Epidemiology of Methicillin-ResistantStaphylococcus aureusat a University Hospital in the Canary Islands

2003 ◽  
Vol 24 (9) ◽  
pp. 667-672 ◽  
Author(s):  
Isabel Montesinos ◽  
Eduardo Salido ◽  
Teresa Delgado ◽  
Maria Lecuona ◽  
Antonio Sierra
Keyword(s):  
Canary Islands ◽  
Tertiary Care ◽  
Control Measures ◽  
University Hospital ◽  
Pfge Type ◽  
Staff Members ◽  
Surveillance Cultures ◽  
Underlying Illness ◽  
Hospital Stays ◽  
Prolonged Hospital

AbstractObjectives:To describe the epidemiology of methicillin-resistantStaphylococcus aureus(MRSA) at a university hospital in Tenerife, Canary Islands, during a 40-month period and to evaluate the effectiveness of the application of control measures.Design:Laboratory-based surveillance, medical charts and microbiological records review, and characterization of strains by pulsed-field gel electrophoresis (PFGE) were used to describe the epidemiology. Infection control practices were introduced as an intervention.Setting:A 650-bed, tertiary-care university hospital.Subjects:Patients with clinical and nasal isolates of MRSA and colonized staff members.Results:The rate of nosocomial MRSA infections was 32.5% for 1997, 17.9% for 1998, 14.5% for 1999, and 25.6% during the first 4 months of 2000. The major sites of isolation for nosocomial MRSA infection included surgical wounds (25%) and the lower respiratory tract (24%). Intensive care units and surgical specialties had more frequent MRSA cases. Characteristics associated with nosocomial MRSA isolates included prior use of intensive antibiotic therapy, prolonged hospital stays, major underlying illness, invasive procedures, and older age. PFGE type A (subtype A1) was the strain most frequently found and the only PFGE type involved in clusters.Conclusions:Surveillance cultures and contact droplet precautions were followed by decreased rates for 2 years. Nevertheless, the spread of PFGE subtype Al to many different areas of the hospital and the increase in incidence during the first third of 2000 indicates either that surveillance cultures were not used widely enough or that compliance with isolation measures was suboptimal.

Prevalence and Overtesting of True Heparin-Induced Thrombocytopenia in a 591-Bed Tertiary Care, Teaching Hospital

2017 ◽  
Vol 34 (6) ◽  
pp. 464-471 ◽  
Author(s):  
Stephen Farley ◽  
Caitlyn Cummings ◽  
William Heuser ◽  
Shan Wang ◽  
Rose Calixte ◽  
...  
Keyword(s):  
New York ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Elisa Test ◽  
Serotonin Release ◽  
University Hospital ◽  
Enzyme Linked Immunosorbent Assay ◽  
Heparin Induced Thrombocytopenia ◽  
Release Assay ◽  
Hospital Stays

Heparin-induced thrombocytopenia type II (HIT) is a rare but potentially fatal antibody-mediated reaction to all forms of heparin (unfractionated heparin, low-molecular weight heparin, heparin flushes, and heparin-coated catheters), which can lead to HIT with thrombosis. Two tests commonly used to screen for HIT include the enzyme-linked immunosorbent assay (ELISA) and serotonin release assay (SRA). This is a retrospective chart review study conducted from January 1, 2013, through December 31, 2014, to estimate the rate of true HIT in critical care patients at Winthrop-University Hospital, located in Mineola, New York. Patients are classified as positive for HIT if both ELISA and SRA immunoassays are positive. We reviewed 507 heparin immunoassays, excluding 64 who had an inappropriate ELISA test sent due to no administration of heparin, enoxaparin, or heparin lock flush at this or previous hospital stays at Winthrop. Of the 443 heparin immunoassays, ELISA results were positive for 66 patients (15.1%), and only 11 (2.5%) patients had true cases of HIT with a 95% confidence interval of 1.3% to 4.4%. The 4T score for those with true HIT (median: 5.0) was statistically higher compared to those without true HIT (median: 2.0; P < .001). Despite guidelines in place, overtesting for HIT is still a prevalent issue.

scholarly journals Cirrhosis aggravates the ninety-day mortality after liver resection for hepatocellular carcinoma

2019 ◽  
Vol 6 (8) ◽  
pp. 2869
Author(s):  
Hosam Farouk Abdelhameed ◽  
Ashraf M. El-Badry
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Hospital Mortality ◽  
Postoperative Mortality ◽  
University Hospital ◽  
Control Group ◽  
Complication Rates ◽  
Hospital Stays ◽  
Cirrhotic Patients ◽  
Prolonged Hospital

Background: Ninety-day postoperative mortality (90-D POM) measures accurately the liver resection-related mortality. In cirrhotic patients, reporting post-hepatectomy-related death only as in-hospital or thirty-day postoperative mortality (30-D POM) may underestimate cirrhosis-related death after liver resection.Methods: Medical records of adult cirrhotic (cirrhosis group) and matched non-cirrhotic (control group) patients, who underwent elective liver resection at Sohag University Hospital (April 2014- March 2018), were analyzed. The 90-D POM versus in-hospital mortality and 30-D POM were compared in both groups.Results: Forty-six patients (23 per group) were eligible for the study. Liver resection was carried out in all cirrhosis group patients for hepatocellular carcinoma (HCC). In the control group, liver resection was indicated for colorectal metastasis (13), benign masses (7) and intrahepatic cholangiocarcinoma (3). Compared with the control group, cirrhotic patients exhibited significantly higher complication rates (p<0.05), prolonged hospital stays (p<0.05), increased postoperative levels of serum bilirubin and reduced prothrombin concentration (p<0.05). In the control group, in-hospital mortality and 30-D POM were zero while 90-D POM was 4%. In the cirrhosis group, the in-hospital mortality and 30-D POM were identical (8.7%), however the 90-D POM was significantly higher and almost doubled (17%). Conclusion: Liver cirrhosis triggers significant mortality that may extend for ninety days postoperatively. In cirrhotic patients, post-hepatectomy death should be reported as 90-D POM rather than the obviously misleading in-hospital mortality or 30-D POM.

Increased Rate of Tuberculin Skin Test Conversion Among Workers at a University Hospital

1992 ◽  
Vol 13 (10) ◽  
pp. 579-581 ◽  
Author(s):  
Julio A. Ramirez ◽  
Pamela Anderson ◽  
Sharon Herp ◽  
Martin J. Raff
Keyword(s):  
Tuberculin Skin Test ◽  
Skin Test ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Control Measures ◽  
University Hospital ◽  
Skin Tests ◽  
Tuberculin Skin Test Conversion ◽  
Cdc Guidelines ◽  
Hospital Patients

AbstractObjectives:To summarize the results of an investigation of increased rates of tuberculin skin test conversion in employees at a university hospital.Design:The results of annual tuberculin skin tests performed on all 1,845 hospital employees from 1986 to 1991 were reviewed.Setting:A 450-bed acute tertiary care university hospital.Results:The rate of tuberculin skin test conversion was 0.35% (standard deviation ± 0.15) from 1986 to 1989 and increased to 1.7% during 1991. Investigation revealed deviations from the Centers for Disease Control (CDC) guidelines for tuberculosis control, which included the failure to consider tuberculosis as a probable cause of community-acquired pneumonia and the failure to initiate isolation precautions when tuberculosis was suspected.Conclusions:The epidemic appeared to be secondary to delays in diagnosis and isolation of patients with pulmonary tuberculosis. Future control measures should include isolation of all hospital patients admitted with pneumonia until tuberculosis has been excluded.

scholarly journals Illness Severity and Outcomes Among Enteric Fever Cases From Bangladesh, Nepal, and Pakistan: Data From the Surveillance for Enteric Fever in Asia Project, 2016–2019

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S222-S231 ◽  
Author(s):  
Ashley T Longley ◽  
Caitlin Hemlock ◽  
Kashmira Date ◽  
Stephen P Luby ◽  
Jason R Andrews ◽  
...  
Keyword(s):  
Blood Culture ◽  
Hospital Stay ◽  
Enteric Fever ◽  
Laboratory Data ◽  
Case Fatality ◽  
Illness Severity ◽  
Control Measures ◽  
Clinical Complications ◽  
Hospital Stays ◽  
Prolonged Hospital

Abstract Background Enteric fever can lead to prolonged hospital stays, clinical complications, and death. The Surveillance for Enteric Fever in Asia Project (SEAP), a prospective surveillance study, characterized the burden of enteric fever, including illness severity, in selected settings in Bangladesh, Nepal, and Pakistan. We assessed disease severity, including hospitalization, clinical complications, and death among SEAP participants. Methods We analyzed clinical and laboratory data from blood culture–confirmed enteric fever cases enrolled in SEAP hospitals and associated network laboratories from September 2016 to September 2019. We used hospitalization and duration of hospital stay as proxies for severity. We conducted a follow-up interview 6 weeks after enrollment to ascertain final outcomes. Results Of the 8705 blood culture-confirmed enteric fever cases enrolled, we identified 6 deaths (case-fatality ratio, .07%; 95% CI, .01–.13%), 2 from Nepal, 4 from Pakistan, and none from Bangladesh. Overall, 1.7% (90/5205) of patients recruited from SEAP hospitals experienced a clinical complication (Bangladesh, 0.6% [18/3032]; Nepal, 2.3% [12/531]; Pakistan, 3.7% [60/1642]). The most identified complications were hepatitis (n = 36), septic shock (n = 22), and pulmonary complications/pneumonia (n = 13). Across countries, 32% (2804/8669) of patients with hospitalization data available were hospitalized (Bangladesh, 27% [1295/4868]; Nepal, 29% [455/1595]; Pakistan, 48% [1054/2206]), with a median hospital stay of 5 days (IQR, 3–7). Conclusions While defined clinical complications and deaths were uncommon at the SEAP sites, the high proportion of hospitalizations and prolonged hospital stays highlight illness severity and the need for enteric fever control measures, including the use of typhoid conjugate vaccines.

scholarly journals Impact of a Nosocomial COVID-19 Outbreak on a Non-COVID-19 Nephrology Ward during the First Wave of the Pandemic in Spain

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 619
Author(s):  
María Milagro Montero ◽  
Carlota Hidalgo López ◽  
Inmaculada López Montesinos ◽  
Luisa Sorli ◽  
Cristina Barrufet Gonzalez ◽  
...  
Keyword(s):  
Infection Control ◽  
Control Strategies ◽  
Tertiary Care ◽  
Control Measures ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Maintenance Hemodialysis ◽  
Prevention Measures ◽  
Transplant Patients ◽  
Infection Control Measures

Introduction: The aim of this study was to analyze a nosocomial coronavirus disease 2019 (COVID-19) outbreak that occurred on a polyvalent non-COVID-19 ward at a tertiary care university hospital in Spain during the first wave of the pandemic and to describe the containment measures taken. The outbreak affected healthcare workers (HCWs) and kidney disease patients including transplant patients and those requiring maintenance hemodialysis. Methods: The outbreak investigation and report were conducted in accordance with the Orion statement guidelines. Results: In this study, 15 cases of COVID-19 affecting 10 patients and 5 HCWs were identified on a ward with 31 beds and 43 HCWs. The patients had tested negative for severe acute respiratory syndrome coronavirus 2 infection on admission. One of the HCWs was identified as the probable index case. Five patients died (mortality rate, 50%). They were all elderly and had significant comorbidities. The infection control measures taken included the transfer of infected patients to COVID-19 isolation wards, implementation of universal preventive measures, weekly PCR testing of patients and HCWs linked to the ward, training of HCWs on infection control and prevention measures, and enhancement of cleaning and disinfection. The outbreak was contained in 2 weeks, and no new cases occurred. Conclusion: Nosocomial COVID-19 outbreaks can have high attack rates involving both patients and HCWs and carry a high risk of patient mortality. Hospitals need to implement effective infection prevention and control strategies to prevent nosocomial COVID-19 spread.

A Randomized, Double-Blind, Placebo-Controlled Trial of Selective Digestive Decontamination Using Oral Gentamicin and Oral Polymyxin E for Eradication of Carbapenem-Resistant Klebsiella pneumoniae Carriage

2012 ◽  
Vol 33 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Lisa Saidel-Odes ◽  
Hana Polachek ◽  
Nehama Peled ◽  
Klaris Riesenberg ◽  
Francisc Schlaeffer ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Selective Digestive Decontamination ◽  
Control Measures ◽  
University Hospital ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Carbapenem Resistant ◽  
Polymyxin E

Objective.To assess the effectiveness of selective digestive decontamination (SDD) for eradicating carbapenem-resistant Klebsiella pneumoniae (CRKP) oropharyngeal and gastrointestinal carriage.Design.A randomized, double-blind, placebo-controlled trial with 7 weeks of follow-up per patient.Setting.A 1,000-bed tertiary-care university hospital.Patients.Adults with CRKP-positive rectal swab cultures.Methods.Patients were blindly randomized (1:1) over a 20-month period. The SDD arm received oral gentamicin and polymyxin E gel (0.5 g 4 times per day) and oral solutions of gentamicin (80 mg 4 times per day) and polymyxin E (1 × 106 units 4 times per day for 7 days). The placebo arm received oral placebo gel 4 times per day and 2 placebo oral solutions 4 times per day for 7 days. Strict contact precautions were applied. Samples obtained from the throat, groin, and urine were also cultured.Results.Forty patients (mean age ± standard deviation, 71 ± 16 years; 65% male) were included. At screening, greater than or equal to 30% of oropharyngeal, greater than or equal to 60% of skin, and greater than or equal to 35% of urine cultures yielded CRKP isolates. All throat cultures became negative in the SDD arm after 3 days (P< .0001). The percentages of rectal cultures that were positive for CRKP were significandy reduced at 2 weeks. At that time, 16.1% of rectal cultures in the placebo arm and 61.1% in the SDD arm were negative (odds ratio, 0.13; 95% confidence interval, 0.02–0.74; P<.0016). A difference between the percentages in the 2 arms was still maintained at 6 weeks (33.3% vs 58.5%). Groin colonization prevalence did not change in either arm, and the prevalence of urine colonization increased in the placebo arm.Conclusions.This SDD regimen could be a suitable decolonization therapy for selected patients colonized with CRKP, such as transplant recipients or immunocompromised patients pending chemotherapy and patients who require major intestinal or oropharyngeal surgery. Moreover, in outbreaks caused by CRKP infections that are uncontrolled by routine infection control measures, SDD could provide additional infection containment.Infect Control Hosp Epidemiol 2012;33(1):14-19

scholarly journals Incidence of post-operative pulmonary complications following emergency laparotomy in tertiary care centre in Vindhya region of Madhya Pradesh, India

2018 ◽  
Vol 5 (3) ◽  
pp. 979
Author(s):  
Mohit Gangwal ◽  
Brijesh Singh
Keyword(s):  
Tertiary Care ◽  
Pulmonary Complications ◽  
Smoking History ◽  
Emergency Laparotomy ◽  
Tertiary Care Centre ◽  
Long Duration ◽  
Life Threatening ◽  
Common Etiology ◽  
Hospital Stays ◽  
Prolonged Hospital

Background: Pulmonary complications after abdominal surgery, including pneumonia, atelectasis and respiratory failure, are significant cause for patient suffering, prolonged hospital stays and increased mortality rate. There are well documented cases of atelectasis, pneumonia, aspiration pneumonitis, Acute respiratory distress syndrome, pleural effusion, empyema, tracheobronchitis etc. Present study aims at studying the incidence of pulmonary complications following emergency laparotomy.Methods: A total of 271 patients who got admitted through SOPD, casualty or transferred from other departments and underwent emergency laparotomy during the period of study were included in the study irrespective of the age and sex. Post operatively patients were regularly monitored and with advent of clinical and investigative findings post-operative pulmonary complications were recorded and incidence was calculated.Results: The mean age of the patients in present study was 36.1 and standard deviation of 15. Out of 271 patients, 219 were males 52 were females. Most common etiology of peritonitis was Peptic perforation (35.4%) followed by ileal perforation (23.6%). Incidence of post-operative pulmonary complications in present study was 30.2%.Conclusions: Post-operative pulmonary complications continue to be a significant morbidity following emergency laparotomies. Preoperative risk factors include smoking history, pre-existing lung disease and cardiac dysfunction. Emergency nature of the procedure, long duration operation and midline incision are the other factors that can increase the risk of PPC. Early identification and aggressive treatment goes a long way to tide over the progress to a life-threatening state.

Risk Factors forClostridium difficileToxin-Associated Diarrhea

1990 ◽  
Vol 11 (6) ◽  
pp. 283-290 ◽  
Author(s):  
Elizabeth Brown ◽  
George H. Talbot ◽  
Peter Axelrod ◽  
Mary Provencher ◽  
Cindy Hoegg
Keyword(s):  
Attack Rate ◽  
Tertiary Care ◽  
Control Measures ◽  
University Hospital ◽  
Third Generation ◽  
Underlying Malignancy ◽  
Usage Patterns ◽  
Duration Of Hospitalization ◽  
Anaerobic Infections ◽  
Third Generation Cephalosporins

AbstractThe hospital-wide attack rate forClostridium difficile-associateddiarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. Thirty-seven cases selected for study were older than 37 control patients, more likely to have an underlying malignancy and less likely hospitalized on the obstetrics/gynecology service. Their mean duration of hospitalization prior to diagnosis was 21 days, versus a mean total length of stay of eight days for controls. All cases received antibiotics, compared to 24 of the controls. Cases were given more antibiotics for longer periods, and more often received clindamycin, third-generation cephalosporins, aminoglycosides and vancomycin. Gender, race, duration of hospitalization, prior surgery and antiulcer therapy were not significant by logistic regression analysis. Epidemiologic variables with significantly different adjusted odds ratios (95% confidence intervals) were age greater than 65 years (14.1, 1.4-141), intensive care unit residence (39.2, 2.2-713), gastrointestinal procedure (23.2, 2.1-255) and more than ten antibiotic days (summation of days of each antibiotic administered) (16.1, 2.2-117). Control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronidazole for therapy of anaerobic infections. By the second half of 1988, the attack rate had dropped progressively to0.74%.

scholarly journals Importance of the Respiratory Tract in Carbapenemase-Producing Enterobacteriaceae Spread

2020 ◽  
Vol 41 (S1) ◽  
pp. s284-s285
Author(s):  
Olaia Pérez Martínez ◽  
Raquel García Rodríguez ◽  
Mª José Pereira Rodríguez ◽  
Angela Varela Camino
Keyword(s):  
Respiratory Tract ◽  
Index Case ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Control Measures ◽  
University Hospital ◽  
Effective Control ◽  
Care Hospital ◽  
Respiratory Sample ◽  
Index Cases

Background: Carbapenemase-producing Enterobacteriaceae (CPE) causes infections associated with high mortality rates among hospitalized patients. CPE transmission occurs frequently, and prevention of patient-to-patient transmission is a priority. However, transmission pathways are not yet completely understood. The colonization of the respiratory tract with a CPE may lead to a higher risk of contamination of the patient’s environment increasing the spread of CPE. Objective: We estimated the rate of CPE spread when respiratory tract infection or colonization is present. Methods: We studied CPE dissemination analyzing a cohort of patients admitted between January 2013 and December 2018 at the university hospital complex of A Corua, a tertiary-care hospital. All patients who were hospitalized in the same room as a patient colonized or infected with a CPE (index case) for at least 24 hours were screened for CPE carriage. The microbiological screening was performed with conventional culture or polymerase chain reaction (PCR) to identified possible CPE patient-to-patient transmission. The screening test included several samples: rectal swab, perineal swab, wound or drainage swab, and low respiratory tract sample. Results: Active screening for CPE carriage was performed in 84 contact patients. Men represent 57.1% of the sample, and the mean age was 78.5 years (men, 68.0 years and women, 80.8 years), with significant differences between sexes (12.9; 95% CI, 19.6 to 6.1). The major group of cases (86.9%) were hospitalized in medical wards. Transmission confirmed by PCR occurred in 13 (15.5%) of 84 contact patients, after a mean exposure to the index case of 13.3 days. No significant differences were detected in terms of mean exposure to index cases between those contact patients who result negative and those who result positive. The 35 index cases (41.7%) tested positive for CPE on the respiratory sample, and exposure to them led to 8 positive contact patients (61.5%). Conclusions: CPE transmission in a tertiary-care hospital occurred frequently. The spread rate is even higher when CPE is present at the respiratory level. Understanding the mode of spread is important for designing effective control measures and adding a respiratory sample to CPE screening could be a key consideration.Funding: NoneDisclosures: None

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