scholarly journals Feasibility and Value of Developing a Regional Antibiogram for Community Hospitals

2018 ◽  
Vol 39 (6) ◽  
pp. 718-722 ◽  
Author(s):  
Christopher J. Hostler ◽  
Rebekah W. Moehring ◽  
Elizabeth S. Dodds Ashley ◽  
Melissa Johnson ◽  
Angelina Davis ◽  
...  
Keyword(s):  
Small Community ◽  
Community Hospitals ◽  
Local Data ◽  
Local Susceptibility ◽  
Gram Negative ◽  
South Central ◽  
Low Prevalence ◽  
Eastern North Carolina ◽  
Susceptibility Rate ◽  
Combined Data

OBJECTIVETo determine the feasibility and value of developing a regional antibiogram for community hospitals.DESIGNMulticenter retrospective analysis of antibiograms.SETTING AND PARTICIPANTSA total of 20 community hospitals in central and eastern North Carolina and south central Virginia participated in this study.METHODSWe combined antibiogram data from participating hospitals for 13 clinically relevant gram-negative pathogen–antibiotic combinations. From this combined antibiogram, we developed a regional antibiogram based on the mean susceptibilities of the combined data.RESULTSWe combined a total of 69,778 bacterial isolates across 13 clinically relevant gram-negative pathogen–antibiotic combinations (median for each combination, 1100; range, 174–27,428). Across all pathogen–antibiotic combinations, 69% of local susceptibility rates fell within 1 SD of the regional mean susceptibility rate, and 97% of local susceptibilities fell within 2 SD of the regional mean susceptibility rate. No individual hospital had >1 pathogen–antibiotic combination with a local susceptibility rate >2 SD of the regional mean susceptibility rate. All hospitals’ local susceptibility rates were within 2 SD of the regional mean susceptibility rate for low-prevalence pathogens (<500 isolates cumulative for the region).CONCLUSIONSSmall community hospitals frequently cannot develop an accurate antibiogram due to a paucity of local data. A regional antibiogram is likely to provide clinically useful information to community hospitals for low-prevalence pathogens.Infect Control Hosp Epidemiol 2018;39:718–722

scholarly journals Epidemiological and phylogenetic analysis reveals Flavobacteriaceae as potential ancestral source of tigecycline resistance gene tet(X)

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Rong Zhang ◽  
Ning Dong ◽  
Zhangqi Shen ◽  
Yu Zeng ◽  
Jiauyue Lu ◽  
...  
Keyword(s):  
Phylogenetic Analysis ◽  
Resistance Gene ◽  
Gc Content ◽  
Zhejiang Province ◽  
Bacterial Strains ◽  
Gram Negative ◽  
E Coli ◽  
Transmission Mechanisms ◽  
Low Prevalence ◽  
Potential Origin

Abstract Emergence of tigecycline-resistance tet(X) gene orthologues rendered tigecycline ineffective as last-resort antibiotic. To understand the potential origin and transmission mechanisms of these genes, we survey the prevalence of tet(X) and its orthologues in 2997 clinical E. coli and K. pneumoniae isolates collected nationwide in China with results showing very low prevalence on these two types of strains, 0.32% and 0%, respectively. Further surveillance of tet(X) orthologues in 3692 different clinical Gram-negative bacterial strains collected during 1994–2019 in hospitals in Zhejiang province, China reveals 106 (2.7%) tet(X)-bearing strains with Flavobacteriaceae being the dominant (97/376, 25.8%) bacteria. In addition, tet(X)s are found to be predominantly located on the chromosomes of Flavobacteriaceae and share similar GC-content as Flavobacteriaceae. It also further evolves into different orthologues and transmits among different species. Data from this work suggest that Flavobacteriaceae could be the potential ancestral source of the tigecycline resistance gene tet(X).

Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria

2018 ◽  
Vol 46 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Eva Leitner ◽  
Elisabeth Zechner ◽  
Elisabeth Ullrich ◽  
Gernot Zarfel ◽  
Josefa Luxner ◽  
...  
Keyword(s):  
Long Term Care ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Care Facilities ◽  
Low Prevalence

scholarly journals Carriage of ESBL-producing Gram-negative bacteria by flies captured in a hospital and its suburban surroundings in Ethiopia

2020 ◽  
Author(s):  
Tafese B Tufa ◽  
Andre Fuchs ◽  
Tobias Wienemann ◽  
Yannik Eggers ◽  
Sileshi Abdissa ◽  
...  
Keyword(s):  
Waste Disposal ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Local Data ◽  
Gram Negative ◽  
Disposal Area ◽  
Route Of Transmission ◽  
The Town ◽  
Orthopedic Ward

Abstract Background: Local data from the Asella Teaching and Referral Hospital in the town of Asella, Ethiopia reveal a high prevalence of extended-spectrum β-lactamase- (ESBL) producing Gram-negative bacteria (GNB) in clinical isolates. To investigate a possible route of transmission, we determined the proportions ESBL-producing GNB in isolates from flies caught in the hospital and in the town of Asella. Methods: Flies were collected in August 2019 from the neonatal intensive care unit (NICU), the orthopedic ward, the hospital’s waste disposal area, and from a butchery situated 1.5 km from the hospital. After trapping, the flies were macerated and suspended in sterile normal saline. The suspensions were inoculated on MacConkey agar and incubated overnight. Species identification and antimicrobial susceptibility testing were performed using Vitek®-MS and VITEK® 2. Results: In total, 103 bacterial isolates were obtained from 85 flies (NICU: 11 isolates from 20 flies, orthopedic ward: 10 isolates from 12 flies, waste disposal area: 37 isolates from 26 flies, butchery: 45 isolates from 27 flies). The proportions of ESBL-producing bacteria among isolates obtained from flies collected in the hospital compound were significantly higher (82%, 90%, and 57% in NICU, orthopedic ward and waste disposal area, respectively) compared to flies collected outside of the hospital compound (2% (1/45) in the butchery) (p≤0.001). The proportion of ESBL was 67% (6/9) among Raoultella spp. 67% (4/6) among Kluyvera spp., 56% (5/9) among Enterobacter spp., 50% (5/10) among E. coli, and 44% (8/18) among Klebsiella spp.. Of the 40 ESBL-genes detected, 85% were CTX-M-like, 83% TEM-like, 23% SHV-like, and 2% CTX-M-2-like. ESBL-producing bacteria showed higher rates of resistance against ciprofloxacin (66% vs. 5%), gentamicin (68% vs. 3%), piperacillin-tazobactam (78% vs. 5%), and trimethoprim-sulfamethoxazole (88% vs. 16%), compared to non-ESBL-producing bacteria. Conclusion: A high proportion of ESBL was identified in isolates from flies caught in the hospital compound compared with isolates of flies collected at a distance of 1.5 km from the hospital. Flies can be potential vectors for transmission of multidrug-resistant (MDR) bacteria within hospitals. Further studies are needed to determine the source of MDR colonization in flies and possible impact of MDR for nosocomial infections.

Multicenter study to evaluate the benefits of technology-assisted workflow on i.v. room efficiency, costs, and safety in small community hospitals

2019 ◽  
Vol 76 (13) ◽  
pp. 964-969 ◽  
Author(s):  
Jordyn P Higgins ◽  
Sarah Hardt ◽  
Debby Cowan ◽  
Eula Beasley ◽  
Stephen F Eckel
Keyword(s):  
United States ◽  
Multicenter Study ◽  
The United States ◽  
Turnaround Time ◽  
Error Reporting ◽  
Small Community ◽  
Community Hospitals ◽  
Error Type ◽  
Average Turnaround Time ◽  
Sterile Product

Abstract Purpose To evaluate the benefits of technology-assisted workflow (TAWF) compared to manual workflow (non-TAWF) on i.v. room efficiency, costs, and safety at community hospitals with less than 200 beds. Methods Four hospitals in the United States (2 with and 2 without TAWF) were evaluated, and characteristics of medication errors and frequency of each error type were measured across the institutions. The average turnaround time per workflow step and cost to prepare each compounded sterile product (CSP) were also calculated. The results were evaluated using descriptive and inferential statistics. Results The TAWF hospital sites detected errors at a significantly higher rate (3.78%) compared to the non-TAWF hospital sites (0.13%) (p < 0.05). The top error-reporting category for the TAWF sites was incorrect medication (71.66%), whereas the top error-reporting category for the non-TAWF sites could not be determined because of the small number of errors detected. Use of TAWF may be associated with a decrease in turnaround time and a decrease in overall cost to prepare a CSP. Conclusion Significantly more errors were detected in small community hospitals that use TAWF in the i.v. room compared to those not using it. There were differences in error types observed between technology and nontechnology groups. The use of TAWF was associated with faster preparation times and lower costs of preparation per CSP.

scholarly journals 619. High Multidrug-Resistant due to TEM and CTX-M-1 Types of Extended-Spectrum β-Lactamase and blaNDM-1 Type Carbapenemase Genes among Clinical Isolates of Gram-Negative Bacilli in Asella, Central Ethiopia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S288-S288
Author(s):  
Tafese B Tufa ◽  
Fuchs André ◽  
Sileshi Abdissa ◽  
Zewdu Hurissa ◽  
Hans Martin Orth ◽  
...  
Keyword(s):  
Resistance Genes ◽  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Local Data ◽  
Gram Negative ◽  
Central Ethiopia ◽  
Unfavorable Clinical Outcome ◽  
Resistance Patterns ◽  
Group 2

Abstract Background Acute infectious diseases and sepsis are among the leading causes of mortality in Ethiopia. The lack of local data concerning causative pathogens and resistance patterns results in suboptimal empirical treatment and unfavorable clinical outcome. The objective of this study was the characterization of bacterial pathogens in hospitalized patients with febrile infections in Central Ethiopia. Methods In total, 684 patients ≥1 year of age with fever admitted to the Asella Teaching Hospital from April 2016 to June 2018 were included. Blood and other appropriate clinical specimens were cultured. Susceptibility testing was performed using the Kirby–Bauer method and VITEK2. Confirmation of species identification and identification of resistance genes were conducted using MALDI-ToF and PCR at a microbiology laboratory in Düsseldorf, Germany. Results In total, 684 study participants were included; 54% were male and mean age was 26.7 years. Thus, the overall culture positivity rate was 7.5%. Of the 83 cultured organisms, 38(46%) were Gram-negative, 43(52%) Gram-positive, and 2(2%) Candida species. Among the 38 Gram-negative isolates, 16(42%) were E. coli, 15(39%) K. pneumoniae, and 4(11%) P. aeruginosa. Resistance against commonly used antibiotics for Gram-negative at the study site was: piperacillin/tazobactam 48%(13), ampicillin/sulbactam 93% (25), cefotaxime 89%(24), ceftazidime 74%(20), Cefipime 74%(20), meropenem 7%(2), amikacin 4% (1) and gentamicin 56%(15). Of 27 Gram-negative available for resistance-gene detection, blaNDM-1 was detected in one K. pneumoniae isolate and blaNDM-1 plus blaOXA-51 in A. baumannii. 81%(22/27) of the Gram-negative rods were confirmed to contain ESBL-genes as follows: TEM 17(77%), CTX-M-1-group 15(68%), SHV-6(27%) and CTX-M-9-group 2(9%). Among isolated S.aureus, 1(5%) was confirmed to be Methicillin-resistant S. aureus. Conclusion We found a high prevalence (81%) of ESBL-producing bacteria and 7.4% carbapenem resistance at the study site. More than half of Gram-negative isolates had two or more mobile resistance genes. These findings warrant the need for local national multidrug-resistant surveillance. Strengthening of antimicrobial stewardship programs is needed in order to face the threat of multidrug-resistant bacteria. Disclosures All authors: No reported disclosures.

Optimal Resources for Rural Surgery

2020 ◽  
Vol 86 (9) ◽  
pp. 1057-1061
Author(s):  
Kelsey A. Musgrove ◽  
Jad M. Abdelsattar ◽  
Stephanie J. LeMaster ◽  
Marguerite C. Ballou ◽  
David A. Kappel ◽  
...  
Keyword(s):  
Life Support ◽  
Surgical Care ◽  
Synthetic Mesh ◽  
Further Education ◽  
Advanced Trauma Life Support ◽  
Small Community ◽  
Ct Scanner ◽  
Community Hospitals ◽  
Emergency General Surgery ◽  
Packed Red Blood Cells

Background Timely access to emergency general surgery services, including trauma, is a critical aspect of patient care. This study looks to identify resource availability at small rural hospitals in order to improve the quality of surgical care. Methods Forty-five nonteaching hospitals in West Virginia were divided into large community hospitals with multiple specialties (LCHs), small community hospitals with fewer specialties (SCHs), and critical access hospitals (CAHs). A 58-question survey on optimal resources for surgery was completed by 1 representative surgeon at each hospital. There were 8 LCHs, 18 SCHs, and 19 CAHs with survey response rates of 100%, 83%, and 89%, respectively. Results One hundred percent of hospitals surveyed had respiratory therapy and ventilator support, computerized tomography (CT) scanner and ultrasound, certified operating rooms, lab support, packed red blood cells (PRBC), and FFP accessible 24/7. Availability of cryoprecipitate, platelets, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) decreased from LCHs to CAHs. The majority had board-certified general surgeons; however, only 86% LCHs, 53% SCHs, and 50% CAHs had advanced trauma life support (ATLS) certification. One hundred percent of LCHs had operating room (OR) crew on call within 30 minutes, emergency cardiovascular equipment, critical care nursing, on-site pathologist, and biologic/synthetic mesh, whereas fewer SCHs and CAHs had these resources. One hundred percent of LCHs and SCHs had anesthesia availability 24/7 compared to 78% of CAHs. Discussion Improving access to the aforementioned resources is of utmost importance to patient outcomes. This will enhance rural surgical care and decrease emergency surgical transfers. Further education and research are necessary to support and improve rural trauma systems.

scholarly journals Study of the Comparative Activity of Piperacillin/Tazobactam with Currently Available Antibiotics against 8206 Aerobic Isolates

1997 ◽  
Vol 8 (3) ◽  
pp. 147-153 ◽  
Author(s):  
Kevin R Forward ◽  
Donald E Low ◽  
Michel Laverdiere ◽  
Robert Rennie ◽  
Andrew E Simor ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
National Committee ◽  
Community Hospitals ◽  
Gram Positive ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Extended Spectrum ◽  
Disk Diffusion Testing ◽  
Extended Spectrum Beta Lactamases ◽  
Gram Positive Cocci

OBJECTIVES: To compare the activity of piperacillin-tazobactam with piperacillin and other parenterally administered antibiotics against aerobic Gram-negative bacilli and Gram-positive cocci isolated from across Canada, and to determine the prevalence of resistance mediated by extended-spectrum cephalosporinases.METHODS: Sixty-one laboratories participated. Disk diffusion testing was performed in accordance with methods outlined by the National Committee for Clinical Laboratory Standards. Susceptibilities were performed on 8206 strains.Escherichia coliandKlebsiella pneumoniaewith reduced susceptibilities to third-generation cephalosporins were screened for extended-spectrum beta-lactamases (ESBLs).RESULTS: Piperacillin-tazobactam was active against 92% of the strains, piperacillin against 81% and ticarcillin-clavulanic acid against 88%. Few differences were observed in the relative susceptibility of strains from teaching or community hospitals, from different anatomic sites or from different regions of the country. Aerobic Gram-negative bacilli tested tended to be more susceptible to all the agents than was recently reported in a similar American study. Only 43% ofEnterococcus faeciumwere susceptible to ampicillin and 42% to piperacillin piperacillin with and without tazobactam. Only two enterococcal strains were resistant to vancomycin, and 19 had intermediate zone sizes. Of the 10 strains ofE coliand eight strains ofK pneumoniaewith reduced susceptibility to extended spectrum cephalosporins, only one demonstrated typical ESBL activity.CONCLUSIONS: Canadian aerobic Gram-positive cocci and Gram-negative bacilli remain highly susceptible to many currently available antibiotics. The findings confirm a broad spectrum of activity of piperacillin-tazobactam and indicate that the pattern of susceptibility is quite uniform from different body sites, in both teaching and community hospitals, and across the country.

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