Emergency Unit Research Articles

Current antibiotic resistance of Enterobacteriaceae isolated at Avicenna military hospital of Marrakesh

Enterobacteriaceae are bacteria found in the digestive system, known for causing infections and displaying antibiotic resistance. The World Health Organization (WHO) identifies strains resistant to third-generation cephalosporins and carbapenems as priority pathogens. This study, conducted at Avicenne Military Hospital of Marrakech, aimed to assess the epidemiological and antibiotic resistance profiles of Enterobacteriaceae over a two-year period (May 2020 - April 2022) to inform updated antibiotic use recommendations. This retrospective study analyzed 1,626 positive bacterial isolates from various hospital departments, including medical, surgical, intensive care, emergency units, and external samples. Of these, 1,163 (71.5%) were Enterobacteriaceae, predominantly Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, primarily isolated from urine, pus, and blood cultures. Antibiotic resistance was assessed, revealing that 614 (52.8%) of Enterobacteriaceae were extended-spectrum beta-lactamase producers (ESBL-E), and 115 (9.9%) were carbapenemase-producing Enterobacteriaceae (CPE). The study’s findings align with existing literature, showing a higher prevalence of Enterobacteriaceae in males and frequent isolation of Escherichia coli. The rise in multidrug-resistant Enterobacteriaceae, particularly ESBL-E and CPE, poses risks such as therapeutic failure, increased morbidity and mortality, and significant economic impacts. To address this, the study emphasizes the importance of early detection, infection control measures, responsible antibiotic prescribing, and collaborative efforts across hospital departments to reduce the spread of resistant strains.

Improving health workers’ well-being in Cittadella Hospital (Province of Padua)

Abstract Issue A healthy workplace increases productivity, creativity and decreases absenteeism and turn-over. It also contributes to creating a more secure work environment with fewer risks of violence. In the past 3 years, the healthcare system has suffered the psychological, economic and social consequences of the COVID-19 pandemic. On the other hand, the healthcare staff reductions determine high levels of work related stress that are often unsustainable. Description In an effort to improve staff well-being, in the Hospital of Cittadella, which counts nearly 1,250 employees, a wide range of activities have been initiated. A questionnaire was submitted to the hospital’s staff and the results showed that nearly 10% of workers had experienced physical symptomatology related to work. The most commonly experienced symptoms included: anxiety, nervousness, headache, stomach ache, excessive fatigue and insomnia. Participants also indicated feeling excessive mental fatigue and emotional overload at the end of their work shift. Results Psychomotor practice, held according to the Aucouturier method, is one of the projects intended especially for the staff operating in Intensive Care, Emergency and Pneumology Units. This method brings focus to controlled breathing, posture, muscle work and movement that help manage stress and fatigue. A Qigong course, which is an ancient Chinese practice designed to optimize the energy within the body reducing the stress levels and increasing general wellbeing, was held every two weeks for 5 months. And finally, Tibetan singing crystal bowls sessions consisted of monthly guided meditation sessions using the sounds of the crystal bowls. Lessons In conclusion, well-being and organizational performance are closely related to each other. It is crucial for any organization to encourage and maintain better physical and mental health of the healthcare staff as it directly affects productivity and consequently user’s satisfaction of the services provided. Key messages • Stress management is important amongst healthcare professionals as they are continuously exposed to different job stressors. • Promoting self awareness and self care can help create a healthier work environment.

A Cross-Sectional Study of the Perception of Individualized Nursing Care Among Nurses in Acute Medical and Perioperative Settings

Background/Objectives: Individualized nursing care allows for systematic assessment and intervention; considers a patient’s preferences, values, and context; and contributes to a positive care trajectory. However, its operationalization has proven to be challenging. This research aimed to evaluate nurses’ perceptions of individualized care and analyze their relationship with sociodemographic variables. Methods: A cross-sectional study was conducted on 122 eligible and registered nurses at a Hospital Center, in the Ophthalmology (operating room and inpatient ward) service, the Cardiology service, the Internal Medicine service, and the Medical Emergency Unit, for adults/older adults in Portugal. The nursing version of the Individualized Care Scale (ICS-Nurse) was used for the assessment, including three sub-dimensions: clinical situation, personal life situation, and decisional control over care-related decisions. Cronbach’s alpha and principal component analysis were used for the data analysis. The STROBE checklist was used to report this study. Results: No statistically significant differences were found based on the age, gender, level of education, or years of professional experience of the nurses within the sub-dimensions of individualization. The nurses overall had a good perception of the importance of individualized care (4.06 ± 0.46 ICS-A-NURSE) but faced difficulties in its implementation during the last shift they worked (3.97 ± 0.49 ICS-B-NURSE). Conclusions: The items considered to be of greatest importance were the response to the physical and emotional needs arising from illness and assistance in decision-making through educational instructions. Aspects related to the personal lives of patients, such as family inclusion in an individual’s care plan, everyday habits, and previous experiences of hospitalization, received the lowest scores. Recognizing priority areas for improvement in the individualization of nursing care can contribute to developing training programs and policies that promote a holistic approach. Future studies should consider patient outcomes related to their needs for individualization.

Osteosarcoma with Pathological Fracture: A Rare Case Report

Introduction: Osteosarcoma is a primary malignant bone tumor originating from stem cells and is characterized by the proliferation of tumor cells that directly form immature bone or bone-like tissue. Osteosarcoma represents only 3% to 5% of all spinal malignancies. The aim of study is to discuss the importance of diagnostic investigation for a relatively rare case of spinal osteosarcoma. Case presentation: A 49 years old female came to the Emergency Unit, with a chief complaint of bilateral weakness of lower extremities for 1 year and worsening in 2 weeks. Upon examination, the initial diagnosis was mistaken for a spinal canal stenosis because metastatic bone disease from previous history of malignant melanoma. Subsequently, a decompression with stabilization fusion and biopsy is performed. Primary osteosarcoma was confirmed from histopathology results. Further chemotherapy is planned referring to confirmed primary osteosarcoma on histopathology. Discussion: Spinal osteosarcoma is very rare. Osteosarcoma occurs most frequently in the appendicular skeleton, especially the distal femur and proximal tibial metaphysis, which account for 90% of all cases. Primary osteosarcomas of the vertebral column are uncommon and occur dominantly in the vertebral body. Biopsy remains the gold standard of care for diagnosis. Conclusion: The performance of MRI and pathologic evaluation with immunohistochemistry is particularly important for the differential diagnosis of soft tissue tumors. Histopathologic analysis also plays an important role in differentiating from metastatic bone disease. An aggressive treatment plan and long-term follow-up are mandatory in managing this case. Keywords: osteosarcoma, spinal osteosarcoma, spinal canal stenosis, malignancy, pathological fracture, rare case.

Clinical Features and Complications of External Auditory Canal Foreign Bodies in the ENT Emergency Unit.

Objective: To determine the risk factor for developing complications in patients undergoing removal procedures for foreign bodies (FBs) in the external auditory canal (EAC) in the otolaryngology (ENT) emergency unit. Methods: Cases involving patients with EAC FBs treated at the ENT emergency unit of a tertiary medical center were retrospectively recruited. Patients were classified into the age < 10 years and ≥10 years groups. Univariate analyses of the complication rates were performed in all patients and the two age groups. Results: The mean age of the 457 patients was 29.9 ± 19.9 (range, 1.0-89.0) years; 42.7% (n = 195) were under 10 years of age, and 57.1% (n = 261) were male. Complications following FB removal occurred in 40 cases (8.8%), with EAC laceration being the most common (4.4%). Patients under 10 years of age had a higher risk of developing complications than those over 10 years (13.8% vs 5.0%, P = .001), with the younger group also showing an increased risk of EAC laceration (6.7% vs 2.7%, P = .039). Conclusion: Patients under 10 years of age had a significantly-higher rate of complications after EAC FB removal in the ENT emergency unit. Sedation or surgical removal under general anesthesia should be considered to minimize the risk of complications after a failed removal under direct vision in this patient group. Further studies are warranted to verify this implication for clinical practice.

Long-term mortality in patients with chronic obstructive pulmonary disease requiring acute non-invasive ventilation with and without obstructive sleep apnoea

IntroductionChronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome (OVS) is associated with higher mortality compared with COPD alone in stable outpatients. However, the prognosis of patients hospitalised with...

The Double-Edged Sword of Immunotherapy—Durvalumab-Induced Polyendocrinopathy—Case Report

Introduction: Immunotherapy is one of the greatest advancements in oncological patient care. The broader the treatment application, the more common the adverse events associated with the therapy. Immune checkpoint inhibitors (ICI) are currently used in numerous malignancies. These drugs influence the immune cells’ interactions, which translates to interruption of immune evasion and increased anti-tumor activity. However, the disruption of immunological signaling pathways often leads to adverse events, such as endocrinological insufficiencies, among which thyroid is the most common. Moreover, the co-appearance of several insufficiencies has been previously described. Case report: A 73-year-old female treated with durvalumab due to non-small cell lung carcinoma was admitted to the emergency unit due to symptoms of ketoacidosis. She had a history of well-controlled type 2 diabetes mellitus and autoimmune thyroiditis. Laboratory results showed increased anti-GAD antibodies, while the low C-peptide level indicated type 1 diabetes mellitus. Moreover, over the course of longer observation, the patient presented with abrupt aggravation of her autoimmune thyroiditis. Conclusions: The new onset of endocrinological insufficiencies is a rare adverse event of immunotherapy. Clinicians must pay particular attention to any signs indicating these life-threatening conditions. In case of the appearance of any endocrinological adverse event, the close cooperation of oncologists and endocrinologists is required to enhance patients’ quality of life.

CHARACTERISTICS OF WORKPLACE AGGRESSION IN MEDICAL PRACTICE

Purpose: To study and analyze the presence of aggression in the workplace among medical professionals in emergency departments. Material/Methods: The study included 227 medical and non-medical personnel from emergency units in the Varna region. Documentary, sociological, and statistical methods are applied. The study was carried out in 2023. Results: A large proportion of emergency workers were the object of aggression from patients or their relatives during work (84.1%, n=191). The object of aggression is the employees in the age group of 51-65 years (35.2%, n=80). More often, aggression is verbal aggression. Doctors and nurses are the object of aggression more often than other categories of staff. Aggression leads to a decrease in the pace of work, intention to leave the workplace, etc. Negative emotional reactions to the intake of alcohol or narcotic substances are among the reasons leading to aggression of the patient or his relatives. Conclusion: The professional activity of medical specialists is related to mental and physical stress. Violence in the workplace is a prerequisite for stress and anxiety. It adversely affects workers.

The effect of three different nonpharmacological methods on cannulation success during peripheral intravenous catheter placement in the emergency unit: a randomized controlled trial

BackgroundPeripheral intravenous catheterization is frequently performed in emergency units, but it is a procedure which is difficult for healthcare professionals and painful for patients. The primary objective of the present study was to examine the effect on venous dilation, procedure duration and pain severity of local heat, cold and vibration applications performed on the intervention area before peripheral intravenous catheterization in adults. The second objective of the study was to examine the effects of age and gender variables on the participants’ pain intensity levels.MethodsA single-blinded randomized controlled trial. The study included 120 adults who were randomly selected between March and August 2023. One application group (n = 30) received local heat application, one group (n = 30) received local cold application, and one (n = 30) received local vibration using the Buzzy® device. The applications, to the site of the peripheral intravenous catheterization, lasted one minute. The control group (n = 30) received standard peripheral intravenous catheterization application. The groups’ vein dilation was assessed with the vein assessment scale, pain felt during catheterization with the visual analog scale, and the duration of the procedure with a chronometer.ResultsIt was found that the venous dilation of the cold application group was significantly higher (p = 0.010, p = 0.015 respectively) and procedure duration was shorter (p = 0.013, p < 0.001 respectively) than that of the heat and vibration application groups, and its pain severity was significantly lower (p = 0.002, p = 0.001 and p = 0.001 respectively) than that of the control group and the heat and vibration application groups.ConclusionsIt was determined that local cold application for one minute to the area of peripheral intravenous catheterization increased venous dilation, shortened application time, and reduced pain.Trial registrationClinicalTrials.gov ID NCT06378424, retrospectively registered 20/04/2024.

Childhood cerebral malaria: Pattern of biochemical parameters and clinical outcome in a Nigerian tertiary hospital

BackgroundThe outcome of children with cerebral malaria involves an interplay of factors including clinical and biochemical parameters, a deep knowledge of these laboratory biochemical parameters is essential. Thus, this study aimed to assess the pattern of the biochemical parameters in children with cerebral malaria and how it may affect the clinical outcomes. MethodsA prospective observational cohort study among fifty subjects at the children's emergency unit. The participants were children aged 6 months to 12 years admitted with a history of fever and altered sensorium, demonstrable malaria parasite in the blood film and cerebrospinal fluid (CSF) analysis not suggestive of central nervous system (CNS) infections. Detailed history was taken with thorough examinations of each child. Samples were collected for malaria parasites, serum electrolytes, urea, creatinine, and blood glucose values. The clinical outcomes were correlated with the analyte levels. Results60 % of the children survived without any sequelae with the highest proportion (70 %) of survivors being children above five years. Children with hypoglycemia had a 3.5-fold higher risk of poor outcomes and this is statistically significant (RR = 3.65 p = 0.014). Hyperkalaemia was significantly associated with poor outcomes (RR = 2.57, p = 0.009). Subjects with hypochloraemia had three times the risk of poor outcome and mortality with statistically significant association (RR = 3.07, χ2 = 8.519, p = 0.004). There was a significant association between metabolic acidosis and poor clinical outcome. (RR = 1.99, χ2 = 4.089, p = 0.043). The parasite density was significantly associated with the serum bicarbonate (HCO3−) and Chloride, p-value < 0.05. ConclusionHypoglycaemia, hyperkalemia, hypochloremia and metabolic acidosis were significantly associated with poor outcomes, thus, good predictors of clinical outcomes in children diagnosed with cerebral malaria. Periodic evaluation and monitoring of these parameters is essential for prompt intervention to forestall devastating outcomes.

Nursing procedures for assisting victims of violence in emergency units

The objective of this study was to carry out the cross-cultural adaptation of the Questionnaire on Preservation of Traces in Victim Assistance by Nurses to the Brazilian reality. The method used was composed by the steps: (1) semantic equivalence; (2) idiomatic equivalence; (3) empirical equivalence; (4) conceptual equivalence; and (5) pre-test. Based on the experts' analysis and recommendations, adjustments were made regarding semantic and empirical equivalence; during the assessment of idiomatic and conceptual equivalence, no changes were made. The pre-test was performed with 24 nurses and the value of Cronbach's alpha coefficient was α = 0.973. The instrument's feasibility assessment showed that most participants found it easy to understand the questionnaire's instructions and questions and mark the answers, which demonstrates its validity with the sample in the pre-test. The performance of the forensic nurse is essential in emergency services. The adapted instrument is valid for use in the Brazilian context.

A-005 Comparison of Performance of High Sensitive Troponin I (cTNIH) by “Point of care” (POC) and Automated cTNIH Immunoassays in Patients at Low Risk of Heart Attack in a Chilean Emergency Unit; Impact on E.R Department Efficiency

Abstract Background Most cases of death from Acute Myocardial Infarction (AMI) occur in the first hours after the manifestation of clinical symptoms, constituting 40 to 65% in the first hour and approximately 80% in the first 24 hours. For the safe, effective, and rapid diagnosis of a patient with suspected AMI, international guidelines recommend that it be done based on clinical symptoms, together with electrocardiogram and analysis of biomarkers in the context of suspected of non-ST-elevation myocardial infarction (NSTEMI). Troponins are the biomarkers of choice with level A level evidence and the ability to perform screening in patients complaining of chest pain and refer it to the correct clinical approach based on the 0h/1h algorithm. To date, the successful clinical implementation of these rapid algorithms is restricted to hospitals working with well-defined workflows and a robust central laboratory structure. The Atellica® vTLi analyzer is based on the chemiluminescence methodology for the quantification of hs-cTnI levels with low sample volume, low complexity, and may enable the rapid management of patients with chest pain and application of 0h/1h algorithm. Objectives The aim of the study is to evaluate clinical performance in effectiveness and efficiency of the hs-cTnI Atellica® vTLi point of care test to rule out acute myocardial infarction in subjects with low-risk chest pain established with a validated predictive rule, in an adult-Chilean emergency unit, compared to clinical evaluation and the commonly used ADVIA Centaur® troponin test. Methods Descriptive, observational, longitudinal study. Patients over 18 years of age, consulting with acute chest pain of at least one hour from symptom onset and a HEART SCORE less than or equal to 3 points were recruited. A venous blood sample was requested for hs-cTnI analysis by Atellica® vTLi Siemens Healthineers and ADVIA Centaur® Siemens Healthineers. The time difference between sample collection and start of sample analysis; the time difference between sample collection and release of sample results was recorded and the concordance between the two results was determined. Results 50 subjects were included in the study. The difference between blood sampling and start of sample analysis was 5 minutes with Atellica® vTLi POC and 68 minutes with ADVIA Centaur®. The concordance of hs-cTnI Atellica® vTLi POC and ADVIA Centaur® was 94% for predicting medical discharge and confirmed acute myocardial infarction. Conclusions The study findings support the safety and efficiency of the hs-cTnI POC test by providing faster results than central laboratory tests with the same analytical quality, with direct impact on reducing care times in patients consulting for low-risk chest pain.

The comprehensive geriatric assessment in emergency and intensive unit settings

This review discusses the challenges that hospitals face when caring for older patients in emergency departments and intensive care units. Beyond chronic diseases, the older person is often affected by acute events, which require, in addition to the typical knowledge of emergency medicine and anesthesia, the holistic and targeted approach of the comprehensive geriatric assessment in the emergency room and intensive care setting. With Italy’s health centers struggling to manage the increasing pressure of patients, the COVID-19 pandemic has highlighted the need for a geriatric approach to address this challenge. This review outlines the Geriatric 5Ms Model of Care, which addresses five domains, and the Domain Management Model, which provides acute medical management.

Intra-orbital Foreign Body

Abstract Background: This case report describes a young man with an intra-orbital foreign body (FB) in both eyes. Case Report: Intra-orbital FBs are rare, with few cases reported in the literature. This is because the orbit protects the globe from external forces, and the orbit is a closed cavity with one opening. This report details the case of a 28-year-old man who presented to the emergency unit with an 11-hour history of an intra-orbital FB. The patient was lying on a bench when a stationary motorcycle fell on him. He noticed that he was unable to open both eyes and was rushed to a peripheral hospital, then subsequently referred to this tertiary center. On examination, he was ill-looking and anxious but not febrile or pale. Systemic examination did not reveal any abnormality. Unaided visual acuity in the right eye (OD) was nil perception of light, while left eye visual acuity (OS) was counting fingers. The right eyelid was ptotic due to edema. He underwent basic laboratory investigations that were all normal. A plain X-ray revealed a radio-opaque FB penetrating the left orbit, fracturing the medial walls into the right orbit, with the round end positioned behind the right globe. The FB was identified as a broken part of a brake/clutch lever from the motorcycle. A computerized tomography scan showed a metallic object in both orbits, accompanied by pneumocephalus, and suggested transection of the right optic nerve. The patient was prepared for FB removal and repair of the lid penetration under general anesthesia, following review by the ENT surgeon and neurosurgeon. The brake lever was successfully removed, and the patient was administered antibiotics. Post-operatively, visual acuity in the right eye remained at nil perception of light, while that in the left eye improved to 6/9 upon discharge. Conclusion: There is no established protocol for managing intra-orbital FBs, as removal depends on factors such as the size, composition, and potential compression damage to structures around the globe, which could further compromise vision or function. Small inert objects may be left in place if removal would cause damage. However, in this case, removal was deemed necessary for several reasons.

Nurses’ Experiences with the Use of Electronic Nursing Record: A Qualitative Study

Background: The electronic nursing record has contributed to improving nursing practice and ensuring nursing quality, but it is still incomplete in supporting nursing workflow. The purpose of this study is to explore the experience of using the electronic nursing record by nurses working in frontline care for trauma, emergency, and infectious disease-exposed patients.Methods: The study employed a qualitative descriptive design and qualitative content analysis. In-depth interviews were conducted with 10 nurses working in emergency, trauma, and critical care units in the tertiary hospital.Results: The nurses’ experiences with the use of the electronic nursing record emerged into three subjects (improvements to electronic nursing record implementation, benefits of electronic nursing record implementation, electronic nursing record user factors), five categories (information finding and sharing function, information input function, facilitating efficient communication, ensuring record quality, need for education), and eight subcategories.Conclusions: Electronic nursing record supports the visualization of special information such as emergency and infection, and has the advantage of facilitating communication between medical staff. Both support better clinical decision-making. However, system instability and low nursing friendliness delay nursing work in the process of inputting, confirming, and sharing information. Copy-andpaste practices, poor quality of records, and insufficient electronic nursing record education were identified as factors to be changed on the user side. Improvement of nursing-friendly interfaces, optimization of nursing workflows, and participation of nurses in the improvement process are necessary. We should also focus on developing electronic nursing record education programs.

Road Traffic Crash-Related Musculoskeletal Injuries in Bafoussam, Cameroon: Exploring the Gaps in Physiotherapy Access and Utilization: A pilot study

Background: Road traffic crashes worldwide result in significant morbidity and mortality, with musculoskeletal injuries often neglected in primary management. This study aims to investigate the prevalence and management of Road Traffic Crash-Related Musculoskeletal Injuries (RTCMI) in Bafoussam, Cameroon. Methods: We conducted a prospective cross-sectional study in Bafoussam's hospital emergency units from January to June 2024. Using an exhaustive sampling, we enrolled 120 road traffic traumatic victims who provided informed consent to participate in the study. We excluded patients unable to communicate due to trauma status. Data analysis employed Excel 2016 with a 95% confidence interval. Results: Our study revealed a RTCMI prevalence of 73%, with fractures being the most common injury (80%). Notably, physiotherapy was not prescribed in primary management, and only 11% received Physiotherapy prescriptions in secondary care. A mere 17% of respondents requested physiotherapy, citing prescription failure (100%), lack of knowledge (83.6%), preference for traditional treatment (21.9%), and high costs (2.7%) as barriers. Conclusion: This study highlights the need for further research into RTCMI management and physiotherapy integration in Cameroon. Our findings suggest significant gaps in prescription, awareness, and accessibility, emphasizing the importance of scaling up this study to inform healthcare policy and practice.

An Audit of Post-neonatal Infant Morbidity and Mortality from Admissions in an Emergency Unit of a Tertiary Hospital in Sokoto, Northwest Nigeria

Background The first year of life is a critical period of adaptation for a young infant during which the child becomes exposed to a lot of infectious agents and other environmental problems as its immune systems and other organs are developing. Magnitude of deaths within the first year of life is a significant socioeconomic index of any population. Challenges can also be brought to the forefront which can be tackled by appropriate authorities. Objectives To assess the causes of morbidity and mortality amongst infants aged 29 days to 12 months admitted in the emergency Paediatric unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto over a 5- year period. Materials and Methods The admission records of children aged 29 days to 12 months were retrieved. Information extracted included socio-demographic data, diagnosis and outcome of admission. These were entered into a study proforma and analysed with SPSS version 23. Results Total admissions were 1776 in the five-year review. Majority were males accounting for 1030 (58%) with M:F ratio of 1.38:1. 972 (55.4%) were aged 6 to 12 months. Top causes of admissions were diarrhoea disease 328 (18.5%), pneumonia 280 (15.8%), sepsis 211 (11.9%), malaria 202 (11.4%) and malnutrition 154 (8.7%). Mortalities were 223 (12.6%). Highest fatalities out of 223 were from sepsis 47 (21.1%), pneumonia 40 (17.9%), malaria 27 (12.1%), malnutrition 25 (11.2%) and diarrhoea disease 20 (9.0%). Higher proportion of the mortalities were in females 14.5% vs 11.2% (X2 = 4.3; p=0.038). Sepsis mortality was high throughout likewise pneumonia but mortality pattern of other disease conditions varied throughout infancy. Conclusion Post-neonatal admissions were mainly due to infections, likewise mortality of which the top causes varied throughout infancy. Females were more proportionately affected by mortality. These insights on the morbidity and mortality patterns calls for more concerted efforts on child survival strategies and targeting this group of infants is imperative.

Length of stay and associated factors among pediatric patients in the pediatric emergency unit of the Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

BackgroundLength of stay in the emergency department is used as a quality indicator to gauge the overall efficiency of emergency care. The performance measure was used to evaluate the quality of care provided in the emergency department.ObjectiveTo assess the length of stay and associated factors among pediatric patients admitted to the pediatric emergency unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.MethodsAn institution-based prospective cross-sectional study design was employed. A systematic random sampling technique was used to select the study participants. Data were collected via semi-structured, interviewer-administered questionnaires and chart reviews. Analysis was performed via the Statistical Package for Social Science software version 27. Binary logistic regression analysis was conducted to identify variables associated with the length of stay. The study was conducted in the Pediatric Emergency Unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, from March 15 to April 15, 2023.ResultsA total of 268 patients participated in the study, with a response rate of 97.81%. The majority of the participants were male (157, 58.6%), with a median age of 3 years. The study revealed that 180 participants (67.2%) experienced a prolonged length of stay. The variables significantly associated with prolonged length of stay included residency (AOR = 2.04, CI: 1.03, 4.025), triage category (AOR = 3.25, CI: 1.08, 5.974), number of investigations (AOR = 2.381, CI: 1.038, 5.462), and waiting for imaging (AOR = 4.230, CI: 1.638, 10.93).ConclusionMany pediatric patients stayed in the emergency room for more than 24 h because of factors such as residency, triage category, number of investigations, and the need for imaging. To address this, we recommend streamlining triage processes, increasing imaging resources, providing additional staff training, developing integrated care pathways, and advocating for policy changes to increase emergency room efficiency and improve patient outcomes.

Incidence and Antibiotic Resistance Patterns of Staphylococcus aureus and Pseudomonas aeruginosa Isolated from Fomites in Critical Units of General Hospital Katsina

Study’s Excerpt Investigation of the role of fomites in the transmission of nosocomial pathogens, specifically Staphylococcus aureus and Pseudomonas aeruginosa, within various units of General Hospital Katsina was carried out. The results reveal high contamination of fomites in the male ward, with significant bacterial colony counts, and the differing susceptibility profiles of S. aureus and P. aeruginosa to commonly used antibiotics. There is need for improved infection control and antibiotic stewardship in the region. Full Abstract Nosocomial infections, predominantly caused by Staphylococcus aureus and Pseudomonas aeruginosa, continue to be a major public health challenge, especially in developing countries, due to their associated morbidity and mortality. This study aimed to isolate and identify bacterial pathogens from fomites in the Accident and Emergency (A&amp;E) unit, male ward, and female ward of General Hospital Katsina and to evaluate their antimicrobial susceptibility patterns. A total of 90 swab samples were collected from frequently touched items such as beddings, door handles, floor surfaces, scissors, and forceps across the three locations. Standard microbiological techniques were utilized for the isolation and identification of S. aureus and P. aeruginosa, followed by antibacterial susceptibility testing using the disc diffusion method. Bacterial growth was observed in 58 (64.4%) samples, with S. aureus accounting for 32 (55.2%) and P. aeruginosa for 26 (44.8%) of the isolates. The male ward exhibited the highest contamination levels, with a mean colony count of 725.25 CFU/plate, significantly higher than the female ward (487.67 CFU/plate) and the A&amp;E unit (48 CFU/plate), as confirmed by a one-way ANOVA (p &lt; 0.05). Chi-square analysis revealed no statistically significant association between bacterial species and hospital location (p = 0.823). The susceptibility testing showed that S. aureus isolates were generally susceptible to Gentamycin, Ciprofloxacin, and Pefloxacin but resistant to Amoxicillin. Conversely, P. aeruginosa displayed high resistance to Gentamycin and Septrin. Conclusively, these findings revealed the critical role of fomites in the transmission of pathogens and highlighted the need for enhanced infection control measures and targeted antibiotic stewardship programs to mitigate the risks associated with these infections.

Prevalence of inappropriate antibiotic doses among pediatric patients of inpatient, outpatient, and emergency care units in Bangladesh: A cross-sectional study.

The heterogeneous pediatric populations, their physiological differences, along with the necessity of performing additional dose calculation, make the pediatric population more vulnerable to the incidences of inappropriate antibiotic doses. This study was conducted to examine and evaluate the appropriateness of antibiotic doses. A cross-sectional study with a quantitative approach was conducted in three hospitals located in Savar from January 06, 2021 to October 17, 2022. This study had used a convenient sampling method to collect 405 filled prescription orders from heterogeneous pediatric patients prescribed by physicians from emergency, inpatient, and outpatient care units of various clinical settings. The Harriet Lane Handbook was used as reference to investigate inappropriate doses of antibiotics. Subsequently, all analyses were conducted using the RStudio 1.3.959 software. Binary logistic regression was used to assess the risk of inappropriate antibiotic prescription in pediatrics. The overall prevalence of inappropriate antibiotic dosing in pediatrics was 335 out of 545 (61.5%). Overdosing (36.3%) and oral antibiotic prescriptions (64%) were more common than underdosing (20.4%) and parenteral antibiotics (36%). The majority (230 out of 405, 56.8%) of pediatric patients had prescriptions with inappropriate antibiotic doses, with prevalence rates of 33.8% for inpatients, 86.7% for outpatients, and 50% for emergency pediatrics. The results also indicated that pediatric patients in outdoor and emergency care units, infants, toddlers, and early childhood, those prescribed two antibiotics simultaneously, and those receiving parenteral antibiotics, were less likely to have inappropriate antibiotic dosages in their prescriptions. This study demonstrated that about one out of every two prescriptions had inappropriate antibiotic doses; in particular, prescriptions containing only one antibiotic exhibited a substantial proportion of inappropriate antibiotic doses. Inappropriate antibiotic doses may result in therapeutic failure, patient harm, and antibiotic resistance. Good clinical pharmacy practice and careful adherence to pediatric dosing standards may minimize inappropriate antibiotic doses.