scholarly journals Patient risk factor stratification is essential for the hospital antibiogram

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Karuna Tiwari ◽  
Samruddhi Patil ◽  
Aparna Naik ◽  
Anjali Shetty ◽  
Kamini Walia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Empiric Therapy ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Salmonella Spp ◽  
Patient Risk ◽  
Extended Spectrum Beta Lactamase ◽  
Type 3

Empiric antimicrobial therapy in hospitalized patients is guided by an institution’s cumulative antibiogram, which may not be adequate in giving information on decision-making for optimal treatment in different patient populations. Adding patient risk factors can make it more useful for clinicians in guiding empiric therapy and for antimicrobial stewardship. Cumulative data were obtained for blood culture and urine isolates from the laboratory information system of a tertiary care hospital for 6 months (January to June 2019). Further stratification of organism types and resistance rates on the basis of patient risk factors (Patient Types 1, 2, and 3) was performed and analyzed. Salmonella spp. was seen in community-acquired ward patients (Types 1 and 2). Streptococcus pneumoniae was seen in Type 1 patients, and Acinetobacter spp. was seen in Type 3 patients. Extended-spectrum beta-lactamase-producing gram-negative infection rates were higher in community patients than in hospital patients. Carbapenem-resistant Enterobacteriaceae rates were high in Type 3 hospitalized patients. Cumulative blood methicillin-resistant Staphylococcus aureus rates were 43% but stratification showed it only in Type 2 and Type 3 ICU patients with 0% in ward patients. Stratified antibiograms based on patient risk factors are valuable for antimicrobial stewardship and help to optimize empiric therapy and increase the understanding of antimicrobial resistance trends.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals Risk factors for wound infection caused by Methicillin Resistant Staphylococcus aureus among hospitalized patients: a case control study from a tertiary care hospital in India

2021 ◽  
Vol 21 (1) ◽  
pp. 286-94
Author(s):  
Latha Thimmappa ◽  
Anil Bhat ◽  
Manjunatha Hande ◽  
Chiranjay Mukhopadhyay ◽  
Elsa Devi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Case Control Study ◽  
Tertiary Care ◽  
Venous Ulcer ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Mrsa Infection ◽  
Control Study

Background: Methicillin Resistant Staphylococcus aureus (MRSA) causes infection in hospitals and communities. The preva- lence and risk factors of MRSA infection is not homogenous across the globe. Objective: To find the risk factors of MRSA infection among hospitalized patients. Methods: Cross-sectional case control study was conducted at a tertiary care hospital in India. The risk factors were collected using checklist from 130 MRSA and 130 Methicillin sensitive staphylococcus aureus (MSSA) infected patients. The pathogens were isolated from the wound swabs according to Clinical and Laboratory Standards Institute guidelines. Results: Both the groups were comparable in terms of age, gender, diabetic status, undergoing invasive procedures, urinary catheterization and smoking (p>0.05). Multivariate logistic regression revealed surgical treatment (OR 4.355; CI 1.03, 18.328; p=0.045), prolonged hospitalization (OR 0.307; CI 0.11, 0.832; p=0.020), tracheostomy (OR 5.298, CI 1.16, 24.298; p=0.032), pressure/venous ulcer (OR 7.205; CI 1.75, 29.606; p=0.006) and previous hospitalization (OR 2.883; CI 1.25, 6.631; p=0.013) as significant risk factors for MRSA infection. Conclusion: Surgical treatment, prolonged and history of hospitalization, having tracheostomy for ventilation and pressure/venous ulcer were the key risk factors. Therefore, special attention has to be given to the preventable risk factors while caring for hospitalized patients to prevent MRSA infection. Keywords: MRSA; infection; India.

scholarly journals Risk Factors for Acquisition and Loss of Clostridium difficile Colonization in Hospitalized Patients

2015 ◽  
Vol 59 (8) ◽  
pp. 4533-4543 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Sondra Seiler ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Content Acquisition ◽  
Stool Samples

ABSTRACTAsymptomatic colonization may contribute toClostridium difficiletransmission. Few data identify which patients are at risk for colonization. We performed a prospective cohort study ofC. difficilecolonization and risk factors forC. difficileacquisition and loss in hospitalized patients. Patients admitted to medical or surgical wards at a tertiary care hospital were enrolled; interviews and chart review were performed to determine patient demographics,C. difficileinfection (CDI) history, medications, and health care exposures. Stool samples/rectal swabs were collected at enrollment and discharge; stool samples from clinical laboratory tests were also included. Samples were cultured forC. difficile, and the isolates were tested for toxins A and B and ribotyped. Chi-square tests and univariate logistic regression were used for the analyses. Two hundred thirty-five patients were enrolled. Of the patients, 21% were colonized withC. difficile(toxigenic and nontoxigenic) at admission and 24% at discharge. Ribotype 027 accounted for 6% of the strains at admission and 12% at discharge. Of the patients colonized at admission, 78% were also colonized at discharge. Cephalosporin use was associated withC. difficileacquisition (47% of patients who acquiredC. difficileversus 25% of patients who did not;P= 0.03). β-lactam–β-lactamase inhibitor combinations were associated with a loss ofC. difficilecolonization (36% of patients who lostC. difficilecolonization versus 8% of patients colonized at both admission and discharge;P= 0.04), as was metronidazole (27% versus 3%;P= 0.03). Antibiotic use affects the epidemiology of asymptomaticC. difficilecolonization, including acquisition and loss, and it requires additional study.

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