Increase in Penicillin and multidrug resistance in Streptococcus pneumoniae (1993-2016): report from a tertiary care hospital laboratory, Pakistan

2022 ◽  
Vol 71 (12) ◽  
pp. 2726-2730
Author(s):  
Afia Zafar ◽  
Farida Khurram Lalani ◽  
Ahmer Arif Longi ◽  
Mohammad Raheel Jajja ◽  
Maera Haider ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Significant Rise ◽  
Penicillin Resistance ◽  
Care Hospital ◽  
Resistance To Penicillin ◽  
Resistance Rates ◽  
The Impact ◽  
Second Period

Background: Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. With the emergence of penicillin-resistant S. pneumoniae (PRSP), treatment has become challenging. The Clinical and Laboratory Standards Institute (CLSI) in 2008 revised its guidelines for S. pneumoniae and recommended separate penicillin breakpoints for meningeal and non-meningeal strains. Similar to penicillin’s, resistance to other classes of antibiotics has emerged globally. Objective: The objective of this study is to determine the trend of resistance to antimicrobials in S. pneumoniae infections and the impact of new CLSI guidelines on penicillin susceptibility among meningeal isolates. Methodology: Twenty-four years (1993-2016) data from S. pneumoniae isolates and their antimicrobial susceptibility was retrieved from the computerized database. Data was divided into two groups for analysis, pre-2008 and post 2008. Results: Penicillin resistance remained unchanged in non-meningeal isolates during both study periods. A significant rise in penicillin resistance in meningeal isolates was observed in the second period 2008-2016 (2.9% vs 36.2%). High resistance rates were observed for co-trimoxazole, tetracycline and erythromycin. Increased trend of multi-drug resistant (MDR) strains were also noted, from 11% in 1999 to 36% in 2016.  Conclusion: The emergence of MDR strains is evident from our dataset. It seems like the rise in PRSP in meningeal isolates is due to revised CLSI guidelines. Overall low resistance to penicillin in non-meningeal isolates and no resistance to ceftriaxone is encouraging and will assist in drafting local guidelines. Cautious use of antimicrobials are essential to reduce further emergence of antimicrobial resistance in indigenous isolates.  

scholarly journals Antimicrobial Resistant Streptococcus pneumoniae

2010 ◽  
Vol 49 (179) ◽  
Author(s):  
B Khanal ◽  
A Acharya ◽  
R Amatya ◽  
R Gurung ◽  
N Paudyal ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Antimicrobial Susceptibility ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Pneumococcal Infections ◽  
Intermediate Resistance ◽  
Resistance To Penicillin ◽  
Susceptibility Patterns

Introduction: Pneumococcal infections are important cause of morbidity and mortality. Knowledge of antimicrobial susceptibility patterns plays important role in the selection of appropriate therapy.  Present study was undertaken to analyze the susceptibility patterns of pneumococcal isolates against  commonly used antimicrobials with special reference to determination of minimum inhibitory  concentration (MIC) of penicillin in a tertiary care hospital in eastern Nepal. Methods: Twenty-six strains of S. pneumoniae isolated from various clinical specimens submitted to microbiology laboratory were evaluated. All isolates were tested for antimicrobial susceptibility by  disk diffusion method. MIC of penicillin was tested by broth dilution method. Results: Of the total isolates 19 (73%) were from invasive infections. Seven isolates were resistant to cotrimoxazole. No resistance to penicillin was seen in disk diffusion testing. Less susceptibility to penicillin (MIC 0.1-1.0 mg/L) was observed in five (17%) isolates. High level resistance to penicillin was not detected. One isolate was multidrug resistant. Conclusions: S. pneumoniaeisolates with intermediate resistance to penicillin prevail in Tertiary Care Hospital in eastern Nepal, causing invasive and noninvasive infections. As intermediate resistance is not detected in routine susceptibility testing, determination of MIC is important. It helps not only in the effective management of life threatening infections but is also essential in continuous monitoring and early detection of resistance. In addition, further study on pneumococcal infections, its antimicrobial resistance profile and correlation with clinical and epidemiological features including serotypes and group prevalence is recommended in future. Keywords: antimicrobial susceptibility pattern, penicillin, Streptococcus pneumoniae.

scholarly journals Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yan-Jun Zheng ◽  
Ting Xie ◽  
Lin Wu ◽  
Xiao-Ying Liu ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antifungal Therapy ◽  
Species Distribution ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Severe Neutropenia ◽  
Care Hospital ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

THE IMPACT OF ANTIMICROBIAL STEWARDSHIP ON THE PATTERNS OF ANTIBIOTICS’ PRESCRIPTION AND CLINICAL OUTCOMES IN THE MEDICAL WARD OF A MALAYSIAN TERTIARY CARE HOSPITAL

2021 ◽  
pp. 20-25
Author(s):  
OVAIS ULLAH SHIRAZI ◽  
NORNY SYAFINAZ AB RAHMAN ◽  
CHE SURAYA ZIN ◽  
HANNAH MD MAHIR ◽  
SYAMHANIN ADNAN
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Ward ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Slope Change ◽  
The Impact

Objective: To evaluate the impact of antimicrobial stewardship (AMS) on antibiotic prescribing patterns and certain clinical outcomes, the length of stay (LOS) and the re-admission rate (RR) of the patients treated within the medical ward of a tertiary care hospital in Malaysia. Methods: This quasi-experimental study was conducted retrospectively. The prescriptions of the AMS included alert antibiotics (AA) such as cefepime, ceftazidime, colistin (polymyxin E), imipenem-cilastatin, meropenem, piperacillin-tazobactam and vancomycin were reviewed for the period of 24 mo before (May, 2012–April, 2014) and after (May, 2014–April, 2016) the AMS implementation for the patients who were treated within the medical ward of a Malaysian tertiary care hospital. Patterns of antibiotics prescribed were determined descriptively. The impact of the AMS on the length of stay (LOS) and readmission rate (RR) was determined by the interrupted time series (ITS) comparative analysis of the pre-and post-AMS segments segregated by the point of onset (May, 2014) of the AMS program. Data analysis was performed through autoregressive integrated moving average (ARIMA) Winter Additive model and the Games-Howell non-parametric post hoc test by using IBM Statistical Package for Social Sciences version 25.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: A total of 1716 prescriptions of the AA included for the AMS program showed that cefepime (623, 36.3%) and piperacillin-tazobactam (424, 24.7%) were the most prescribed antibiotics from May 2012 to April 2016. A 23.6% drop in the number of the AA prescriptions was observed during the 24-month post-AMS period. The LOS of the patients using any of the AA showed a post-AMS decline by 3.5 d. The patients’ LOS showed an average reduction of 0.12 (95% CI, 0.05–0.19, P=0.001) with the level and slope change of 0.18 (95% CI, 0.04–0.32, P=0.02) and 0.074 (95% CI, 0.02–0.12, P=0.002), respectively. Similarly, the percent RR reduced from 20.0 to 9.85 during the 24-month post-AMS period. The observed post-AMS mean monthly reduction of the RR for the patients using any AA was 0.38 (95% CI, 0.23–0.53, P<0.001) with the level and slope change of 0.33 (95% CI, 0.14–0.51, P=0.02) and 0.37 (95% CI, 0.16–0.58, P=0.001), respectively. Conclusion: The AMS program of a Malaysian tertiary care hospital was a coordinated set of interventions implemented by the AMS team of the hospital that comprised of the infectious diseases (ID) physician, clinical pharmacists and microbiologist. The successful implementation of the AMS program from May, 2014 to April, 2016 within the medical ward resulted in the drop of the number of AA prescriptions that sequentially resulted in the significant (P<0.05) post-AMS reduction of the LOS and the RR.

scholarly journals Comparative Study of Physiological and Haematological Parameters among Mild and Severe COVID-19 Patients Admitted in Tertiary Care Hospital of Pune District, India

2021 ◽  
pp. 132-139
Author(s):  
Suchita Sachin Palve ◽  
Pallavi Sachin Chaudhari
Keyword(s):  
Inflammatory Responses ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Specific Treatment ◽  
Haematological Parameters ◽  
Care Hospital ◽  
Physiological Variables ◽  
The World ◽  
High Level ◽  
The Impact

Background: The COVID-19 pandemic has put global health at stake by creating havoc all over the world, due to which the world, as well as health agencies, are experiencing the greatest challenges. This disease is a health emergency due to its high level of infectiousness and the non-availability of any specific treatment [1]. Objectives: To determine and compare the significance of physiological and haematological parameters in the diagnosis of COVID 19 infection and compare the association of physiological and haematological parameters among mild and severe COVID-19 patients. Methodology: The present comparative, observational study was carried out in a designated tertiary care hospital, where admission of COVID19 patients in Pune district, India. Various parameters like age, height, weight, BMI, various physiological variables, haematological parameters, and CRP levels were assessed among 202 Mild and 50 severe COVID 19 diagnosed patients on day one of the hospital's stays. Results: Pearson’s correlation coefficient showed a significant correlation among physiological and haematological variables compared to both groups, especially physiological parameters like SBP and DBP. The results showed that TLC, CRP, NLR, PLR, among COVID 19 patients cans work as important biomarkers to understand the disease prognosis. Conclusion: Study of physiological and haematological parameters and their interrelation will help in understanding the impact of COVID 19 infection on the reactive inflammatory responses and help in understanding the prognosis of the disease among mild and severe patients.

scholarly journals The impact of infectious disease consultation in candidemia in a tertiary care hospital in Japan over 12 years

PLoS ONE ◽  
2019 ◽  
Vol 14 (4) ◽  
pp. e0215996 ◽  
Author(s):  
Masahiro Ishikane ◽  
Kayoko Hayakawa ◽  
Satoshi Kutsuna ◽  
Nozomi Takeshita ◽  
Norio Ohmagari
Keyword(s):  
Infectious Disease ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Infectious Disease Consultation ◽  
The Impact

scholarly journals High Prevalence of Antimicrobial Resistance Among Gram-Negative Isolated Bacilli in Intensive Care Units at a Tertiary-Care Hospital in Yucatán Mexico

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 588 ◽  
Author(s):  
Andrés H. Uc-Cachón ◽  
Carlos Gracida-Osorno ◽  
Iván G. Luna-Chi ◽  
Jonathan G. Jiménez-Guillermo ◽  
Gloria M. Molina-Salinas
Keyword(s):  
Escherichia Coli ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Intensive Care Units ◽  
High Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Gram Negative ◽  
Resistance Rates

Background and Objectives: Antimicrobial resistance (AMR) is increasing worldwide and imposes significant life-threatening risks to several different populations, especially to those in intensive care units (ICU). The most commonly isolated organisms in ICU comprise gram-negative bacilli (GNB), and these represent a leading cause of serious infections. This study was conducted to describe the prevalence of resistance in GNB isolated from patients in adults, pediatric, and neonatal ICU in a tertiary-care hospital in Mérida, Mexico. Materials and Methods: A retrospective study was done on samples collected in Neonatal (NICU), Pediatric (PICU) and Adult (AICU) ICU of Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social in Mérida, México. The identification of isolates and antimicrobial susceptibility testing were performed using an automated system. Results: A total of 517 GNB strains were isolated. The most common positive culture was bronchial secretions. Pseudomonas aeruginosa was the prevalent pathogen in NICU and PICU, whereas Escherichia coli was common in the AICU. Overall, GNB exhibited a high resistance rates for Ampicillin (95.85%), Cefuroxime (84.17%), Piperacillin (82.93%), Cefotaxime (78.07%), Ceftriaxone (77.41%), Aztreonam (75.23%), Cefazolin (75.00%), and Ceftazidime (73.19%). There are significant differences in the resistance rates of GNB from different ICUs for penicillins, cephalosporins, carbapenems and fluoroquinolones drugs. Escherichia coli (multidrug-resistant [MDR] = 91.57%, highly resistant microorganisms [HRMO] = 90.36%) and Acinetobacter baumannii (MDR = 86.79%, HRMO = 83.02%) exhibited the highest percentage of MDR and HRMO profiles. The prevalence of the extended-spectrum beta-lactamases (ESBL)-producing isolates was 83.13% in E. coli, 78.84% in Klebsiella pneumoniae, and 66.67% in Proteus mirabilis, respectively. Conclusions: The high resistance rates to drugs were exhibited by our GNB isolates. Continuous surveillance and control of the use of antimicrobials are urgently needed to reduce the emergence and spreading of MDR, HRMO, and/or ESBL-producing bacilli.

The impact of the Tsunami on hospitalzations at the tertiary care hospital in the Southern Province of Sri Lanka

2008 ◽  
Vol 3 (3) ◽  
pp. 147-155 ◽  
Author(s):  
Truls Østbye, MD, PhD ◽  
Thyagi Ponnamperuma, MBBS ◽  
Nayana Fernando, MBBS, MSc ◽  
Vathsala Abeygunawardena, MSc ◽  
W.A.A. Wijayasiri, MBBS, MSc ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
International Classification Of Diseases ◽  
Care Hospital ◽  
Disease Patterns ◽  
Disaster Relief Operations ◽  
Classification Of Diseases ◽  
Relief Operations ◽  
The Impact

Objective: Sri Lanka’s human, physical, social, and economic resources suffered a massive impact after the tsunami of December 26, 2004. To assist in preparing for future disasters, the authors sought to characterize the pattern of hospitalizations from the main impact zone in the Southern Province.Design: Retrospective chart review.Setting: Patients admitted to Teaching Hospital, Karapitiya, the only tertiary care hospital in the Southern Province.Patients, Participants: All hospital admissions on the day of and week following the tsunami, and a random sample (5 percent) of admissions from the month preceding, and the 3 months following the tsunami were coded according to the International Classification of Diseases, 10th Edition, analyzed, and geomapped.Intervention: N/A.Main Outcome Measure(s): The overall daily number of hospitalizations increased by 50 percent on the day of the tsunami and decreased in the following week.Results: Before the tsunami, injuries typically accounted for 20 percent of hospital admissions. However, injuries were markedly higher (89 percent of the total) on the day of the tsunami and remained elevated (35 percent) during the following week. After the initial peak in injuries (including near drownings), there was no increase in the frequency of infectious, cardiac, or psychiatric admissions.Conclusions: Injuries (including near drownings) were the most common cause of admissions immediately after the tsunami.The distribution of specific diagnoses differed from that seen after other natural disasters such as earthquakes and hurricanes. A central aspect of disaster relief operations and planning includes a thorough understanding of the postdisaster health effects and changes in disease patterns.

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