scholarly journals Epidemiology of Drug-resistant Tuberculosis in a Tertiary Care Center in Oman, 2006−2015

2017 ◽  
Vol 32 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Zied Gaifer ◽  
Ahmed Babiker ◽  
Dawar Rizavi
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Drug Resistant ◽  
Tertiary Care Center ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis

scholarly journals 1363. Does Genotypic Testing Improve Treatment Outcomes in Drug-Resistant Tuberculosis?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S493-S494
Author(s):  
Anupa Thampy ◽  
Marilyn Ninan ◽  
Joy Sarojini Michael ◽  
Priscilla Rupali
Keyword(s):  
Treatment Outcomes ◽  
Care Center ◽  
Tertiary Care ◽  
Small Sample ◽  
Adverse Outcomes ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Good Outcome ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant

Abstract Background Treatment of drug-resistant tuberculosis (DR-TB) requires toxic and complex drug regimens. Dismal outcomes occur due to a delay in the report of susceptibility results. WHO endorses genotypic tests like line probe assay (Mtbdrsl) for an early diagnosis enabling start of robust treatment regimens. Data correlating Mtbdrsl and specific mutations with outcome are rare. Methods A concurrent cohort study was conducted on all patients diagnosed to have DR-TB between January 2016 and June 2017 in the departments of Pulmonary Medicine and Infectious Diseases at a tertiary care center in India. Patients aged >18 years with a positive Mtbdrsl (done on culture) or Mycobacterial culture were prospectively followed up till completion of therapy for assessment of outcomes. Patients were divided into 2 groups based on diagnostic method used: culture group and Mtbdrsl group. Risk factors for adverse outcomes were assessed. Results Total of 82 patients, of which 62.2% were males with a mean age of 32 years were included; 50 in the Mtbdrsl group and 32 in the culture group. Among these, 40.2% were multi-drug-resistant Tuberculosis (MDR-TB), 53.7% were Pre–XDR (pre-extensively drug resistant i.e, quinolone-resistant tuberculosis) and 6.1% were XDR (extensively drug-resistant TB). Isolated pulmonary involvement (46.3%) was common followed by disseminated TB (29.3%). Overall good outcome was seen in 39/82 (14.6% cured and 32.9% completed treatment) and bad outcome in 43/82 (41.5% lost to follow up, 7.3% treatment failure and 3.7% died). Good outcome was noted in Mtbdrsl group was 22/50 (44%) vs. 17/32 (53.1%) in the culture group. Mtbdrsl group had 140 days mean decrease in time to initiation of appropriate therapy but the odds of having a better outcome was 0.693 (CI: 0.284–1.690, P = 0.499). Among the 15 different types of mutations, FQ mutations gyrA 94Gly and gyrA 90Val comprised 15% each with gyrA 94Gly noted to have a poorer outcome [OR 2.5 (CI 0.471–13.265)]. All 5 patients with XDR TB (50 % had rrs 1401Gly mutation) had a poor outcome. Conclusion Contrary to what is expected, Mtbdrsl did not significantly contribute to better treatment outcomes. High-risk mutation gyrA 94Gly was prevalent and associated with poorer outcomes. Small sample size and a wide variety of mutations preclude generalizability of our results. Disclosures All authors: No reported disclosures.

scholarly journals 1196. Is the Weekend Staff Really to Blame? Challenges in Isolation Compliance at an Academic Tertiary Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S429-S429
Author(s):  
Sonia Bassett ◽  
Kelley M Boston ◽  
Luis Ostrosky-Zeichner
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Significant Variation ◽  
Normal Approximation ◽  
Care Center ◽  
Tertiary Care ◽  
Visual Observation ◽  
Protective Equipment ◽  
Drug Resistant ◽  
Tertiary Care Center

Abstract Background Transmission-based isolation precautions are implemented in an effort to decrease the risk of transmission of pathogens. Weekend staff are perceived to have lower compliance. Methods Visual observation of healthcare worker (HCW) compliance with an institutional isolation precautions practices was done at an academic tertiary care center. In the first quarter of 2019, observations were completed for 894 patients who required contact, droplet or airborne isolation precautions. Observations included patients with infection or colonization with multi-drug-resistant organisms (MDRO) or highly transmissible infections. Observations focused on availability of appropriate supplies, compliance with infection control practices, and documentation. Audits were performed on workdays and weekends, and results were communicated to unit leadership via email. Comparison of proportions was calculated using the normal approximation in Minitab18. Results Compliance with the different elements of the audit can be seen in Table 1. HCW compliance with the use of personal protective equipment and hand hygiene on exit from the room had the lowest compliance and was statistically lower on weekends than on weekdays, and compliance was significantly lower than all other categories for both weekday and weekend measurements. Fifty-seven percent of all patients had missed compliance on one or more elements. There was not a statistically significant variation in practice between weekends and weekdays in overall compliance. Conclusion There is opportunity for improvement in all compliance on isolation practices facility-wide, and elements that require changes in behavior had the lowest compliance, and were lower on weekend shifts. We did not find other differences in performance for weekend staff vs. weekday staff. Educational measures should focus on all individual staff across all shifts. Disclosures All authors: No reported disclosures.

scholarly journals Prevalence, risk and genetic characteristics of drug-resistant tuberculosis in a tertiary care tuberculosis hospital in China

2019 ◽  
Vol Volume 12 ◽  
pp. 2457-2465
Author(s):  
Li-li Zhao ◽  
Ming-xiang Huang ◽  
Tong-yang Xiao ◽  
Hai-can Liu ◽  
Ma-chao Li ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Genetic Characteristics ◽  
Resistant Tuberculosis
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