Use of Local Community Hospital Data for Surveillance of Antimicrobial Resistance

2006 ◽  
Vol 27 (3) ◽  
pp. 299-301 ◽  
Author(s):  
Susan M. Farner
Keyword(s):  
Streptococcus Pneumoniae ◽  
Confidence Interval ◽  
Catchment Area ◽  
Local Community ◽  
Community Hospital ◽  
Antibiotic Use ◽  
Hospital Data ◽  
Susceptibility Data ◽  
Central Illinois ◽  
Local Antibiotic

We sought to determine whether antimicrobial susceptibility data from a nonteaching community hospital could be used to detect statistically significant local increases in resistance among Streptococcus pneumoniae over a 5-year period. Minimum inhibitory concentrations (MICs) of penicillin and ceftriaxone from 1997-1998 were compared with those from 2000-2001. MICs of penicillin and ceftriaxone for organisms collected in a nonteaching community hospital in central Illinois were used for analysis. The hospital has 224 beds and a catchment area of approximately 40 miles. There were significant increases in MICs of penicillin and ceftriaxone between 1997-1998 and 2000-2001. The MIC of penicillin increased from 0.042 to 0.121 μg/mL (P = .001; 95% confidence interval, -1.713 to -0.388), and the MIC of ceftriaxone increased from 0.028 to 0.071μg/mL (P = .005; 95% confidence interval, -1.353 to -0.188). There were no significant changes in the percentage of S. pneumoniae isolates that were resistant, intermediate, or susceptible to penicillin and ceftriaxone. MIC data from a community hospital can be used to detect local increases in the rate of resistance before antibiogram data show significant changes. This information is important for demonstrating to physicians the need to review local antibiotic use in the attempt to slow the development of resistant organisms in the community.

The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

scholarly journals Using Hydrological Mapping to Evaluate the Effectiveness of the Bener Dam Development in Reducing Flood Risk in Purworejo Regency, Central Java

2020 ◽  
Vol 34 (2) ◽  
Author(s):  
Sudaryatno Sudaryatno ◽  
Bagus Wiratmoko ◽  
Winanda Winanda ◽  
Shelly Yeni Saputri
Keyword(s):  
Remote Sensing ◽  
Rainy Season ◽  
Catchment Area ◽  
Local Community ◽  
Remote Sensing Data ◽  
Peak Discharge ◽  
Economic Losses ◽  
Dam Reservoir ◽  
Central Java ◽  
Concentration Time

The Bogowonto Hulu sub-watershed has high flooding potential, especially during the rainy season. This flooding causes physical, social, and economic losses for the local community and so the Bener Dam was built to reduce the volume of flooding in the area. This research aims to find out the effectiveness of the Bener Dam in overcoming the problem of flooding around the Bogowonto Hulu sub-watershed. The effectiveness of dams can be analysed by comparing the volume of the dam reservoir with the peak discharge amount generated. The value of peak discharge can be obtained using remote-sensing data and mathematical calculations following the rational method. Using this method, the estimated peak discharge value obtained for the watershed was 302.3 m3/s while the value of dam capacity was only 210 m3/s, giving 92.3 m3/s of flooding potential. It is necessary to reduce the potential for flooding by building an IR reservoir in the catchment area, so that rainwater is accommodated rather than being immediately depleted, and to reduce concentration time.

scholarly journals Invasiveness of Serotypes and Clones of Streptococcus pneumoniae among Children in Finland

2005 ◽  
Vol 73 (1) ◽  
pp. 431-435 ◽  
Author(s):  
William P. Hanage ◽  
Tarja H. Kaijalainen ◽  
Ritva K. Syrjänen ◽  
Kari Auranen ◽  
Maija Leinonen ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Confidence Interval ◽  
Multilocus Sequence Typing ◽  
Invasive Disease ◽  
Invasive Infection ◽  
Data Set ◽  
Dramatic Effect ◽  
Life Threatening ◽  
The Difference ◽  
Sequence Types

ABSTRACT Streptococcus pneumoniae (the pneumococcus) causes diseases from otitis media to life-threatening invasive infection. The species is extremely antigenically and clonally diverse. We wished to determine odds ratios (ORs) for serotypes and clones of S. pneumoniae that cause invasive disease in Finland. A total of 224 isolates of S. pneumoniae from cases of invasive disease in children <2 years of age in Finland between 1995 and 1999 were serotyped, and sequence types (STs) were determined by multilocus sequence typing. These STs were compared with a previously published carriage data set. STs from invasive disease were significantly less diverse than those from carriage (invasive disease, 0.038 ± 0.01; carriage, 0.019 ± 0.005). The ORs of serotypes 14, 18C, 19A, and 6B were significantly greater than 1, indicating association with invasive disease. The ORs of 6A and 11A were significantly less than 1. The difference between 6A and 6B is significant, which suggests that relatively subtle changes in the capsule may have a dramatic effect upon disease potential. We found that ST 156, the Spain9V-3 clone which mainly expressed serotype 14 in Finland, is strongly associated with invasive disease (OR, 10.1; 95% confidence interval, 1.3 to 79.5). Significant associations with invasive disease were also detected for STs 482, 191, 124, and 138, and associations with carriage were detected for STs 485 and 62. These results demonstrate the invasive phenotype of the serotype 14 variant of the Spain9V-3 clone and differences between members of the same serogroup in invasive disease potential.

scholarly journals COMPARISON OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS IN HEALTHY COMMUNITY HOSPITAL VISITORS[CA-MRSA] AND HOSPITAL STAFF [HA-MRSA]

2015 ◽  
Vol 7 ◽  
pp. e2015053 ◽  
Author(s):  
Nirmal A Pathare ◽  
Anil Pathare
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Staphylococcus Aureus ◽  
Confidence Interval ◽  
Cell Phone ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Community Hospital ◽  
Nasal Colonization ◽  
Methicillin Resistant ◽  
Healthy Community

Background: The prevalence of community associated methicillin resistant Staphylococcus aureus [CA-MRSA] in unknown in Oman.Methods: Nasal and cell phones swabs were collected from hospital visitors and health-care workers on sterile polyester swabs and directly inoculated onto a mannitol salt agar containing oxacillin, allowing growth of methicillin-resistant microorganisms. Antibiotic susceptibility tests were performed using Kirby Bauer’s disc diffusion method on the isolates. A brief survey questionnaire was requested be filled to ascertain the exposure to known risk factors for CA-MRSA carriage.Results: Overall, nasal colonization with CA-MRSA was seen in 34 individuals (18%, 95% confidence interval [CI] =12.5%-23.5%), whereas, CA-MRSA was additionally isolated from the cell phone surface in 12 participants (6.3%, 95% CI =5.6%-6.98%). Nasal colonization prevalence with HA-MRSA was seen in 16 individuals (13.8%, 95% confidence interval [CI] =7.5%-20.06%), whereas, HA-MRSA was additionally isolated from the cell phone surface in 3 participants (2.6%, 95% CI =1.7-4.54).  Antibiotic sensitivity was 100% to linezolid and rifampicin in the CA-MRSA isolates. Antibiotic resistance to vancomycin and clindamycin varied between 9-11 % in the CA-MRSA isolates.  There was no statistically significant correlation between CA-MRSA nasal carriage and the risk factors (P>0.05, Chi-square test).Conclusions: The prevalence of CA-MRSA in the healthy community hospital visitors was 18 % (95% CI, 12.5% to 23.5%) as compared to 13.8% [HA-MRSA] in the hospital health-care staff. In spite of a significant prevalence of CA-MRSA, these strains were mostly sensitive. Recommendation the universal techniques of hand washing, personal hygiene and sanitation are thus warranted. 

scholarly journals Klebsiella pneumoniae pneumonia in patients with rheumatic autoimmune diseases: clinical characteristics, antimicrobial resistance and factors associated with extended-spectrum β-lactamase production

2020 ◽  
Author(s):  
Yang Liu ◽  
Yecheng Liu ◽  
Jiayuan Dai ◽  
Anlei Liu ◽  
Yi Li ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Klebsiella Pneumoniae ◽  
Autoimmune Diseases ◽  
Multivariate Logistic Regression Analysis ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Esbl Production ◽  
Factors Associated ◽  
Susceptibility Data ◽  
Extended Spectrum

Abstract Background: Over the past decades, Klebsiella pneumoniae (K. pneumoniae) infections have been increasing and affected immunocompromised patients nosocomially and communally, with extended-spectrum β-lactamase (ESBL) production becoming a major concern. Patients with rheumatic autoimmune diseases, mostly receiving immunosuppressive therapy, are vulnerable to various infections, including K. pneumoniae. However, few have investigated K. pneumoniae infections in this specific population. This study aimed to identify factors associated with ESBL production and mortality of K. pneumoniae pneumonia among patients with rheumatic autoimmune diseases in the Emergency Department. Methods: We retrospectively investigated patients with rheumatic diseases who were diagnosed with pneumonia, with K. pneumoniae isolated from their respiratory tract samples. Prognostic factors and risk factors for ESBL production were determined with univariate and multivariate logistic regression analysis. Empirical therapy and antimicrobial susceptibility data were also collected. Results: Of 477 K. pneumoniae pneumonia patients, 60 were enrolled into this study. The in-hospital mortality was 28.3%. Septic shock, ICU admission, the need for mechanical ventilation and change of antibiotics due to clinical deterioration, all related to mortality, were included as unfavorable clinical outcomes. Multivariate analysis suggested that ESBL production (OR, 6.793; p = 0.012), initial PCT≥0.5 ng/ml (OR, 5.024; p = 0.033) and respiratory failure at admission (OR, 4.401; p = 0.046) predicted increased mortality. ESBL production was significantly associated with dose of corticosteroids (OR, 1.031; p = 0.013) and CMV viremia (OR, 4.697; p = 0.043), instead of previous hospitalization and antibiotic use, in patients with rheumatic autoimmune diseases. The most commonly used empirical antibiotic was ceftazidime, while most isolates showed less resistance to carbapenems and amikacin in susceptibility testing. Conclusions: K. pneumoniae pneumonia could be life-threatening in patients with rheumatic autoimmune diseases. Our findings suggested that ESBL production, initial PCT≥0.5 ng/ml and respiratory failure at admission were independent factors associated with poor prognosis. Dose of corticosteroids and CMV viremia, predicting ESBL production in K. pneumoniae pneumonia, may help make individualized antibiotic decisions in clinical practice.

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