scholarly journals Surveillance of surgical-site infections and antimicrobial resistance patterns in a tertiary hospital in Alexandria, Egypt

2020 ◽  
Vol 14 (03) ◽  
pp. 277-283
Author(s):  
May Raouf ◽  
Thoraya Ghazal ◽  
Mohamed Kassem ◽  
Abdelfattah Agamya ◽  
Amira Amer
Keyword(s):  
Antimicrobial Resistance ◽  
Clinical Laboratory ◽  
Surgical Site Infections ◽  
Tertiary Hospital ◽  
Drug Resistant ◽  
Post Discharge ◽  
Flight Mass Spectrometry ◽  
Resistance Patterns ◽  
Antibiotics Susceptibility

Introduction: Surveillance and antimicrobial resistance (AMR) monitoring are fundamental to Health care associated infections control. Limited data are available from developing countries for both. This study aimed to evaluate incidence and risk factors of surgical site infections (SSIs), etiological pathogens and AMR patterns identification. Methodology: A prospective active surveillance study was implemented over a 24- month period at a 110-bed multispecialty non-teaching tertiary hospital. Follow up data were collected for 30-90 days. SSI was diagnosed according to Centers for Disease Control and Prevention and National Healthcare Safety Network (CDC/NHSN) criteria. The SSI isolates were identified by Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDITOF/MS). Antibiotics susceptibility test was performed according to Clinical Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results: Out of a total of 3,642 patients, 70% had complete follow-up. SSI was detected in 57 cases (2.3%), 61.4% of which were detected post discharge. Factors significantly associated with increased SSI risk included smoking, diabetes, ASA score 5/E, ICU admission, previous admission and increased hospital stay. Sixty-five isolates were obtained; 70.8% were GNB while 24.6% were GPC and 4.6% were Candida albicans. Regarding AMR, 58.7% of isolates were extended spectrum β lactamase (ESBL) producers while 45.7% were Carbapenem resistant. Multi drug resistant (MDR) was detected in 13% of isolates, 54.3% were extended drug resistant (XDR) and 10.9% were pan drug resistant (PDR). Eighty-six percent of Staphylococci isolates were methicillin-resistant. Conclusion: Despite low SSI rates detected, the high incidence of AMR identified is alarming.

scholarly journals Implementing a Combined Infection Prevention and Control with Antimicrobial Stewardship Joint Program to Prevent Caesarean Section Surgical Site Infections and Antimicrobial Resistance: a Tanzanian Tertiary Hospital Experience

2020 ◽  
Author(s):  
Elisa Gentilotti ◽  
Pasquale De Nardo ◽  
Boniface Nguhuni ◽  
Alessandro Piscini ◽  
Caroline Damian ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Caesarean Section ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Surgical Site Infections ◽  
Tertiary Hospital ◽  
Infection Prevention And Control ◽  
Post Intervention ◽  
Combined Infection ◽  
And Control

Abstract Background. Surgical site infections are a leading cause of morbidity and mortality after caesarean section, especially in Low and Middle Income Countries. We hypothesized that a combined infection prevention and control with antimicrobial stewardship joint program would decrease the rate of post- caesarean section surgical site infections at the Obstetrics & Gynaecology Department of a Tanzanian tertiary hospital. Methods. The intervention included: 1. formal and on-job trainings on infection prevention and control; 2. evidence-based education on antimicrobial resistance and good antimicrobial prescribing practice. A second survey was performed to determine the impact of the intervention. The primary outcome of the study was post-caesarean section surgical site infections prevalence and secondary outcome the determinant factors of surgical site infections before/after the intervention and overall. The microbiological characteristics and patterns of antimicrobial resistance were ascertained.Results. Total 464 and 573 women were surveyed before and after the intervention, respectively. After the intervention, the antibiotic prophylaxis was administered to a significantly higher number of patients (98% vs 2%, p<0.001), caesarean sections were performed by more qualified operators (40% vs 28%, p=0.001), with higher rates of Pfannenstiel skin incisions (29% vs 18%, p<0.001) and of absorbable continuous intradermic sutures (30% vs 19%, p<0.001). The total number of post-caesarean section surgical site infections was 225 (48%) in the pre-intervention and 95 (17%) in the post intervention group (p<0.001). A low prevalence of gram-positive isolates and of methicillin-resistant Staphylococus aureus was detected in the post-intervention survey. Conclusions. Further researches are needed to better understand the potential of a hospital-based multidisciplinary approach to surgical site infections and antimicrobial resistance prevention in resource-constrained settings.

scholarly journals Yield of Systematic Longitudinal Screening of Household Contacts of Pre-Extensively Drug Resistant (PreXDR) and Extensively Drug Resistant (XDR) Tuberculosis Patients in Mumbai, India

2020 ◽  
Vol 5 (2) ◽  
pp. 83
Author(s):  
Roma Haresh Paryani ◽  
Vivek Gupta ◽  
Pramila Singh ◽  
Madhur Verma ◽  
Sabira Sheikh ◽  
...  
Keyword(s):  
Contact Tracing ◽  
Drug Resistant ◽  
Household Contacts ◽  
Tb Treatment ◽  
Extensively Drug Resistant ◽  
High Incidence ◽  
Resistance Patterns ◽  
One Year ◽  
Index Cases

While risk of tuberculosis (TB) is high among household contacts (HHCs) of pre-extensively drug resistant (pre-XDR) TB and XDR-TB, data on yield of systematic longitudinal screening are lacking. We aim to describe the yield of systematic longitudinal TB contact tracing among HHCs of patients with pre-XDR-TB and XDR-TB. At the Médecins Sans Frontières (MSF) clinic, Mumbai, India a cohort comprising 518 HHCs of 109 pre-XDR and XDR index cases was enrolled between January 2016 and June 2018. Regular HHC follow-ups were done till one year post treatment of index cases. Of 518 HHCs, 23 had TB (21 on TB treatment and two newly diagnosed) at the time of first visit. Of the rest, 19% HHCs had no follow-ups. Fourteen (3.5%) TB cases were identified among 400 HHCs; incidence rate: 2072/100,000 person-years (95% CI: 1227–3499). The overall yield of household contact tracing was 3% (16/518). Of 14 who were diagnosed with TB during follow-up, six had drug susceptible TB (DSTB); six had pre-XDR-TB and one had XDR-TB. Five of fourteen cases had resistance patterns concordant with their index case. In view of the high incidence of TB among HHCs of pre-XDR and XDR-TB cases, follow-up of HHCs for at least the duration of index cases’ treatment should be considered.

Use of health databases to deal with underreporting of surgical site infections due to suboptimal post-discharge follow-up

2020 ◽  
Vol 104 (2) ◽  
pp. 239-242
Author(s):  
C. Gagliotti ◽  
R. Buttazzi ◽  
A. Ricciardi ◽  
E. Ricchizzi ◽  
G. Lanciotti ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Post Discharge

Late mortality with a 3-year follow-up of hospitalized patients with heart failure with normal, mid-range or reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Dutra ◽  
B Ferraz De Oliveira Gomes ◽  
T Moreira Curcio ◽  
L De Oliveira Pereira ◽  
B Ferreira Da Silva Mendes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariate Analysis ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Clinical Laboratory ◽  
Categorical Variables ◽  
Post Discharge ◽  
Late Mortality ◽  
Reduced Ejection Fraction

Abstract Introduction In 2016, the European Society of Cardiology published a new concept of heart failure (HF) inbetween HF with reduced ejection fraction (EF) (HFrEF; EF&lt;40%) and HF with preserved EF (HFpEF; EF&gt;50%), the HF with mid-range EF (HFmrEF; EF between 40% and 49%). There are few studies evaluating its distinct clinical characteristics, especially in Latin America. Objective To compare clinical, laboratory and mortality characteristics in individuals with HFpEF, HFmrEF and HFrEF. Method Retrospective analysis in a prospective database of Brazilian coronary care unit admissions of patients clinically diagnosed with decompensated HF associated with serum cerebral natriuretic peptide (BNP) levels above 400 mg/dL, between September 2011 and June 2019. The clinical and laboratory characteristics of the patients, as well as the HF classification into HFpEF, HFmrEF and HFrEF, were evaluated with the first echocardiogram of the hospitalization. Analysis of variance (ANOVA) to compare means, the chi-square test for categorical variables, and the Cox regression for survival analysis were performed, with a significance level of 5%. Results The analysis included 519 patients (mean age, 74.46±12.75 years; men, 59.6%). Post-discharge follow-up was 2.94±2.55 years. Late mortality according to EF did not statistically differ between groups (53.8% x 52.1% x 57.9%, p=0.5). Multivariate analysis with Cox regression showed the following main predictors of late mortality: age (aHR 1.03; 95% CI: 1.02–1.04) and dementia (aHR 1.85; 95% CI: 1.31–2.62). The HFpEF group (aHR 1.63; 95% CI: 1.08–2.94) had higher mortality as compared to the HFmrEF (aHR 0.59; 95% CI: 0.36–0.97) and the HFrEF (aHR 0.63; 95% CI: 0.32–1.2) groups. Conclusion Factors associated with aging, such as dementia, were predictors of higher late mortality. The multivariate analysis of survival, regardless of the risk factors studied, showed a higher 3-year mortality in the HFpEF group as compared to that of the HFmrEF and HFrEF groups. Funding Acknowledgement Type of funding source: None

scholarly journals Diverse commensal E. coli clones and plasmids disseminate antimicrobial resistance genes in domestic animals and children in a semi-rural community in Ecuador

2019 ◽  
Author(s):  
Liseth Salinas ◽  
Paúl Cárdenas ◽  
Timothy J. Johnson ◽  
Karla Vasco ◽  
Jay Graham ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Rural Community ◽  
Resistance Genes ◽  
Domestic Animals ◽  
Drug Resistant ◽  
Phenotypic Resistance ◽  
E Coli ◽  
Antimicrobial Resistance Genes ◽  
Resistance Patterns

ABSTRACTThe increased prevalence of antimicrobial resistance (AMR) among Enterobacteriaceae has had major clinical and economic impacts in human medicine. Many of the multi-drug resistant (MDR) Enterobacteriaceae found in humans are community-acquired and linked to food animals (i.e. livestock raised for meat and dairy products). In this study, we examined whether numerically dominant, commensal Escherichia coli strains from humans (n=63 isolates) and domestic animals (n=174 isolates) in the same community and with matching phenotypic AMR patterns, were clonally related or shared the same plasmids. We identified 25 multi-drug resistant isolates (i.e. resistant to 3 or more antimicrobial classes) that shared identical phenotypic resistance patterns. We then investigated the diversity of E. coli clones, AMR genes and plasmids carrying the AMR genes using conjugation, replicon typing and whole genome sequencing. None of the MDR E. coli isolates (from children and domestic animals) analyzed were clonal. While the majority of isolates shared the same antimicrobial resistance genes and replicons, DNA sequencing indicated that these genes and replicons were found on different plasmid structures. Our findings suggest that nonclonal resistance gene dissemination is common in this community and that diverse plasmids carrying AMR genes presents a significant challenge for understanding the movement of AMR in a community.IMPORTANCEEven though Escherichia coli strains may share nearly identical AMR profiles, AMR genes, and overlap in space and time, the diversity of clones and plasmids challenges to research that aims to identify sources of AMR. Horizontal gene transfer appears to play a much larger role than clonal expansion in the spread of AMR in the community.

scholarly journals Antimicrobial resistance in coagulase-negative staphylococci isolated from subclinical mastitis in Ettawa Crossbred goat (PE) in Yogyakarta, Indonesia

2021 ◽  
Vol 22 (6) ◽  
Author(s):  
Widodo Suwito ◽  
WIDAGDO SRI NUGROHO ◽  
AGNESIA ENDANG TRI HASTUTI WAHYUNI ◽  
BAMBANG SUMIARTO
Keyword(s):  
Antimicrobial Resistance ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Subclinical Mastitis ◽  
Multidrug Resistant ◽  
Resistance Rate ◽  
Diffusion Method ◽  
Disc Diffusion Method ◽  
Coagulase Negative Staphylococci ◽  
Resistance Patterns

Abstract. Suwito W, Nugroho WS, Wahyuni AETH, Sumiarto B. 2021. Antimicrobial resistance in coagulase-negative staphylococci isolated from subclinical mastitis in Ettawa Crossbred goat (PE) in Yogyakarta, Indonesia. Biodiversitas 22: 3418-3422. Subclinical mastitis (SCM) in Ettawa Crossbred Goat (PE) is most frequently caused by staphylococci with a significant reduction in milk yield. The aim of this study is to determine antimicrobial resistance patterns of coagulase-negative staphylococci (CoNS) from PE goat SCM. A total of 36 CoNS isolates originating from PE goat SCM were collected in semisolid tube use in this study. All CoNS isolates were further examined for antimicrobial susceptibility testing by the Kirby-Bauer disc diffusion method. Antibiotic susceptibility of CoNS isolated samples according to Clinical Laboratory Standards Institute (CLSI). The CoNS isolates showed the highest resistance rate against sulfamethoxazole (65%), ampicillin (55.56%), penicillin (45%), cefoxitin (33.33%), erythromycin (25%), oxytetracycline (20%), tetracycline (15%), gentamicin and neomycin (11.11%), while oxacillin was sensitive. The highest of multiple antimicrobials resistance observed 15% in ampicillin, penicillin and tetracycline, then 5-10% in ampicillin, penicillin, erythromycin, tetracycline and oxytetracycline. The majority of CoNS in this study were resistant to sulfamethoxazole and then, followed by ampicillin, penicillin, cefoxitin, erythromycin, oxytetracycline, tetracycline, gentamicin and neomycin. In addition, most isolates were penicillin-resistant and multidrug-resistant (MDR).

scholarly journals Effect of Antimicrobial Stewardship on Oral Quinolone Use and Resistance Patterns over 8 Years (2013–2020)

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1426
Author(s):  
Atsushi Uda ◽  
Katsumi Shigemura ◽  
Koichi Kitagawa ◽  
Kayo Osawa ◽  
Mari Kusuki ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Tertiary Hospital ◽  
Antimicrobial Use ◽  
Positive Trend ◽  
National Guidelines ◽  
Significant Positive Trend ◽  
Days Of Therapy ◽  
Resistance Patterns

Since 2014, several global and national guidelines have been introduced to address the problem of antimicrobial resistance. We conducted a campaign in a tertiary hospital to promote appropriate quinolone use through educational lectures in 2018. The aim of this retrospective study was to evaluate the changes in the following: prescription characteristics, trend of oral quinolone use, and antibiotic susceptibility of bacteria from 2013 to 2020. Antimicrobial use was assessed as days of therapy per 1000 patient-days. We found a significant reduction in unnecessary antibiotic prescriptions between December 2013 and December 2020. Significant negative trends were detected in the use of quinolones over 8 years (outpatients, coefficient = −0.15655, p < 0.001; inpatients, coefficient = −0.004825, p = 0.0016). In particular, the monthly mean use of quinolones among outpatients significantly decreased by 11% from 2013 to 2014 (p < 0.05) and reduced further by 31% from 2017 to 2020 (p < 0.001). A significant positive trend was observed in the susceptibility of Pseudomonas aeruginosa to levofloxacin (p < 0.001). These results demonstrate that the use of oral quinolones was further reduced following educational intervention and the bacterial susceptibility improved with optimal quinolone usage compared to that in 2013.

scholarly journals Determination of Antimicrobial Resistance Patterns in Bloodstream Infections-Isolated Bacteria From a University Tertiary Hospital Patients

2019 ◽  
Vol 7 (2) ◽  
pp. 49-54
Author(s):  
Alka Hasani ◽  
Nasim Asadi Faezi ◽  
Mohammad Ahangarzadeh Rezaee ◽  
Elham Sheykhsaran ◽  
Narges Darabi ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Bloodstream Infections ◽  
Tertiary Hospital ◽  
Resistance Rate ◽  
High Morbidity ◽  
Hospital Patients ◽  
Resistance Patterns ◽  
Susceptibility Patterns

Background: Bloodstream infections are considered a significant medical concern associated with high morbidity and mortality rates. Therefore, physicians should be guided to use antimicrobial susceptibility patterns in order to select appropriate empiric antimicrobial agents to treat the patients who suffer from bacteremia. Objective: The present study aimed to determine antimicrobial resistance and susceptibility patterns in isolates collected from bloodstream infections. Materials and Methods: To achieve this, a total of 710 bacterial blood culture isolates were collected from Sina hospital, and then susceptibility patterns to a number of antibiotics were analyzed according to Clinical and Laboratory Standards Institute guidelines. Results: The identified isolates included Staphylococcus aureus 14 (20.6%), Escherichia coli 14 (20.6%), Acinetobacter baumannii 12 (17.6%), Pseudomonas aeruginosa 11 (16.2%), Coagulasenegative Staphylococcus 8 (11.8%), Klebsiella pneumoniae 6 (8.8%), and Enterobacter spp. 3 (4.4%). The total resistance rate to co-trimoxazole, ceftriaxone, ceftazidime, cefotaxime, ofloxacin, gentamicin, ciprofloxacin, levofloxacin, amikacin, and imipenem was 44 (64.7%), 42 (61.8%), 39 (57.4%), 38 (55.9%), 35 (51.51%), 32 (47.1%), 31 (45.6%), 25 (36.8%), and 27 (39.7%), respectively. Finally, the susceptibility rate to amikacin and imipenem was 43 (63.2%) and 41 (60.3%), respectively. Conclusion: In general, A. baumannii strains isolated from blood cultures were resistant to most antibiotics and the greatest sensitivity was observed to gentamicin (58.3%) compared to other antibiotics. Therefore, gentamicin was found as the most effective antibiotic for treating bloodstream infections caused by A. baumannii.

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