vol 5 (8) ◽  
pp. 672-676
Author(s):  
Hridhay. K.Prit ◽  
Dr. Perumal Boney
Keyword(s):  
Retrospective Analysis ◽  
Conservative Management ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Solid Organ ◽  
Care Hospital ◽  
The Past ◽  
Radiological Parameters ◽  
Hepatic Injuries

The management of solid organ injuries has changed drastically over the past couple of decades, with there being a shift from operative to conservative mode of management. The main purpose of this study is to establish radiological parameters for conservative management in order to make conservative mode of management more efficient. Retrospective analysis of solid organ injuries was done for 50 patients between January 2020 and March 2020 in a tertiary care hospital. It is found that conservative mode of management can be considered for patients belonging to grade I, II and III according to AAST classification of Splenic and Hepatic injuries whereas in Renal injuries it is considered for patients belonging to grade I and II

scholarly journals Profile of fungal blood stream infection (BSI) in neonate at tertiary care hospital in South India

2018 ◽  
Vol 5 (6) ◽  
pp. 2199
Author(s):  
Shanmuga Sundaram C. ◽  
Kamalarathnam C. N.
Keyword(s):  
Risk Factors ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Broad Spectrum ◽  
Tertiary Care Hospital ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Blood Stream ◽  
Central Line ◽  
Care Hospital

Background: Advancement in neonatal care has led to remarkable improvement in survival of new-born.  Fungal infections in new born are an important health problem associated with substantial morbidity and mortality. The objective of this study was to assess the prevalence and epidemiology of neonatal fungal blood stream infection and to analyze risk factor associated with mortality due to fungal septicemia.Methods: This is a retrospective study of all neonatal fungal cases admitted from July 2016 to June 2017 to a tertiary care hospital in South India.Results: Isolation rate of fungal blood stream infection was 3.3%. Risk factors observed for candida blood stream infection were Broad spectrum antibiotic usage >7 days (91.18%) followed by central line >7 days (58.9%) and total parenteral nutrition (50.68%). Poor weight gain (71.23%), respiratory distress (68.4%) are common clinical presentation. Mortality among candida blood stream infection was 29 (39.72%). On step-wise logistic regression analysis, prolonged rupture of membrane and endotracheal tube placement for more than 7 days were significant independent predictors of mortality in neonatal candida blood stream infection.Conclusions: Candida blood stream infection is significant problem in our unit. It occurs in 3.3 %of neonates admitted in our unit and accounts for 34% of blood culture positive sepsis. Non-albican candidiasis is the predominant agent causing candida blood stream infection. Fungal prophylaxis may be recommended in neonates with risk factors like birth weight less than 1500 gms, those requiring ventilation for more than 7 days, those on total parenteral nutrition for more than 7 days and those on prolonged broad-spectrum antibiotics. It reemphasizes the need for aseptic insertion, maintenance, early identification of catheter related infection and early removal of central line. 

A Clinical Study on Acute Kidney Injury in Cirrhotic Patients

2021 ◽  
Vol 8 (8) ◽  
pp. 420-424
Author(s):  
Sathish Obalanarasimhaiah ◽  
Kiran Shankar ◽  
Balakrishna Nanjundappa Setty ◽  
Gnanendra Dibbadahalli Mariyanna ◽  
Nagesh Nayakarahalli Swamigowda ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Acute Kidney Injury ◽  
Portal Hypertension ◽  
Hospital Admission ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Care Hospital ◽  
Age Group ◽  
Arterial Blood

BACKGROUND The increased propensity for acute kidney injury (AKI) in patients with cirrhosis stems from haemodynamic abnormalities typical for patients with cirrhosis and ascites. 15 which is due to development of portal hypertension and portosystemic collaterals with splanchnic and systemic vasodilatation, resulting in decrease in effective arterial blood volume with increase in renin angiotensin-aldosterone system (RAAS), sympathetic nervous system and non-osmotic release of antidiuretic hormone causing sodium retention, increased intravascular volume, and a hyperdynamic circulatory state, 16 complemented with increased production of nitric oxide which is considered the main cause of vasodilatation in cirrhosis. Mechanism of renal dysfunction in cirrhosis includes portal hypertension & its accompanying haemodynamic abnormalities15 leading to increased synthesis of endogenous vasodilatory compounds such as nitric oxide leading to vasodilatation in splanchnic & systemic arterial systems ultimately leading to activation of reninangiotensinogen–aldosterone system causing compensatory renal vasoconstriction & hypo-perfusion resulting into renal failure. We wanted to study the clinical profile of patients with AKI who presented to a tertiary care hospital in Bangalore. METHODS Ninety-four patients of either gender admitted in the department of gastroenterology at a tertiary care hospital with age > 18 years with either diagnosed or newly diagnosed case of cirrhosis of liver (including both compensated & decompensated cases) admitted with acute kidney injury diagnosed according to International Club of Ascites Classification were enrolled in this study. The sample size was based on number of eligible patients admitted to tertiary care hospital during the study period. Details of the study were explained to them and consent was taken either from the patient or their attender. RESULTS Most patients were in the age group > 60 yrs. with 32 male patients (45.07 %) in the age group of 40 - 60 years & 13 female patients (56.52 %) in the age group of > 60 yrs. 78.7 % of patients developed AKI before hospital admission i.e., at community level; whereas 21.3 % of patients developed AKI after hospital admission i.e., they had normal creatinine level on admission. CONCLUSIONS Pre renal AKI was the most common cause of AKI followed by hepatorenal syndrome & acute tubular necrosis (ATN) comprising 52.1 %, 28.7 % & 19.1 % respectively. KEYWORDS AKI, Cirrhosis, ATN

scholarly journals SOCIODEMOGRAPHIC PROFILE OF PATIENTS WITH ACUTE POISONING IN THE EMERGENCY WARDS OF A TERTIARY CARE HOSPITAL

2018 ◽  
Vol 10 (6) ◽  
pp. 50
Author(s):  
Sathvika Reddy ◽  
Devi Revathi ◽  
V. Lakshmi Prasanna ◽  
Aruna C. Ramesh
Keyword(s):  
Hospital Admission ◽  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Age Groups ◽  
Lower Class ◽  
Acute Poisoning ◽  
Urban Region ◽  
Care Hospital ◽  
Admission Variables

Objective: To assess the socio-demographic profile and outcomes in the patients with poisoning admitted to the emergency wards of a tertiary care hospital.Methods: The prospective observational study was conducted for a period of six months in the emergency wards of a tertiary care hospital. The demographic data, hospital admission variables and outcomes were collected from various sources and documented. Cluster analysis was used to find the interaction between the socio-demographic and hospital admission variables in association with outcomes of poisoning.Results: A total of 133 patients were admitted with acute poisoning. The mean age was 27.76±15.5%. Females (51.1%) were dominant over males (48.8%). Incidents of poisoning were predominant in married (49.6%), literates (41.35%), abiding in urban region (86.4%) and belonging to upper lower class (37.6%). The poisonings were intentional (69.17%) occurring through oral route (81.2%) at home (82%). Reason for poisoning was the most significant (1.00*) predictor followed by route of poisoning. Patients with mild symptoms were 85.71% 10.5% moderate and severe symptoms 3.75%. Majority of the victims recovered (82.71%) whilst 4.51% died.Conclusion: Poisoning patterns vary with socio-demographic and socio-economic status, which is a prevalent social and economic issue in developing countries. Depression acts as a slow poison and is common among younger age groups leading to increased cases of intentional poisoning, thereby indicating a necessity for appropriate psychiatric counselling, medical and peer management strategies to identify the individuals in need that can reduce the risk of next attempt.

scholarly journals Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh

2020 ◽  
Author(s):  
Md. Abdur Rafi ◽  
Md. Zahidus Sayeed ◽  
Papia Sultana ◽  
Saw Aik ◽  
Golam Hossain
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Logistic Regression ◽  
Hospital Admission ◽  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Care Hospital ◽  
Primary Care Center ◽  
Multivariate Logistic Regression

Abstract Background: Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study thus aims at finding the factors associated with prolonged pre-hospital delay and the impact of this delay on in hospital treatment outcome of MI patients of Northern Bangladesh. Methods: This cross sectional study was conducted in December 2019 in cardiology ward of a 1000 bed tertiary care hospital of Bangladesh. Socio demographic data, clinical features and patients’ health seeking behavior was collected in a structured questionnaire from the patients diagnosed as STEMI or non-STEMI. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Patients were classified into two groups, those who admitted within 6 hours and those who admitted after 6 hours. Chi-square (χ²) test and multivariate logistic regression were used to estimate the determinants associated with delayed hospital admission. Effect of pre-hospital delay was determined using univariate and multivariate logistic regression. Results: 337 patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6 hours. In logistic regression, determinants of pre-hospital delay were patients age (for <40 years aOR 2.43, 95% CI 0.73-8.12; for 40 to 60 years aOR 0.44, 95% CI 0.21-0.93), family income (for lower income aOR 5.74, 95% CI 0.89-37.06; for middle income aOR 14.22, 95% CI 2.15-94.17), distance from primary care center £5 km (aOR 0.42, 95% CI 0.12-0.90), predominant chest pain (aOR 0.15, 95% CI 0.05-0.48), considering symptoms as non-significant (aOR 17.81, 95% CI 5.92-53.48), referral from primary care center (for government hospital aOR 4.45, 95% CI 2.03-9.74; for private hospital OR 98.67, 95% CI 11.87-820.34) and not having family history of MI (aOR 2.65, 95% CI 1.24-5.71). Risk of in hospital death was almost 4 times higher who admitted after 6 hours in multivariate logistic regression (OR 4.64, 95% CI 1.87-11.50). Conclusion: Delayed hospital admission after onset of MI is more common in Bangladesh compared to developed countries. Appropriate measures should be taken by policy makers to improve this situation.

scholarly journals Clinical Presentation and Disease Course of 37 Consecutive Cases of Progressive Multifocal Leukoencephalopathy (PML) at a German Tertiary-Care Hospital: A Retrospective Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Lisa M. Graf ◽  
Sina C. Rosenkranz ◽  
Angelique Hölzemer ◽  
Christian Hagel ◽  
Einar Goebell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Tertiary Care Hospital ◽  
Clinical Course ◽  
Tertiary Care ◽  
Solid Organ Transplantation ◽  
Clinical Aspects ◽  
Special Focus ◽  
Solid Organ ◽  
Care Hospital

Background: Progressive multifocal leukoencephalopathy (PML) caused by JCV is a rare but frequently fatal disease of the central nervous system, usually affecting immunocompromised individuals. Our study aims to expand the data on patient characteristics, diagnosis, clinical course, possible PML-directed treatment, and outcome of patients with PML at a German tertiary-care hospital.Methods:In this single-center observational cohort study, 37 consecutive patients with a confirmed diagnosis of PML seen at the University Medical Center Hamburg-Eppendorf from 2013 until 2019 were retrospectively analyzed by chart review with a special focus on demographics, risk factors, and clinical aspects as well as PML-directed treatment and survival.Results:We identified 37 patients with definite, probable, and possible PML diagnosis. 36 patients (97%) had underlying immunosuppressive disorders such as HIV/AIDS (n = 17; 46%), previous treatment with monoclonal antibodies (n = 6; 16%), hematological or oncological malignancies (n = 6; 16%), sarcoidosis (n = 5; 14%), solid organ transplantation (n = 1; 3%), and diagnosis of mixed connective tissue disease (n = 1; 3%). In only one patient no evident immunocompromised condition was detected (n = 1; 3%). Treatment attempts to improve the outcome of PML were reported in 13 patients (n = 13; 35%). Twenty seven percent of patients were lost to follow-up (n = 10). Twenty four-month survival rate after diagnosis of PML was 56% (n = 15).Conclusion: This interdisciplinary retrospective study describes epidemiology, risk factors, clinical course, and treatment trials in patients with PML at a German tertiary-care hospital. Acquired immunosuppression due to HIV-1 constituted the leading cause of PML in this monocenter cohort.

scholarly journals Perceived coercion and need for hospital admission among psychiatric in-patients: figures from a Pakistani tertiary care hospital

2011 ◽  
Vol 8 (1) ◽  
pp. 14-16
Author(s):  
Saman I. Zuberi ◽  
Ayesha Sajid ◽  
Abdul Wahab Yousafzai ◽  
Naila Bhutto ◽  
Murad Moosa Khan
Keyword(s):  
Hospital Admission ◽  
Tertiary Care Hospital ◽  
Psychiatric Patients ◽  
Tertiary Care ◽  
Community Health Services ◽  
Decision Makers ◽  
Care Hospital ◽  
Verbal Persuasion ◽  
Physical Force ◽  
Perceived Coercion

In Pakistan, an increasing proportion of psychiatric patients present to community health services as crisis admissions, with their relatives as the main decision makers. Patients are bound to perceive this process as coercive. Farnham & James (2000) report that elements of coercion are found even in voluntary hospital admission, in the form of verbal persuasion, physical force and threats of commitment. Few patients consider hospitalisation justified and most view the process of admission negatively (Swartz et al, 2003; Katsakou & Priebe, 2006; Priebe et al, 2009).

Asymptomatic Clostridium difficile colonization in a tertiary care hospital: Admission prevalence and risk factors

2013 ◽  
Vol 41 (5) ◽  
pp. 390-393 ◽  
Author(s):  
Surbhi Leekha ◽  
Kimberly C. Aronhalt ◽  
Lynne M. Sloan ◽  
Robin Patel ◽  
Robert Orenstein
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Admission ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Admission Prevalence
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