Central Line Research Articles

Generalised scaled boundary isogeometric analysis – a method for structural analysis of naturally shaped timber structures

ABSTRACT Natural building materials, such as naturally shaped tree trunks, have been used in construction since ancient times. Wood is primarily processed as a long, thin product due to its growth and structure, leaving many parts unused. These neglected parts, like branches, can be used for load-bearing structures. However, they require a new parametric description due to material and geometric behaviour differences. It's crucial to transfer these geometries into the calculation model accurately. The surface is described using NURBS based on image data to realise this. Applying the Scaled Boundary Isogeometric Analysis (SBIGA) can directly use these geometries for structural analysis. This method combines the concepts from the scaled boundary finite element method (SBFEM) with the isogeometric analysis (IGA). In this technique, two-dimensional surfaces are scaled to a centre point. When used in the context of thin, long structures, obtuse-angled polyhedrons occur within a patch, leading to numerical condition problems. This motivates this contribution to modify the conventional SBIGA towards a generalised scheme. This work introduces a generalised SBIGA approach, employing a scaling centre line instead of a scaling centre point. This enables the analysis of slender, curved objects without additional structure partitioning, simplifying the preprocessing while improving the performance.

An Industrial Control System for Cement Sulfates Content Using a Feedforward and Feedback Mechanism

This study examines the design and long-term implementation of a feedforward and feedback (FF–FB) mechanism in a control system for cement sulfates applied to all types of cement produced in two mills at a production facility. We compared the results with those of a previous controller (SC) that operated in the same unit. The Shewhart charts of the annual SO3 mean values and the nonparametric Mann–Whitney test demonstrate that, for the FF–FB controller, the mean values more effectively approach the SO3 target than the older controller in two out of the three cement types. The s-charts for the annual standard deviation of all cement types and mills indicate that the ratio of the central lines of FF–FB to SC ranges from 0.39 to 0.59, representing a significant improvement. The application of the error propagation technique validates and explains these improvements. The effectiveness of the installed system is due to two main factors. The feedforward (FF) component tracks the set point of SO3 when the mill begins grinding a different type of cement, while the feedback (FB) component effectively attenuates the fluctuations in the sulfates of the raw materials.

Risk factors for postoperative complications in preterm infants with surgical necrotizing enterocolitis and associated outcomes.

We aim to determine clinical risk factors for postoperative complications in preterm infants with surgical necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). A retrospective cohort study of preterm infants with surgical NEC or SIP to compare clinical factors between those with and without postoperative complications. 78/109 (71.5%) infants had any complication following surgical NEC. Adhesions (20/35, 57.1%) and wound infection (6/35, 17.1%) were the most common single surgical complications. Patients with a single surgical complication (35/66, 53%) were significantly less likely to be exposed to antenatal steroids, more frequently had a jejunostomy, needed a central line longer, and had a longer length of stay than those without any surgical complication. Infants with > 1 surgical complication (43/71, 60.5%) included mainly females, and had AKI more frequently at NEC onset, lower weight z-scores and lower weight for length z- scores at 36 weeks PMA than those without any complications.On multinomial logistic regression, antenatal steroids exposure (OR 0.23 [CI 0.06, 0.84]; p = 0.027) was independently associated with lower risk and jejunostomy 4.81 (1.29, 17.9) was independently associated with higher risk of developing a single complication. AKI following disease onset (OR 5.33 (1.38, 20.6), P = 0.015) was independently associated with > 1 complication in surgical NEC/SIP infants. Infants with postoperative complications following surgical NEC were more likely to be female, have additional morbidities, and demonstrate growth failure at 36 weeks PMA than those without surgical complications. There was no difference in mortality between those with and without surgical complications.

Tunable superconducting resonators via on-chip control of local magnetic field

Abstract Superconducting microwave resonators play a pivotal role in superconducting quantum circuits. The ability to fine-tune their resonant frequencies provides enhanced control and flexibility. Here, we introduce a frequency-tunable superconducting coplanar waveguide resonator. By applying electrical currents through specifically designed ground wires, we achieve the generation and control of a localized magnetic field on the central line of the resonator, enabling continuous tuning of its resonant frequency. We demonstrate a frequency tuning range of 54.85 MHz in a 6.21 GHz resonator. This integrated and tunable resonator holds great potential as a dynamically tunable filter and as a key component of communication buses and memory elements in superconducting quantum computing.

A dataset of 1 km grid drainage density in China (2019)

Drainage density is an outcome of the combined influence of watershed landform, climate, soil, and vegetation. As a comprehensive characterization index, the measurement and monitoring of drainage density is of great significance to environmental protection and water resources allocation in regional watersheds. This paper uses river water surface vector data from the third National Land Survey, extracting the river center line. Then, the kilometer grid network production software is employed to generate the dataset of 1 km grid drainage density in China. Rigorous quality control and quality inspection measures throughout all stages of data processing have been implemented, including river surface vector extraction, river skeleton line extraction, and kilometer grid density calculation, to ensure the correctness, integrity and consistency of the data. This dataset can be used for national and regional hydrogeological analysis, soil erosion estimation, planning and layout of basic monitoring station network, etc.

Study on Optimization of Low-Voltage Multi-Port Flexible Interconnection Device in AC/DC Hybrid Distribution

At present, the back-to-back multilevel modular converter (BTB-MMC) used in low and medium voltage flexible interconnection projects has the disadvantages of high cost and large footprint. Based on MMC, a multi-port flexible interconnection device for AC/DC hybrid distribution network is designed. Firstly, the topology structure and power regulation principle of the device are described by constructing the model of the low and medium port multi-port flexible device. Secondly, an improved inverter model based on independent center line module is proposed, and a multi-objective optimization compensation strategy for multi-function grid-connected inverters is proposed, which effectively improves the ability of independent inverters to carry unbalanced loads and optimizes power quality. Finally, a set of 750 V/50 kW experimental prototype is built, and the performance of the prototype is tested to verify the advantages of the voltage stability of the device.

Development of an Anatomically Accurate Three-Dimensional Simulation Model for Pediatric Central Line Placement

Abstract Intensive care unit patients can require a central venous catheter (CVC) which medical trainees often place. The purpose of this study was to create a novel three-dimensional (3D) printed model, based on actual patient anatomy from a de-identified computed tomography (CT) scan, with improved anatomy, tactile properties, and realism beyond current task trainers for pediatric CVC placement simulation. Bakken Center researchers converted CT DICOM slices into a 3D model using multiple computer programs and multiple 3D printers. Faculty of various subspecialties at our institution attempted to place a CVC line into the model and then evaluated the model in 5 categories using an anonymous REDCap survey. Fifteen faculty participated and fourteen completed their survey. Feedback, based on a 0–10 scale with 10 being highest, was as follows: the model's size scored an average of 8.4, the model's tactile properties scored a 6.1, the model's anatomy received a 7.1, the model's perceived usefulness for practicing central line placement received a 7.6, and the model received a 7.6 in regard to whether it should be utilized in procedural training curriculums. Additional comments were collected in the survey and participants requested that the model's blood vessels be fully visible on ultrasound and that the model be firmer. In conclusion, creating a 3D simulation model for pediatric CVC placement is possible.

The effect of taurolidine on the time-to-positivity of blood cultures

Taurolidine containing lock solutions (TL) are a promising method for the prevention of central line associated bloodstream infections. Per accident, the TL may not always be aspirated from the central venous catheter (CVC) before blood cultures are obtained. The TL could, unintentionally, end up in a blood culture vial, possibly altering the results. The aim of this study was to investigate the effect of the TLs on the detection of microbial growth in blood culture vials. Different lock solutions (taurolidine-citrate-heparin (TCHL), taurolidine, heparin, citrate or NaCl) were added to BD BACTECTM blood culture vials (Plus Aerobic/F, Lytic/10 Anaerobic/F or Peds Plus/F) before spiking with Staphylococcus aureus (ATCC 29213 or a clinical strain) or Escherichia coli (ATCC 25922 or a clinical strain) in the presence and absence of blood. Subsequently, blood culture vials were incubated in the BD BACTEC FX instrument with Time-to-positivity (TTP) as primary outcome. In addition, the effect of the TCHL on a variety of other micro-organisms was tested. In the presence of taurolidine, the TTP was considerably delayed or vials even remained negative as compared to vials containing heparin, citrate or NaCl. This effect was dose-dependent. The delayed TTP was much less pronounced in the presence of blood, but still notable. This study stresses the clinical importance of discarding TLs from the CVC before obtaining a blood culture.

Using the Seraph® 100 Microbind® Affinity blood filter under slow flow conditions through 18 G and 16 G central lines.

The Seraph® 100 Microbind® Affinity blood filter (Seraph® 100) has been in use since 2019 for the treatment of fulminant or difficult to treat blood stream infections as an adjunct to pharmacotherapy. In 2020 the device received emergency use authorization by the US Food and Drug Administration for the treatment of critically ill COVID-19 patients with confirmed or imminent respiratory failure. Results of an international registry showed that the Seraph® 100 was operated under blood flow rates of 100-350 mL/min. As those conditions require a large bore central line, a dialysis catheter is currently considered indispensable to operate the Seraph® 100. The use of smaller catheter lumina has neither been evaluated in vitro nor in vivo. In vitro pressure data before and after the Seraph® 100 at various blood pump rates (prepump line 16 G, postpump line 18 G) with saline and human plasma were obtained. Further, anecdotal flow and pressure data of two patients treated with the Seraph® 100 for a COVID-19 infection are reported. At a pump speed of 50 mL/min pre-Seraph® pressure using saline was -70 [-70 to -60] mm Hg. In comparison, using plasma pre-Seraph® pressure was lower at -120 [-120 to -105] mm Hg; p < 0.001 (t-test). The post-Seraph® pressure at 50 mL/min using saline of 120 [110-130] mm Hg was not different from plasma at 130 [120-140] mm Hg, p = 0.152 (t-test). Blood flow rates of 50 mL/min did not lead to preAP levels below -250 mm Hg in the two clinical cases. Seraph® 100 blood flow rate of 50 mL/min may be achieved using low flow vascular access, allowing to treat a blood volume 72 L in 24 h.

Discharge Formula and Hydraulics of Rectangular Side Weirs in the Small Channel and Field Inlet

In this study, experimental investigations were conducted on rectangular side weirs with different widths and heights. Corresponding simulations were also performed to analyze hydraulic characteristics including the water surface profile, flow velocity, and pressure. The relationship between the discharge coefficient and the Froude number, as well as the ratios of the side weir height and width to upstream water depth, was determined. A discharge formula was derived based on a dimensional analysis. The results demonstrated good agreement between simulated and experimental data, indicating the reliability of numerical simulations using FLOW-3D software (version 11.1). Notably, significant fluctuations in water surface profiles near the side weir were observed compared to those along the center line or away from the side weir in the main channel, suggesting that the entrance effect of the side weir did not propagate towards the center line of the main channel. The proposed discharge formula exhibited relative errors within 10%, thereby satisfying the flow measurement requirements for small channels and field inlets.

Infrared vertical external cavity surface emitting laser threshold magnetometer

Nitrogen-vacancy (NV) centers have considerable promise as high sensitivity magnetometers; however, they are commonly limited by inefficient collection and low contrasts. Laser threshold magnetometry (LTM) enables efficient collection and high contrasts, providing a path toward higher sensitivity magnetometry. We demonstrate an infrared LTM using an ensemble of NV centers in a single-crystal diamond plate integrated into a vertical external cavity surface emitting laser. The laser was tuned to the spin-dependent absorption line of the NV centers, allowing for optical readout by monitoring the laser output power. We demonstrate a magnetic sensitivity of 7.5 nT/Hz in the frequency range between 10 and 50 Hz. Furthermore, the contrast and the projected photon shot noise limited (PSNL) sensitivity are shown to improve significantly by operating close to the lasing threshold, achieving 18.4% and 26.6 pT/Hz near the threshold. In addition, an unexpected saturable absorption phenomenon was observed near the threshold, which enhanced the contrast and projected PSNL sensitivity.

Temporal samples of visual information guides skilled interception.

This study investigated whether performance of an interceptive skill requires an intact visual-perception-action cycle. Eleven skilled male Australian rules football athletes (Mage = 17.54, SD = 0.15) were recruited from an elite developmental pathway squad for a within-subject study. Participants were required to kick a ball directly at a goal from a 20-meter distance while wearing a pair of stroboscopic glasses. The glasses were used to create four vision conditions. Condition one kept intact the visual-perception-action cycle with uninterrupted vision of the motor skill. Three other conditions included stroboscopic vision that presented temporal samples of vision, which interrupted the perception-action cycle through progressive increases to intermittent vision occlusion of the motor skill. Goal kick error of ball position relative to a central target line within the goal and number of successful goals kicked were measured. Written report of internal and external focus of attention was also measured after each vision condition. Generalized estimating equation analysis did not reveal a significant decrement in kick target error, nor accuracy of goals scored, across normal to stroboscopic vision conditions. Performance was maintained despite a shift in attention focus from external to internal across normal to stroboscopic vision conditions. These findings have theoretical and practical implications for the visual regulation of skilled interceptive actions.

Central venous catheter tip positioning using ultrasound in pediatric patients-A prospective observational study.

In children, central venous catheter (CVC) placement is usually performed under ultrasound guidance for optimal visualization of vessels and reduction of puncture-related complications. Nevertheless, in many cases, additional radiographic examinations are performed to check the position of the catheter tip. The primary objective of this observational feasibility study was to determine the number of ultrasound-guided central venous catheter tips that can be identified in a subsequent position check using ultrasonography. Furthermore, we investigated the optimal ultrasound window, time expenditure, and success rate concerning puncture attempts and side effects. In addition, we compared the calculated and real insertion depths and analyzed the position of the catheter tip on postoperative radiographs with the tracheal bifurcation as a traditional landmark. Ninety children with congenital heart defects who required a central venous line for cardiac surgery were included in this single-center study. After the insertion of the catheter, the optimal position of its tip was controlled using one of four predefined ultrasound windows. A chest radiograph was obtained postoperatively in accordance with hospital standards to check the catheter tip position determined by ultrasonography. The children had a median (IQR) age of 11.5 (4.0, 58.8) months and a mean (SD) BMI of 15.3 (2.91) kg/m2 Ultrasound visualization of the catheter tip was successful in 86/90 (95.6%) children (95% confidence interval [CI]: 91.3%, 99.8%). Postoperative radiographic examination showed that the catheter tip was in the desired position in 94.4% (95% CI: 89.7%, 99.2%) of the cases. None of the children needed the catheter tip position being corrected based on chest radiography. Additional radiation exposure after the placement of central venous catheters can be avoided with the correct interpretation of standardized ultrasound windows, especially in vulnerable children with cardiac disease.

Path tracking control of a steerable catheter in transcatheter cardiology interventions

PurposeIntracardiac transcatheter interventions allow for reducing trauma and hospitalization stays as compared to standard surgery. In the treatment of mitral regurgitation, the most widely adopted transcatheter approach consists in deploying a clip on the mitral valve leaflets by means of a catheter that is run through veins from a peripheral access to the left atrium. However, precise manipulation of the catheter from outside the body while copying with the path constraints imposed by the vessels remains challenging.MethodsWe proposed a path tracking control framework that provides adequate motion commands to the robotic steerable catheter for autonomous navigation through vascular lumens. The proposed work implements a catheter kinematic model featuring nonholonomic constraints. Relying on the real-time measurements from an electromagnetic sensor and a fiber Bragg grating sensor, a two-level feedback controller was designed to control the catheter.ResultsThe proposed method was tested in a patient-specific vessel phantom. A median position error between the center line of the vessel and the catheter tip trajectory was found to be below 2 mm, with a maximum error below 3 mm. Statistical testing confirmed that the performance of the proposed method exhibited no significant difference in both free space and the contact region.ConclusionThe preliminary in vitro studies presented in this paper showed promising accuracy in navigating the catheter within the vessel. The proposed approach enables autonomous control of a steerable catheter for transcatheter cardiology interventions without the request of calibrating the intuitive parameters or acquiring a training dataset.

Parenteral nutrition-associated liver injury: clinical relevance and mechanistic insights.

Intestinal failure-associated liver disease (IFALD) is a relatively common complication in individuals receiving parenteral nutrition (PN). IFALD can be manifested as different types of liver injury, including steatosis, cholestasis, and fibrosis, and could result in liver failure in some cases. The onset and progression of IFALD are highly dependent on various patient and PN-related risk factors. Despite still being under investigation, several mechanisms have been proposed. Liver injury can originate due to caloric overload, nutrient deficiency, and toxicity, as well as phytosterol content, and omega-6 to omega-3 fatty acids ratio contained in lipid emulsions. Additional mechanisms include immature or defective bile acid metabolism, acute heart failure, infections, and sepsis exerting negative effects via Toll-like receptor 4 and nuclear factor κB inflammatory signaling. Furthermore, lack of enteral feeding, gut dysbiosis, and altered enterohepatic circulation that affect the farnesoid x receptor-fibroblast growth factor 19 axis can also contribute to IFALD. Various best practices can be adopted to minimize the risk of developing IFALD, such as prevention and management of central line infections and sepsis, preservation of intestine's length, a switch to oral and enteral feeding, cyclic PN, avoidance of overfeeding and soybean oil-based lipid formulations, and avoiding hepatotoxic substances. The present review thus provides a comprehensive overview of all relevant aspects inherent to IFALD. Further research focused on clinical observations, translational models, and advanced toxicological knowledge frameworks is needed to gain more insight into the molecular pathogenesis of hepatotoxicity, reduce IFALD incidence, and encourage the safe use of PN.

Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study

BackgroundA previous study on mechanical complications after central venous catheterisation demonstrated differences in complication rates between male and female operators. The objective of this subgroup analysis was to further investigate these differences. The hypothesis was that differences in distribution of predefined variables between operator genders could be identified.MethodsThis was a subgroup analysis of a prospective, multicentre, observational cohort study conducted between March 2019 and December 2020 including 8 586 patients ≥ 16 years receiving central venous catheters at four emergency care hospitals. The main outcome measure was major mechanical complications defined as major bleeding, severe cardiac arrhythmia, pneumothorax, arterial catheterisation, and persistent nerve injury. Independent t-test and χ2 test were used to investigate differences in distribution of major mechanical complications and predefined variables between male and female operators. Multivariable logistic regression analysis was used to determine association between operator gender and major mechanical complications.ResultsFemale operators had a lower rate of major mechanical complications than male operators (0.4% vs 0.8%, P = .02), were less experienced (P < .001), had more patients with invasive positive pressure ventilation (P < .001), more often chose the internal jugular vein (P < .001) and more frequently used ultrasound guidance (P < .001). Male operators more often chose the subclavian vein (P < .001) and inserted more catheters with bore size ≥ 9 Fr (P < .001). Multivariable logistic regression analysis showed that male operator gender was associated with major mechanical complication (OR 2.67 [95% CI: 1.26–5.64]) after correction for other relevant independent variables.ConclusionsThe hypothesis was confirmed as differences in distribution of predefined variables between operator genders were found. Despite being less experienced, female operators had a lower rate of major mechanical complications. Furthermore, male operator gender was independently associated with a higher risk of major mechanical complications. Future studies are needed to further investigate differences in risk behaviour between male and female operators.Trial registrationClinicaltrials.gov identifier: NCT03782324. Date of registration: 20/12/2018.

Supportive Care of Hematopoietic Stem Cell Donors.

Supportive care needs for hematopoietic stem cell recipients have been studied. Less is known about the care needs of stem cell donors. Care challenges arise at donor selection, preparation for the donation, the donation procedure and the immediate and long-term after-care. Care needs were analyzed for 1,831 consecutive bone marrow and peripheral stem cell donors at MedStar Georgetown University Hospital between January 2018 and August 2023 in support of a review of the current literature. During the selection, related donors may experience psychological pressures affecting their motivation, while donation centers may be willing to accept co-morbidities in these donors which might preclude donation in unrelated peers. For bone marrow donations, it is important to select donors not only according to optimal genetic matching criteria but also according to suitable donor/recipient weight ratios, to facilitate sufficient stem cell yields. During the donation preparation phase, side effects and complications related to stem cell stimulation must be anticipated and managed for peripheral cell donors, while the pros and cons of autologous blood donation should be evaluated carefully for bone marrow donors. The stem cell donation procedure itself carries potential side effects and complications as well. Peripheral cell donors may require a central line and may encounter hypocalcemia, thrombocytopenia, and anemia. Bone marrow donors face risks associated with anesthesia, blood loss and pain. Post-procedure care focusses on pain management, blood cell recovery and the psychological support necessary to regain a high quality-of-life existence. Hematopoietic stem donors are giving part of themselves to save another's life. They deserve comprehensive supportive care to accompany them throughout the donation process.

Experimental Characterization of Propeller-Induced Flow (PIF) below a Multi-Rotor UAV

The availability of multi-rotor UAVs with lifting capacities of several kilograms allows for a new paradigm in atmospheric measurement techniques, i.e., the integration of research-grade sonic anemometers for airborne turbulence measurements. With their ability to hover and move very slowly, this approach yields unrevealed flexibility compared to mast-based sonic anemometers for a wide range of boundary layer investigations that require an accurate characterization of the turbulent flow. For an optimized sensor placement, potential disturbances by the propeller-induced flow (PIF) must be considered. The PIF characterization can be done by CFD simulations, which, however, require validation. For this purpose, we conducted an experiment to map the PIF below a multi-rotor drone using a mobile array of five sonic anemometers. To achieve measurements in a controlled environment, the drone was mounted inside a hall at a 90° angle to its usual flying orientation, thus leading to the development of a horizontal downwash, which is not subject to a pronounced ground effect. The resulting dataset maps the PIF parallel to the rotor plane from two rotor diameters, beneath, to 10 D, and perpendicular to the rotor plane from the center line of the downwash to a distance of 3 D. This measurement strategy resulted in a detailed three-dimensional picture of the downwash below the drone in high spatial resolution. The experimental results show that the PIF quickly decreases with increasing distance from the centerline of the downwash in the direction perpendicular to the rotor plane. At a distance of 1 D from the centerline, the PIF reduced to less than 4 ms−1 within the first 5 D beneath the drone, and no conclusive disturbance was measured at 2 D out from the centerline. A PIF greater than 4 ms−1 was still observed along the center of the downwash at a distance of 10 D for both throttle settings tested (35% and 45%). Within the first 4 D under the rotor plane, flow convergence towards the center of the downwash was measured before changing to diverging, causing the downwash to expand. This coincides with the transition from the four individual downwash cores into a single one. The turbulent velocity fluctuations within the downwash were found to be largest towards the edges, where the shear between the PIF and the stagnant surrounding air is the largest.

Are routine chest radiographs still indicated after central line insertion? A scoping review.

Central venous catheters are increasingly inserted using point-of-care ultrasound (POCUS) guidance. Following insertion, it is still common to request a confirmatory chest radiograph for subclavian and internal jugular lines, at least outside of the operating theater. This scoping review addresses: (i) the justification for routine post-insertion radiographs, (ii) whether it would better to use post-insertion POCUS instead, and (iii) the perceived barriers to change. We searched the electronic databases, Ovid MEDLINE (1946-) and Ovid EMBASE (1974-), using the MESH terms ("Echography" OR "Ultrasonography" OR "Ultrasound") AND "Central Venous Catheter" up until February 2023. We also searched clinical practice guidelines, and targeted literature, including cited and citing articles. We included adults (⩾18 years) and English and French language publications. We included randomized control trials, prospective and retrospective cohort studies, systematic reviews, and surveys. Four thousand seventy-one articles were screened, 117 full-text articles accessed, and 41 retained. Thirteen examined cardiac/vascular methods; 5 examined isolated contrast-enhanced ultrasonography; 7 examined isolated rapid atrial swirl sign; and 13 examined combined/integrated methods. In addition, three systematic reviews/meta-analyses and one survey addressed barriers to POCUS adoption. We believe that the literature supports retiring the routine post-central line chest radiograph. This is not only because POCUS has made line insertion safer, but because POCUS performs at least as well, and is associated with less radiation, lower cost, time savings, and greater accuracy. There has been less written about perceived barriers to change, but the literature shows that these concerns- which include upfront costs, time-to-train, medicolegal concerns and habit- can be challenged and hence overcome.

Risk factors and outcome associated with the acquisition of MDR linezolid-resistant Enterococcus faecium: a report from tertiary care centre.

The aim of the study was to determine the resistance profile of linezolid-resistant Enterococcus faecium (LREfm) and to investigate risk factors and outcomes associated with LREfm infections. A prospective case-control study was undertaken (2019 to 2022) and included 202 patients with LREfm infections (cases) and 200 controls with LSEfm infections. Clinical data was prospectively collected and analysed for risk factors and outcomes. Antimicrobial susceptibility was performed, and resistance profile was studied using WHOnet. Risk factors associated with LREfm infection were site of infection UTI (OR 5.87, 95% CI 2.59-13.29, p ≤ 0.001), prior use of carbapenem (OR 2.85 95% CI 1.62-5.02, p ≤ 0.001) and linezolid (OR 10.13, 95% CI 4.13-24.82, p ≤ 0.001), use of central line (OR 5.54, 95% CI 2.35-13.09, p ≤ 0.001), urinary catheter (OR 0.29, 95% CI 0.12-0.70, p ≤ 0.001) and ventilation (OR 14.87, 95% CI 7.86-28.11, p ≤ 0.007). The hospital stay 8-14 days (< 0.001) prior to infection and the mortality rate (p = 0.003) were also significantly high among patients with LREfm infections. Linezolid and vancomycin resistance coexisted; further, MDR, XDR and PDR phenotypes were significantly higher among LREfm. This study provided insight into epidemiology of MDR LREfm in a setting where linezolid use is high. The main drivers of infections with LREfm are multiple, including use of carbapenems and linezolid. Invasive procedures and increased hospital stay facilitate spread through breach in infection control practises. As therapeutic options are limited, ongoing surveillance of LREfm and VRE is critical to guide appropriate use of linezolid and infection control policies.