scholarly journals Clinical management of cUTI, cIAI, and HABP/VABP attributable to carbapenem-resistant Gram-negative infections in Spain

2021 ◽  
Author(s):  
Ricard Ferrer ◽  
María Carmen Fariñas ◽  
Emilio Maseda ◽  
Miguel Salavert ◽  
German Bou ◽  
...  
Keyword(s):  
Clinical Management ◽  
Bacterial Pneumonia ◽  
Chart Review ◽  
Complicated Urinary Tract Infection ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Post Discharge ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Healthcare Associated

Introduction. Carbapenem-resistant Gram-negative (CRGN) infections are a major public health problem in Spain, often implicated in complicated, healthcare-associated infections that require the use of potentially toxic antibacterial agents of last resort. The objective of this study was to assess the clinical management of complicated infections caused by CRGN bacteria in Spanish hospitals. Methods. The study included: 1) a survey assessing the GN infection and antibacterial susceptibility profile in five participating Spanish hospitals and 2) a non-interventional, retrospective single cohort chart review of 100 patients with complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), or hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP) attributable to CRGN pathogens. Results. In the participating hospitals CRGN prevalence was 9.3% amongst complicated infections. In the retrospective cohort, 92% of infections were healthcare-associated, and Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common pathogens. OXA was the most frequently detected carbapenemase type (71.4%). We found that carbapenems were frequently used to treat cUTI, cIAI, HABP/VABP caused by CRGN pathogens. Carbapenem use, particularly in combination with other agents, persisted after confirmation of carbapenem resistance. Clinical cure was 66.0%, mortality during hospitalization 35.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. Conclusion. Our results reflect the high burden and unmet needs associated with the management of complicated infections attributable to CRGN pathogens in Spain and highlight the urgent need for enhanced clinical management of these difficult-to-treat infections.

Healthcare-Associated Infections: Not Only a Clinical Burden, But a Forensic Point of View

2019 ◽  
Vol 20 (8) ◽  
pp. 658-664 ◽  
Author(s):  
Marco Di Paolo ◽  
Luigi Papi ◽  
Paolo Malacarne ◽  
Federica Gori ◽  
Emanuela Turillazzi
Keyword(s):  
Health Care ◽  
Clinical Medicine ◽  
Methodological Approach ◽  
Care Facility ◽  
Public Health Problem ◽  
Control Measures ◽  
Major Public Health Problem ◽  
Healthcare Associated Infections ◽  
Open Communication ◽  
Healthcare Associated

Background: Healthcare-associated infections (HCAIs) occur when patients receiving treatment in a health care setting develop an infection. They represent a major public health problem, requiring the integration of clinical medicine, pathology, epidemiology, laboratory sciences, and, finally, forensic medicine. Methods: The determination of cause of death is fundamental not only in the cases of presumed malpractice to ascertain the causal link with any negligent behavior both of health facilities and of individual professionals, but also for epidemiological purposes since it may help to know the global burden of HCAIs, that remains undetermined because of the difficulty of gathering reliable diagnostic data. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insult, is mandatory in HCAIs related deaths. Results: Important tasks for forensic specialists in hospitals and health services centers are the promotion of transparency and open communication by health-care workers on the risk of HCAIs, thus facilitating patients’ engagement and the implementation of educational interventions for professionals aimed to improve their knowledge and adherence to prevention and control measures. Conclusion: HCAIs are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for healthcare institution and workers committed to making healthcare safer. Clinicians are at the forefront in the war against HCAIs, however, also forensic pathologists have a remarkable role.

scholarly journals Hybrid Simulation for Modeling Healthcare-associated Infections: Promising But Challenging

2020 ◽  
Author(s):  
Le Khanh Ngan Nguyen ◽  
Itamar Megiddo ◽  
Susan Howick
Keyword(s):  
Hybrid Simulation ◽  
Public Health Problem ◽  
Simulation Models ◽  
Hybrid Models ◽  
Major Public Health Problem ◽  
Healthcare Associated Infections ◽  
Simulation Performance ◽  
Systems Simulation ◽  
Healthcare Associated ◽  
And Control

Abstract Healthcare-associated infections (HAIs) are a major public health problem as they pose a serious risk for patients and providers, increasing morbidity, mortality, and length of stay, as well as costs to patients and the health system. Prevention and control of HAIs has, therefore, become a priority for most healthcare systems. Systems simulation models have provided insights into the dynamics of HAIs and help to evaluate the effect of infection control interventions. However, as each systems simulation modeling method has strengths and limitations, combining these methods in hybrid models can offer a better tool to gain complementary views on, and deeper insights into HAIs. Hybrid models can, therefore, assist decision-making at different levels of management, and provide a balance between simulation performance and result accuracy. This report discusses these benefits in more depth but also highlights some challenges associated with the use of hybrid simulation models for modeling HAIs.

scholarly journals Diagnostic, Prognostic, and Therapeutic Value of Circulating miRNAs in Heart Failure Patients Associated with Oxidative Stress

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Md Sayed Ali Sheikh ◽  
Umme Salma ◽  
Baohai Zhang ◽  
Jimei Chen ◽  
Jian Zhuang ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Clinical Management ◽  
Treatment Strategies ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Circulating Mirnas ◽  
Heart Failure Patients

Heart failure is a major public health problem especially in the aging population (≥65 years old), affecting nearly 5 million Americans and 15 million European people. Effective management of heart failure (HF) depends on a correct and rapid diagnosis. Presently, BNP (brain natriuretic peptide) or N-terminal pro-brain natriuretic peptide (NT-proBNP) assay is generally accepted by the international community for diagnostic evaluation and risk stratification of patients with HF. However, regardless of its widespread clinical use, BNP is still encumbered by reduced specificity. As a result, diagnosis of heart failure remains challenging. Although significant improvement happened in the clinical management of HF over the last 2 decades, traditional treatments are ultimately ineffective in many patients who progress to advanced HF. Therefore, a novel diagnostic, prognostic biomarker and new therapeutic approach are required for clinical management of HF patients. Circulating miRNAs seem to be the right choice for novel noninvasive biomarkers as well as new treatment strategies for HF. In this review, we briefly discuss the diagnostic, prognostic, and therapeutic role of circulating miRNAs in heart failure patients. We also mentioned our own technique of extraction of RNA and detection of circulating miRNAs from human plasma and oxidative stress associated miRNAs with HF.

scholarly journals Evaluation of antimicrobial activity of the fixed oil of Bowdichia virgilioides Kunth (Fabaceae) seeds

Gaia Scientia ◽  
2016 ◽  
Vol 10 (4) ◽  
pp. 681-689
Author(s):  
Filipe Gutierre Carvalho de Lima ◽  
Maria Arlene Pessoa da Silva ◽  
Beatriz Tupinambá Freitas ◽  
José Carlos Marques Freitas ◽  
Claudener de Souza Teixeira ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Activity ◽  
Antibacterial Activity ◽  
Antibiotic Resistance ◽  
Bacterial Resistance ◽  
Public Health Problem ◽  
Biologically Active ◽  
Major Public Health Problem ◽  
Gram Negative ◽  
The Family

Bacterial resistance to current drugs is a major public health problem worldwide. The search for biologically active compounds that act synergistically with antibiotics for their use at lower concentrations would be of great help in overcoming bacterial resistance. Bowdichia virgilioides Kunth, also known as sucupira-preta or sucupira-do-cerrado, is a species of the family LeguminosaePapilionoidea that occurs in both primary and secondary formations, always in fast-draining areas. The objective of this study was to evaluate of antibiotic modulation through of the fixed oil from the seeds of B. virgiloides activity. . The seeds showed a considerable amount of oil, with a yield of approximately 11%. The oil did not inhibit bacterial growth, but its combination with the antibiotics tested produced growth inhibition. Our data indicated that the oil extracted from B. virgiloides seeds has no antibacterial activity at clinically relevant concentrations, but when combined with aminoglycoside antibiotics, it showed modulatory activity, lowering the antibiotic resistance of Gram-negative strains.

scholarly journals Medical practitioner’s knowledge on dengue management and clinical practices in Bhutan

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254369
Author(s):  
Tsheten Tsheten ◽  
Archie C. A. Clements ◽  
Darren J. Gray ◽  
Kinley Gyeltshen ◽  
Kinley Wangdi
Keyword(s):  
Clinical Management ◽  
Management Practices ◽  
Health Workers ◽  
Public Health Problem ◽  
Fluid Replacement ◽  
Severe Dengue ◽  
Warning Sign ◽  
Major Public Health Problem ◽  
Clinical Practices ◽  
Health Council

Background Dengue has emerged as a major public health problem in Bhutan, with increasing incidence and widening geographic spread over recent years. This study aimed to investigate the knowledge and clinical management of dengue among medical practitioners in Bhutan. Methods We administered a survey questionnaire to all practitioners currently registered under the Bhutan Medical and Health Council. The questionnaire contained items on four domains including transmission, clinical course and presentation, diagnosis and management, and surveillance and prevention of dengue. Participants were able to respond using an online Qualtrics survey, with the invitation and link distributed via email. Results A total of 97 respondents were included in the study (response rate: 12.7%), of which 61.86% were Health Assistants/Clinical Officers (HAs/COs) and 38.14% were medical doctors. The afternoon feeding behaviour of Aedes mosquito was correctly identified by only 24.7% of the respondents, and ~66.0% of them failed to identify lethargy as a warning sign for severe dengue. Knowledge on diagnosis using NS1 antigen and the clinical significance of elevated haematocrit for initial fluid replacement was strikingly low at 47.4% and 27.8% respectively. Despite dengue being a nationally notifiable disease, ~60% of respondents were not knowledgeable on the timing and type of cases to be reported. Respondent’s median score was higher for the surveillance and reporting domain, followed by their knowledge on transmission of dengue. Statistically significant factors associated with higher knowledge included respondents being a medical doctor, working in a hospital and experience of having diagnosed dengue. Conclusion The study revealed major gaps on knowledge and clinical management practices related to dengue in Bhutan. Physicians and health workers working in Basic Health Units need training and regular supervision to improve their knowledge on the care of dengue patients.

scholarly journals A Review of Superbug: A Global Threat in Health Care System

2018 ◽  
Vol 4 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Bhuiyan Mohammad Mahtab Uddin ◽  
Md Abdullah Yusuf ◽  
Zubair Ahmed Ratan
Keyword(s):  
Public Health ◽  
Health Problem ◽  
Antimicrobial Agents ◽  
Public Health Problem ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Major Public Health Problem ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Hospital Acquired

The rapid spread and dissemination of the multidrug-resistant bacteria worldwide represents a major public health problem. The development of antibiotics decreased the mortality among the human and animals leading to a better life expectancy. But the injudicious use of antimicrobials and selection pressure the microbes have developed resistance which became more prominent during last few decades. With the evolution of Methicilin-resistant Staphylococcus aureus (MRSA), Hospital-acquired MRSA, Communityacquired MRSA and MDR TB (Multidrug resistant tuberculosis) challenge for the clinicians have increased to a greater extent. The global emergence and dissemination of acquired carbapenemases among gram negative bacteria are considered a major public health problem. Gram-negative bacteria, most notably Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, are among the most important causes of serious hospital-acquired and community-onset bacterial infections in humans, and resistance to antimicrobial agents in these bacteria has become an increasingly relevant problem. Recent development in nanotechnology based drug delivery system may prove to be solution for combating these resistant bacteria. However policies and regulations for antibiotic use should be formulated to control the further development of resistance among the microbes.Bangladesh Journal of Infectious Diseases 2017;4(1):25-28

scholarly journals Carbapenem-Resistant Enterobacteriaceae Infections: Results From a Retrospective Series and Implications for the Design of Prospective Clinical Trials

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Elizabeth L. Alexander ◽  
Jeffery Loutit ◽  
Mario Tumbarello ◽  
Richard Wunderink ◽  
Tim Felton ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Patient Population ◽  
Bacterial Pneumonia ◽  
Complicated Urinary Tract Infection ◽  
Clinical Trial Design ◽  
New Drugs ◽  
External Control ◽  
Phase 3 ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The increasing incidence of multidrug-resistant Gram negatives, such as carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a critical need for new antimicrobials. Most studies of new antimicrobials have been performed in patients with nondrug-resistant pathogens. We performed a retrospective analysis of patients with CRE infections to inform the design of phase 3 clinical trials. Methods This was a retrospective study at 22 centers in 4 countries. Baseline data, treatment, and outcomes were collected in patients with complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), and bacteremia due to CRE. Results Two hundred fifty-six cases of CRE infection were identified: 75 cUTI/AP, 21 HABP, 20 VABP, and 140 bacteremia. The patient population had significant comorbidities: 32.8% had chronic renal insufficiency, and 26.2% were immunocompromised. Illness severity at presentation was high: 29.3% presented with septic shock. Treatment regimens varied widely; however, a majority of patients received combination therapy. Outcomes were universally poor (28-day mortality was 28.1%) across all sites of infection, particularly in dialysis patients and those with sepsis. Conclusions The CRE infections occured in patients with substantial comorbidities and were associated with high mortality and low rates of clinical cure with available antibiotics. Patients with these comorbidities are often excluded from enrollment in clinical trials for registration of new drugs. These results led to changes in the inclusion/exclusion criteria of a phase 3 trial to better represent the patient population with CRE infections and enable enrollment. Observational studies may become increasingly important to guide clinical trial design, inform on the existing standard of care, and provide an external control for subsequent trials.

scholarly journals Current Promising Antibiotics and Future Approaches in Combating Carbapenemase-Producing Enterobacteriaceae

Proceedings ◽  
2021 ◽  
Vol 66 (1) ◽  
pp. 25
Author(s):  
Corneliu Ovidiu Vrancianu ◽  
Elena Georgiana Dobre ◽  
Irina Gheorghe ◽  
Ilda Barbu ◽  
Roxana Elena Cristian ◽  
...  
Keyword(s):  
Carbapenem Resistance ◽  
Healthcare Associated Infections ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
High Incidence ◽  
Low Probability ◽  
Almost All ◽  
Healthcare Associated ◽  
Review Current ◽  
Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant (CR) Gram-negative bacilli, including Enterobacteriaceae and the non-fermenters, represent the most notorious pathogens due to the high incidence of morbidity and mortality, especially in immunocompromised patients in intensive care units. Carbapenem resistance is mainly associated with the production of carbapenemases, which are β-lactamases belonging to different Ambler classes (A, B, D) that can be encoded by both chromosomal and plasmid-mediated genes. These enzymes represent the most potent β-lactamases, hydrolyzing a wide variety of β-lactams, including carbapenems, cephalosporins, penicillin, and aztreonam. The major issues associated with carbapenemase production are both clinical, posing significant challenges in the treatment of healthcare-associated infections by compromising the activity of the last-resort antibiotics, and epidemiological, due to their dissemination across almost all geographic regions. An important advancement is a handful of newly launched antibiotics targeting some of the current most problematic Gram-negative pathogens, namely carbapenem-resistant Enterobacteriaceae (CRE). The most appropriate antimicrobial therapy to treat CRE infections is still controversial. Combination therapy is preferred over monotherapy due to its broad-spectrum coverage, synergic activity, and low probability of selecting resistance. In this mini-review, current and future promising antibiotics that are currently under investigation for winning the war against the emerging CRE are discussed.

scholarly journals High Burden of Resistant Gram-Negative Pathogens Causing Device-Associated Healthcare Infections in Saudi Arabia, 2008–2016

2020 ◽  
Vol 41 (S1) ◽  
pp. s249-s250
Author(s):  
Hanan Balkhy ◽  
Aiman Ramadan ◽  
Majid Alshamrani ◽  
Asim Alsaedi ◽  
Wafa Al Nasser ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Saudi Arabia ◽  
Bacterial Resistance ◽  
National Guard ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
The Us ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Resistance Rates

Objectives: There is local and regional deficiency in the data examining the contribution of resistant pathogens to device-associated healthcare-associated infections (DA-HAIs). We examined such data in a multihospital system in Saudi Arabia in comparison with the US NHSN reports. Methods: Surveillance of DA-HAIs was prospectively conducted between 2008 and 2016 in 4 hospitals of Ministry of National Guard Health Affairs. Consecutive NHSN reports were used for comparison. Definitions and methodology of DA-HAIs and bacterial resistance were based on the NHSN reports. Results: In total, 1,260 pathogens causing 1,141 DA-HAI events were included. Gram-negative pathogens (GNPs) were responsible for 62.5% of DA-HAIs, with significantly higher Klebsiella, Pseudomonas, Acinetobacter, and Enterobacter than NHSN hospitals. Approximately 28.3% of GNPs and 23.5% of gram-positive pathogens (GPPs) exhibited some type of resistance. Nearly 34.3% of Klebsiella were cephalosporin-resistant; 4.8% of Enterobacteriaceae were carbapenem-resistant (CRE); 24.4% of Staphylococcus aureus were methicillin-resistant (MRSA; and 21.9% of Enterococci were Vancomycin-resistant (VRE). The multidrug resistance (MDR) rates were 65.0% for Acinetobacter, 26.4% for Escherichia coli, 23.0% for Klebsiella, and 14.9% for Pseudomonas. Resistant GNPs including cephalosporin-resistant Klebsiella, MDR Klebsiella, and MDR Escherichia coli were significantly more frequent than in NHSN hospitals, whereas resistant GPPs including MRSA and VRE were significantly less frequent than in NHSN hospitals. Conclusion: Compared with American hospitals, GNPs that contribute to DA-HAIs in Saudi hospitals show more resistance. The higher resistance rates in Klebsiella and Escherichia coli are alarming and call for effective antimicrobial stewardship programs.Funding: NoneDisclosures: None

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