scholarly journals Microbial Disruption Indices to Detect Colonization With Multidrug-Resistant Organisms

2017 ◽  
Vol 38 (11) ◽  
pp. 1312-1318 ◽  
Author(s):  
Rafael Araos ◽  
Veronica Montgomery ◽  
Juan A. Ugalde ◽  
Graham M. Snyder ◽  
Erika M. C. D’Agata
Keyword(s):  
Hospital Admission ◽  
Microbial Diversity ◽  
Multidrug Resistant ◽  
Rrna Gene ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Fecal Microbiome ◽  
Culture Techniques ◽  
Multidrug Resistant Organisms

OBJECTIVETo characterize the microbial disruption indices of hospitalized patients to predict colonization with multidrug-resistant organisms (MDROs).DESIGNA cross-sectional survey of the fecal microbiome was conducted in a tertiary referral, acute-care hospital in Boston, Massachusetts.PARTICIPANTSThe study population consisted of adult patients hospitalized in general medical/surgical wards.METHODSRectal swabs were obtained from patients within 48 hours of hospital admission and screened for MDRO colonization using conventional culture techniques. The V4 region of the 16S rRNA gene was sequenced to assess the fecal microbiome. Microbial diversity and composition, as well as the functional potential of the microbial communities present in fecal samples, were compared between patients with and without MDRO colonization.RESULTSA total of 44 patients were included in the study, of whom 11 (25%) were colonized with at least 1 MDRO. Reduced microbial diversity and high abundance of metabolic pathways associated with multidrug-resistance mechanisms characterized the fecal microbiome of patients colonized with MDRO at hospital admission.CONCLUSIONSOur data suggest that microbial disruption indices may be key to predicting MDRO colonization and could provide novel infection control approaches.Infect Control Hosp Epidemiol 2017;38:1312–1318

scholarly journals Coexistence of β-Lactamases in Community-Acquired Infections in a Tertiary Care Hospital in India

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Shahzad Mirza ◽  
Savita Jadhav ◽  
R. N. Misra ◽  
Nikunja Kumar Das
Keyword(s):  
Tertiary Care ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Clinical Samples ◽  
Care Hospital ◽  
Cross Sectional ◽  
Beta Lactamases ◽  
Antibiotic Susceptibility Test ◽  
Multidrug Resistant Organisms ◽  
Control And Prevention

Introduction. The trends of β-lactamases producing Enterobacteriaceae is ever increasing, and limited studies have reported investigating coexistence of β lactamases in Enterobacteriaceae. A cross-sectional study after approval from the Institutional Ethical committee was conducted between June 2014 and May 2016 in community-acquired infections due to multidrug-resistant organisms in our tertiary care. Nonrepetitive clinical samples from the out-patient department (OPD) were processed for bacteriological culture and identification of Enterobacteriaceae. An antibiotic susceptibility test, screening, and phenotypic confirmation for ESBLs and carbapenemases and AmpC producers were performed to check for coexistence of these enzymes. Results. Nonrepetitive clinical specimens processed for culture and identification in our hospital revealed 417 positive isolates in community acquired infections which were multidrug-resistant organisms, and on screening for β-lactamases, 293 isolates were positive for one of the three beta lactamases, ESBL, AmpC, or carbapnemases. Coproduction of ESBL and MBL was seen in 5 isolates, 35 isolates showed coproduction of ESBL and AmpC enzymes, and AmpC and MBL coproduction was exhibited in only in 5 isolates. Conclusions. Coexistence of ESBLs, AmpC producers, and carbapenemases has been described. Continuous monitoring and surveillance and proper infection control and prevention practices will limit the further spread of these superbugs within the hospital and beyond.

Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired

2016 ◽  
Vol 38 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Stefan Erb ◽  
Reno Frei ◽  
Marc Dangel ◽  
Andreas F. Widmer
Keyword(s):  
Infection Control ◽  
Hospital Admission ◽  
Diagnosis Related Groups ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Multidrug Resistant Organisms ◽  
Definition Of ◽  
The Impact

BACKGROUNDInfections and colonization with multidrug-resistant organisms (MDROs) identified >48 hours after hospital admission are considered healthcare-acquired according to the definition of the Centers for Disease Control and Prevention (CDC). Some may originate from delayed diagnosis rather than true acquisition in the hospital, potentially diluting the impact of infection control programs. In addition, such infections are not necessarily reimbursed in a healthcare system based on the diagnosis-related groups (DRGs).OBJECTIVEThe goal of the study was to estimate the preventable proportion of healthcare-acquired infections in a tertiary care hospital in Switzerland by analyzing patients colonized or infected with MDROs.METHODSAll hospitalized patients with healthcare-acquired MDRO infection or colonization (HAMIC) or according to the CDC definition (CDC-HAMIC) were prospectively assessed from 2002 to 2011 to determine whether there was evidence for nosocomial transmission. We utilized an additional work-up with epidemiological, microbiological, and molecular typing data to determine the true preventable proportion of HAMICs.RESULTSOverall, 1,190 cases with infection or colonization with MDROs were analyzed; 274 (23.0%) were classified as CDC-HAMICs. Only 51.8% of CDC-HAMICs had confirmed evidence of hospital-acquisition and were considered preventable. Specifically, 57% of MRSA infections, 83.3% of VRE infections, 43.9% of ESBL infections, and 74.1% of non-ESBL MDRO infections were preventable HAMICs.CONCLUSIONSThe CDC definition overestimates the preventable proportion of HAMICs with MDROs by more than 50%. Relying only on the CDC definition of HAMICs may lead to inaccurate measurement of the impact of infection control interventions and to inadequate reimbursement under the DRG system.Infect. Control Hosp. Epidemiol. 2016;1–6

Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

2021 ◽  
pp. 1-6
Author(s):  
Katherine D. Ellingson ◽  
Brie N. Noble ◽  
Genevieve L. Buser ◽  
Graham M. Snyder ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Research Network ◽  
Resistant Organism ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hospital Size ◽  
Academic Affiliation ◽  
Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

scholarly journals Multi-country cross-sectional study of colonization with multidrug-resistant organisms: protocol and methods for the Antibiotic Resistance in Communities and Hospitals (ARCH) studies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aditya Sharma ◽  
Ulzii-Orishikh Luvsansharav ◽  
Prabasaj Paul ◽  
Joseph D. Lutgring ◽  
Douglas R. Call ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multidrug Resistant ◽  
Population Based ◽  
Community Dwelling ◽  
Mitigation Strategies ◽  
Invasive Infection ◽  
Cross Sectional ◽  
Global Epidemiology ◽  
Multidrug Resistant Organisms ◽  
High Threat

Abstract Background Antimicrobial resistance is a global health emergency. Persons colonized with multidrug-resistant organisms (MDROs) are at risk for developing subsequent multidrug-resistant infections, as colonization represents an important precursor to invasive infection. Despite reports documenting the worldwide dissemination of MDROs, fundamental questions remain regarding the burden of resistance, metrics to measure prevalence, and determinants of spread. We describe a multi-site colonization survey protocol that aims to quantify the population-based prevalence and associated risk factors for colonization with high-threat MDROs among community dwelling participants and patients admitted to hospitals within a defined population-catchment area. Methods Researchers in five countries (Bangladesh, Chile, Guatemala, Kenya, and India) will conduct a cross-sectional, population-based prevalence survey consisting of a risk factor questionnaire and collection of specimens to evaluate colonization with three high-threat MDROs: extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESCrE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA). Healthy adults residing in a household within the sampling area will be enrolled in addition to eligible hospitalized adults. Colonizing isolates of these MDROs will be compared by multilocus sequence typing (MLST) to routinely collected invasive clinical isolates, where available, to determine potential pathogenicity. A colonizing MDRO isolate will be categorized as potentially pathogenic if the MLST pattern of the colonizing isolate matches the MLST pattern of an invasive clinical isolate. The outcomes of this study will be estimates of the population-based prevalence of colonization with ESCrE, CRE, and MRSA; determination of the proportion of colonizing ESCrE, CRE, and MRSA with pathogenic characteristics based on MLST; identification of factors independently associated with ESCrE, CRE, and MRSA colonization; and creation an archive of ESCrE, CRE, and MRSA isolates for future study. Discussion This is the first study to use a common protocol to evaluate population-based prevalence and risk factors associated with MDRO colonization among community-dwelling and hospitalized adults in multiple countries with diverse epidemiological conditions, including low- and middle-income settings. The results will be used to better describe the global epidemiology of MDROs and guide the development of mitigation strategies in both community and healthcare settings. These standardized baseline surveys can also inform future studies seeking to further characterize MDRO epidemiology globally.

Factors associated with choice of delivery with or without epidural analgesia among laboring women: a cross-sectional survey at a tertiary care hospital of a developing country

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Samina Ismail ◽  
Shemila Abbasi ◽  
Sobia Khan ◽  
Abdul Monem ◽  
Gauhar Afshan
Keyword(s):  
Epidural Analgesia ◽  
Health Care Providers ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Providers ◽  
Sources Of Information ◽  
Hospital Data ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Natural Birth

AbstractAims:The aim of this study was to evaluate the factors responsible for epidural analgesia (EA) refusal among parturient patients.Methods:In this prospective cross-sectional study of six months, we included all consenting postpartum patients having a non-operative delivery in the obstetric unit of our hospital. Data were collected on a predesigned questionnaire and included information such as parity, education, reasons for delivering with or without EA, source of information and patient satisfaction. Knowledge regarding EA was assessed from patients delivering without EA.Results:From 933 patients enrolled, 730 (78.2%) delivered without EA, and 203 (21.7%) with EA. Only 11 (1.5%) patients refused EA for the reason of having natural birth process. Otherwise common reasons were misconceptions (65.9%) and lack of awareness about EA (20.5%); 70.5% had no knowledge of common side effects of EA. Among patients delivering with EA, 92.6% were offered EA by health care providers and had obstetricians and anesthesiologists as their sources of information.Conclusions:Patients in developing countries are laboring without EA, even in centers where there is a provision for it. The main reasons for not availing themselves of EA are lack of awareness and knowledge and misconceptions, rather than the desire to have un-medicated natural birth.

scholarly journals Clinical profile and functional disability of patients with migraine

2016 ◽  
Vol 07 (02) ◽  
pp. 250-256 ◽  
Author(s):  
Vishnu Renjith ◽  
Mamatha Shivananda Pai ◽  
Flavia Castelino ◽  
Aparna Pai ◽  
Anice George
Keyword(s):  
Functional Disability ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Primary Headache ◽  
Headache Disorder ◽  
Episodic Migraine ◽  
Clinical Profile ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional

ABSTRACT Background: Migraine is a common disabling primary headache disorder. Globally, migraine was ranked as the seventh highest cause of disability. Aim: The aim of the study was to explore the clinical profile and functional disability of patients with migraine. Settings and Design: A cross-sectional survey was conducted at the neurology outpatient department of a tertiary care hospital in Karnataka. Materials and Methods: Using a consecutive sampling technique, 60 patients were recruited for the study. Descriptive and inferential statistics were used to analyze the data. Results: Majority of the participants were in the age group of 18–40 years with a mean age 35.22 years. There was a female preponderance with 70% of study participants being females. The various symptoms experienced by patients include throbbing pain (90%), photophobia (93.3%), phonophobia (85%), nausea (76.7%), and vomiting (41.7%). Most of the subjects (73.3%) under the study belonged to moderate to severe levels of functional disability. About 53.3% of patients were in the category of episodic migraine and 46.7% were in the category of chronic migraine. Conclusion: Migraine is associated with moderate to severe functional disability. Frequency of migraine has a positive correlation with the levels of disability/migraine disability assessment scores of migraineurs.

Oral health knowledge, attitude and practices among nurses in a tertiary care hospital in Bangalore, India: a cross-sectional survey

2019 ◽  
Vol 55 (2-3) ◽  
pp. 261-274 ◽  
Author(s):  
Philcy Philip ◽  
Amy Villarosa ◽  
Anitha Gopinath ◽  
Carolin Elizabeth ◽  
Gift Norman ◽  
...  
Keyword(s):  
Oral Health ◽  
Health Knowledge ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Oral Health Knowledge
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