Acquisition of Methicillin-Resistant Staphylococcus aureus in a Large Intensive Care Unit

2003 ◽  
Vol 24 (5) ◽  
pp. 322-326 ◽  
Author(s):  
Caroline Marshall ◽  
Glenys Harrington ◽  
Rory Wolfe ◽  
Christopher K. Fairley ◽  
Steve Wesselingh ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multivariate Analyses ◽  
University Hospital ◽  
Trauma Patients ◽  
Increased Risk ◽  
Risk Patients ◽  
Mrsa Colonization ◽  
Previous Admission

AbstractObjectives:To determine the prevalence of MRSA colonization on admission to the ICU and the incidence of MRSA colonization in the ICU.Design:Prospective cohort study.Setting:University hospital.Participants:Patients admitted to the ICU in 2000-2001.Methods:Patients were screened for MRSA with nose, throat, groin, and axilla swabs on admission and discharge. MRSA acquisition was defined as a negative admission screen and a positive discharge screen. Risk factors analyzed included previous wards/current unit, gender, age, and length of stay prior to and in the ICU. Univariate and multivariate analyses were performed using logistic regression.Results:Of screened patients, 6.8% were MRSA colonized on admission to the ICU. Some patients (11.4%) became newly colonized during their stay in the ICU. Factors that remained significant in the multivariate analysis of MRSA colonization on admission were previous admission to various wards and length of stay prior to ICU admission of more than 3 days. In the multivariate analysis of MRSA acquisition in the ICU, being a trauma patient and length of stay in the ICU greater than 2 days remained significant. Thirty-six percent of patients had both admission and discharge swabs taken. This percentage increased in the presence of a supervisory nurse.Conclusion:Significant acquisition of MRSA occurs in the ICU of our hospital, with trauma patients at increased risk. Patients who had been on the cardiothoracic ward prior to the ICU had a lower risk of MRSA colonization on admission. Presence of a supervisory nurse improved compliance with screening.

Methicillin-Resistant Staphylococcus aureus in a Trauma Population: Does Colonization Predict Infection?

2009 ◽  
Vol 75 (6) ◽  
pp. 458-462 ◽  
Author(s):  
Chasen A. Croft ◽  
Vicente A. Mejia ◽  
Donald E. Barker ◽  
Robert A. Maxwell ◽  
Benjamin W. Dart ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Trauma Patients ◽  
Death Rates ◽  
Methicillin Resistant ◽  
Trauma Population ◽  
Risk Patients ◽  
Level I ◽  
Mrsa Colonization ◽  
Colonization Status

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly responsible for infections in hospitalized patients. Patients colonized with MRSA appear to be at higher risk for subsequent MRSA infections than those who are not colonized. In this study, we determined MRSA colonization status of trauma patients at hospital admission and compared the incidence of subsequent MRSA infections between MRSA colonized and noncolonized patients. Collected data were entered into databases at a single, Level I trauma center over a 13-month period. Three hundred fifty-five adult trauma patients were screened for MRSA on admission to the trauma intensive care unit. The patients were categorized into two groups, those colonized with MRSA at admission and those who were not. Thirty-six of 355 patients (10.1%) were colonized. Of the 319 patients not colonized, 21 (6.6%) developed MRSA infections. Twelve of 36 (33.3%) colonized patients developed MRSA infections ( P < 0.001). No differences in types of MRSA infections were found between the two groups. Colonized patients who developed MRSA infections had higher death rates, 22.2 versus 5.0 per cent ( P < 0.001). Patients colonized with MRSA on admission may be at higher risk for developing MRSA infections during hospitalization. MRSA screening protocols should be used to identify these at-risk patients.

The Effect of Sarcopenia on Outcomes in Geriatric Blunt Trauma

2017 ◽  
Vol 83 (11) ◽  
pp. 1203-1208 ◽  
Author(s):  
Mahdi Malekpour ◽  
Kelly Bridgham ◽  
Kathryn Jaap ◽  
Ryan Erwin ◽  
Kenneth Widom ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Blunt Trauma ◽  
Odds Ratio ◽  
Lumbar Vertebra ◽  
Objective Measure ◽  
Trauma Patients ◽  
The Third ◽  
Increased Risk ◽  
Axial Ct

Elderly patients are at a higher risk of morbidity and mortality after trauma, which is reflected through higher frailty indices. Data collection using existing frailty indices is often not possible because of brain injury, dementia, or inability to communicate with the patient. Sarcopenia is a reliable objective measure for frailty that can be readily assessed in CT imaging. In this study, we aimed to evaluate the effect of sarcopenia on the outcomes of geriatric blunt trauma patients. Left psoas area (LPA) was measured at the level of the third lumbar vertebra on the axial CT images. LPA was normalized for height (LPA mm2/m2) and after stratification by gender, sarcopenia was defined as LPA measurements in the lowest quartile. A total of 1175 patients consisting of 597 males and 578 females were studied. LPAs below 242.6 mm2/m2 in males and below 187.8 mm2/m2 in females were considered to be sarcopenic. We found sarcopenia in 149 males and 145 females. In multivariate analysis, sarcopenia was associated with a higher risk of in-hospital mortality (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.01–2.56) and a higher risk of discharge to less favorable destinations (OR: 1.42, 95% CI: 1.05–1.97). Lastly, sarcopenic patients had an increased risk of prolonged hospitalization (hazard ratio: 1.21, 95% CI: 1.04–1.40).

Prognostic Impact of Comorbidities In A Cohort of 788 MDS Patients Based On A CIRS-G Derived Score. A MDS Piedmont Registry Prospective Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1729-1729
Author(s):  
Emanuela Messa ◽  
Daniela Gioia ◽  
Claudia Bertassello ◽  
Gianni Ciccone ◽  
Bernardino Allione ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Impact ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Increased Risk ◽  
Risk Patients ◽  
Progression Risk ◽  
Cox Analysis ◽  
Severe Grade

Abstract Abstract 1729 Background: Management of neoplastic patients is strongly influenced by comorbidities, especially in more advanced ages. Due to that, comorbidities evaluation is a critical issue in the global assessment of patients (pts) affected by myelodysplastic syndromes (MDS). Until now, there is no agreement on which comorbidity index (CI) is more suitable in this setting and different CI has been proposed. Recently a new MDS-specific score (MDS-CI) has been published by Della Porta et al., while the majority of CI in use has been developed in geriatric oncology setting. One of the most useful is Cumulative Illness Rating Scale of Geriatrics (CIRS-G). Aim of our study: Aim of our study was to test the usefulness of the conventional and easy to apply CIRS-G score among a cohort of MDS pts enrolled in the MDS Piedmont Registry from 1999 to 2010 in predicting OS and leukemic progression. Materials and methods: 788 patients from the MDS Piedmont Registry with CIRS-G evaluation at diagnosis were included in our statistical analysis. 78% of the patients were low and Int-1 IPSS risk, the remaining 22% were Int-2-high risk. The majority of patients (69%) carried an histological diagnosis of non RAEB MDS according to WHO classification, the remaining 31% were RAEB I-II. Age stratification was as follows: 10% up to 60, 23% from 61 to 70, 43% from 71 to 80, 24% over 80 years. Comorbidities with score up to 2 were considered mild while the ones with values higher than 2 were considered severe. We evaluated the global impairment of each patient creating two comorbidity scores based on the number of mild comorbidities (mild comorbidities score, MCS) and severe comorbidities (severe comorbidities score, SCS). Results: The majority of our patients showed only mild comorbidities and the comorbidities with the greater number of patients carrying severe grade of impairment are the cardiac (25%), hypertensive (30%) and endocrinological (20%) ones. COX analysis did not show an impact of comorbidities on leukemic progression risk while there is a statistically significant impact on overall survival of respiratory, renal, urological and osteo-muscular comorbidities (HR respectively of 1,18; 1,3; 1,3; 1,16). There is a trend of increased risk of non MDS related death in patients with severe grade of each comorbidity. Then we set up a Fine and Gray regression model in order to evaluate the global impact of comorbidities on leukemic progression and overall survival according to SCS and MCS. Neither SCS nor MCS showed an impact on the leukemic progression risk. Considering overall survival (OS), MCS showed a HR of 1,12 (p= 0,009) and moreover SCS has a strong impact on the risk of death (HR 1,59; p= 0,000). MCS remains statistically significant in low IPSS risk patients (p<0,001) while there is no influence of MCS on OS considering high IPSS risk patients (p=0,244). COX analysis stratifying pts for performance status (PS) and age classes confirmed the results obtained in the whole population. We performed a multivariate analysis and confirmed that SCS score (p=0,0006), age and IPSS (all p<0,0001) but not PS (p=0,22) are independent prognostic factors in OS prediction. Conclusions: Our data based on a prospective evaluation of 788 MDS patients enrolled in the MDS Piedmont Registry showed that CIRS-G evaluation is a suitable and easy to apply method useful in patients evaluation at diagnosis and during disease management. In our multivariate analysis IPSS is the most useful tool for leukemic progression evaluation, while SCS score (derived from CIRS-G evaluation) and age are the most important variables able to predict overall survival while PS at diagnosis does not add any useful information for this evaluation. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Risks and Benefits of Sex-Mismatched Hematopoietic Cell Transplantation Differ By Conditioning Intensity

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2537-2537
Author(s):  
Hideki Nakasone ◽  
Mats Remberger ◽  
Lu Tian ◽  
Petter Brodin ◽  
Bita Sahaf ◽  
...  
Keyword(s):  
Multivariate Analyses ◽  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Chronic Gvhd ◽  
Lymphocytic Leukemia ◽  
Hematopoietic Cell ◽  
University Hospital ◽  
Cell Transplant ◽  
Increased Risk ◽  
Conditioning Intensity

Abstract Backgrounds: Sex-mismatched hematopoietic cell transplant (HCT), especially HCT of male recipients with female donors (F->M) is known to be associated with a higher incidence of graft-versus-host disease (GVHD) and inferior survival. Total lymphoid irradiation with anti-thymocyte globulin (TLI-ATG) has been reported to reduce GVHD incidences and non-relapse mortality (NRM). We hypothesized that TLI-ATG could reduce adverse effects of sex-mismatched HCT without reducing graft-versus leukemia/lymphoma (GVL) effect. Methods: We reviewed clinical charts of 1041 adult recipients who received peripheral blood stem cell transplant between 2006 and 2013 at Stanford University (n=749) and Karolinska University Hospital (n=292). Primary diseases included acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), lymphoma, chronic lymphocytic leukemia (CLL) and others. Our study excluded indications for which TLI-ATG is not used such as acute lymphoblastic leukemia. Haplo-identical HCT and recipients who received GVHD prophylaxis other than cyclosporine and tacrolimus were also excluded. Impacts of sex-mismatch on clinical outcomes were separately assessed in TLI-ATG (n=437), reduced-intensity conditioning (RIC, n=266), and myeloablative conditioning (MAC, n=345). We also measured allo-antibodies (HY-Ab) against 5 HY-antigens encoded on the Y-chromosome (DBY, UTY, ZFY, EIF1AY, and RPS4Y) at 3 months (3m) post F->M HCT in the Stanford cohort. Results: F->M HCT was significantly associated with an increased risk of acute GVHD grade 2-4 in the RIC group (HR 1.96, P<0.01) and an increased risk of chronic GVHD in the MAC group (HR 1.83, P<0.01), while no impact of sex-mismatch on GVHD was observed in the TLI-ATG group. F->M HCT was also associated with an increased risk of NRM only in the MAC group (HR 1.84, P=0.022), while there was no difference in the TLI-ATG or RIC group. In the TLI-ATG group, relapse incidences of sex-mismatched HCT at 2 years post-HCT (40% in F->M HCT and 33 % in M->F HCT) were significantly lower than that of sex-matched HCT (52%, P<0.01, Fig1). Multivariate analyses revealed that sex-mismatch was significantly associated with reduced relapse in the TLI-ATG group (HR 0.64 in F->M and 0.59 in M->F, P<0.01 in each), while no difference was observed in the RIC or MAC group. The GVL benefit of sex-mismatch in TLI-ATG was observed in AML and lymphoma patients other than CLL. In MDS and CLL patients, the GVL benefit by sex-mismatch was not observed. We found that the overall survival (OS) of sex-mismatch recipients (69% in F->M and 70% in M->F HCT at 2 years post-HCT) was higher than that of sex-matched HCT (56%, P<0.01, Fig 1) in the TLI-ATG group. In contrast, for MAC recipients, OS of F->M HCT (49%) was significantly inferior to those of sex-matched HCT (60%) and M->F HCT (58%, P=0.01). Multivariate analyses confirmed that sex-mismatch was significantly associated with superior OS in the TLI-ATG group (HR 0.69 in F->M, P=0.037; HR 0.61 in M->F, P=0.014), while F->M HCT was significantly associated with inferior OS in the MAC group (HR 1.59, P=0.018). In the TLI-ATG group, the benefit of sex-mismatched HCT on OS seems due to the reduced relapse rate. We previously reported HY-Ab response post-HCT was associated with chronic GVHD as a representative of allo-Ab response (Nakasone et al. ASH 2013). We then hypothesized that HY-Ab response 3m post-HCT could predict reduced relapse in F->M HCT with TLI-ATG. Excluding patients with MDS and CLL because of the absence of GVL benefit by sex-mismatch in TLI-ATG (above), relapse incidence at 2 years post-HCT was higher in the recipients who had no HY-Ab response at 3m post-HCT vs. those who did (49% vs. 26%, P=0.037, Fig 2). Multivariate analysis corroberated that the detection of HY-Ab 3m post-HCT was significantly associated with reduced relapse in F->M HCT with TLI-ATG (HR 0.29, P=0.039). On the other hand, in the MAC group, HY-Ab 3m post-HCT was not significantly associated with reduced relapse. Conclusion: Benefits and risks of sex-mismatch differ according to conditioning intensity. Recipients of TLI-ATG conditioning preferentially benefit from sex-mismatched HCT with significantly reduced relapse rates and improved OS. HY-Ab 3m post-HCT as a representative of allo-Ab demonstrated the association with reduced relapse in the TLI-ATG group. We believe that sex-mismatched HCT should be selected in TLI-ATG, while F->M HCT should be avoided in MAC. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals High Anemia Prevalence in Korean Older Adults, an Advent Healthcare Problem: 2007-2016 KNHANES

2020 ◽  
Author(s):  
Hee won Chueh ◽  
Hye Lim Jung ◽  
Ye Jee Shim ◽  
Hyoung Soo Choi ◽  
Jin Yeong Han
Keyword(s):  
Rheumatoid Arthritis ◽  
Older Adults ◽  
Multivariate Analyses ◽  
University Hospital ◽  
Categorical Variables ◽  
High Morbidity ◽  
Older Individuals ◽  
Female Sex ◽  
Korean Adults ◽  
Increased Risk

Abstract BACKGROUND: Anemia is associated with high morbidity and mortality in older people. However, the prevalence and characteristics of anemia in older individuals are not fully understood, and national data on these aspects in older Korean adults are lacking. This study aimed to evaluate the prevalence and characteristics of anemia in older adults using data from the Korea National Health and Nutrition Examination Survey (KNHANES), which is a nationwide cross-sectional epidemiological study conducted by the Korean Ministry of Health and Welfare.METHODS: Data from a total of 62,825 participants of the 2007-2016 KNHANES were compiled and analyzed to investigate differences in participant characteristics and potential risk factors for anemia. Differences in clinical characteristics of participants were compared across subgroups using the chi-square test for categorical variables and independent t-test for continuous variables. Univariate and multivariate analyses using logistic regression were performed to identify related clinical factors.RESULTS: The prevalence of anemia was higher in the population aged ≥ 65 years than in the younger population. Anemia was also more prevalent among females than among males, but this difference was not significant in people aged >85 years. Being underweight, receiving a social allowance, living alone, and having comorbidities such as hypertension, rheumatoid arthritis, diabetes mellitus (DM), cancer, and chronic renal failure (CRF) were more common among older adults with anemia than among the population without anemia. In univariate and multivariate analyses, older age, female sex, underweight, and presence of comorbidities including rheumatoid arthritis, DM, cancer, and CRF were associated with an increased risk of anemia.CONCLUSIONS: This study revealed that age, female sex, underweight, and the presence of comorbidities such as rheumatoid arthritis, DM, cancer, and CRF were associated with an increased risk of anemia in older Korean adults. Further study on causal relationships between anemia and other variables in the older population is necessary.Trial registration: KNHANES has been approved by the KCDC Research Ethics Review Committee, annually since 2007 (2007-02CON-04-P, 2008-05EXP-01-C, 2009-01CON-03-2C, 2010-02CON-21-C, 2011-02CON-06-C, 2012-01EXP-01-2C, 2013-07CON-03-4C, 2013-12EXP-03-5C, 2015-01-02-6C). Ethical approval of this study was obtained through the Institutional Review Board of Dong-A University Hospital (DAUHIRB-EXP-20-035).

scholarly journals Alcohol use in severely injured trauma patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Antti Riuttanen ◽  
Saara J. Jäntti ◽  
Ville M. Mattila
Keyword(s):  
Alcohol Use ◽  
Length Of Stay ◽  
Injury Severity ◽  
Relative Proportion ◽  
University Hospital ◽  
Trauma Patients ◽  
Severely Injured ◽  
New Injury Severity Score ◽  
Severity Scores ◽  
Medical Histories

Abstract Alcohol is a major risk factor for several types of injuries, and it is associated with almost all types and mechanisms of injury. The focus of the study was to evaluate alcohol use in severely injured trauma patients with New Injury Severity Score (NISS) of 16 or over, and to compare mortality, injury severity scores and mechanisms and patterns of injury between patients with positive and negative blood alcohol levels (BAL). Medical histories of all severely injured trauma patients (n = 347 patients) enrolled prospectively in Trauma Register of Tampere University Hospital (TAUH) between January 2016 to December 2017 were evaluated for alcohol/substance use, injury mechanism, mortality and length of stay in Intensive Care Unit (ICU). A total of 252 of 347 patients (72.6%) were tested for alcohol with either direct blood test (50.1%, 174/347), breathalyser (11.2%, 39/347), or both (11.2%, 39/347). After untested patients were excluded, 53.5% of adult patients (18–64 years), 20.5% of elderly patients (above 65 years) and 13.3% of paediatric patients (0–17 years) tested BAL positive. The mean measured BAL for the study population was 1.9 g/L. The incidence of injuries was elevated in the early evenings and the relative proportion of BAL positive patients was highest (67.7%) during the night. Injury severity scores (ISS or NISS) and length of stay in ICU were not adversely affected by alcohol use. Mortality was higher in patients with negative BAL (18.2% vs. 7.7%, p = 0.0019). Falls from stairs, and assaults were more common in patients with positive BAL (15.4% vs. 5.4% and 8.7% vs. 2.7%, p < 0.006, respectively). There were no notable differences in injury patterns between the two groups. Alcohol use among severely injured trauma patients is common. Injury mechanisms between patients with positive and negative BAL have differences, but alcohol use will not increase mortality or prolong length of stay in ICU. This study supports the previously reported findings that BAL is not a suitable marker to assess patient mortality in trauma setting.

High Incidence of Venous Thromboembolism (VTE) in Patients with Cancer Hospitalized at a University Hospital in Chile. Efficacy of Pharmacological Thromboprophylaxis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4119-4119
Author(s):  
Guillermo F. Conte ◽  
Gaston L. Figueroa ◽  
Arie D. Altmann ◽  
Luisa A. Donaire
Keyword(s):  
Cancer Patients ◽  
Oral Anticoagulant Therapy ◽  
University Hospital ◽  
Disease Stage ◽  
Medical Conditions ◽  
Oncologic Surgery ◽  
Increased Risk ◽  
High Incidence ◽  
Risk Patients ◽  
Pharmacological Thromboprophylaxis

Abstract Inpatients are at increased risk of VTE due to multiple factors. Cancer diagnosis is an important risk factor determined through prospective studies. The aims of this study are to know the incidence of VTE in cancer patients hospitalized due to acute medical conditions and describe the use of pharmacological thromboprophylaxis and its efficacy. Methods: Retrospective analysis of cancer patients admitted to the University of Chile Clinical Hospital due to acute medical conditions between 2003 and 2004. Exclusion criteria: VTE diagnosed at admission, oral anticoagulant therapy at admission, age &lt;18 years, admission to Intensive Care Unit (ICU). It was necessary to confirm VTE diagnosis by ultrasonography or angio-CT scan. Results: Data of 366 patients was retrieved. The cancer origin was: gastric (38%), lung (19%), colorectal (15%), breast (10%), hepatocarcinoma (5%), others (13%). Seventy-seven percent of the cases presented an advanced disease (stage TNM III-IV). The main diagnoses at admission were: pneumonia (17%), vomits/dehydratation (16%), urinary tract infection (7%), decompensated diabetes mellitus (7%), digestive hemorrhage (7%). In 125 cases (34%) no type of pharmacological thromboprophylaxis was used; unfractionated heparin was used in 120 (33%) (5000 U sc c/8–12 hr) and low-molecular-weight heparin (dalteparin or enoxaparin) in 121 (33%). The VTE incidence was 3% (11 cases). In patients who did not receive thromboprophylaxis, the VTE incidence was 6.4% (8/125) versus 1.2% (3/241) in those who were administered heparin or LMWH (Odds Ratio=0.18 CI 95% 0.05–0.65). The group of patients who did not receive thromboprophylaxis was younger (median 60 vs. 65 years), had a higher frequency of thrombocytopenia (&lt;150.000; 39% vs. 15%) and hypoprothrombinemia (INR&gt;1.5; 35% vs. 14%), and a lower frequency of recent oncologic surgery (3% vs.19%). Conclusions: Cancer patients with acute medical conditions showed a high incidence of symptomatic VTE (3% in this series). One third of patients were not administered pharmacological thromboprophylaxis. The use of thromboprophylaxis in these high-risk patients was associated to a significative reduction of the VTE frequency.

scholarly journals Designing Hospital Key Performance Indicators for Academic Centers: Measuring the Average Length of Stay

2016 ◽  
Vol 6 (1) ◽  
pp. 5-11
Author(s):  
Omar A. Ayoub ◽  
Mohamed N. AlAma ◽  
Kamal M. AlGhalayini ◽  
Wesam A. Alhejily ◽  
Mohammed S. Abdulwahab ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Performance Indicator ◽  
Average Length ◽  
Performance Measure ◽  
University Hospital ◽  
Patient Specific ◽  
Design Quality ◽  
Average Length Of Stay ◽  
Risk Patients

Background: Length of stay is an important performance indicator for hospital management and a key measure of health care efficiency. This paper aims to determine the average length of stay in our center and the factors that influence it. We also investigate whether our hospital's length of stay is a key performance measure that can be used to design quality improvement initiatives. Methods: We performed a retrospective analysis of hospitalizations at the Multi-disciplinary Internal Medicine Department of King Abdulaziz University Hospital, Jeddah between 2010 and 2013. We collected data including demographics, admitting diagnosis, admitting unit, treatments administered, and history of transfer from the Intensive Care Unit. Results: The mean length of stay was 5.9 (6.8) days. Patients admitted through the Emergency Department were more likely to have a longer hospital stay compared with those admitted through Day Care or the Outpatient Department (P < 0.001). Expatriates (P < 0.001), bedridden patients (P = 0.02), and those who received prophylaxis for deep venous thrombosis (P < 0.001) were more likely to have a longer length of stay than the rest of the sample. Furthermore, patients admitted in the morning hours had a significantly shorter length of stay than those admitted in the evening hours (P < 0.001). Conclusion: The length of stay among patients at our department is affected by hospital- or patient-specific factors. Health care can be improved by identifying and monitoring the length of stay in high-risk patients.  

scholarly journals The Impact of Multidrug-Resistant Organisms Infection on Outcomes in Burn Injury Patients at Sanglah General Hospital, Bali

2021 ◽  
Vol 9 (A) ◽  
pp. 463-467
Author(s):  
Gede Wara Samsarga ◽  
I Made Suka Adnyana ◽  
Ni Nyoman Sri Budayanti ◽  
I Gusti Putu Hendra Sanjaya ◽  
Agus Roy Rusly Hariantana Hamid ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Antibiotic Therapy ◽  
General Hospital ◽  
Burn Injury ◽  
Multidrug Resistant ◽  
Burn Patients ◽  
Increased Risk ◽  
Multidrug Resistant Organisms ◽  
The Impact

BACKGROUND: Research related to the impact of multidrug resistant organisms (MDRO) infection on clinical outcomes in burns is still limited. AIM: This study evaluated the effect of MDRO infection on morbidity and mortality of burn patients. METHODS: A single-center retrospective cohort study was conducted on burn patients admitted to the burn unit of Sanglah General Hospital, Bali, between 2018 and 2020. MDRO patients were described as those who had at least one positive MDRO culture. All other patients were included in the non-MDRO group. Measurement and analysis included mortality and five indicators of morbidity: length of stay, duration of antibiotic therapy, sepsis, pneumonia, and acute kidney injury (AKI). RESULTS: Significant associations of MDRO infection were found for duration of antibiotic therapy (0 vs. 7 days), sepsis (odds ratio [OR] 13.90 [95% Confidence interval (CI) 95% 2.88–67.10]), pneumonia (OR 12,67 [95% CI 3.26–49.23]), and mortality (OR 9.75 [95% CI 2.00–47.50]). No significant association was found for the length of stay and the incidence of AKI. Multivariate analysis found that MDRO infection increased risk of sepsis (OR 36.53 [95% CI 2.05–652.45], pneumonia (OR 10.75 [95% CI 1.87–61.86]) and mortality (OR 57.09 [95% CI 1.41–2318.87]). Multivariate analysis of MDRO infection with duration of antibiotic therapy found no independent variables that were significantly related. CONCLUSION: These research findings suggest that MDRO infections are associated with increasing length of antibiotic treatment, sepsis, pneumonia, and mortality in burn patients.

scholarly journals Methicillin-resistant Staphylococcus aureus among healthcare workers: screening, risk factors and treatment

2021 ◽  
Author(s):  
Rahmathulla Safiyul Rahman ◽  
Badr Mohammed Beyari ◽  
Kawlah Essam Samarin ◽  
Khalid Mohammed Alamri ◽  
Marwan Abdulaziz Bader ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Healthcare Workers ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Skin Diseases ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Increased Risk ◽  
Wide Range ◽  
Mrsa Colonization

Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen of clinical significance within the community and healthcare settings. It has been reported with a variety of infections, including endocarditis, bloodstream infections, pneumonia, joint and bone infections, and soft tissue and skin infections. Although many efforts have been exerted to eradicate the rates of infections and studies have reported a decreasing pattern in the prevalence rates over the years, it has been demonstrated that MRSA represents a significant challenge to the healthcare systems and the affected patients. In this literature review, we have provided a discussion regarding the risk factors, screening, and treatment of MRSA among healthcare workers (HCWs) based on the evidence obtained from the current relevant studies in the literature. HCWs are at increased risk of MRSA colonization, and many risk factors have been identified. These mainly include poor hygiene practices, chronic skin diseases, and having a history of working in an MRSA-endemic country. Decolonization practices are the main line of treatment of MRSA colonization among HCWs because antibiotic therapy is usually of limited use because of the increasing resistance to a wide range of antibiotics. Applying adequate interventions as taking care of hand hygiene and using alcohol-based disinfectants is recommended to achieve better outcomes. Increasing awareness among HCWs is also a potential approach to achieve better management.

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