scholarly journals High drug resistance among Gram-negative bacteria in sputum samples from an intensive care unit in Nepal

2021 ◽  
Vol 11 (1) ◽  
pp. 64-69
Author(s):  
R. Ghimire ◽  
H. A. Gupte ◽  
S. Shrestha ◽  
P. Thekkur ◽  
S. Kharel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Secondary Data ◽  
Cross Sectional Study ◽  
Sputum Culture ◽  
University Teaching ◽  
Cross Sectional ◽  
Icu Patients ◽  
Icu Discharge ◽  
Resistance Patterns

SETTING: Tribhuvan University Teaching Hospital, Kathmandu, Nepal.OBJECTIVES: 1) To report the number and proportion of Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas (PABS) species among intensive care unit (ICU) patients with sputum culture; and 2) to assess antimicrobial resistance patterns, demographic and clinical characteristics associated with resistance to at least one antibiotic and ICU discharge outcomes among those patients with PABS species admitted to hospital between 14 April 2018 and 13 April 2019.DESIGN: This was a hospital-based, cross-sectional study using secondary data.RESULTS: Of 166 who underwent sputum culture, 104 (63%) had bacterial growth, of which, 67 (64%) showed PABS species. Of the positive cultures, Pseudomonas, Acinetobacter, Burkholderia and Stenotrophomonas were present in respectively 32 (30.7%), 31 (29.8%), 1 (1%) and 3 (2.8%). Pseudomonas showed a high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). Acinetobacter was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). Of the 67 with PABS infection, 32 (48%) died.CONCLUSION: The study showed a high prevalence of Pseudomonas and Acinetobacter and the emergence of Stenotrophomonas in sputum culture samples of ICU patients. This highlights the need for monitoring PABS and associated resistance patterns to reduce mortality in ICU patients.

scholarly journals Admission Profile and Outcome of Patients in a Level III Intensive Care Unit: A Two-Year Comparative Study

2020 ◽  
Vol 42 (3) ◽  
pp. 52-56
Author(s):  
Sunil Pathak ◽  
Subhash P Acharya ◽  
Pragya Acharya ◽  
Binita Bhattarai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Stable Condition ◽  
Severity Of Illness ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Cross Sectional ◽  
Female Ratio ◽  
Number Of Patients ◽  
Male Preponderance

Introduction An Intensive Care Unit (ICU) is an area where critically ill patients are admitted and the highest level of care is provided with close intensive monitoring and management. Clinical audit is a must to measure indicators of the quality of care in ICU and benchmarking outcome. The main aim of the study was to evaluate the profile of patients admitted to ICU and assess their outcome of two consecutive years. MethodsA single-institutional, descriptive cross-sectional study was conducted on all adult patients admitted to the ICU of Tribhuvan University Teaching Hospital, Kathmandu, between April 2018 and April 2020 (Baisakh 2075 to Chaitra 2076). ResultsWith an average of 1.98 admissions per day, a total of 1447 patients were admitted to TUTH ICU over the period of two years. A male preponderance was noted with a male to female ratio of 1.19:1. Most of the patients admitted were neurosurgical cases 429 (29.6%). A total of 884 (61%) were shifted out of ICU in stable condition while the overall mortality was 458 (31.6%). ConclusionThis study shows that there is a higher severity of illness at admission as well as a comparatively high mortality rate. More number of patients were male, of age group of 15-65 years, with medical and neurosurgical conditions. This study of profile and outcome of patients admitted in ICU can serve as a quality indicator as well as evidence on which planning and policymaking can be based upon in the future.

Screening of Hearing in Infants at Risk in a Tertiary Care Centre: A Descriptive Cross- sectional Study

2020 ◽  
Vol 3 (2) ◽  
pp. 3-7
Author(s):  
Bijaya Kharel ◽  
Yogesh Neupane ◽  
Prashant Tripathi ◽  
Pabina Rayamajhi ◽  
Sureshwor Lal Karna ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
At Risk ◽  
Hearing Loss ◽  
Intensive Care ◽  
Birth Weight ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ototoxic Drugs

Background: Screening of hearing impairment in children facilitates earlier identification, management and prevention of disability. The objective of this study was to perform a screening of hearing in infants at risk in Tribhuvan University Teaching Hospital. Methods: A descriptive cross-sectional study was done among 228 infants who were at risk of hearing loss. All ‘at risk’ infants born to mothers in Tribhuvan University Teaching Hospital and ‘at risk’ children below one year of age admitted in the pediatric ward and intensive care unit were screened for hearing loss by automated otoacoustic emission (OAE) and automated auditory brainstem reflex (ABR). The results were categorized as pass or refer (fail). The association between hearing loss and the potential risk factors was analyzed. Results: Out of 228 infants screened, 117 (51%) were male and 111 (49%) were female. Seventy (30.7%) failed OAE and 44 (19.3%) failed ABR. Univariate analysis (Pearson Chi-square test) showed that the failure rate for ABR was significantly associated with preterm babies (p = 0.009), low birth weight (p = 0.009), usage of ototoxic drugs (p = 0.03), and intensive care unit stay of more than five days (p = 0.03). Only preterm birth was significantly associated with failed OAE test (p = 0.03). Conclusion: Premature birth (gestational age < 34 weeks) was associated with failure of the ABR and OAE tests. The infants with low birth weight, history of ototoxic drugs, ICU stay more than 5 days were only associated with ABR test failure.

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Cardiac Intensive Care ◽  
Hospital Protocol

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

scholarly journals Invasive candidiasis in a Brazilian neonatal intensive care unit

2021 ◽  
Vol 21 (2) ◽  
pp. 547-552
Author(s):  
Henrique Yuji Watanabe Silva ◽  
Felipe Teixeira de Mello Freitas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Invasive Candidiasis ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Antibiotics Use ◽  
Elbw Neonates

Abstract Objectives: to describe the epidemiology of invasive candidiasis in a neonatal intensive care unit. Methods: cross-sectional study that included all neonates with invasive candidiasis confirmed by blood culture from April 2015 to June 2018. Demographic, clinical and microbiological data were analyzed, comparing neonates with extreme low birth weight (ELBW) with neonates ≥ 1000g birth weight, considering a p <0.05 as statistically significant. Results: there were 38 cases of invasive candidiasis, resulting in an overall incidence of 2.5%. Twelve (32%) were ELBW neonates and 26 (68%) neonates ≥ 1000g birth weight, an incidence of 4.4% and 2.0%, respectively. Abdominal surgery was more frequent among neonates with birth weight ≥ 1000g compared to ELBW neonates (85% vs. 17%; p <0.01), as well as the median in days of antibiotics use (18 vs. 10.5; p = 0.04). The median in days of mechanical ventilation was more frequent among ELBW neonates (10 vs. 5.5; p = 0.04). The majority of Candida species were non-albicans (64%). Fatality rate was 32%. Conclusions: the incidence of invasive candidiasis among neonates with birth weight ≥ 1000g was higher than that found in the literature. This group has a higher proportion of gastrointestinal malformations that require surgery. Thus, fluconazole prophylaxis may be necessary for a broader group of neonates.

scholarly journals Drug utilization pattern of antimicrobials in intensive care unit of a tertiary care teaching hospital

2020 ◽  
Vol 9 (10) ◽  
pp. 1594
Author(s):  
Saswat Satapathy ◽  
Yajnesh P. Sahu ◽  
Ashok K. Panigrahi ◽  
Bhabagrahi Rath ◽  
Ananta N. Patra
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Utilization ◽  
Drug Prescription ◽  
Tertiary Care ◽  
Quality Of Healthcare ◽  
Cross Sectional Study ◽  
Utilization Pattern ◽  
Prescribing Practices ◽  
Cross Sectional

Background: The intensive care unit is a setting where the multiple medications are prescribed to patients. Antimicrobials are heavily prescribed in the ICUs, which in turn enhance the risk of antimicrobial resistance, increase the side effects and increases the cost of treatment. Drug utilization study is a component of medical auditing that aims to monitor and evaluate the drug prescription patterns and to suggest necessary modifications in the prescribing practices to achieve rational therapeutic practice.Methods: A cross-sectional study was conducted in which data of patients admitted to ICU during the period from June 2019 to August 2019 was collected from the Medical Record Section of the hospital. Drug utilization pattern of antimicrobials in ICU was analyzed.Results: Out of 90 patients, 60 were males and 30 were females. The average duration of stay in ICU was 7.53 days. The most common antibiotic prescribed was ceftriaxone followed by piperacillin and tazobactam with DDD/100 bed days of 24.2 and 17.3 respectively.Conclusions: In this study, the results appeared to be similar to those reported in previous studies. However, prescription protocols need to be addressed to guide appropriate use of antimicrobials in the ICU setting. Therefore, it is necessary to conduct drug utilization research to understand the drug consumption and for implementation of protocols to improve the quality of healthcare. 

scholarly journals Inhaled Nitric Oxide in Patients with Severe COVID-19 Infection at Intensive Care Unit – A Cross Sectional Study

2021 ◽  
Vol 7 (4) ◽  
pp. 318-319
Author(s):  
Laura Herranz ◽  
Juliana Gurgel da Silveira ◽  
Luis Filipe Lannes Trocado ◽  
Anna Luiza Alvaraes ◽  
Juliana Fittipaldi
Keyword(s):  
Nitric Oxide ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Cross Sectional Study ◽  
Inhaled Nitric Oxide ◽  
Sectional Study ◽  
Cross Sectional
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