Bed Tertiary Care Hospital Research Articles

Candida species in catheter associated urinary tract infection in ICU patients at a tertiary care hospital in North India: An observational study

Introduction: Catheter associated urinary tract infection (CAUTI) is most common nosocomial infection which constitutes ~80% of nosocomial urinary tract infections (UTIs). Candida albicans has been most commonly isolated in past but in recent years non-albicans candida has emerged as the more common agent causing UTI in ICU settings. The study aimed to assess the burden of various candida species in symptomatic CAUTI in ICU patients and to test their susceptibility pattern for various antifungal agents. Materials and methods: Study was performed at a 1050 bed tertiary care hospital of northern India. Over a period of 1 year, total 147 urine samples from symptomatic CAUTI patients admitted in ICU were collected. Gram’s staining and culture on CLED agar was done. All yeast isolates were tested for speciation of Candida & antifungal susceptibility by an automated commercial system - VITEK 2. Results: Among 147 urine samples, 34 (23.12%) were positive for various Candida species. 61.76% positive patients were female and 38.23% were male. Maximum numbers of Candida isolates were found in above 60 years age group. 27 (79.41%) were due to non-albicans Candida spp. and 7 (20.58%) were due to Candida albicans. All Candida species were found to be sensitive to voriconazole, amphotericin B, caspofungin and micafungin. Few isolates of certain species like C.albicans and C.non-albicans showed resistance to fluconazole and/or flucytosine. Conclusion: Changing pattern of Candida species causing UTIs around the world points towards continuous need for surveillance, thus helping us in providing appropriate therapy.

Evaluation of Medication Error Incident Reports at a Tertiary Care Hospital

Background: Whether an adverse drug event (ADE) occurred or not, medication errors (MEs) are thought to be a barrier that prevents patients from administering the right dose of treatments at the proper time at any point in the process of taking treatments. It was found that medication errors caused about 7,000 patient deaths, and these errors accounted for 30% of all issues in hospitals. This study aimed at assessing the incidents of medication errors at a tertiary care center of King Fahd Hospital, Jazan, Saudi Arabia. Methods: A retrospective study was conducted from January 2015 to December 2015 of patients\' residents at a bed tertiary care hospital. The hospital\'s medication safety reporting program was used by healthcare professionals to report many types of safety incidents, including MEs. Data were analyzed using SPSS, version 20. A P value < 0.05 was considered significant. Results: The study included 491 patients; their ages ranged between < 20 to >60 years old, and 53.2% were females. The most identified drug-related problems (DRPs) were single (73.1%), and 12.2% of DRPs were multiple. The most common DRP types were improper dosage (38.9%) and wrong frequency (35.3%), followed by wrong drug (9.3%) or omission error (8.8%). The gender of patients was the only significant factor associated with medication error incidence. The type of DRP was the significant factor affecting the multiplicity of DRP. Conclusion: The present study demonstrated a high prevalence of drug-related problems in Jazan, Saudi Arabia. More training and knowledge in prescribing and administering drugs should be provided to healthcare professionals.

CLINICAL OUTCOMES FOLLOWING INTRODUCTION OF A MULTIDISCIPLINARY PULMONARY EMBOLISM RESPONSE TEAM AT AN ACADEMIC TERTIARY CARE MEDICAL CENTER

CLINICAL OUTCOMES FOLLOWING INTRODUCTION OF A MULTIDISCIPLINARY PULMONARY EMBOLISM RESPONSE TEAM AT AN ACADEMIC TERTIARY CARE MEDICAL CENTER

Duration of exposure is the most important risk factor for nosocomial COVID-19 in open multibed wards

Background: The National University Hospital (NUH) is a 1,200 bed tertiary-care hospital with no documented nosocomial transmission of COVID-19 among patients for the first year and a half of the pandemic, despite 65% of the patients being housed in 4- to 8-bedded open cubicles with shared bathrooms. However, this arrangement changed in late September 2021 with large community clusters including in healthcare institutions nationally associated with the spread of the δ (delta) variant of SARS-CoV-2. We conducted a retrospective review of hospital epidemiology data to determine risk factors for SARS-COV-2 transmission during this period. Methods: Index patients were defined as the first patient in an open cubicle with a confirmed positive SARS-CoV-2 PCR test. Contacts were defined as being in the same cubicle as a patient before isolation from 2 days before symptom onset, up to 7 days from positive test if asymptomatic. Clinical and patient movement data were obtained manually from routine clinical records. Proximity of the contact from the index was classified as within, or more than, 2 m away, according to the prevailing definition from the Singapore Ministry of Health. A univariate analysis was performed to identify risk factors for nosocomial acquisition of SARS-CoV-2. The analysis was deemed exempt from ethics review (reference no. NHG-DSRB-2021/01026). Results: From October 1 to November 30, 2021, 30 index cases occurred in open cubicles identified (median, 9 days after admission; IQR, 19 days). Contact tracing yielded 211 contacts, of whom 10 (4.7%) were infected. Linear regression analysis found the duration of contact for each hour spent in the same room as the index case was the only statistically significant risk variable for contracting COVID-19, with an odds ratio 1.02 (Table 1). Conclusions: Patients in open cubicles are at risk for nosocomial transmission of COVID-19 and other infections. The duration of contact appeared to be more important than vaccination status of index or ward ventilation status. Larger multicentered studies are needed to validate this finding, which has significant implications for infection prevention strategies and pandemic planning.Funding: NoneDisclosures: None

COVID-19 Associated Mucormycosis (CAM) - A Case Series from a Tertiary Care Hospital in India

Purpose: Coronavirus disease (COVID-19) remains a health concern with new emerging challenges as rise of opportunistic mucormycosis infections in COVID-19 patients has been found to increase morbidity and mortality. Even though rare, COVID-19 associated mucormycosis has been reported from across the world. We present a retrospective cases series of 132 patients diagnosed as COVID-19 associated mucormycosis in a tertiary care hospital in North India during May 9th to 30th 2021. Materials and Methods: Our 1500 bed tertiary care hospital is one of the partners in the Mycotic Infections in COVID-19 (MUNCO) registry, Albert Einstein College of Medicine, Bronx, New York. Data were collected in the REDCap database. Profile of the patients has been presented according to demographic profile, comorbidities, laboratory parameters, ICU admission, oxygen support and treatment outcomes. Analysis of risk factors for mortality has been undertaken along with a prediction model for mortality. Result: The proportion of males and females was 72.7% and 27.3% respectively. The mean age of the study subjects was 53.1 years. The major comorbidity was Diabetes (57.6%) followed by Hypertension (40.9%) and Coronary artery disease (11.4%). About 13% patients used long term corticosteroid. Further, 70.5% patients required an ICU admission and 47.0% patients required oxygen support whereas ventilator requirement was for 13.6% patients. Overall death rate of mucormycosis patients was 16.7%. The risk factors identified for death were raised levels of CRP >73, Ferritin >358, SGOT >39 and Creatinine >1.15 as well as oxygen requirement. Conclusion: Clinicians must examine the possibility of concomitant fungal infection in COVID-19 patients especially who are geriatric or comorbid with Diabetes Mellitus. Those with raised levels of CRP, Ferritin, SGOT and Creatinine levels as well as those needing oxygen need to be vigilantly monitored to minimize the risk of mortality.

Trends of a syndromic approached based respiratory PCR during the second wave of the COVID 19 pandemic in a tertiary care center in Mumbai

PurposeThe clinical presentation of COVID 19 disease caused by Severe Acute Respiratory Syndrome Related Coronavirus – 2 (SARS-CoV2) is similar to other causes of upper respiratory viral infections caused by influenza, epidemic corona viruses, Parainfluenza virus etc. This study was undertaken to study the presence of different pathogens in the nasopharyngeal samples of symptomatic patients visiting the COVID OPD or the Emergency services over six month duration.Methods & MaterialsThis was a prospective study from Dec 2020 to May 2021 conducted in a 220 bed tertiary care hospital in Mumbai. We are a designated COVID care hospital with 55 isolation beds including 16 beds in the COVID ICU, a dedicated OPD for symptomatic patients and Emergency services (EMS). The test was performed on a syndromic approach based respiratory PCR with 22 targets inclusive of SARS-CoV2. Nasal and a pharyngeal swab samples (NPS) were collected and the results of the test were available in 1.5 hours from sample receipt to the lab.ResultsA total of 335 patient samples were received during the study period for the syndromic approach based PCR. 133 (39.7%) of the symptomatic patients had a positive test result. 87(26%) SARS-CoV2 and 27(8.05%) Rhinovirus/Enterovirus (RhV/EV) were the two common viruses that were identified during the study duration. Other viruses, like Parainfluenza 3 (PIV3), Coronavirus 229E (229E), Coronavirus HKU1 (HKU1), Influenza AH3 (AH3), H1N1, Coronavirus OC43 (OC43) and Adenovirus were also identified. We observed co-infections 1 each of RhV/EV+AH3, RhV/EV + OC43, SARS-CoV2 +PIV3 and 2 cases of SARS-CoV2+HKU1. The trend indicated the appearance of the 2nd wave of SARS-CoV2 infection that Mumbai experienced between 1st March to 15th May 2021. Other pathogens were mostly seen in the symptomatic population especially before and after the 2nd wave.ConclusionOur study documented the appearance of the second wave in Mumbai between 1st March to 15th May 2021. Approximately,34.5% of patients has other respiratory pathogens detected in the syndromic PCR. This is the 1st study from Mumbai documenting the types of respiratory pathogens and co infections seen during the 2nd wave of the COVID 19 pandemic in Mumbai.

Meticillin-resistant Staphylococcus aureus Contact Screening Strategy in a Low Prevalence Setting; a Nested Case-Control Study

SummaryBackgroundThe optimal screening strategy in hospitals to identify secondary cases after contact with a meticillin-resistant Staphylococcus aureus (MRSA) index patient in a low prevalence setting is not well defined. We aimed at identifying factors associated with documented MRSA transmissions.MethodSingle center, retrospective, nested case-control study. We evaluated the screening strategy in our 950 bed tertiary care hospital from 2008 – 2014. Room and ward contacts of MRSA index patients present at time of MRSA identification were screened. We compared characteristics of Staphylococcus aureus Protein A (spa)-type matched contact patients (cases) to negative or spa-type mismatched contact patients (controls).ResultsAmong 270,000 inpatients from 2008 – 2014, 215 MRSA screenings yielded 3013 contact patients, and 6 (0.2%) spa-type matched pairs. We included 225 controls for the nested case-control study. The contact type for the cases was more frequently “same room” and less frequently “same ward” compared with the controls (P = 0.001). Also, exposure time was longer for cases (median of 6 days [IQR 3–9]) than for controls (1 day [0–3], P=0.016).ConclusionThe extensive MRSA screening strategy revealed only few index/contact matches based on spa-typing. Prolonged exposure time and a shared room were significantly associated with MRSA transmission. A targeted screening strategy may be more useful in a low prevalence setting than screening entire wards.

PD32-03 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION. SURGICAL TECHNIQUE WITH 10 YEAR EXPERIENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (PD32)1 Sep 2021PD32-03 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION. SURGICAL TECHNIQUE WITH 10 YEAR EXPERIENCE Cassandra Schuster, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002033.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy with uterus preservation (RASCP-UP) is a transabdominal approach to repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and preserves female sexual organs. Although hysterectomy may be performed at the time of POP repair, many women choose to preserve their uterus for reasons of sexuality, female identity, religion, maintenance of maximal vaginal length, and resistance to removal of a normal organ. METHODS: Data is collected from an IRB approved prospectively maintained database of robotic POP repair in an 836 bed tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port. Commercially available 4 x 24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate >10 cm anterior and posterior dissections of the vaginal walls. The anterior vaginal wall component is brought through the broad ligament and joined with the posteriorly placed component for attachment to the Anterior Longitudinal Ligament with GoreTex sutures. The mesh is then completely covered by peritoneum. All patients for RASCP-UP had Stage 4 prolapse with maximal anterior, posterior and apical descent with the cervix at the apex of the descent. All patients had normal PAP smears and pelvic ultrasounds. RESULTS: Between 2010 and 2021 a total of 351 patients underwent RASCP at the same institution. Of these, 54 presented with complete vaginal vault eversion requesting RASCP-UP. Mean age was 67.5 years and mean BMI 26.8. Cases were completed with robotic console time between 61 and 121 minutes and all patients discharged within 24-48 hours. At mean 60 month (12–124 month) follow-up, there were no mesh erosions, hernias, or reoperations for prolapse. There was one reoperation for hysterectomy at 6 year follow up for suspected endometrial carcinoma and one reoperation for small bowel obstruction in a patient with extensive lysis of adhesions. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence CONCLUSIONS: RASCP-UP is a reproducible, reliable procedure for patients with severe POP who desire uterus preservation. The surgery restores normal vaginal axis and length without placement of mesh material through vaginal mucosa. Long-term results show durable functional repair. Is the “unnecessary” removal of an otherwise normal uterus “necessary” for repair of POP? For a number of female patients, the answer appears to be no. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e545-e545 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Robert Carey More articles by this author Expand All Advertisement Loading ...

PD32-05 COMPARISON OF HEAVY WEIGHT VERSUS LIGHT WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY USING FOUR MESHES AND 351 CASES

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (PD32)1 Sep 2021PD32-05 COMPARISON OF HEAVY WEIGHT VERSUS LIGHT WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY USING FOUR MESHES AND 351 CASES Cassandra Schuster, Maximilian Carey, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Maximilian CareyMaximilian Carey More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002033.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: All FDA approved wide pore polypropylene Y-mesh grafts available for robotic sacrocolpopexy have variance in the mesh weight, pore size, thickness, surface area ratio and suture pull out strengths. In this study we evaluated results observed for robotic sacrocolpopexy performed with four separate wide pore polypropylene Y meshes that differ markedly in their physical properties. METHODS: Data is collected from an IRB approved prospectively maintained retrospective database of robotic sacrocolpopexy cases performed at an 836 bed tertiary care hospital by a single surgeon. Using analysis matched for covariates of BMI, prolapse stage and previous attempts at repair, We evaluated whether the weight of the Y-mesh influenced the anatomic outcome and rate of de novo SUI at mean 46 month follow-up. RESULTS: Between 2011 and 2020, a total of 351 patients underwent robotic sacrocolpopexy for POP-Q Stage IV VVP. The cases were divided between 4 different mesh materials (n=50, 50, 100, and 151) in patients undergoing repair. The mesh material varied from the heaviest mesh weight (52 g/m2, 527 microns thick, and a suture pull out strength of 18.3 N) to the lightest weight mesh (25 g/m2, 200 microns thick, and suture pull out strength of 23.3 N). At mean 46 month follow-up, anatomic success for apical prolapse was 100% and there was no difference in the rates of Grade 2 or less anterior or posterior prolase in each group (4%). De novo SUI was found in 10% patients in the heaviest mesh group and in 8% of patients in the lighter mesh groups. All de novo SUI patients did not have a mid urethral sling, MUS, placed at the time of the procedure. There was one mesh erosion in the light weight mesh group in a salvage patient that underwent concomitant pre-existing mesh removal at the time of surgery. CONCLUSIONS: Although the two Y-meshes are markedly different in their weight, surface area, thickness and suture pullout strength, there was no observed significant difference in the anatomic success of repair, the rate of de novo stress urinary incontinence or mesh erosion. The rates of de novo SUI seen in this study, have led us to perform a MUS procedure at the time of sacrocolpopexy for all Grade IV prolapse patients. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e546-e546 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Maximilian Carey More articles by this author Robert Carey More articles by this author Expand All Advertisement Loading ...

Reported adverse effects following COVID-19 vaccination at a tertiary care hospital, focus on cerebral venous sinus thrombosis (CVST)

ABSTRACT Objectives: Several cases of unusual thrombotic events with thrombocytopenia were reported in several countries, in association with AstraZeneca’s COVID-19 vaccine. The European medicines agency conducted a detailed review and concluded that there was no evidence to suggest an association of thrombotic events with the use of COVID-19 vaccine AstraZeneca. Methods: King Abdulaziz Medical City is a 1500 bed tertiary care hospital in Riyadh, Saudi Arabia; this study describes spontaneously reported vaccine adverse effects received through the hospital’s internal electronic safety reporting system from December 2020 to 13 April 2021. We assessed each report for causality association utilizing the world health organization’s (WHO) causality assessment of an adverse event following immunization (AEFI) classification 2nd Edition 2019. Results: The majority of the reported events were mild to moderate, there were five serious events, one reported cardiac arrest, two cerebral venous sinus thrombosis, and two pulmonary embolism. Clinical and laboratory summary of the five patients are presented in detail. Conclusions: Efforts of pharmacovigilance in mediating the rare risk of thrombosis associated with COVID-19 vaccine are crucial in providing awareness on the possible risk factors and signs/symptoms that should raise red flags.

Does continuity in nursing staff matter? A pilot study on correlation of central line-associated bloodstream infections and employee turnover

BackgroundUnderstaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question.MethodsIn January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated.ResultsOver a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r = −0.058, P = 0.787).ConclusionsProspectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates.

Epidemiology of multi drug resistant gram negative bacteria in Kathmandu, Nepal

Purpose: Multi drug resistant (MDR) bacterial infections are considered to be hospital-acquired in high income countries. Little data are available regarding the epidemiology of MDR bacteria in low and middle-income countries. Our study looked at the epidemiology of gram negative bacterial infections in Kathmandu, Nepal. Methods & Materials: Kathmandu Model Hospital is a 125 bed tertiary care hospital, in Kathmandu, Nepal. All patients hospitalized with MDR bacterial infections over a 12 month period were retrospectively evaluated. MDR bacteria included those with extended spectrum beta lactamase (ESBL), carbapenem (CRE) or colistin resistance. Age matched controls of patients with clinical infection but negative cultures were selected during the same time period. Water surveillance was performed to identify a potential source of environmental exposure. 55 vials were filled from various drinking water sources in Kathmandu; including bottled water, home reservoirs, and community taps. Water samples were analyzed by centrifugation and conventional culture techniques. Results: No significant differences in patient characteristics were noted between the groups (Table 1). Among the cases, 73% had E. coli, 15% had Acinetobacter sp (ACBC), and 12% had K. pneumoniae. The majority of infections in both groups were community acquired. 5 water samples from 4 locations were found to have ACBC.Tabled 1CasesControlsAge years mean (range)54 (23-95)54 (18-89)Sex Male13 (32%)17 (43%) Female27 (68%)23 (57%)Admission Diagnosis Respiratory7 (18%)18 (45%) Genitourinary17 (43%)5 (13%) Skin and Soft Tissue4 (10%)0 (0%) Abdominal9 (22%)5 (13%) Unknown source3 (7%)12 (29%)Comorbidities Cardiac1211 Respiratory213 Renal52 Endocrine135 Other83Hospital Ward Medicine25 (64%)27 (68%) Surgery9 (23%)10 (25%) Gynecology5 (13%)3 (7%)Organism E. coli290 K. pneumoniae50 ACBC60 No growth040Community Acquired3936Hospital Acquired14 Open table in a new tab Conclusion: Gram negative bacterial resistance is a prevalent concern in low and middle-income countries. Our study demonstrated gram negative bacteria in the drinking water in various locations throughout Kathmandu. This is a possible source of community acquired MDR bacterial infection.

Impact of novel blood culture collection bundle to reduce blood culture contamination rates: An important continuous quality improvement indicator of laboratory medicine

Introduction: Blood cultures play a very important role in the diagnostic algorithm for managing patients with sepsis. Contamination of blood cultures complicate patient care resulting in unnecessary antibiotic use, prolonged hospital stays and more financial burden on the patient. Hence, microbiology laboratories strive to keep contamination rates within <3% as per international standards. Aim: To monitor blood culture contamination rate and reduce contamination using a novel blood culture collection (BCC) bundle. Materials and Methods: A prospective interventional study carried out in a newly set up Microbiology laboratory of a 200 bed tertiary care hospital in North Mumbai. Blood cultures from various clinical areas of the hospital were processed using the BacT/Alert system (BioMereiux, Marcy l'etiole, France). All positive blood cultures were co-related clinically and assigned as pathogens or contaminants. Blood culture contamination rates were actively monitored and BCC bundle was introduced to reduce contamination, which comprised six steps to follow while performing BCC. Active surveillance, audits of the collection process and root cause analysis (RCA) of blood culture contamination were done simultaneously. This was followed by feedback to phlebotomists, nurses and doctors. Periodic and need-based onsite training of health-care workers was also done. Results: Different types of Health Care Workers were performing the procedure. The most common contaminant grown were Gram-positive cocci 159 (25.5%), followed by Gram-negative bacilli 58 (9.32%), and Bacillus spp. 37 (5.95%). It was observed that skin disinfection and incorrect order of draw were two main reasons for the contamination. Over a period of 18 months, BCC bundle implementation reduced the contamination from 17% to 4%. Conclusion: RCA, training, surveillance and audits are essential to improve the quality of blood culture results. Implementation of the BCC bundle benefits both the microbiology laboratory and the clinical teams by decreasing the growth of contaminants and improving the utility of blood culture for better management of patients in sepsis bringing in favorable outcomes.

Early pH change predicts intensive care unit mortality

Aim of the Study:Metabolic acidosis is associated with increased mortality in critically ill patients. We hypothesized that early correction of acidosis of presumed metabolic origin results in improved outcomes.Patients and Methods:We conducted a prospective, observational study from February 2015 to June 2016 in a 12 bed mixed intensive care unit (ICU) of a 1000 bed tertiary care hospital in the north of India. ICU patients aged above 18 years with an admission pH ≥7.0 to <7.35 of presumed metabolic origin were included. Arterial blood gas parameters including pH, PaO2, PaCO2, HCO3−, Na+, K+, Cl−, anion gap (AG), base excess, and lactate at 0, 6, and 24 h along with other standard laboratory investigations were recorded. The primary outcome was to assess the impact of early pH changes on mortality at day 28 of ICU.Results:A total of 104 patients with 60.6% males and 91.3% medical patients were included in the study. Sepsis of lung origin (60.6%) was the predominant etiology. By day 28, 68 (65.4%) patients had died. Median age was 49.5 years, weight 61.7 kg, Sequential Organ Failure Assessment, and Acute Physiologic and Chronic Health Evaluation II scores were 16 and 12, respectively. Nonsurvivors had a higher vasopressor index (P < 0.01), lactate and central venous oxygen saturation (P < 0.05), and lower pH (P < 0.05). A pH correction/change of ≥1.16% during the first 24 h had the best receiver operating characteristic for predicting survival at day 28, with area under the curve (95% confidence interval, 0.72 [0.62–0.82], P < 0.05) compared to HCO3-, BE, lactate, and AG.Conclusions:Metabolic acidosis is associated with higher mortality in ICU. The rate of change in pH may better predict ICU mortality than other metabolic indices.

Barriers and facilitators to infection control at a hospital in northern India: a qualitative study

BackgroundHospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries. Effective implementation of infection control practices is crucial to reducing the transmission of hospital acquired infections at hospitals worldwide. Yet, no comprehensive assessments of the barriers to sustained, successful implementation of hospital interventions have been performed in Indian healthcare settings to date. The Systems Engineering Initiative for Patient Safety (SEIPS) model examines problems through the lens of interactions between people and systems. It is a natural fit for investigating the behavioral and systematic components of infection control practices.MethodsWe conducted a qualitative study to assess the facilitators and barriers to infection control practices at a 1250 bed tertiary care hospital in Haryana, northern India. Twenty semi-structured interviews of nurses and physicians, selected by convenience sampling, were conducted in English using an interview guide based on the SEIPS model. All interview data was subsequently transcribed and coded for themes.ResultsPerson, task, and organizational level factors were the primary barriers and facilitators to infection control at this hospital. Major barriers included a high rate of nursing staff turnover, time spent training new staff, limitations in language competency, and heavy clinical workloads. A well developed infection control team and an institutional climate that prioritizes infection control were major facilitators.ConclusionsInstitutional support is critical to the effective implementation of infection control practices. Prioritizing resources to recruit and retain trained, experienced nursing staff is also essential.

PD17-03 MATCHED PAIR ANALYSIS COMPARING HEAVY WEIGHT VERSUS LIGHTER WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse II1 Apr 2017PD17-03 MATCHED PAIR ANALYSIS COMPARING HEAVY WEIGHT VERSUS LIGHTER WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY Robert Carey, Ali Harris, Maximilian Carey, and Karim Ghazli Robert CareyRobert Carey More articles by this author , Ali HarrisAli Harris More articles by this author , Maximilian CareyMaximilian Carey More articles by this author , and Karim GhazliKarim Ghazli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.850AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES All FDA approved wide pore polypropylene Y-mesh grafts available for robotic sacrocolpopexy have variance in the mesh weight, pore size, thickness, surface area ratio and suture pull out strengths. In this study we evaluated results observed for robotic sacrocolpopexy performed with two separate wide pore polypropylene Y meshes that differ markedly in their physical properties. METHODS Data is collected from an IRB approved prospectively maintained retrospective database of robotic sacrocolpopexy cases performed at an 836 bed tertiary care hospital by a single surgeon. Using analysis matched for covariates of BMI, POP-Q stage, surgeon, and previous attempts at repair, we evaluated whether the weight of the Y-mesh influenced the anatomic outcome and rate of de novo SUI at two year follow-up. RESULTS Between 2011 and 2016, a total of 175 patients underwent robotic sacrocolpopexy for POP-Q Stage IV VVP. 50 patients undergoing repair with a heavy mesh weight (52 g/m2, 527 microns thick, and a suture pull out strength of 18.3 N) were matched to 50 patients undergoing repair with a lighter weight mesh ( 25 g/m2, 200 microns thick, and suture pull out strength of 23.3 N). At two year follow-up, anatomic success for apical prolapse was 100% and 2 patients (4%) in each group were found to have residual Grade 2 anterior prolapse and 2 patients (4%) in each group found to have Grade 2 posterior prolapse. De novo SUI was found in 5 patients (10%) in the heavy mesh group and 4 patients (8%) in the lighter mesh group. All de novo SUI patients did not have a mid urethral sling, MUS, placed at the time of the procedure. There was one mesh erosion in the light weight mesh group in a salvage patient that underwent concomitant pre-existing mesh removal at the time of surgery. CONCLUSIONS Although the two Y-meshes are markedly different in their weight, surface area, thickness and suture pullout strength, there was no observed significant difference in the anatomic success of repair, the rate of de novo stress urinary incontinence or mesh erosion. The rates of de novo SUI seen in this study, have led us to perform a MUS procedure at the time of sacrocolpopexy for all Grade IV prolapse patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e353-e354 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Robert Carey More articles by this author Ali Harris More articles by this author Maximilian Carey More articles by this author Karim Ghazli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Audiological Evaluation of Patients Taking Kanamycin for Multidrug Resistant Tuberculosis.

The incidence of multidrug resistant tuberculosis is increasing in developing countries. Aminoglycosides are an integral part of second-line drugs, however ototoxicity is a major limitation for their use. This study aims to determine the extent of hearing loss in patients taking one of the commonly prescribed drugs for Multidrug resistant tuberculosis (MDR-TB), Kanamycin, at a Government Medical College, Patiala, Punjab, India, which is a 1200 bed tertiary care hospital. A total of 100 patients (68 males and 32 females) with confirmed diagnosis of MDR-TB were included in this study conducted between January 2012 and February 2014. Subjects were between 15 to 60 years of age, with a mean age of 37.46 ± 10.1. Pure tone audiometry (PTA) was performed before the start of the therapy, as a baseline, and was repeated after 1 week and 6 weeks of Kanamycin use to assess hearing loss as an effect of therapy. Of the 100 patients examined, ototoxicity was found in 18 subjects post therapy. Incidence of high frequency hearing loss was 2% at week 1, and 12% after 6 weeks of follow up. However, 4% of the cases developed flat loss at week 6. The hearing loss was bilateral in 13 patients and unilateral in 5 patients. Ototoxicity was more common in males (66.67%) compared to females (33.3%). Maximum cases were found in the age group of 36 to 45 years (36.8%), the majority being from a rural background (83.3%). The association with socioeconomic status (P=0.024) and co-morbid conditions like diabetes and hypertension (P=0.001) reached statistical significance. Lack of specific guidelines to monitor patients taking aminoglycosides makes ototoxicity a major adverse effect of their use in MDR-TB. More studies are mandated to study the risk factors associated with the development of ototoxicity and for the development of alternate drugs for the treatment of MDR-TB.

Pseudomeningitis due to Pseudomonas aeruginosa in a paedriatic ward of a tertiary care centre: a glimpse on infection control measures

Paediatric bacterial meningitis is a life threatening illness. We report a pseudo-outbreak of Pseudomonas aeruginosa meningitis in neonates from the neonatal intensive care unit (NICU) and paediatric ward of our 567 bed tertiary care hospital. The infection control team (ICT) investigated the cause of a sudden significant increase of Pseudomonas meningitis in neonates. A retrospective analysis of all the isolates from CSF and environmental sampling from NICU and paediatric ward was done. Direct culture of autoclaved rubber caps of glass vials as well as cetrimide and chlorhexidine solution yielded growth of P. aeruginosa, with an antibiogram similar to CSF isolates. Pseudo-infection not only burdens the work of health care providers but also has financial implications; hence every measure should be taken to prevent it.

Correlation of CYP2C19 genotype with plasma voriconazole levels: a preliminary retrospective study in Indians

Voriconazole is an antifungal drug essentially metabolized by cytochrome P450 (CYP2C19) isozyme. Plasma voriconazole levels exhibit wide inter-individual variability due to several factors like age, weight, food or drug interactions or CYP2C19 polymorphisms. In the present study, we assessed the correlation of voriconazole levels with CYP2C19 genotype in patients on voriconazole therapy. Biochemistry Department of a 480 inpatient bed tertiary care hospital in India. Plasma voriconazole estimation was done in seventy-two patients on standard weight based voriconazole therapy by High Performance Liquid Chromatography (HPLC) while genotype assessment for the CYP2C19*2 and *3 was done by PCR-RFLP and *17 by ARMS-PCR. Statistical analysis and genotype-phenotype correlation was done by comparing the drug levels with the CYP2C19 genotype. CYP2C19 polymorphisms influence voriconazole metabolism. A wide variability is seen in plasma levels with only 51% attaining therapeutic levels. The allele frequency of *2, *3 and *17 variant were found to be 33.3, 0.7 and 18% respectively. The drug levels in carriers of *2 allele (poor metabolizers) was twofold higher than that in extensive metabolizers. However, the influence of *2 allele was compromised in presence of *17 allele and patients had low voriconazole levels. In addition to the genotype, co-medication and clinical condition remarkably influenced voriconazole concentration. Plasma voriconazole levels are influenced by CYP2C19 variants, drug interactions and clinical condition of the patient. Genotype assessment at initiation of therapy followed by drug monitoring would help optimizing therapeutic efficacy and minimizing toxicity.

Adverse drug events in patients admitted to an emergency department: an analysis of direct costs.

Several economic evaluations of adverse drug events (ADEs) exist, but the underlying methodology has not been standardized so far. The aim of the study was to combine prospective, intensive pharmacovigilance methods, and standardized accounting data to calculate direct costs of community-acquired ADEs (caADEs) contributing to emergency department (ED) admission and subsequent hospitalization. A prospective observational study with three phases extending over 2 years was implemented in a 749 bed tertiary care hospital with an annual ED census of approximately 45 000 patients. The patient records of all adult non-trauma ED admissions were systematically analyzed by a team of emergency physicians, clinical pharmacologists, and pharmacists for potential ADE. Associated diagnosis related group costs were extracted from standardized accounting data. Of 2262 patients attending the ED during the study periods, the hospitalization of 366 patients (16.2%) was related to one or more caADEs of which 97.5% were considered predictable and 62.0% were classified as preventable. The mean caADE-related diagnosis related group costs were €2743 (95% bias-corrected and accelerated CI: €2498 to €3018). Extrapolated to a national scale, this corresponds to caADE-related costs of €2.245bn for the German health insurance funds, annually. Costs of €1.310bn could be attributed to events classified as predictable and preventable. In an ED, caADEs are frequent, and a significant proportion of these events and their related costs appear to be predictable and preventable. The ED as a first-line provider for ADE cases appears to be an appropriate environment to implement strategic and operative improvements for enhanced patient safety.