scholarly journals Impact of Antibiotic Use during Hospitalization on the Development of Gastrointestinal Colonization with Escherichia coli with Reduced Fluoroquinolone Susceptibility

2013 ◽  
Vol 34 (10) ◽  
pp. 1070-1076 ◽  
Author(s):  
Jennifer H. Han ◽  
Warren B. Bilker ◽  
Irving Nachamkin ◽  
Pam Tolomeo ◽  
Xiangqun Mao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients ◽  
Fluoroquinolone Resistance ◽  
Gastrointestinal Colonization ◽  
The Impact ◽  
Time Varying Covariates

Objective.Infections due to fluoroquinolone-resistant Escherichia coli (FQREC) are associated with significant morbidity and mortality. Fluoroquinolone resistance likely arises at the level of gastrointestinal colonization. The objective of this study was to identify risk factors for the development of FQREC gastrointestinal tract colonization in hospitalized patients, including the impact of antibiotics prescribed during hospitalization.Design.A prospective cohort study was conducted from 2002 to 2004 within a university health system.Methods.Hospitalized patients initially colonized with fluoroquinolone-susceptible E. coli were followed up with serial fecal sampling for new FQREC colonization or until hospital discharge or death. A Cox proportional hazards regression model was developed to identify risk factors for new FQREC colonization, with antibiotic exposure modeled as time-varying covariates.Results.Of 395 subjects, 73 (18.5%) became newly colonized with FQREC. Length of stay before sampling (hazard ratio [HR], 1.02 [95% confidence interval (CI), 1.1–1.03]; P = .003) and malignancy (HR, 0.37 [95% CI, 0.21–0.67]; P = .001) were significantly associated with the development of FQREC colonization. In addition, receipt of a first-generation cephalosporin (HR, 1.19 [95% CI, 1.10–1.29]; P<.001) or cefepime (HR, 1.05 [95% CI, 1.00–1.10]; P = .048) during hospitalization increased the risk of new FQREC colonization.Conclusions.The acquisition of FQREC in the hospital setting is complex, and antimicrobial stewardship programs should take into account patterns of antibiotic use in implementing strategies to reduce the development of new FQREC colonization. Future studies are needed to identify risk factors for infection in hospitalized patients newly colonized with FQREC.

scholarly journals Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s24-s24
Author(s):  
Marisa Hudson ◽  
Mayar Al Mohajer
Keyword(s):  
Hand Hygiene ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Incidence Density ◽  
Contact Precautions ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

scholarly journals Impact of Extended-Spectrum β-Lactamase Production on Treatment Outcomes of Acute Pyelonephritis Caused by Escherichia coli in Patients without Health Care-Associated Risk Factors

2015 ◽  
Vol 59 (4) ◽  
pp. 1962-1968 ◽  
Author(s):  
Sun Hee Park ◽  
Su-Mi Choi ◽  
Dong-Gun Lee ◽  
Sung-Yeon Cho ◽  
Hyo-Jin Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Health Care ◽  
Treatment Outcomes ◽  
Acute Pyelonephritis ◽  
Esbl Production ◽  
Content Type ◽  
E Coli ◽  
Extended Spectrum ◽  
The Impact

ABSTRACTExtended-spectrum β-lactamase-producingEscherichia coli(ESBL-EC) is increasingly identified as a cause of acute pyelonephritis (APN) among patients without recent health care contact, i.e., community-associated APN. This case-control study compared 75 cases of community-associated ESBL-EC APN (CA-ESBL) to 225 controls of community-associated non-ESBL-EC APN (CA-non-ESBL) to identify the risk factors for ESBL-EC acquisition and investigate the impact of ESBL on the treatment outcomes of community-associated APN (CA-APN) caused byE. coliat a Korean hospital during 2007 to 2013. The baseline characteristics were similar between the cases and controls; the risk factors for ESBL-EC were age (>55 years), antibiotic use within the previous year, and diabetes with recurrent APN. The severity of illness did not differ between CA-ESBL and CA-non-ESBL (Acute Physiology and Chronic Health Evaluation [APACHE] II scores [mean ± standard deviation], 7.7 ± 5.9 versus 6.4 ± 5.3;P= 0.071). The proportions of clinical (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.57 to 5.38;P= 0.323) and microbiological (OR, 1.16; 95% CI, 0.51 to 2.65;P= 0.730) cures were similar, although the CA-ESBL APN patients were less likely to receive appropriate antibiotics within 48 h. A multivariable Cox proportional hazards analysis of the prognostic factors for CA-APN caused byE. colishowed that ESBL production was not a significant factor for clinical (hazard ratio [HR], 0.39; 95% CI, 0.12 to 1.30;P= 0.126) or microbiological (HR, 0.49; 95% CI, 0.21 to 1.12;P= 0.091) failure. The estimates did not change after incorporating weights calculated using propensity scores for acquiring ESBL-EC. Therefore, ESBL production did not negatively affect treatment outcomes among patients with community-associatedE. coliAPN.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals Nephrectomy Delay of More than 10 Weeks from Diagnosis Is Associated with Decreased Overall Survival in pT3 RCC

2021 ◽  
Vol 8 (2) ◽  
pp. 27-33
Author(s):  
Jiping Zeng ◽  
Ken Batai ◽  
Benjamin Lee
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Logistic Regression ◽  
Proportional Hazards ◽  
Surgical Margin ◽  
Cox Proportional Hazards ◽  
Cancer Center ◽  
Integrated Network ◽  
Factors Associated ◽  
The Impact

In this study, we aimed to evaluate the impact of surgical wait time (SWT) on outcomes of patients with renal cell carcinoma (RCC), and to investigate risk factors associated with prolonged SWT. Using the National Cancer Database, we retrospectively reviewed the records of patients with pT3 RCC treated with radical or partial nephrectomy between 2004 and 2014. The cohort was divided based on SWT. The primary out-come was 5-year overall survival (OS). Logistic regression analysis was used to investigate the risk factors associated with delayed surgery. Cox proportional hazards models were fitted to assess relations between SWT and 5-year OS after adjusting for confounding factors. A total of 22,653 patients were included in the analysis. Patients with SWT > 10 weeks had higher occurrence of upstaging. Using logistic regression, we found that female patients, African-American or Spanish origin patients, treatment in academic or integrated network cancer center, lack of insurance, median household income of <$38,000, and the Charlson–Deyo score of ≥1 were more likely to have prolonged SWT. SWT > 10 weeks was associated with decreased 5-year OS (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15–1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, gender, race, insurance status, Charlson–Deyo score, tumor size, and surgical margin status (adjusted HR, 1.13; 95% CI, 1.04–1.24). In conclusion, the vast majority of patients underwent surgery within 10 weeks. There is a statistically significant trend of increasing SWT over the study period. SWT > 10 weeks is associated with decreased 5-year OS.

scholarly journals Risk Factors for Fluoroquinolone Resistance in Nosocomial Escherichia coli and Klebsiella pneumoniae Infections

2002 ◽  
Vol 162 (21) ◽  
pp. 2469 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Neil O. Fishman ◽  
Warren B. Bilker ◽  
Analia Castiglioni ◽  
Joshua P. Metlay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Fluoroquinolone Resistance

scholarly journals 2049. Trends in Antibiotic Use and Antibiotic Resistance among Veterans Affairs Community Living Centers from 2011 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S690-S691
Author(s):  
Haley Appaneal ◽  
Aisling Caffrey ◽  
Stephanie Hughes ◽  
Vrishali Lopes ◽  
Robin L Jump ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Fluoroquinolone Resistance ◽  
Antibiotic Overuse ◽  
Community Living Centers ◽  
Resistance Rates ◽  
Klebsiella Spp

Abstract Background Antibiotic resistance is a global public health crisis, with antibiotic overuse contributing to selection pressure, and thus driving antibiotic resistance. Strategies to reduce antibiotic overuse may slow the development of resistance, but large-scale studies assessing trends in antibiotic use and resistance among nursing homes at the national level are limited. We describe trends in antibiotic use and resistance nationally among Veterans Affairs (VA) Community Living Centers (CLCs). Methods We assessed antibiotic use and microbiological cultures among VA CLC residents from 2011 to 2017. Antibiotics were grouped into eight drug classes and annual days of antibiotic therapy per 1,000 bed-days were calculated. Facility-weighted annual antibiotic resistance rates were calculated. Joinpoint Software was used for regression analyses of trends over time and to estimate annual average percent changes (AAPC) with 95% confidence intervals (CI). Results Over 7 years and among 146 CLCs, several significant trends in decreasing antibiotic use and corresponding reductions in resistance were identified. Fluoroquinolone use decreased by 9.9% annually (95% CI −11.6 to −8.2%) and fluoroquinolone resistance decreased by 2.3% per year for Escherichia coli, 5.1% for Klebsiella spp., 1.8% for Proteus mirabilis, 4.9% for Pseudomonas aeruginosa, 12.6% for Enterobacter spp., and 3.2% for Enterococcus spp. Anti-pseudomonal penicillin use decreased by 6.6% annually (95% CI −10.6 to −2.4%) and anti-pseudomonal penicillin resistance rates decreased each year by 7.9% for Escherichia coli, 8.9% for Klebsiella spp., 15.2% for Proteus mirabilis and 4.2% for Pseudomonas aeruginosa. Anti-staphylococcal penicillin use decreased by 5.4% annually (95% CI −10.0 to −0.5%) and resistance in Staphylococcus aureus decreased 1.7% per year. Conclusion Nationally among VA CLCs, we observed significant reductions in the use of several classes of antibiotics with corresponding reductions in antibiotic resistance, including an impressive decline in fluoroquinolone use and corresponding decreases in fluoroquinolone resistance among six organisms. Future research should assess whether reductions in antibiotic use predict later reductions in antibiotic resistance and improvements in resident outcomes. Disclosures All authors: No reported disclosures.

scholarly journals Risk factors for respiratory Aspergillus fumigatus in German Cystic Fibrosis patients and impact on lung function

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Uta Düesberg ◽  
Julia Wosniok ◽  
Lutz Naehrlich ◽  
Patience Eschenhagen ◽  
Carsten Schwarz
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Lung Function ◽  
Aspergillus Fumigatus ◽  
Age Groups ◽  
Antibiotic Use ◽  
Lower Lung ◽  
Lung Infections ◽  
The Impact

Abstract Airway inflammation and chronic lung infections in cystic fibrosis (CF) patients are mostly caused by bacteria, e.g. Pseudomonas aeruginosa (PA). The role of fungi in the CF lung is still not well elucidated, but evidence for a harmful and complex role is getting stronger. The most common filamentous fungus in CF is Aspergillus fumigatus (AF). Age and continuous antibiotic treatment have been discussed as risk factors for AF colonisation but did not differentiate between transient and persistent AF colonisation. Also, the impact of co-colonisation of PA and AF on lung function is still under investigation. Data from patients with CF registered in the German Cystic Fibrosis Registry database in 2016 and 2017 were retrospectively analysed, involving descriptive and multivariate analysis to assess risk factors for transient or persistent AF colonisation. Age represented an independent risk factor for persistent AF colonisation. Prevalence was low in children less than ten years, highest in the middle age and getting lower in higher age (≥ 50 years). Continuous antibiotic lung treatment was significantly associated with AF prevalence in all age groups. CF patients with chronic PA infection had a lower lung function (FEV1%predicted), which was not influenced by an additional AF colonisation. AF colonisation without chronic PA infection, however, was significantly associated with a lower function, too. Older age up to 49 years and continuous antibiotic use were found to be the main risk factors for AF permanent colonisation. AF might be associated with decrease of lung function if not disguised by chronic PA infection.

Ecological Study of the Effectiveness of Isolation Precautions in the Management of Hospitalized Patients Colonized or Infected WithAcinetobacter baumannii

2008 ◽  
Vol 29 (12) ◽  
pp. 1118-1123 ◽  
Author(s):  
Houssein Gbaguidi-Haore ◽  
Sophie Legast ◽  
Michelle Thouverez ◽  
Xavier Bertrand ◽  
Daniel Talon
Keyword(s):  
Ecological Study ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Annual Incidence ◽  
University Hospital ◽  
Outcome Variable ◽  
Care Hospital ◽  
Aggregated Data ◽  
The Impact

Objective.To assess the impact of isolation precautions on the incidence of patients colonized or infected withAcinetobacter baumannii(case patients) in a university hospital during the period from 1999 to 2006.Design.Ecological study.Setting.The Besançon University Hospital in France, a 1,200-bed acute care hospital with approximately 50,000 admissions per year.Methods.Using Poisson regression analysis, we evaluated a total of 350,000 patient-days to determine the annual incidence of case patients. This annual incidence was used as the outcome variable, and infection control practices, antibiotic use, and other aggregated data regarding patients' age, sex, McCabe score, and immune status were used as covariates.Results.The implementation of isolation precautions was independently and negatively associated with the incidence of patients colonized or infected withA. baumannii(relative risk, 0.50 [95% confidence interval, 0.40–0.64];P< .001).Conclusions.Our study suggests that the implementation of isolation precautions, in addition to standard precautions, effectively prevents the spread ofA. baumanniiin a hospital setting.

Prevalence of Risk Factors for VTE In Hospitalized Medical and Surgical Patients. Data From the Comparison of Methods for Thromboembolic Risk Assessment with Clinical Perceptions and AwareneSS In Real Life Surgical and Medical Patients (COMPASS) Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3337-3337
Author(s):  
Grigoris T Gerotziafas ◽  
Miltos Chrysanthidis ◽  
Reda Isaad ◽  
Hela Baccouche ◽  
Chrysoula Papageorgiou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Gastrointestinal Disease ◽  
Real Life ◽  
Bleeding Risk ◽  
Hospitalized Patients ◽  
Assessment Model ◽  
Surgical Patients ◽  
Medical Patients ◽  
The Impact

Abstract Abstract 3337 Introduction: Risk assessment models (RAM) are helpful tools for the screening VTE risk in hospitalized patients. Most of the available RAMs have been constructed on a disease-based or surgery-based approach and include some of the most relevant risk factors for VTE. There is limited information on the impact and importance of individual and comorbidity related risk factors for VTE present during hospitalization on the global VTE risk. Incorporation of the most frequent VTE risk and bleeding risk factors related to comorbidities might improve the ability of RAM to detect real-life patients at risk VTE and to evaluate drawbacks for the application of thromboprophylaxis. Aim of the study: The primary aim of the COMPASS programme was to evaluate the prevalence of the all known VTE and bleeding risk factors reported in the literature in real-life surgical and medical hospitalized patients. Methods: A prospective multicenter cross-sectional observational study was conducted in 6 hospitals in Greece and 1 in France. All inpatients aged >40 years hospitalised for medical diseases and inpatients aged >18 years admitted due to a surgical procedure and hospitalisation for a period exceeding three days were included. Patients and their treating physicians were interviewed with standardised questionnaire including all VTE and bleeding risk factors described in literature (130 items) on the third day of hospitalisation. Patients not giving informed consent, or receiving anticoagulant treatment for any reason or hospitalised in order to undergo diagnostic investigation without any further therapeutic intervention were excluded. Results: A total of 806 patients were enrolled in the study (414 medical and 392 surgical). Most frequent causes of hospitalisation in medical patients were infection (42%), ischemic stroke (14%), cancer (13%), gastrointestinal disease (9%), pulmonary disease (4%), renal disease (3%) and rheumatologic disease (1,4%). Surgical patients were hospitalised for vascular disease (22%) cancer (19,4%) gastrointestinal disease (12,5%), infection (8%), orthopaedic surgery and trauma (14%) or minor surgery (7%). Analysis of the frequency of risk factors for VTE showed that active cancer, recent hospitalisation, venous insufficiency and total bed rest without bathroom privileges were frequent in both groups. Medical patients had significantly more frequently than surgical patients several important predisposing risk factors for VTE. Moreover, medical patient had more frequently than surgical ones bleeding risk factors. The data for the most frequent risk factors are summarised in Table 1. Conclusion: COMPASS is the first registry that provides key data on the prevalence of all known VTE and bleeding risk factors in real life medical and surgical patients hospitalised in two countries of European Union. The analysis of the data shows that in addition to risk stemin from the disease or surgical act both medical and surgical patients share common VTE risk factors. The careful analysis of the most frequent and relevant VTE risk factors will allow the derivation of a practical VTE and bleeding risk assessment model taken into account these factors. Disclosures: Chrysanthidis: Sanofi-Aventis: Employment.

scholarly journals Prevalence and Risk Factors for Selection of Quinolone-Resistant Escherichia coli Strains in Fecal Flora of Patients Receiving Quinolone Therapy

2008 ◽  
Vol 53 (3) ◽  
pp. 1287-1289 ◽  
Author(s):  
D. Yagci ◽  
F. Yoruk ◽  
A. Azap ◽  
O. Memikoglu
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Risk Factor ◽  
Hospitalized Patients ◽  
Fecal Flora ◽  
Fecal Carriage ◽  
Before And After ◽  
Selection Of

ABSTRACT Patients taking quinolones as inpatients (n = 55) or outpatients (n = 40) and newly hospitalized patients who were not on quinolone therapy (n = 41) were assessed for fecal carriage of quinolone-resistant Escherichia coli (QREC) strains before and after therapy/hospitalization. Fluoroquinolone use in the previous 6 months was found to be a risk factor for QREC carriage before therapy/hospitalization. The prevalence of QREC strains in fecal flora increased steadily with the duration of quinolone therapy.

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