scholarly journals Stenotrophomonas Bacteremia Antibiotic Susceptibility and Prognostic Determinants: Mayo Clinic 10-Year Experience

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Ahmed M Hamdi ◽  
Madiha Fida ◽  
Omar M Abu Saleh ◽  
Elena Beam
Keyword(s):  
At Risk ◽  
Common Source ◽  
High Morbidity ◽  
Population At Risk ◽  
The Past ◽  
Source Of Infection ◽  
Risk Sources ◽  
Sources Of Infection ◽  
Susceptibility Profiles ◽  
Hospital Acquired

Abstract Background Stenotrophomonas maltophilia is a gram-negative, opportunistic infection that is usually hospital-acquired and associated with high morbidity and mortality. The reported increase in S. maltophilia infections is presumed to be due to an increase in the population at risk. Methods We retrospectively reviewed 10-year data for S. maltophilia bacteremia in hospitalized adults at our institution to determine the population at risk, sources of infection, common complications, antimicrobial susceptibility profiles, and clinical outcome trends over the past decade. Results Among the 98 patients analyzed, the most common source of infection was catheter-related (62, 63.3%). Most isolates (61, 65%) were resistant to ceftazidime; fewer were resistant to trimethoprim-sulfamethoxazole (TMP-SMX; 2, 2.1%) and levofloxacin (22, 23.4%). All-cause in-hospital mortality was 29.6% (29 patients). The highest mortality, 53.8%, was observed in pulmonary sources of bacteremia. Conclusions Although TMP-SMX continues to have reliable activity in our cohort, we noted resistance to TMP-SMX in patients with recent TMP-SMX exposure, including a case with developing resistance to TMP-SMX while on therapy.

scholarly journals 1042. Stenotrophomans maltophilia Bacteremia, A 10-Year Tertiary Center Experience

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S311-S311 ◽  
Author(s):  
Ahmed Hamdi ◽  
Madiha Fida ◽  
Omar AbuSaleh ◽  
Elena Beam
Keyword(s):  
At Risk ◽  
Broad Spectrum ◽  
Treatment Options ◽  
Hemodynamic Instability ◽  
Fluoroquinolone Resistance ◽  
Common Source ◽  
High Morbidity ◽  
Tertiary Center ◽  
Risk Sources ◽  
Patients At Risk

Abstract Background Stenotrophomonas maltophilia is a hospital acquired infection that is associated with high morbidity and mortality. There has been a reported rise in S. maltophilia infections, presumed secondary to the increase in the population at risk. Methods We retrospectively reviewed all hospitalized adult patients in Mayo Clinic, MN with S. maltophilia bacteremia from January 2008 through January 2018. We analyzed patient population and described patients at risk, sources of infection, and changes in antimicrobial susceptibility profile. Results A total of 94 patients were analyzed, including 52 males, median age of 56 (46–65.75 IQR). The population included 60 infections in those with malignancies and 30 infections in transplant recipients. At presentation, 58 (61.7%) were febrile, while 54 (58.1%) presented with hemodynamic instability. Majority (70.2%) received broad-spectrum antimicrobials within 2 weeks of presentation. The most common source was catheter associated infection (n = 60), 15 cases were secondary to gastrointestinal, and 9 due to a pulmonary source. Almost half, 46 (48.9%) required ICU admission. Two patients were diagnosed with endocarditis. Most isolates, 61(64.9%), were resistant to ceftazidime, 2 (2.2%) resistant to TMP/SMX and 20 (21.5%) were resistant to levofloxacin. Exposure to a quinolone in the 30 days prior to presentation did not impact fluoroquinolone resistance. Five patients were exposed to Trimethoprim/Sulfamethoxazole (TMP/SMX) in the 30 days prior to presentation, which was associated with higher rate of TMP/SMX resistance compared with those without exposure (80% vs. 98.8%, P = 0.004). Treatment options commonly included combination therapy, and TMP/SMX was a primary agent used in the majority, 59 (62.8%). All-cause in-hospital mortality was 26.6%. All-cause mortality was lower for line associated infections (16.67%) vs. other sources (44.12%) with P = 0.0038. Conclusion S. maltophilia bacteremia should be considered in hospitalized patients with recent use of broad-spectrum antibiotics. Although TMP/SMX continues to have reliable activity, use of empiric ceftazidime pending susceptibility testing should be avoided as trend toward increasing resistance is noted. We noted a drop in TMP/SMX susceptibility in those with recent reported TMP/SMX use. Disclosures All authors: No reported disclosures.

Penyelidikan KLB keracunan makanan acara ruwahan di desa Mulo, Gunung Kidul provinsi DIY

2018 ◽  
pp. 1
Author(s):  
Mur Prasetyaningrum ◽  
Z. Chomariyah ◽  
Trisno Agung Wibowo
Keyword(s):  
At Risk ◽  
Total Population ◽  
Total Coliform ◽  
Case Control ◽  
P Value ◽  
Common Source ◽  
Population At Risk ◽  
E Coli

Tujuan: Studi ini untuk mengetahui gambaran KLB keracunan pangan yang terjadi di desa Mulo menurut deskripsi epidemiologi, faktor risiko dan penyebab KLB keracunan makanan. Metode: Studi ini menggunakan studi analitik case control, dimana kasus adalah orang yang mengalami sakit pada tanggal 7 - 8 Mei 2017, tinggal di desa Mulo dan mengkonsumsi makanan olahan dari bapak S dan K. Instrument menggunakan kuesioner. Hasil: KLB terjadi di Desa Mulo RT 5 dan 6 dengan jumlah kasus sebanyak 18 orang dari total population at risk 112 orang dengan gejala utama diare (100%), mual (72,2%), demam (66,6%), pusing (66,6%) dan muntah (50%). Dari diagnosa banding menurut gejala, masa inkubasi dan agent penyebab keracunan, kecurigaan kontaminasi bakteri mengarah pada E. Coli (ETEC). Masa inkubasi 1-16 jam (rata-rata 9 jam) dan common source curve. Penyaji makanan ada dua (pak K dan pak S). Dari perhitungan AR, berdasarkan sumber makanan mengarah pada makanan dari pak S (AR=42,8%). Bedasarkan menu, perhitungan OR dan CI 95 % jenis makanan yang dicurigai sebagai penyebab KLB adalah urap/gudangan (OR=4,33; p value0,0071) dan sayur lombok (OR=6,31; p value 0,0071). Sampel yang didapatkan adalah sampel air bersih, feses, dan muntahan penderita, sampel makanan tidak didapatkan karena keterlambatan informasi dari masyarakat. Hasil laboratorium, Total Coliform sampel air bersih melebihi ambang batas, sampel feses dan muntahan mengandung bakteri Klebsiella pneumonia.Simpulan: Terdapat 3 (tiga) faktor yang diduga sebagai penyebab keracunan pada warga Desa Mulo yaitu air bersih untuk mengolah makanan tercemar bakteri patogen, pengolahan makanan tidak hygienis dan penyajian makanan pada suhu ruang lebih dari 1 jam.

Electrical Impedance Spectroscopy as a Powerful Analytical Tool for Monitoring Microbiological Growth on Medical Implants

2008 ◽  
pp. 487-496
Author(s):  
Louise M. Oliver ◽  
E. T. McAdams ◽  
P. S.M. Dunlop ◽  
J. A. Byrne ◽  
I. S. Blair ◽  
...  
Keyword(s):  
Electrical Impedance Spectroscopy ◽  
Common Source ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Source Of Infection ◽  
Powerful Analytical Tool ◽  
Catheter Surface ◽  
Intravascular Catheters ◽  
Micro Organisms ◽  
Hospital Acquired

Hospital-acquired infections (HAI) are defined as infections that are neither present nor incubating when a patient enters the hospital (Bourn, 2000). Their effects vary from discomfort to prolonged or permanent disability and they may contribute directly or substantially to a patient’s death. HAI’s are estimated to cost the National Health Service (NHS) in England £1 billion annually (Bourn, 2000) with as many as 5,000 patients dying as a result of acquiring such an infection (Anon, 2001). Not all hospital-acquired infections are preventable but Infection Control Teams believe that they could be reduced by at least 15%, with yearly savings of £150 million (Anon, 2001). Central intravascular catheters have been found to be a common source of infection. Catheters can become infected via a number of different routes with the infection proliferating in multiple areas along the catheter surface. It has been reported that over 40% of the identified micro-organisms causing hospital-acquired infection were Staphylococci, an organism that is typically found on the natural skin flora (Bourn, 2000).

scholarly journals Current Perspective on Hospital Acquired Infection

2020 ◽  
pp. 22-30
Author(s):  
B. S. Rithu ◽  
Aishwarya Lakshmi
Keyword(s):  
Major Complication ◽  
Microbial Pathogens ◽  
Hospital Environment ◽  
Healthcare Sector ◽  
High Morbidity ◽  
Source Of Infection ◽  
Bioluminescence Assay ◽  
Microbiological Techniques ◽  
Atp Bioluminescence Assay ◽  
Hospital Acquired

Health care associated infections (HCAI) are a major complication faced by the healthcare sector leading to high morbidity and mortality. These infections are caused via the persistence of microbial pathogens in the hospital environment for extended periods (weeks to months) on contaminated surfaces. Foodborne illness is another significant source of infection in hospitals due to improper cleaning practices in the food operating sectors. Thus, frequent hygiene monitoring and efficient cleaning practices may reduce the rate of hospital-acquired infections. Contamination detection by traditional microbiological techniques is laborious, which has paved the way for the development of rapid biotechnological testing kits such as the ATP bioluminescence assay, which can be used as a rapid indicator of contamination.

Track 2.b Introduction: Design & Democracy

2019 ◽  
Vol 2 (1) ◽  
pp. 213
Author(s):  
Virginia TASSINARI ◽  
Ezio MANZINI ◽  
Maurizio TELI ◽  
Liesbeth HUYBRECHTS
Keyword(s):  
At Risk ◽  
Design Research ◽  
Core Theme ◽  
The Past ◽  
Noam Chomsky ◽  
Local Contexts ◽  
Democratic Discourse ◽  
Different Parts

The issue of design and democracy is an urgent and rather controversial one. Democracy has always been a core theme in design research, but in the past years it has shifted in meaning. The current discourse in design research that has been working in a participatory way on common issues in given local contexts, has developed an enhanced focus on rethinking democracy. This is the topic of some recent design conferences, such PDC2018, Nordes2017 and DRS2018, and of the DESIS Philosophy Talk #6 “Regenerating Democracy?” (www.desis-philosophytalks.org), from which this track originates. To reflect on the role and responsibility of designers in a time where democracy in its various forms is often put at risk seems an urgent matter to us. The concern for the ways in which the democratic discourse is put at risk in many different parts of the word is registered outside the design community (for instance by philosophers such as Noam Chomsky), as well as within (see for instance Manzini’s and Margolin’s call Design Stand Up (http://www.democracy-design.org). Therefore, the need to articulate a discussion on this difficult matter, and to find a common vocabulary we can share to talk about it. One of the difficulties encountered for instance when discussing this issue, is that the word “democracy” is understood in different ways, in relation to the traditions and contexts in which it is framed. Philosophically speaking, there are diverse discourses on democracy that currently inspire design researchers and theorists, such as Arendt, Dewey, Negri and Hardt, Schmitt, Mouffe, Rancière, Agamben, Rawls, Habermas, Latour, Gramsci, whose positions on this topic are very diverse. How can these authors guide us to further articulate this discussion? In which ways can these philosophers support and enrich design’s innovation discourses on design and democracy, and guide our thinking in addressing sensitive and yet timely questions, such as what design can do in what seems to be dark times for democracy, and whether design can possibly contribute to enrich the current democratic ecosystems, making them more strong and resilient?

scholarly journals 284. Evaluation of Oral Step-Down Therapy for Enterobacteriaceae Bloodstream Infection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Sara Utley ◽  
Dawn Bouknight ◽  
Radha Patel ◽  
Kent Stock
Keyword(s):  
Bloodstream Infection ◽  
Oral Therapy ◽  
Common Source ◽  
Oral Antibiotic ◽  
Beta Lactam ◽  
Hospital System ◽  
Source Of Infection ◽  
Complete Treatment ◽  
Antibiotic Duration ◽  
Alternate Source

Abstract Background Oral antibiotic stepdown therapy for Gram-negative (GN) bloodstream infection (BSI) appears to be a safe option, though high bioavailability drugs like fluoroquinolones (FQ) and trimethoprim-sulfamethoxazole are often recommended without clear evidence demonstrating superiority. Due to increasing concerns of FQ resistance and collateral damage with an increasing community C. difficile rate, our organization sought to reduce overall FQ use and a shift toward oral beta-lactams (BL) was observed. A review was conducted to assess the outcomes of this shift. Methods This retrospective cohort included all patients within our 3-hospital system who had a positive GN blood culture and were transitioned to oral therapy to complete treatment outpatient for bacteremia between Jan 2017-Sept 2019. The primary outcome was recurrent BSI within 30 days of completing initial treatment. Secondary outcomes included 30-day mortality, 30-day recurrence of organism at an alternate source, 30-day readmission, and 90-day BSI relapse. Results Of 191 GN BSIs, 77 patients were transitioned to oral therapy. The mean age was 68 years, 60% were female. The most common source of infection was described as urine (39/77), intra-abdominal (16/77), unknown (13/77). Mean total antibiotic duration (IV plus PO) was 14 days (range 7–33). Patients received an average of 5 days IV prior to transitioning to PO therapy. The most common PO class was a 1st gen cephalosporin (29/77), followed by BL/BL inhibitor (16/77), and a FQ (13/77). There were no 30-day relapse BSIs observed in this cohort. There was 1 patient discharged to inpatient hospice, and no other 30-day mortality observed. There were 4 recurrent UTIs observed within 30 days, none of which required readmission. Of the twelve 30-day readmissions, 1 was considered by the investigators to be related to the initial infection. Conclusion An opportunity for education regarding duration of therapy was identified. Oral beta lactam use in our limited population appears to be a reasonable option to facilitate discharge. Results should be confirmed in additional, larger studies. Disclosures All Authors: No reported disclosures

scholarly journals Missing the Point in Point Prevalence: Harnessing EMR Data to Identify Epi-Linked Patients in an Outbreak Investigation

2020 ◽  
Vol 41 (S1) ◽  
pp. s318-s318
Author(s):  
Lisa Stancill ◽  
Lauren DiBiase ◽  
Emily Sickbert-Bennett
Keyword(s):  
At Risk ◽  
Disease Transmission ◽  
Healthcare Setting ◽  
Point Prevalence ◽  
Positive Patient ◽  
Outbreak Investigation ◽  
Population At Risk ◽  
Outbreak Investigations ◽  
Overlap Method ◽  
Prevalence Screen

Background: A critical step during outbreak investigations is actively screening for additional cases to assess ongoing transmission. In the healthcare setting, one widely used method is point-prevalence screening on the whole unit where a positive patient is housed. Although this point-prevalence approach captures the “place,” it can miss the “person” and “time” elements that define the population-at-risk. Methods: At University of North Carolina (UNC) Hospitals, we used business intelligence tools to build a query that harnesses the admission, discharge, and transfer (ADT) data from the electronic medical record (EMR). Using this data identifies every patient who overlapped in time and space with a positive patient. An additional query identifies currently admitted overlap patients and their current location. During an outbreak investigation, an analyst executes these queries in the mornings when surveillance screens are scheduled. The queries generate a list of patients to screen that are prioritized on the number of days they were in the same unit with the positive patient. This overlap methodology successfully captures the person, place, and time associated with possible disease transmission. We implemented the overlap method for the last 3 months following 1 year of point-prevalence approach screening during a novel disease outbreak at UNC Hospitals. Results: In total, 4,385 unique patients overlapped with previously identified infected or colonized patients, of which 781 (17.8%) from 40 departments were screened over 15 months. During a subsequent, currently ongoing, outbreak, we are utilizing the overlap method and in 6 weeks have already screened 161 of the 1,234 overlapping patients (13%). After 3 rounds of overlap screening, we have already been able to identify 1 additional positive patient. This patient was on the same unit as patient zero 4 months prior but was readmitted to a unit that would not have received a point-prevalence screen using the standard approach. Conclusions: Surveillance screening is a time-consuming, resource-intensive effort that requires collaboration between infection prevention, clinical staff, patients, and the laboratory. By harnessing EMR ADT data, we can better target the population at risk and more efficiently utilize resources during outbreak investigations. In addition, the overlap method fills a gap in the current CDC guidelines by focusing on patients who were on the same unit with any positive patient, including those who discharged and readmitted. Most importantly, we identified an additional positive patient that would not have been detected through a point-prevalence screen, helping us prevent further disease transmission.Funding: NoneDisclosures: None

Effects of Criminal Sanctions on Drunk Drivers: Beyond Incarceration

1988 ◽  
Vol 34 (1) ◽  
pp. 29-42 ◽  
Author(s):  
Gerald R. Wheeler ◽  
Rodney V. Hissong
Keyword(s):  
At Risk ◽  
Statistical Analysis ◽  
Survival Time ◽  
Drunk Driving ◽  
Population At Risk ◽  
Criminal Sanctions ◽  
Drunk Drivers ◽  
First Offenders ◽  
Alternative Sanctions

Proponents of mandatory jail laws contend that alternative sanctions such as probation and fines have failed to modify behavior of those convicted of drunk driving (DWI). In order to test this proposition, we evaluated the effects of probation, fines, and jail sentences on DWI recidivism of a randomly selected DWI population at risk for 36 months. Utilizing survival time statistical analysis, the findings showed no significant differences in outcome among sanctions. As predicted, persons with a DWI history recidivated significantly sooner than first offenders. We conclude by advocating a policy of alternative sanctions to incarceration for drunk drivers.

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