scholarly journals Multidrug-Resistant Organisms from Ophthalmic Cultures: Antibiotic Resistance and Visual Acuity

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1002-e1007
Author(s):  
Alexandra J Schulte ◽  
Brian K Agan ◽  
Heuy-Ching Wang ◽  
Patrick T McGann ◽  
Brett W Davies ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Primary Outcome ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Surveillance Network ◽  
Specific Data ◽  
Pseudomonas Spp ◽  
Multidrug Resistant Organisms

Abstract Introduction There is a growing trend of multidrug-resistant organisms (MDRO). The goal of this study was to characterize MDRO at a single center from ophthalmic cultures to better understand how treatments were tailored and to assess effect on visual acuity. Materials and Methods The MDRO data were collected by the Multidrug-Resistant Organism Repository and Surveillance Network from the Brooke Army Medical Center clinical laboratory. Both patient- and isolate-specific data were collected and qualitatively analyzed. Primary outcome measures were organism and type of resistance, anatomic location of isolate, initial and final antibiotic choice, and visual acuity. Results Thirty-one bacterial culture samples were analyzed from 29 patients. Twenty-two (72%) were Gram-positive and all were methicillin-resistant Staphylococcus aureus (MRSA). Nine (29%) were Gram-negative and of these five were Pseudomonas spp. Fourteen (45%) isolates were cultured from the cornea, nine (29%) from the lid, four (13%) from the conjunctiva, and four (13%) from other locations. The majority (66.6%) required adjustment of initial antibiotics following ocular culture results. Sixteen adult patients had recorded initial and final visual acuities. Fifteen of those 16 patients had stable or improved visual acuities following treatment of the infection, but five patients had a final visual acuity less than 20/200. Conclusion This study demonstrated a high frequency of corneal MDRO infections and specifically MRSA and Pseudomonas spp. isolates. Antibiotic treatments frequently required adjustment. Further prospective study of visual outcomes from ophthalmic MDRO cultures is needed.

scholarly journals Intra-abdominal Infections: The Role of Anaerobes, Enterococci, Fungi, and Multidrug-Resistant Organisms

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Gil Marcus ◽  
Samuel Levy ◽  
Ghaleb Salhab ◽  
Bethlehem Mengesha ◽  
Oran Tzuman ◽  
...  
Keyword(s):  
Roc Curve ◽  
Operating Characteristic ◽  
Medical Center ◽  
Hospital Setting ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Multidrug Resistant Organisms ◽  
Abdominal Infections ◽  
Healthcare Associated

Abstract Background Intra-abdominal infections (IAI) constitute a common reason for hospitalization. However, there is lack of standardization in empiric management of (1) anaerobes, (2) enterococci, (3) fungi, and (4) multidrug-resistant organisms (MDRO). The recommendation is to institute empiric coverage for some of these organisms in “high-risk community-acquired” or in “healthcare-associated” infections (HCAI), but exact definitions are not provided. Methods Epidemiological study of IAI was conducted at Assaf Harofeh Medical Center (May–November 2013). Logistic and Cox regressions were used to analyze predictors and outcomes of IAI, respectively. The performances of established HCAI definitions to predict MDRO-IAI upon admission were calculated by receiver operating characteristic (ROC) curve analyses. Results After reviewing 8219 discharge notes, 253 consecutive patients were enrolled (43 [17%] children). There were 116 patients with appendicitis, 93 biliary infections, and 17 with diverticulitis. Cultures were obtained from 88 patients (35%), and 44 of them (50%) yielded a microbiologically confirmed IAI: 9% fungal, 11% enterococcal, 25% anaerobic, and 34% MDRO. Eighty percent of MDRO-IAIs were present upon admission, but the area under the ROC curve of predicting MDRO-IAI upon admission by the commonly used HCAI definitions were low (0.73 and 0.69). Independent predictors for MDRO-IAI were advanced age and active malignancy. Conclusions Multidrug-resistant organism-IAIs are common, and empiric broad-spectrum coverage is important among elderly patients with active malignancy, even if the infection onset was outside the hospital setting, regardless of current HCAI definitions. Outcomes analyses suggest that empiric regimens should routinely contain antianaerobes (except for biliary IAI); however, empiric antienterococcal or antifungals regimens are seldom needed.

scholarly journals The Influence of Multidrug-Resistant Bacteria on Clinical Outcomes of Diabetic Foot Ulcers: A Systematic Review

2021 ◽  
Vol 10 (9) ◽  
pp. 1948
Author(s):  
Gianmarco Matta-Gutiérrez ◽  
Esther García-Morales ◽  
Yolanda García-Álvarez ◽  
Francisco Javier Álvaro-Afonso ◽  
Raúl Juan Molines-Barroso ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Mortality Rates ◽  
Multidrug Resistant ◽  
Healing Time ◽  
Cochrane Library ◽  
Foot Ulcers ◽  
Resistant Organism ◽  
Diabetic Foot Ulcers ◽  
Multidrug Resistant Organisms

Multidrug-resistant organism infections have become important in recent years due to the increased prevalence of diabetic foot ulcers and their possible consequences. This study aimed to systematically review and evaluate ulcer duration, healing time, hospital stay, amputation, and mortality rates in patients with diabetic foot ulcers caused by infection with multidrug-resistant organisms. PubMed, the Cochrane Library, and Web of Science were searched in May 2020 to find observational studies in English about the clinical outcomes of multidrug-resistant organism infection in diabetic foot ulcers. Eight studies met the inclusion criteria, and these studies included 923 patients. The overall methodological quality of the study was moderate. Ulcer duration was described in six studies, and there was no practical association with multidrug-resistant organisms. Two out of three studies reported a longer healing time in multidrug-resistant organism infections than in non-multidrug-resistant organism infections. Clinical outcomes included the duration of hospitalisation, surgeries, amputations, and deaths. Lower limb amputation was the most reported clinical outcome in the included studies, and was more prevalent in the multidrug-resistant organism infections. We concluded that there was not enough evidence that multidrug-resistant organisms hindered the healing of diabetic foot ulcers. In contrast to the clinical outcomes, multidrug-resistant organisms affect both amputation rates and mortality rates.

Combining antibiotics with silver nanoparticles: A potential treatment strategy against antimicrobial resistance

2021 ◽  
pp. 1-22
Author(s):  
Maryam Afridi ◽  
Saeed Ahmad Khan ◽  
Ruqayya Afridi ◽  
Farman Ullah ◽  
Abdul Majid ◽  
...  
Keyword(s):  
Antimicrobial Properties ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Antibacterial Resistance ◽  
Current Crisis ◽  
Mortality And Morbidity ◽  
Multidrug Resistant Organisms ◽  
Attractive Option ◽  
Silver Nps

Growing resistance to currently approved antibiotics is posing serious concern worldwide. The multidrug-resistant organisms are a major cause of mortality and morbidity around the globe. The limited options to treat infections caused by resistant organism requires alternative strategies to increase the effectiveness of antibiotic for better clinical outcomes. Recent advances in nanotechnology have enabled the drugs to be used in nanoscale to increase the effectiveness of antibiotics. The use of nanoparticles to treat infectious diseases has a long history in the pharmaceutical market, and the versatility of these particles to incorporate various materials as carriers make it an attractive option to combat the current crisis of emerging antibacterial resistance. Silver, a metal with many medical applications, has inherent antimicrobial properties. Therefore, silver NPs are appearing as one of the best options to be used in combination with antibiotics to increase effectiveness against resistant bacteria. Here, we discuss the applications and mechanisms of silver NPs to treat microbial resistance in light of recent research.

scholarly journals 528. Longitudinal Evaluation of Chlorhexidine Resistance Among Multidrug-Resistant Organisms in Relation to Intervention of Daily Chlorhexidine Bathing in Adult Intensive Care Units

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S254-S254
Author(s):  
Min Ja Kim ◽  
You Seung Chung ◽  
Hojin Lee ◽  
Jin Woong Suh ◽  
Yoojung Cheong ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Laboratory ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Multidrug Resistant Organisms ◽  
Before And After ◽  
The Republic

Abstract Background Chlorhexidine digluconate (CHG), the most widely used antiseptic, has recently been applied to patient washing to decolonize the multidrug-resistant organisms (MDROs), but there are little data on susceptibilities of MDROs to CHG. The purpose of this study was to evaluate CHG resistance among MDROs before and after the intervention of daily CHG bathing in adult intensive care units (ICUs). Methods The intervention of daily body washing with 2% CHG cloths were taken in adult patients the medical or surgical ICU of 23-bed by a crossover manner for 6 months (MICU, July to December 2017; SICU, January to June 2018) in a 1,050-bed, university hospital in the Republic of Korea. Available MDRO isolates were randomly selected from clinical cultures of ICU patients within 6 months before, during and after the intervention, including MRSA, MR-CoNS, VRE, Carbapenem-resistant Pseudomonas aeruginosa (CR-PA), CR-Acinetobacter baumannii (CR-AB). Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method set by the Clinical Laboratory Standards Institute. Determination of the minimum bactericidal concentrations (MBCs) was performed by subculturing 10 µL from each well without visible microbial growth. Cumulative amounts of CHG used in both ICUs was estimated across the study period from January 2008 to June 2018. Results The cumulative CHG consumption from both ICUs increased sharply from 27,503 g to 29,556 g after one-year intervention. The ranges of MICs and MBCs of CHG among MDRO clinical isolates selected by a 6-month phase are summarized in Table 1. Particularly, CR-PA and CR-AB isolates revealed four to eight times higher MICs and MBCs compared with the majority of Gram-positives excepting some VRE isolates. On the other hand, neither MICs and MBCs ranges of CHG from the MDRO isolates nor the monthly incidence of the MDROs from both ICUs were significantly increased before and after the intervention of daily CHG bathing. Conclusion This study indicates that some Gram-negative MDRO isolates with higher MICs and MBCs of CHG might be from longstanding exposure to CHG or efflux pumps. Although 2% daily CHG bathing uses over 1,000 times higher concentrations than the lethal concentration, it might be needed to monitor CHG resistance among MDROs. Disclosures All authors: No reported disclosures.

scholarly journals 1764. The Gut: A Veiled Reservoir for Multidrug-resistant Organisms (MDROs) Below the Tip of the Iceberg

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S63-S63
Author(s):  
Teppei Shimasaki ◽  
Yoona Rhee ◽  
Rachel D Yelin ◽  
Michelle Ariston ◽  
Stefanie Ollison ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Targeted Prevention ◽  
Prevention Measures ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Clinical Culture

Abstract Background Clinical culture results are sometimes used to estimate the burden of multidrug-resistant organisms (MDROs) in hospitals. The association between positive clinical culture results and prevalence of MDROs in the gut is incompletely understood. Methods Rectal swab or stool samples were collected daily from adult medical intensive care unit (MICU) patients and cultured for target MDROs using selective media between January 2017 and January 2018 at Rush University Medical Center, a 676-bed tertiary-care center in Chicago. Resistance mechanisms were confirmed by phenotypic methods and/or polymerase chain reaction. Clinical culture results during MICU stay were extracted from the hospital information system. Target MDROs included vancomycin-resistant Enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB). Patients with either a study or clinical culture positive for a target MDRO were analyzed. Results We collected 5,086 study samples from 1,661 unique admissions (1,419 patients) and included here data from 413 unique admissions (397 patients) with completed microbiologic analysis. Median (IQR) patient age was 65 (51–75) years and length of MICU stay was 3 (3–4) days. A total of 156 (37.8%) patients had a target MDRO detected from a study sample at any point; 57 (36.5%) patients had >1 MDRO detected. Overall prevalence of these MDROs was found to be 22.5% VRE, 6.5% CRE, 19.8% ESBL, 4.4% CRPA, and 0.7% CRAB. New MDRO acquisition was observed in 58 (14.6%) patients (figure). Once a target MDRO was detected in a study sample, 82.2% of subsequent study samples were positive for that MDRO. Only 13 (5.8%) patients had a positive clinical culture for any target MDRO during their MICU stay (table). Conclusion Clinical cultures capture only the tip of the resistance iceberg and alone are insufficient to guide MDRO-targeted prevention strategies. Universal infection prevention measures are an alternative that may be preferred in settings where overall prevalence of MDROs is moderate or high and patients may be colonized with >1 MDRO. Disclosures All authors: No reported disclosures.

scholarly journals 1180. Colonization with Multidrug-Resistant Organisms Is Associated with Subsequent Infection in the Ventricular Assist Device Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S423-S423
Author(s):  
Scott C Roberts ◽  
Jonathan D Rich ◽  
Duc T Pham ◽  
Rebecca Harap ◽  
Valentina Stosor
Keyword(s):  
Ventricular Assist Device ◽  
Retrospective Cohort ◽  
Multidrug Resistant ◽  
Ventricular Assist Devices ◽  
Resistant Organism ◽  
Subsequent Infection ◽  
Assist Device ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Multidrug Resistant Organisms

Abstract Background Infection is a leading cause of morbidity and mortality in the ventricular assist device (VAD) population. We performed a retrospective cohort study outlining the epidemiology of multidrug-resistant organism (MDRO) colonization and infection rates in this population. Methods We performed a longitudinal retrospective cohort of all patients receiving continuous-flow (axial and centrifugal) ventricular assist devices from July 2008 to September 2018 at Northwestern Memorial Hospital. Peri-operative prophylaxis from July 2008 to June 2013 was vancomycin, rifampin, ciprofloxacin, and fluconazole, and vancomycin plus cefuroxime from June 2013 to September 2018. VAD-specific and VAD-related Infections were classified according to ISHLT 2013 definitions. Patients were screened for methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis or Enterococcus faecium, or extended-spectrum β-lactamase producing Gram-negative rods. Statistics were performed using IBM® SPSS Statistics version 25.0. Comparative statistics were performed using two-sided Fisher’s exact test with a P-value of <0.05 deemed significant. Results A total of 89 patients with ventricular assist devices developed either VAD-specific or VAD-related infections and were included in the analysis. 77% of patients (n = 66) were colonized with an MDRO; 29% (n = 25) with MRSA, 73% (n = 63) with VRE, and 24% (n = 21) with an ESBL organism. 17.9% (n = 16) of patients who went on to develop infection was secondary to MDROs. Colonization with an MDRO was associated with subsequent infection secondary to these organisms (P = 0.018). Conclusion Colonization rates of multidrug-resistant organisms in the VAD population are high. VRE rates were significantly higher than MRSA or ESBL, possible as a result of peri-implantation utilization of vancomycin as surgical site prophylaxis. MDRO colonization was associated with progression to VAD-specific or VAD-related Infection. Disclosures All authors: No reported disclosures.

Management of Inpatients Colonized or Infected With Antimicrobial-Resistant Bacteria in Hospitals in the United States

2005 ◽  
Vol 26 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Rebecca H. Sunenshine ◽  
Laura A. Liedtke ◽  
Scott K. Fridkin ◽  
Larry J. Strausbaugh ◽  
Keyword(s):  
Infectious Diseases ◽  
The United States ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Emerging Infections ◽  
Contact Precautions ◽  
Surveillance Cultures ◽  
Multidrug Resistant Organisms ◽  
General Wards

AbstractBackground:Although guidelines for multidrug-resistant organisms generally include recommendations for contact precautions and surveillance cultures, it is not known how frequently U.S. hospitals implement these measures on a routine basis and whether infectious diseases consultants endorse their use.Methods:The Emerging Infections Network surveyed its members, infectious diseases consultants, to assess their use of and support for contact precautions and surveillance cultures for routine management of multidrug-resistant organisms in their principal inpatient workplace. Specifically, members were asked about use of these strategies for methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant, gram-negative bacilli on general wards, ICUs, and transplant units.Results:Overall, 400 (86%) of 463 respondents supported the routine use of contact precautions to control one or more multidrug-resistant organisms in at least one unit, and 89% worked in hospitals that use them. In contrast, 50% of respondents favored routine use of surveillance cultures to manage at least one multidrug-resistant organism in any unit, and 30% of respondents worked in hospitals that use them routinely in any unit. Members favored routine use of surveillance cultures significantly more in ICUs and transplant units than in general wards for each multidrug-resistant organism (P<.001).Conclusions:Most of the infectious diseases consultants endorsed the use of contact precautions for routine management of patients colonized or infected with multidrug-resistant organisms and work in hospitals that have implemented them. In contrast, infectious diseases consultants are divided about the role of routine surveillance cultures in multidrug-resistant organism management, and few work in hospitals that use them.

scholarly journals The Impact of Multidrug-Resistant Organisms on Outcomes in Patients With Diabetic Foot Infections

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Oryan Henig ◽  
Jason M Pogue ◽  
Emily Martin ◽  
Umar Hayat ◽  
Mahmoud Ja’ara ◽  
...  
Keyword(s):  
Propensity Score ◽  
Diabetic Foot ◽  
Medical Center ◽  
Conditional Logistic Regression ◽  
Generation Cephalosporin ◽  
Multidrug Resistant ◽  
Diabetic Foot Infections ◽  
Increased Risk ◽  
Multidrug Resistant Organisms ◽  
The Impact

Abstract Background Multidrug-resistant organisms (MDROs) are important diabetic foot infection (DFI) pathogens. This study evaluated the impact of DFIs associated with MDRO pathogens (DFI-MDRO) on clinical outcomes. Methods Adults admitted to Detroit Medical Center from January 2012 to December 2015 with culture-positive DFI were included. Associations between outcomes and DFI-MDRO (evaluated as a single group that included methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci, Enterobacteriaceae resistant to third-generation cephalosporin [3GCR-EC], Acinetobacter baumannii, and Pseudomonas aeruginosa) were analyzed. Outcomes included above- and below-knee lower extremity amputation (LEA), readmissions, and mortality within a year after DFI. A propensity score predicting the likelihood of having DFI-MDRO was computed by comparing patients with DFI-MDRO with patients with DFI with non-MDRO pathogens (DFI-non-MDRO). Using conditional logistic regression, DFI-MDRO was analyzed as an independent variable after patients in the MDRO and non-MDRO groups were matched by propensity score. Results Six hundred forty-eight patients were included, with a mean age ± SD of 58.4 ± 13.7. Most patients in the cohort presented with chronic infection (75%). DFI-MDRO occurred in greater than one-half of the cohort (n = 364, 56%), and MRSA was the most common MDRO (n = 224, 62% of the DFI-MDRO group). In propensity-matched analyses, DFI-MDRO was not associated with 1-year LEA or readmissions, but was associated with recurrent DFI episodes (odds ratio, 2.1; 95% confidence interval, 1.38–3.21). Conclusions DFI-MDRO was associated with a 2-fold increased risk of recurrent DFI compared with patients with DFI-non-MDRO.

Sign in / Sign up

Export Citation Format

Share Document