scholarly journals Examination of staphylococcal stethoscope contamination in the emergency department (pilot) study (EXSSCITED pilot study)

CJEM ◽  
2011 ◽  
Vol 13 (04) ◽  
pp. 239-244 ◽  
Author(s):  
Patrick H.P. Tang ◽  
Andrew Worster ◽  
Jocelyn A. Srigley ◽  
Cheryl L. Main
Keyword(s):  
Emergency Department ◽  
Staphylococcus Aureus ◽  
Pilot Study ◽  
Observational Cohort Study ◽  
Patient Assessment ◽  
Coagulase Negative Staphylococci ◽  
Staff Members ◽  
Bacterial Cultures ◽  
Observational Cohort ◽  
Study Participants

ABSTRACT Introduction: The objective of this study was to determine the prevalence of Staphylococcus-contaminated stethoscopes belonging to emergency department (ED) staff and to identify the proportion of these that were Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA). Methods: We conducted a prospective observational cohort study of bacterial cultures from 100 ED staff members' stethoscopes at three EDs. Study participants were asked to complete a questionnaire. Results: Fifty-four specimens grew coagulase-negative staphylococci and one grew methicillin-susceptible S. aureus. No MRSA was cultured. Only 8% of participants, all of whom were nurses, reported cleaning their stethoscope before or after each patient assessment. Alcohol-based wipes were most commonly used to clean stethoscopes. A lack of time, being too busy, and forgetfulness were the most frequently reported reasons for not cleaning the stethoscope in the ED. Conclusions: This study indicates that although stethoscope contamination rates in these EDs are high, the prevalence of S. aureus or MRSA on stethoscopes is low.

scholarly journals Treatment Duration for Uncomplicated Staphylococcus aureus Bacteremia To Prevent Relapse: Analysis of a Prospective Observational Cohort Study

2012 ◽  
Vol 57 (3) ◽  
pp. 1150-1156 ◽  
Author(s):  
Yong Pil Chong ◽  
Song Mi Moon ◽  
Kyung-Mi Bang ◽  
Hyun Jung Park ◽  
So-Youn Park ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Practice Guidelines ◽  
Observational Cohort Study ◽  
Care Hospital ◽  
Prospective Observational Cohort Study ◽  
Short Course ◽  
Observational Cohort

ABSTRACTPractice guidelines recommend at least 14 days of antibiotic therapy for uncomplicatedStaphylococcus aureusbacteremia (SAB). However, these recommendations have not been formally evaluated in clinical studies. To evaluate the duration of therapy for uncomplicated SAB, we analyzed data from our prospective cohort of patients with SAB. A prospective observational cohort study was performed in patients with SAB at a tertiary-care hospital in Korea between August 2008 and September 2010. All adult patients with SAB were prospectively enrolled and observed over a 12-week period. Uncomplicated SAB was defined as follows: negative results of follow-up blood cultures at 2 to 4 days, defervescence within 72 h of therapy, no evidence of metastatic infection, and catheter-related bloodstream infection or primary bacteremia without evidence of endocarditis on echocardiography. Of 483 patients with SAB, 111 met the study criteria for uncomplicated SAB. Fifty-three (47.7%) had methicillin-resistant SAB. When short-course therapy (<14 days) and intermediate-course therapy (≥14 days) were compared, the treatment failure rates (10/38 [26.3%] versus 16/73 [21.9%]) and crude mortality (7/38 [18.4%] versus 16/73 [21.9%]) did not differ significantly between the two groups. However, short-course therapy was significantly associated with relapse (3/38 [7.9%] versus 0/73;P= 0.036). In multivariate analysis, primary bacteremia was associated with a trend toward increased treatment failure (P= 0.06). Therefore, in the treatment of uncomplicated SAB, it seems reasonable to consider at least 14 days of antibiotic therapy to prevent relapse, as practice guidelines recommend. Because of its poor prognosis, primary bacteremia, even with a low risk of complication, should not be treated with short-course therapy.

scholarly journals True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study

BMJ ◽  
2019 ◽  
pp. l729 ◽  
Author(s):  
Mark Mariathas ◽  
Rick Allan ◽  
Sanjay Ramamoorthy ◽  
Bartosz Olechowski ◽  
Jonathan Hinton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Clinical Reason ◽  
Observational Cohort ◽  
Study Participants

AbstractObjectiveTo determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital.DesignProspective, observational cohort study.SettingUniversity Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017.Participants20 000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason. Hs-cTnI concentrations were measured in all study participants and nested for analysis except when the supervising doctor had requested hs-cTnI for clinical reasons.Main outcome measuresDistribution of hs-cTnI concentrations of all study participants and specifically the 99th centile.ResultsThe 99th centile of hs-cTnI for the whole population was 296 ng/L compared with the manufacturer’s quoted level of 40 ng/L (currently used clinically as the upper limit of normal; ULN). Hs-cTnI concentrations were greater than 40 ng/L in one in 20 (5.4%, n=1080) of the total population. After excluding participants diagnosed as having acute myocardial infarction (n=122) and those in whom hs-cTnI was requested for clinical reasons (n=1707), the 99th centile was 189 ng/L for the remainder (n=18 171). The 99th centile was 563 ng/L for inpatients (n=4759) and 65 ng/L for outpatients (n=9280). Patients from the emergency department (n=3706) had a 99th centile of 215 ng/L, with 6.07% (n=225) greater than the recommended ULN. 39.02% (n=48) of all patients from the critical care units (n=123) and 14.16% (n=67) of all medical inpatients had an hs-cTnI concentration greater than the recommended ULN.ConclusionsOf 20 000 consecutive patients undergoing a blood test for any clinical reason at our hospital, one in 20 had an hs-cTnI greater than the recommended ULN. These data highlight the need for clinical staff to interpret hs-cTnI concentrations carefully, particularly when applying the recommended ULN to diagnose acute myocardial infarction, in order to avoid misdiagnosis in the absence of an appropriate clinical presentation.Trial registrationClinicaltrials.govNCT03047785.

scholarly journals Effect of prior receipt of antibiotics on the pathogen distribution: a retrospective observational cohort study on 27 792 patients

2019 ◽  
Author(s):  
Leiqing Li ◽  
Lingcheng Xu ◽  
Rongsheng Zhu ◽  
Jiaojiao Song ◽  
Xuanding Wang
Keyword(s):  
Staphylococcus Aureus ◽  
Body Fluid ◽  
Antimicrobial Agents ◽  
Observational Cohort Study ◽  
Urine Samples ◽  
Separation Rate ◽  
Before And After ◽  
Fermenting Bacteria ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Background: There have been no systematic studies of microbiological differences before and after antibiotics treatment. The aim of this study was to evaluate the effect of prior receipt of antibiotics on the microorganism distribution. Methods: A retrospective, observational cohort study was conducted in a 3 200-bed tertiary, referral, teaching hospital in eastern China. During a 2-year period, all hospitalized patients treated with antimicrobial agents were enrolled in this study. Among 48 692 patients evaluated, the 27 792 (57.1%) who were sampled within two days before or after administration of the first dose of antimicrobial agents were included. Distribution of clinical specimens and the microorganism were compared between before and after antibiotic drug treatment groups. Results: Compared to specimens taken after antibiotics exposure, specimens taken before antibiotics exposure had a higher proportion of blood and urine specimens and a higher culture positive rate (all P<0.001). Higher percentages of Staphylococcus aureus (9.9% vs. 8.5%, P=0.041), non-fermenting bacteria (27.7% vs. 19.9%, P<0.001), and fungi 8.4% vs. 4.0%, P<0.001) were isolated from the group after antibiotics exposure, while the percentages of Streptococcus spp. (4.8% vs. 2.7%, P<0.001), Haemophilus influenzae (2.3% vs. 0.8%, P<0.001), and Moraxella catarrhalis (0.7% vs. 0.1%, P<0.001) were higher in the group before antibiotics exposure. Further analysis found significant differences of microbes derived from respiratory secretions, blood or urine samples. We found, after antibiotics exposure, the separation rate of non-fermenting bacteria was significantly increased (all P < 0.05), and the separation rate of Candida spp. was higher, with statistical significance in airway secretion and urine samples (both P < 0.05), but the separation rate of Staphylococcus aureus among the three groups was not affected by antibiotics. In addition, the isolation rate of Streptococcus spp. in blood and urine samples decreased significantly (both P < 0.05) after antibiotics exposure. Interestingly, no statistical difference was found for microbes isolated from body fluid specimens between the two groups. Conclusions: The outcome revealed that antibiotic-insensitive organisms such as non-fermentative bacteria and fungi were more frequently isolated after antibiotics exposure. However, this trend might be specimen dependent and was not obvious in body fluid specimens.

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