scholarly journals Comparison of the novel Uroquattro HB&L™ system and classical phenotypic method for rapid screening of multidrug-resistant organism colonization at the University Hospital Centre Split, Croatia

2020 ◽  
Vol 40 (1) ◽  
pp. 15-19
Author(s):  
Jelena Marinović ◽  
Marija Tonkić ◽  
Miroslav Barišić ◽  
Marina Radić ◽  
Ivana Goić-Barišić ◽  
...  
Keyword(s):  
Sample Size ◽  
Rapid Method ◽  
Classical Method ◽  
Multidrug Resistant ◽  
Small Sample ◽  
University Hospital ◽  
Rapid Screening ◽  
Resistant Organism ◽  
Selective Media ◽  
The University

Background. Infections caused by multidrug-resistant organisms (MDRO) are difficult to treat and associated with poor outcomes for patients. Therefore, early identification and management of colonization are essential as first steps in infection prevention. Culture-based methods have been widely used for MDRO screening. The turnaround time (TAT) for the identification of carriers varies between 48-72 h with this method. The aim of our study was to compare the performance of the new rapid semiautomatic method for detection of MDRO (HB&L Uroquattro, Alifax) with standard cultivation on selective media. Methods. Twenty-one axillary, 20 nose and 19 rectal swabs were taken in duplicate on two selected days at the University Hospital Centre Split, Croatia. Swabs were cultivated and MDRO isolates were identified on selective media (Chromagar MRSA and Chromagar ESBL) according to the standard operating procedure. Novel Alifax method was performed according to manufacturer’s instructions. Results. TAT for the new method was significantly lower (6.5 h) in comparison to the classical method. With classical method, 10 extended spectrum ß-lactamases (ESBL) producing strains from 10 different rectal specimens were isolated on Chromagar ESBL media. Exactly the same specimens were positive for the presence of ESBL-producing bacteria by rapid Alifax method. On selective Chromagar MRSA media, 11 MDRO were isolated, while rapid method detected 11 MDRO from the same specimens. Conclusions. High concordance of positive and negative results obtained with classical and rapid method is encouraging. However, our study was performed on a small sample size and further research with larger sample size is needed.

Reduction of Environmental Contamination With Multidrug-Resistant Bacteria by Copper-Alloy Coating of Surfaces in a Highly Endemic Setting

2017 ◽  
Vol 38 (7) ◽  
pp. 765-771 ◽  
Author(s):  
Maria Souli ◽  
Anastasia Antoniadou ◽  
Ioannis Katsarolis ◽  
Irini Mavrou ◽  
Elisabeth Paramythiotou ◽  
...  
Keyword(s):  
Phase 1 ◽  
Demographic Data ◽  
Alloy Coating ◽  
Multidrug Resistant ◽  
Copper Coating ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Gram Negative ◽  
Coated Surfaces

OBJECTIVETo evaluate the efficacy of copper-coating in reducing environmental colonization in an intensive-care unit (ICU) with multidrug-resistant-organism (MDRO) endemicityDESIGNInterventional, comparative crossover trialSETTINGThe general ICU of Attikon University hospital in Athens, GreecePATIENTSThose admitted to ICU compartments A and B during the study periodMETHODSBefore any intervention (phase 1), the optimum sampling method using 2 nylon swabs was validated. In phase 2, 6 copper-coated beds (ie, with coated upper, lower, and side rails) and accessories (ie, coated side table, intravenous [i.v.] pole stands, side-cart handles, and manual antiseptic dispenser cover) were introduced as follows: During phase 2a (September 2011 to February 2012), coated items were placed next to noncoated ones (controls) in both compartments A and B; during phase 2b (May 2012 to January 2013), all copper-coated items were placed in compartment A, and all noncoated ones (controls) in compartment B. Patients were randomly assigned to available beds. Environmental samples were cultured quantitatively for clinically important bacteria. Clinical and demographic data were collected from medical records.RESULTSCopper coating significantly reduced the percentage of colonized surfaces (55.6% vs 72.5%; P<.0001), the percentage of surfaces colonized by MDR gram-negative bacteria (13.8% vs 22.7%; P=.003) or by enterococci (4% vs 17%; P=.014), the total bioburden (2,858 vs 7,631 cfu/100 cm2; P=.008), and the bioburden of gram-negative isolates, specifically (261 vs 1,266 cfu/100 cm2; P=.049). This effect was more pronounced when the ratio of coated surfaces around the patient was increased (phase 2b).CONCLUSIONSCopper-coated items in an ICU setting with endemic high antimicrobial resistance reduced environmental colonization by MDROs.Infect Control Hosp Epidemiol 2017;38:765–771

Survey of the University of Florida hematology/oncology fellows on perceived skills of independent management of oncologic pain, chemotherapy-related nausea and vomiting, and end-of-life discussions.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 7-7
Author(s):  
Jennifer Lynn Ricks ◽  
Myron Chang ◽  
Qi An ◽  
Nam H. Dang
Keyword(s):  
Pain Management ◽  
Sample Size ◽  
End Of Life ◽  
Online Teaching ◽  
Small Sample ◽  
Comfort Level ◽  
P Value ◽  
University Of Florida ◽  
Additional Training ◽  
The University

7 Background: Prior literature in oncology suggests that oncologists receive less training during fellowship in the areas of pain management, chemotherapy-related nausea/vomiting (CRNV), and end-of-life (EOL) discussions than is desired for later practice. As such, confidence in management could be improved by focused interventions. This survey sought to determine whether fellows in the department of Hematology/Oncology at the University of Florida (UF) felt they would benefit from additional education in these areas. Methods: An anonymous voluntary survey was administered by an impartial third party to assess the fourteen fellows’ comfort levels. Questions numbered 1-7 focused on oncologic pain, numbers 8-17 on CRNV, and numbers 18-28 on EOL care. Answers were converted to a numeric scale in the range of 1-4, with 4 points as the highest endorsement of confidence and 1 point as the lowest comfort level. 95% confidence intervals were used to analyze results of each question. Results: 79% (95% CI:57%-100%) of fellows felt additional training in pain management and CRNV would be beneficial. Half of fellows surveyed (50%, 95% CI:24%-76%) considered need for additional training in EOL discussions worthwhile. The scores were not significantly different when stratified by year of training (p value = 0.10, 0.48, 0.20). Conclusions: We conclude that the majority of UF Hematology/Oncology fellows feel that additional training in oncologic pain and CRNV is desired. This is significant as it parallels national trends. Limitations of the study include relatively small sample size, thus the absence of any statistically significant differences in responses by year of training may have been a result of the sample size. Several methods exist to satisfy this perceived need, including targeted lectures or standardized online teaching modules from the American Society of Clinical Oncology. A future prospective study using these modules is underway to further validate our findings. [Table: see text]

scholarly journals Infectious Diseases Consultation Reduces 30-Day and 1-Year All-Cause Mortality for Multidrug-Resistant Organism Infections

2018 ◽  
Vol 5 (3) ◽  
Author(s):  
Jason P Burnham ◽  
Margaret A Olsen ◽  
Dustin Stwalley ◽  
Jennie H Kwon ◽  
Hilary M Babcock ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Proportional Hazards ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Cox Proportional Hazards ◽  
Small Sample ◽  
Resistant Organism ◽  
Tertiary Referral Center ◽  
Cox Proportional Hazards Models ◽  
Polymicrobial Infections

Abstract Background Multidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistant Staphylococcus aureus bloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections. Methods This study was conducted with a retrospective cohort (January 1, 2006–October 1, 2015) at an academic tertiary referral center. We identified patients with MDROs in a sterile site or bronchoalveolar lavage/bronchial wash culture. Mortality and readmissions within 1 year of index culture were identified, and the association of ID consultation with these outcomes was determined using Cox proportional hazards models with inverse weighting by the propensity score for ID consultation. Results A total of 4214 patients with MDRO infections were identified. ID consultation was significantly associated with reductions in 30-day and 1-year mortality for resistant S. aureus (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.36–0.63; and HR, 0.73, 95% CI, 0.61–0.86) and Enterobacteriaceae (HR, 0.41; 95% CI, 0.27–0.64; and HR, 0.74; 95% CI, 0.59–0.94), and 30-day mortality for polymicrobial infections (HR, 0.51; 95% CI, 0.31–0.86) but not Acinetobacter or Pseudomonas. For resistant Enterococcus, ID consultation was marginally associated with decreased 30-day mortality (HR, 0.81; 95% CI, 0.62–1.06). ID consultation was associated with reduced 30-day readmission for resistant Enterobacteriaceae. Conclusions ID consultation was associated with significant reductions in 30-day and 1-year mortality for resistant S. aureus and Enterobacteriaceae, and 30-day mortality for polymicrobial infections. There was no association between ID consultation and mortality for patients with resistant Pseudomonas, Acinetobacter, or Enterococcus, possibly due to small sample sizes. Our results suggest that ID consultation may be beneficial for patients with some MDRO infections.

A censored sequential posterior odd test method in testability demonstration test planning

2020 ◽  
Vol 234 (4) ◽  
pp. 579-587 ◽  
Author(s):  
Yong Zhang ◽  
Chao Wang ◽  
Xin Lin ◽  
Guanjun Liu ◽  
Peng Yang ◽  
...  
Keyword(s):  
Sample Size ◽  
Fault Injection ◽  
Classical Method ◽  
Small Sample ◽  
Test Method ◽  
Fault Detection And Isolation ◽  
Test Results ◽  
Case Application ◽  
Increasing Demand ◽  
Average Sample

Testability demonstration tests can effectively verify product capabilities of fault detection and isolation; however, they suffer from insufficient samples, long cycles and high costs due to destructiveness of fault injection tests, which leads to an increasing demand for small sample tests. The sequential posterior odd test can effectively reduce sample sizes, but test results can be random and the sample size may be large. In this article, a censored sequential posterior odd test method is proposed, which can control the incremental risk caused by forced censoring within a contracted range by risk splitting. The development process of the testability demonstration test based on the censored sequential posterior odd test is designed. The number of censored tests and the calculation method of the censored threshold are presented. The case application shows that with the same prior distribution and constraint parameters, the average sample size of the proposed method is smaller than that of the sequential posterior odd test and of the classical method considering risks for both producers and consumers. The presented method can further reduce the risk of misjudgment and the number of test samples, contributing to the reduction of the test cycle and costs.

scholarly journals Preliminary Attempt to Predict Risk of Invasive Pulmonary Aspergillosis in Patients with Influenza: Decision Trees May Help?

Antibiotics ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. 644
Author(s):  
Valeria Bellelli ◽  
Guido Siccardi ◽  
Livia Conte ◽  
Luigi Celani ◽  
Elena Congeduti ◽  
...  
Keyword(s):  
Decision Trees ◽  
Small Sample Size ◽  
Invasive Pulmonary Aspergillosis ◽  
Small Sample ◽  
University Hospital ◽  
Machine Learning Techniques ◽  
Pulmonary Aspergillosis ◽  
Vulnerable Patients ◽  
Learning Techniques ◽  
The University

Invasive pulmonary aspergillosis (IPA) is typically considered a disease of immunocompromised patients, but, recently, many cases have been reported in patients without typical risk factors. The aim of our study is to develop a risk predictive model for IPA through machine learning techniques (decision trees) in patients with influenza. We conducted a retrospective observational study analyzing data regarding patients diagnosed with influenza hospitalized at the University Hospital “Umberto I” of Rome during the 2018-2019 season. We collected five IPA cases out of 77 influenza patients. Although the small sample size is a limit, the most vulnerable patients among the influenza-infected population seem to be those with evidence of lymphocytopenia and those that received corticosteroid therapy.

scholarly journals Colonization with multidrug-resistant organisms impairs survival in patients with hepatocellular carcinoma

2021 ◽  
Author(s):  
Vera Himmelsbach ◽  
Mate Knabe ◽  
Phillip G. Ferstl ◽  
Kai-Henrik Peiffer ◽  
Jan A. Stratmann ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Multidrug Resistant Organisms ◽  
Severe Cirrhosis ◽  
The University ◽  
The Impact ◽  
First 90 Days

Abstract Introduction MDRO-colonization has been shown to impair survival in patients with hematological malignancies and solid tumors as well as in patients with liver disease. Despite the increasing spread of multidrug-resistant organisms (MDRO), its impact on patients with hepatocellular carcinoma (HCC) has not been studied. We conducted this retrospective study to analyze the impact of MDRO-colonization on overall prognosis in HCC patients. Materials and methods All patients with confirmed HCC diagnosed between January 2008 and December 2017 at the University Hospital Frankfurt were included in this study. HCC patients with a positive MDRO screening before or within the first 90 days after diagnosis of HCC were defined as colonized HCC patients, HCC patients with a negative MDRO screening were defined as noncolonized HCC patients. Results 59 (6%) colonized and 895 (94%) noncolonized HCC patients were included. Enterobacterales with extended-spectrum β-lactamase-like phenotype with or without resistance to fluoroquinolones (ESBL/ ± FQ) were the most frequently found MDRO with 59%, followed by vancomycin-resistant Enterococcus faecium with 37%. Colonized HCC patients had more severe cirrhosis and more advanced HCC stage compared to noncolonized HCC patients. Colonized HCC patients showed an impaired survival with a median OS of 189 days (6.3 months) compared to a median OS of 1001 days (33.4 months) in noncolonized HCC patients. MDRO-colonization was identified as an independent risk factor associated with survival in multivariate analysis. Conclusion MDRO-colonization is an independent risk factor for survival in patients with HCC highlighting the importance of regular MDRO screening, isolation measures as well as interdisciplinary antibiotic steward-ship programs to guide responsible use of antibiotic agents.

scholarly journals Prevalence and Antimicrobial Resistance of Enterococcus Species: A Retrospective Cohort Study in Italy

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1552
Author(s):  
Mariarosaria Boccella ◽  
Biagio Santella ◽  
Pasquale Pagliano ◽  
Anna De Filippis ◽  
Vincenzo Casolaro ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Treatment Guideline ◽  
Multidrug Resistant ◽  
Resistance Rate ◽  
University Hospital ◽  
Clinical Samples ◽  
Enterococcus Species ◽  
Enterococcus Spp ◽  
High Level ◽  
The University

Antimicrobial resistance represents one of the main threats to healthy ecosystems. In recent years, among the multidrug-resistant microorganisms responsible for nosocomial infections, the Enterococcus species have received much attention. Indeed, Enterococcus have peculiar skills in their ability to acquire resistance genes and to cause severe diseases, such as endocarditis. This study showed the prevalence and antimicrobial resistance rate of Enterococcus spp. isolated from clinical samples, from January 2015 to December 2019 at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno, Italy. A total of 3236 isolates of Enterococcus faecalis (82.2%) and Enterococcus faecium (17.8%) were collected from urine cultures, blood cultures, catheters, respiratory tract, and other samples. Bacterial identification and antibiotic susceptibility were performed with VITEK 2. E. faecium showed a high resistance rate against ampicillin (84.5%), ampicillin/sulbactam (82.7%), and imipenem (86.7%), while E. faecalis showed the highest resistance rate against gentamicin and streptomycin high level, but both were highly sensitive to such antibiotics as tigecycline and vancomycin. Studies of surveillance are an important tool to detect changes in the resistance profiles of the main pathogens. These antimicrobial susceptibility patterns are necessary to improve the empirical treatment guideline of infections.

scholarly journals Evaluation of a flexible and integrative psychiatric care model in a department of child and adolescent psychiatry in Tübingen, Germany: study protocol (EVA_TIBAS)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne Neumann ◽  
Helene Hense ◽  
Fabian Baum ◽  
Roman Kliemt ◽  
Martin Seifert ◽  
...  
Keyword(s):  
Sample Size ◽  
Adolescent Psychiatry ◽  
Standard Care ◽  
Psychiatric Treatment ◽  
Child And Adolescent Psychiatry ◽  
University Hospital ◽  
The Social ◽  
Model Project ◽  
The University

Abstract Background Model projects for flexible and integrated treatment (FIT) in Germany aim at advancing the quality of care for people with mental disorders. A new FIT model project was established in 2017 at the Department of child and adolescent psychiatry (KJP) of the University Hospital Tübingen (Universitätsklinikum Tübingen, UKT). The study design of EVA_TIBAS presented here describes the evaluation of the FIT model project at the KJP of the UKT. This evaluation aims at quantifying the anticipated FIT model project changes, which are to improve patients’ cross-sectoral care at the same maximum cost as standard care. Methods EVA_TIBAS is a controlled cohort study using a mix of quantitative and qualitative methods. The FIT evaluation consists of three modules. In Module A, anonymized claims data of a statutory health insurance fund will be used to compare outcomes (duration of inpatient and day care psychiatric treatment, inpatient and day care psychiatric length of stay, outpatient psychiatric treatment in hospital, inpatient hospital readmission, emergency admission rate, direct medical costs) of patients treated in the model hospital with patients treated in structurally comparable control hospitals (estimated sample size = ca. 600 patients). In Module B, patient-reported outcomes (health related quality of life, symptom burden, return to psychosocial relationships (e.g. school, friends, hobbies), treatment satisfaction, societal costs) will be assessed quantitatively using validated questionnaires for the model and two control hospitals (estimated sample size = ca. 300 patients). A subsequent health economic evaluation will be based on cost-effectiveness analyses from both the insurance fund’s and the societal perspective. In Module C, about 30 semi-structured interviews will examine the quality of offer, effects and benefits of the service offered by the social service of the AOK Baden-Württemberg (for stabilizing the overall situation of care in the family) in the model hospital. A focus group discussion will address the quality of cooperation between employees of the university hospital and the social services. Discussion The results of this evaluation will be used to inform policy makers whether this FIT model project or aspects of it should be implemented into standard care. Trial registration This study was registered at ClinicalTrials.gov PRS (ID: NCT04727359, date: 27 January 2021).

scholarly journals Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June‒December 2015

2016 ◽  
Vol 21 (2) ◽  
Author(s):  
Claudia Reinheimer ◽  
Volkhard A. J. Kempf ◽  
Stephan Göttig ◽  
Michael Hogardt ◽  
Thomas A. Wichelhaus ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Multidrug Resistant ◽  
Control Measures ◽  
University Hospital ◽  
Healthcare Personnel ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Infection Control Measures ◽  
Multidrug Resistant Organisms ◽  
The University

Multidrug-resistant Gram-negative bacteria (MDR GNB) were found to colonise 60.8% (95% confidence interval: 52.3–68.9) of 143 refugee patients mainly from Syria (47), Afghanistan (29), and Somalia (14) admitted to the University Hospital Frankfurt, Germany, between June and December 2015. This percentage exceeds the prevalence of MDR GNB in resident patients four–fold. Healthcare personnel should be aware of this and the need to implement or adapt adequate infection control measures.

scholarly journals Characteristics, Influencing Factors, Predictive Scoring System, and Outcomes of the Patients with Nephrotoxicity Associated with Administration of Intravenous Colistin

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 2
Author(s):  
Pornpen Sangthawan ◽  
Alan Frederick Geater ◽  
Surarit Naorungroj ◽  
Piyarat Nikomrat ◽  
Ozioma Forstinus Nwabor ◽  
...  
Keyword(s):  
Prediction Model ◽  
Influencing Factors ◽  
Scoring System ◽  
Mortality Rates ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Global Public Health ◽  
Gram Negative ◽  
Overall Performance ◽  
The University

Multidrug-resistant Gram-negative infection is a major global public health threat. Currently, colistin is considered the last-resort treatment despite its nephrotoxicity. The purpose of this study was to estimate the incidence, characteristics, and influencing factors and to develop a prediction model for colistin-associated nephrotoxicity. A retrospective study was conducted in the university hospital in the South of Thailand from December 2015 to June 2019. A total of 381 patients (median age (IQR) of 64 (51–62) years) were analyzed. Overall, 282 (74%) had nephrotoxicity according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification. In-hospital, 30-day mortality rates and cost of hospital admission were significantly higher among those with nephrotoxicity. Age > 60 years, comorbidities, serum albumin less than 3.5 g/dL, and concomitant nephrotoxic use were significantly associated with colistin-associated nephrotoxicity with adjusted OR (95% CI) 2.01 (1.23–2.45), 1.85 (1.18–3.6), 1.68 (1.09–2.99), and 1.77 (1.10–2.97), respectively. The prediction model for high-risk colistin-associated nephrotoxicity was identified with good overall performance (specificity of 79.6% (95% CI 70.3–87.1) and positive predictive value of 92.1% (95% CI 88.0–95.1)). In conclusion, the incidence of colistin-associated nephrotoxicity was high and incurred significant morbidity, mortality, and economic burden. Our predictive scoring system is relatively simple and useful for optimizing colistin therapy.

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