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 Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

2012 ◽  
Vol 4 (01) ◽  
pp. 039-042 ◽  
Author(s):  
Simit H Kumar ◽  
Anuradha S De ◽  
Sujata M Baveja ◽  
Madhuri A Gore
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Care Hospital ◽  
Acinetobacter Species ◽  
Carbapenem Resistant

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

Evaluation of Hospital Room Assignment and Acquisition of Clostridium difficile Infection

2011 ◽  
Vol 32 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Megan K. Shaughnessy ◽  
Renee L. Micielli ◽  
Daryl D. DePestel ◽  
Jennifer Arndt ◽  
Cathy L. Strachan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clostridium Difficile ◽  
Tertiary Care ◽  
Significant Risk ◽  
Extended Period ◽  
Significant Risk Factor ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Icu Discharge

Background and Objective.Clostridium difficile spores persist in hospital environments for an extended period. We evaluated whether admission to a room previously occupied by a patient with C. difficile infection (CDI) increased the risk of acquiring CDI.Design.Retrospective cohort study.Setting.Medical intensive care unit (ICU) at a tertiary care hospital.Methods.Patients admitted from January 1, 2005, through June 30, 2006, were evaluated for a diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge. Medical, ICU, and pharmacy records were reviewed for other CDI risk factors. Admitted patients who did develop CDI were compared with admitted patients who did not.Results.Among 1,844 patients admitted to the ICU, 134 CDI cases were identified. After exclusions, 1,770 admitted patients remained for analysis. Of the patients who acquired CDI after admission to the ICU, 4.6% had a prior occupant without CDI, whereas 11.0% had a prior occupant with CDI (P = .002). The effect of room on CDI acquisition remained a significant risk factor (P = .008) when Kaplan-Meier curves were used. The prior occupant's CDI status remained significant (P = .01; hazard ratio, 2.35) when controlling for the current patient's age, Acute Physiology and Chronic Health Evaluation III score, exposure to proton pump inhibitors, and antibiotic use.Conclusions.A prior room occupant with CDI is a significant risk factor for CDI acquisition, independent of established CDI risk factors. These findings have implications for room placement and hospital design.

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.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals MALNUTRITION, SEPSIS AND TUMOR LYSIS SYNDROME ARE ASSOCIATED WITH INCREASED RATE OF ACUTE MORTALITY IN MATURE B CELL NON-HODGKIN LYMPHOMA IN PEDIATRIC POPULATION- STUDY FROM TERTIARY CARE HOSPITAL IN PAKISTAN

2019 ◽  
Vol 11 (1) ◽  
pp. 02019043
Author(s):  
Raheela Mansoor
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
B Cell ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Tumor Lysis Syndrome ◽  
Significant Risk ◽  
Early Death ◽  
Care Hospital ◽  
Tumor Lysis

Background:            Outcomes of pediatric mature B cell NHL in resource challenged countries are negatively affected by increased rate of early and toxic deaths. Aim of this study is to assess rate of acute mortality and define significant risk factors present in children with mature B Cell NHL. Methods: A retrospective analysis was done of patients with B cell NHL from January 2012 till December 2016. Risk factors studied for acute mortality were malnutrition, stage, prior surgery with open laparotomy, LDH levels, tumor lysis syndrome, sepsis and fungal infection Results: Total 233 patients were enrolled in the study. Eighty five (36.4%) were below 15th percentile.  Treatment was started in 226 patients. Eighty eight percent children showed 20% response after COP pre-phase. Tumor lysis syndrome was developed in 20.6 % (n = 48) children and 42.9% (n = 100) patients had sepsis, 71/100 patients had culture proven sepsis. 19.7% (n = 46) patients developed fungal infection. There was 19.7% (n = 46) acute mortality.  Most common cause of death was sepsis (n = 22, 47.8%) followed by acute renal failure secondary to tumor lysis syndrome. On multivariate analysis, three independent variables found significant for early death are malnutrition, sepsis and tumor lysis syndrome. Conclusion: Rate of acute mortality in B cell NHL is high in our set up and significant risk factors are tumor lysis syndrome, sepsis and malnourishment at time of presentation.

scholarly journals Severe anemia and adverse pregnancy outcome in a tertiary care hospital in North India

2018 ◽  
Vol 7 (2) ◽  
pp. 483
Author(s):  
Premlata Yadav
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Peripheral Blood ◽  
Tertiary Care ◽  
Significant Risk ◽  
North India ◽  
Deficiency Anemia ◽  
Care Hospital ◽  
Severe Anemia ◽  
In Pregnancy

Background: Anaemia is commonest medical disorder in pregnancy with 88% prevalence in India mainly due to ignorance, poverty and gender bias. 40-60% of maternal deaths in developing countries. According to the recent standard laid down by WHO anemia is present when the hemoglobin (Hb) concentration in the peripheral blood is less than 11 gm/dl. The most common cause of anemia in pregnancy is iron deficiency. Anemia is diagnosed by estimating the hemoglobin concentration and examining a peripheral blood smear for the characteristic red blood cell changes. The aim of the study was to determine the association between severe anemia, maternal and perinatal complications.Methods: Case control study was done in department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences Ranchi, India from February 2016 to July 2016. 100 pregnant women, admitted for delivery and having severe anemia were studied and compared with 100 non-anaemic women of similar demographic features. Maternal and perinatal complications were observed. Pearson, chi-square and Fischer exact tests were used to calculate significance of results.Results: Of the severely anaemic mothers, 36% babies were low birth weight (p=0.042) and 20% were small for gestational age (p = 0.026), as compared to 18% and 10% of controls, respectively.Conclusions: Severe maternal anemia carries significant risk of hemorrhage and infection in the mother. It is also associated with preterm birth, low birth weight.

Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients

2002 ◽  
Vol 22 (3) ◽  
pp. 335-338 ◽  
Author(s):  
Robert E. Ariano ◽  
Christine Franczuk ◽  
Adrian Fine ◽  
Godfrey K.M. Harding ◽  
Sheryl A. Zelenitsky
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Significant Risk ◽  
Response Rates ◽  
Care Hospital ◽  
Clinical Failure ◽  
Empiric Treatment

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.

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