Hospitals In Trinidad Research Articles

Whole genome sequencing reveals complex resistome features of Klebsiella pneumoniae isolated from patients at major hospitals in Trinidad, West Indies

ObjectivesAntibiotic-resistant Klebsiella pneumoniae is a human pathogen of major global concern due to its ability to cause multiple severe diseases that are often difficult to treat therapeutically. This study aimed to investigate the resistome of local clinical K. pneumoniae isolates. MethodsHerein, we used a whole genome sequencing approach and bioinformatics tools to reconstruct the resistome of 10 clinical K. pneumoniae isolates and one clinical isolate of the closely related Klebsiella quasipneumoniae obtained from patients from three major hospitals in Trinidad, West Indies. ResultsThe results of the study revealed the presence of a complex antibiotic-resistant armoury among the local isolates with multiple resistance mechanisms involving (i) inactivation of antibiotics, (ii) efflux pumps, (iii) antibiotic target alteration, protection, and replacement against antibiotics, and (iv) altered porin protein that reduced the permeability to antibiotics. Several resistance genes such as blaCTX-M-15, blaTEM-1B, blaSHV-28, blaKPC-2, oqxA, sul1, tetD, aac(6′)-Ib-cr5, aph(6)-Id, and fosA6, which are known to confer resistance to antibiotics used to treat K. pneumoniae infections. In most cases, the resistance genes were flanked by mobile elements, including insertion sequences and transposons, which facilitate the spread of these genetic features among related organisms. ConclusionThis is the first comprehensive study to thoroughly investigate the resistome of clinical K. pneumoniae isolates and K. quasipneumoniae from Trinidad, West Indies. These findings suggest that monitoring K. pneumoniae and its genome-wide antibiotic resistance features in clinical strains would be of critical importance for guiding antibiotic stewardship programs and improving regional disease management systems for this pathogen.

Comparative genomics and virulome analysis reveal unique features associated with clinical strains of Klebsiella pneumoniae and Klebsiella quasipneumoniae from Trinidad, West Indies.

Klebsiella pneumoniae and Klebsiella quasipneumoniae are closely related human pathogens of global concern. The more recently described K. quasipneumoniae shares similar morphological characteristics with K. pneumoniae and is commonly misidentified as this species using traditional laboratory techniques. The vast mobilome in these pathogenic bacteria influences the dissemination of virulence factors in high-risk environments and it is, therefore, critical to monitor strains for developing effective clinical management strategies. Herein, this study utilized Illumina sequencing to characterize the whole genomes of nine clinical K. pneumoniae and one K. quasipneumoniae isolate obtained from patients of 3 major hospitals in Trinidad, West Indies. Reconstruction of the assembled genomes and implementation of several bioinformatic tools revealed unique features such as high pathogenicity islands associated with the isolates. The K. pneumoniae isolates were categorized as classical (n = 3), uropathogenic (n = 5), or hypervirulent (n = 1) strains. In silico multilocus sequence typing, and phylogenetic analysis showed that isolates were related to several international high-risk genotypes, including sequence types ST11, ST15, ST86, and ST307. Analysis of the virulome and mobilome of these pathogens showed unique and clinically important features including the presence of genes associated with Type 1 and Type 3 fimbriae, the aerobactin and yersiniabactin siderophore systems, the K2 and O1/2, and the O3 and O5 serotypes. These genes were either on or in close proximity to insertion sequence elements, phage sequences, and plasmids. Several secretion systems including the Type VI system and relevant effector proteins were prevalent in the local isolates. This is the first comprehensive study investigating the genomes of clinical K. pneumoniae and K. quasipneumoniae isolates from Trinidad, West Indies. The data presented illustrate the diversity of Trinidadian clinical K. pneumoniae isolates as well as significant virulence biomarkers and mobile elements associated with these isolates. Additionally, the genomes of the local isolates will add to global databases and thus can be used in future surveillance or genomic studies in this country and the wider Caribbean region.

Attitudes and Perceived Barriers to Research Among Residents in Obstetrics and Gynecology in Trinidad and Tobago: A National Multicenter Cross-sectional Study.

High-quality research forms the basis of evidence-based practice and sets the foundation for trainees to develop critical thinking skills and approach clinical problems with an inquisitive mind. The attitudes to research however vary widely and there are significant barriers to conducting research relevant to each clinical discipline. Understanding both the attitudes of residents to research and the barriers to conducting research could allow for strategies to improve this core aspect of clinical development. This aim of this study was to characterise current attitudes and perceived barriers towards conducting research among residents in Obstetrics and Gynecology in Trinidad and Tobago. An online survey was sent to all residents in the four major public hospitals in Trinidad and Tobago. The 10-min previously piloted questionnaire contained questions related to demographics, career level, research experience, attitudes to research as well as perceived barriers to conducting research. The response rate was 74% (48/65). Although most (77%) respondents were interested in performing research, lack of time (56%) and insufficient training in research (59%) were the main barriers. Lack of mentorship or supervision as well as departmental issues such as access to case notes, electronic databases and bureaucratic issues were also found to hamper a research-oriented environment. For residents in Obstetrics and Gynecology, curricula revision is urgently required to include protected research time, training in research methodology, formal and dedicated research mentors in order to promote a research-oriented culture that ensures a greater understanding and output of research in this specialty.

A Short Report on Strokes at San Fernando General Hospital

ABSTRACT Stroke is a leading cause of mortality and disability globally and has been noted to have an increased incidence in developing countries. Despite being a highly prevalent non-communicable disease only limited data currently exist in Trinidad and Tobago. A cross-sectional study was done as an audit to assess stroke admissions for all patients older than 16 years old at San Fernando General Hospital. During the period 28th October, 2020 to 8th January, 2021 (72 days) there were 411 total stroke admissions (5.6 strokes per day). This consisted of 56.4% females and 43.6% males with the majority between the ages of 50 to 80 years for both sexes. Most stroke admissions were of Indo-Trinidadian ethnicity (60.2%) followed by Afro-Trinidadian (35.3%). Of the total stroke admissions 91.1% were found to be ischemic with 2.0% TIAs, and 5.9% hemorrhagic. Hypertension was the most common comorbidity found in stroke patients followed by diabetes mellitus at 77% and 51% respectively. Of the total stroke admissions, 34% had previous strokes. Length of stay averaged 5.3 days with a standard deviation of 9 days. The derived estimate of 347 strokes per 100,000 per year is comparable to the highest incidence globally. This high incidence was revealed despite factors that may lead the overall total to be an underestimate (only one hospital’s region included and data collected during the COVID-19 pandemic). This preliminary study can be utilized to understand the burden of illness of stroke within one of the major hospitals in Trinidad and Tobago.

Characterization of Beta-Lactam Resistance Genes and Virulence Factors Associated with Multidrug-Resistant Klebsiella pneumoniae Isolated from Patients at Major Hospitals in Trinidad, West Indies.

Accurate species identification and antibiotic resistance profiling are essential for the effective management of infections caused by bacterial pathogens. In this study, 373 clinical isolates of K. pneumoniae from major hospitals in Trinidad, West Indies, were characterized for resistance against beta-lactam antibiotics and the presence of genes encoding important virulence factors. Most of the isolates showed extended spectrum β-lactamase (ESBL) activity but few also displayed carbapenemase or 'ESBL + carbapenemase' activities. Polymerase chain reaction analysis revealed the presence of genes for ESBL subtypes blaTEM, blaSHV, and blaCTX-M that were dominant in isolates with the ESBL phenotype as well as those that did not show ESBL or carbapenemase activities. The carbapenem resistance gene, blaKPC, and the metallo-β-lactamase (MBL) gene, blaNDM-1, were also detected in some of the isolates. Multiple virulence genes were also detected, but the fimH-uge was the most common combination found among the local isolates. The findings of this study represent the first comprehensive study on the prevalence of ESBL, KPC and MBL genes and virulence profiling in antibiotic-resistant K. pneumoniae in Trinidad. Furthermore, the occurrence of multiple resistant phenotypes and gene combinations were revealed, though at low prevalence rates. This work emphasizes the need to implement molecular-based techniques in diagnostic workflows for rapid and accurate species identification and profiling of resistance and virulence genes in K. pneumoniae in Trinidad and Tobago.

Laboratory predictors for COVID-19 Intensive Care Unit admissions in Trinidad and Tobago.

Understanding symptoms associated with COVID-19 cases requiring intensive care unit(ICU) attention is important in management of the life-threatening cases of the disease. This study aimed to determine laboratory indicators of ICU admission for COVID-19 patients. For this retrospective chart review study, data from 116 patients(ICU, n = 18, Non-ICU, n = 98) with confirmed SARS-CoV-2, managed at two hospitals in Trinidad and Tobago, from March 12th to April 12th 2020, were analyzed. The median age of non-ICU patients was 59.0(IQR = 23.5) years; ICU patients had a median age of 62.5(IR = 17.5). From univariate analysis, laboratory indicators significantly associated with ICU admission included WBC(P = 0.037), lymphocyte(P = 0.016), LDH(P = 0.002), AST(P = 0.005) and CRP(P = 0.0001). However, multivariate analysis including WBC, neutrophil, lymphocyte, PLT, AST, LDH, ALT and CRP indicated that only AST was associated with high odds of ICU admission(OR 0.002, 95% CI 0.000–0.004, P = 0.017). Statistically significant AUC were obtained for neutrophil(AUC = 0.704, P = 0.007), CRP (AUC = 0.81, p = 0.00) and LDH(AUC = 0.766, P = 0.00) and AST (AUC = 0.729, P = 0.003). The findings indicate that neutrophils, AST and LDH's ROC curves are good tests, CRP curve is a very good test, but lymphocyte curve is a poor test, in determining COVID-19 patients for ICU admission. Neutrophil, AST, LDH and CRP are suitable predictors of COVID-19 patients that should receive intensive unit care. The study provides significant insights into laboratory parameters that can be used to predict COVID-19 severity and important considerations for healthcare providers in making evidence-based decisions regarding COVID-19 patient management, especially in the context of limited ICU facilities. This study was not funded.

Quantitative phase analysis and microstructural characterization of urinary tract calculi with X-ray diffraction Rietveld analysis on a Caribbean island

In the twin-island state of Trinidad and Tobago, urinary stone analysis is not routinely performed. This study investigates, via powder X-ray diffraction, 52 urinary tract calculi collected from hospitals in Trinidad. Of these, 46 stones were analysed with Rietveld refinement for quantitative analysis and materials characterization. Refined unit-cell, microstructural and weight fraction parameters were obtained, with the last being used for stone classification. The results revealed seven distinct mineralogical phases of varying frequency: calcium oxalate monohydrate (COM, 58%), calcium oxalate dihydrate (COD, 23%), carbonated apatite (APA, 48%), brushite (BRU, 6%), struvite (STR, 42%), uric acid (UA, 23%) and ammonium acid urate (AAU, 19%). The average refined crystallite sizes were 1352 ± 90 Å (COM), 1921 ± 285 Å (COD), 83 ± 5 Å (APA), 1172 ± 9 Å (BRU), 1843 ± 138 Å (STR), 981 ± 87 Å (UA) and 292 ± 83 Å (AAU). Subsequently, 36.5% of stones were categorized as phosphates, 34.6% as oxalates, 13.5% as uric acid/urates and 15.4% as mixed compositions. The study findings highlight the importance of stone analysis as a necessary step towards disease management of local patients, and endorse the application of Rietveld refinement as a natural extension to diffraction-based kidney stone investigations.

Traditional Methods of Health Education are not enough to Reduce Major Lower Limb Amputations in Trinidad & Tobago; A Seven Year Retrospective Study

Background: Major lower extremity amputation is defined as any amputation of the limb performed above the level of the ankle. Indications often include severe infection, ischemia, trauma and tumours. Total amputation rate in Trinidad and Tobago (T&T) is not yet known. Data is only available from a single center in Trinidad and Tobago over a two year period and not from the entire country and the number of total amputation was based on simple speculation and general estimate. The aim of this study is to first time document the exact annual amputation rate in T&T with their demographic characteristics and also to find out whether the existing methods of health education are effective in reducing amputations. Methods: A retrospective review of all lower limb amputations was performed in all 5 public hospitals in Trinidad and Tobago from January 2012 to December 2018. Annual major lower limb amputations in the 10 private hospitals were also documented. Data collected on patients demographics included patient’s age, sex, race, and amputation type. Results: A total of 3586 (85.87%) major lower limb amputations were performed in the public and 590 (14.13%) in the private hospitals over our 7 year study period. The average annual major lower limb amputation rate in T&T is about 600 (596.5) with an average daily rate of 1.63. The mean age of our study group was 65.7 (23-103) years with a male to female ratio of 1.2:1. Afro Trinidadian accounted for 1962 (47%), Indo Trinidadian 1899 (42%) and other 11%. The predominant type of amputations was above knee 55.06% (n=2299) compared to below knee 44.94% (n=1877). Diabetic foot complications accounted for the majority of amputations in this study. The amputation rate has not declined over the years; rather there has been an annual increase over the study. Conclusions: The annual major lower limb amputation rate in T&T is significantly higher than previous estimates. This is very costly in the context of our limited resources and alarming on our already exhausted economy. This study shows that diabetes and peripheral vascular disease continue to be major risk factors for lower limb amputations: this negatively impacts the overall health of our society. Current methods have failed to reduce amputations. We recommend an integrated multidisciplinary approach involving doctors, diabetic nurse counselors, dieticians, podiatrists, physiotherapists, social welfare officers, politicians, religious leaders and social scientists. Continued education on diabetes, its complications and foot care as well as modifications of current methods are essential to minimize limb loss.

Nosocomial Infections at Three Regional Tertiary Hospitals in Trinidad and Tobago

Objective: The main objectives of this research were to conduct and provide accurate and original findings related to the epidemiological study of nosocomial infections at three regional tertiary hospitals in Trinidad and Tobago. Specifically, the researcher determined; the frequency of nosocomial infections (NI), the frequency of multiple drug resistance among bacterial organisms associated with NI, infection control measures practiced at the research hospitals and the cost of such NI in terms of morbidity and mortality Synopsis: This study estimated the rate of nosocomial infections (NI) among patients at three major regional hospitals in Trinidad and Tobago and evaluated the frequency of pathogens associated with nosocomial infections. Approximately 450 of 126, 668 patients had nosocomial infections and the most frequent type of nosocomial pathogens were: Staphylococcus sp. (22.5%), Pseudomonas aeruginosa sp. (12.7%), Acinetobacter (11.8%) and Klebsiella sp. (11.6%). Methods: A one-year prospective cross-sectional study was carried out. The nosocomial pathogens were retrieved from the microbiology laboratory. Antimicrobial susceptibility test by the disk diffusion method were done on all bacterial isolates. Data was analysed using SPSS version 20.0. Results: This research revealed that 450 inpatients suffered nosocomial infections, with thirty (30) mortalities during the twelve (12) months that the study lasted (June 2013 to May 2014) at three regional hospitals of Trinidad and Tobago. The incidence of nosocomial infections was 5.8% and the nosocomial infection rate was 3.6 per 1000 (450/126,668). The highest rate (30.1%) was observed in the Intensive Care Unit (82/272 admissions). The most frequent type of nosocomial infection was Skin and Soft Tissue Infections 168 (37.3%). Staphylococcus sp. (22.5%), Pseudomonas aeruginosa sp. (12.7%), Acinetobacter (11.8%) and Klebsiella sp. (11.6%) were the most frequently occurring nosocomial pathogens. Conclusion: Consistency in performing good hygiene practices is vital for reducing the high nosocomial rate found at the research sites. Prediction of these infections is very important as a part of clinical surveillance programs to take preventive measures in advance. The antimicrobial susceptibility pattern rate (ASPR) showed that only 8.3 % (5/60) of the isolates were antibiotic-susceptible strains.

Exploring the Knowledge Levels, Attitudes and Beliefs of Patients’ Relatives Towards Organ Donation in the Intensive Care Units of Two Majors Hospitals in Trinidad

Purpose: To ascertain the Knowledge levels, Attitudes and Beliefs towards Organ Donation by Relatives of Patients in the Intensive Care Unit at two Tertiary Care Hospitals in Trinidad.
 
 Methods: A quantitative descriptive study in which the researchers’-designed and pretested self-administered questionnaire was used on a sample of 133 randomly selected patients’ relatives from two main intensive care hospitals units of Trinidad. The respondents were requested to give their consent after necessary ethical approval was received. Data entry was done manually but the analysis was done with the SPSS version 12 programme. Results were presented as frequencies.
 
 Results: Demographic characteristics indicate that most were females, of African ethnicity, and Christianity as their main religion. The majority of participants had high level of knowledge (69.2%) while 57.9% of them had unfavourable attitude towards organ donation. Most (86.5%) had positive belief. It also showed that the respondents’ knowledge towards organ donation is significantly related to their age and religion, (P≤, 0.05) while their attitudes are significantly related to their gender and ethnicity (p≤0.05). Their belief is only significantly associated with their marital status.
 
 Discussion: The findings of the study were compared with previous studies and the researchers showed how the relevant theories that guided the study were used to explain the findings. 
 
 Conclusion: Based on the findings, the researchers made a number of recommendations particularly related to public education in attempt to address the attitudes of the public related to organ donation in Trinidad and Tobago.

Trends in place of death in a small developing country: a population-level study using death certificate data

BackgroundValuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of death (POD). Scarce data exist on the POD in...

Perceptions of Registered Nurses/Midwives and Obstetricians on Having Males as Expectant Fathers Present in the Delivery Room at Public Hospitals in Trinidad and Tobago: Implications for Women and Their Partners

This study explored the perspectives of obstetricians and registered nurses/midwives on the presence of expectant fathers in the delivery room with a view to understanding the implications for the mother as well as the expectant father. A qualitative research design using a phenomenological approach to understand the nuances and challenges that affect the perceptions and attitudes of obstetricians and registered nurses/midwives on the research issue. Five focus group discussions and five key informant interviews were the data collection strategies. Data were coded openly then combined to form themes which were utilized as the framework for data analysis. Three major themes emerged in the findings which included potential benefits to the mother, potential benefits to the father and potential benefits to the relationship. Generally, obstetricians and registered nurses/midwives held positive views about their presence in the delivery suite. This was related to the perceived positive impact that he could have on the woman during the inter-natal and post-natal periods as well as the quality of the relationship. By extension, their presence could have positive long term benefits on the quality of the relationship. The presence of expectant fathers in the delivery room could have a positive impact on the delivery experience for mothers, fathers and the long term relationship. The findings could provide a framework for other studies including a prospective study on the long term implications for the presence of expectant fathers in the delivery room.

Assessment of knowledge, attitudes, and practices towards infection prevention among healthcare workers in Trinidad and Tobago

Background: The objective of the study was assessment of knowledge, attitudes, and practices (KAP) towards infection prevention among healthcare workers (HCW) in Trinidad and Tobago.Methods: A cross-sectional study was conducted among 300 HCWs from three regional hospitals in Trinidad and Tobago about their knowledge, attitude, and practice towards infection prevention in the country. All information’s were collected through interview using structured questionnaires. The data was collected from April to June 2016; thoroughly checked and cleaned for completeness before analysis with SPSS version 20 statistical software. The 95% confident interval and the p value were used to check for association between the dependent and independent variables. A p value of <0.05 was considered statistically significant. Finally, the findings of the study were explained using tables.Results: A total of 300 HCW participated in the study, with a 100% response rate. In this study only 20.3% respondents were knowledgeable, 46.7% had good attitude and 44% had good practices toward infection prevention, suggesting less than satisfactory scores in this study.Conclusions: The results highlight generally poor knowledge, attitudes and practices towards infection prevention in the three hospitals in Trinidad and Tobago. Therefore, policies and measures should be put in place to ensure regular training programs for HCW, providing strong understanding and a positive outlook on infection prevention.

A study in a hospital setting in Trinidad and Tobago, West Indies, on the psychological factors that cause road traffic collisions

The following research paper aims to examine the psychological factors that have led to road traffic collisions (RTCs) by conducting research on drivers who had been admitted to the Accident and Emergency department at four major hospitals in Trinidad as RTC cases. A cross-sectional survey was conducted in four major hospitals in Trinidad. Sample size was 900 participants admitted to the hospital as RTC cases, and the sample was selected using Daniel’s formula. All 900 participants were drivers involved in an RTC and were mostly male, and majority of drivers involved in an RTC were within the age group of 30–39 years. The survey was conducted in a 3-month window between March and June 2013. The results of the survey indicated that there was a significant relationship between most of the factors and RTCs, that is, p<0.05. This indicated that the null hypotheses did not hold. Thus, there was an positive correlation. The study revealed that attitude of drivers, real driving practice and the driving knowledge possessed by the driver were associated factors for RTCs. The survey also established that factors such as stress, the lack of sleep and fatigue were also likely to be associated with RTC.

Knowledge and attitudes of medical and nursing practitioners regarding non-beneficial futile care in the intensive care units of Trinidad and Tobago

Objective To determine the knowledge and attitudes of healthcare personnel regarding the provision of non-beneficial futile care in the intensive care units at the major public hospitals in Trinidad and Tobago. Method Prospective data collection was done using a questionnaire administered to the medical and nursing staff of the intensive care units. The questionnaire was designed to capture the opinions regarding the futile care offered to terminally ill patients at the intensive care units. The responses were based on a five-point Likert scale. The influence of factors such as age, gender, duration of work experience, religious belief, ethnicity, occupational category and educational status on the responses were analysed. Results A total of 274 completed responses (86% response rate) were obtained from doctors and nurses. The frequency with which the respondents encountered ethical or legal problems in the intensive care unit varied widely from ‘daily’ to ‘yearly’. The majority felt that knowledge of ethics is important, and only 32% knew the legal issues pertaining to their work. Eighty percent of doctors and nurses had no knowledge of an existing Hospital Ethics Committee and its role in ethical dilemmas. Although 62% said their decisions regarding futile care will be influenced by their scientific knowledge, only 32% agreed to withdraw care. Eighty percent said that the government should pass appropriate laws regarding withdrawal of futile care. Conclusions Most healthcare providers in intensive care unit are not knowledgeable in the ethical and legal issues of non-beneficial futile care. There is a need to devise means to bring awareness and educate intensive care unit healthcare providers in this subject.

Deriving Hospital Catchment Areas from Mobile Phone Data

GIScience 2016 Short Paper Proceedings Deriving Hospital Catchment Areas from Mobile Phone Data Bernd Resch 1,2 , Azmat Arif 1 , Gautier Krings 3 , Guillaume Vankeerberghen 3 , Marc Buekenhout 4 University of Salzburg, Department of Geoinformatics – Z_GIS, Schillerstrasse 30, 5020 Salzburg, Austria Email: bernd.resch@sbg.ac.at, azmat.arif@stud.sbg.ac.at Harvard University, Center for Geographical Analysis, 1737 Cambridge Street, Cambridge, MA 02138, USA Real Impact Analytics, 5 Place du Champ de Mars, 1050 Brussels, Belgium Email: {gautier.krings; guillaume.vankeerberghen}@realimpactanalytics.com Email: mbuekenhout@msn.com Abstract Delineating catchment areas of medical facilities is essential for estimating the quality of a health-care system and to maximise the efficiency of health service provision. One critical shortcoming of previous approaches are manifested in their comprehensive assumptions about a hospital’s patients by using census data or gravity models. In contrast, our approach uses anonymised mobile and landline phone data to derive hospital catchment areas. Our goal is not to assess the quality of the health care system, but to identify the geographic areas, in which people actually use a hospital. Thus, our results reveal new insights into the catchment areas of hospitals by minimising assumptions about demographic factors. 1. Introduction and Related Work Adequate provision of health services is a central priority of health professionals and policy makers worldwide. More, the efficiency of health care systems, i.e., the provision of best possible service with minimum resources, is critical to public providers (Fransen et al. 2015). These requirements have led to a number of studies to analyse catchment areas and service quality of medical facilities. Even though geospatial analysis methods have existed for decades, there is still a general lack of studies that have mapped and examined health service catchments in practice, not only from a theoretical viewpoint (Schuurman et al. 2006). Previous approaches for delineating medical catchment areas comprise statistical population-to-provider ratios, gravitational models, travel cost estimation, analysis of the physical distance between hospitals, census-based patient-origin analysis, commuter-based approaches of modelling spatial accessibility (Fransen et al. 2015; Wang and Wheeler 2015), or the two-step floating catchment area method based on the physician-to-population ratio (Luo and Wang 2003). The major drawback of these approaches is that they make far- reaching assumptions about a hospital’s patients by applying census data, travel times or gravity models. Moreover, they do not take heterogeneous activity and mobility patterns into account or only derive them from static census data. Thus, the approach proposed in this paper uses anonymised mobile and landline phone data to delineate hospital catchment areas. Like this, we aim to identify the geographic areas, in which people use a hospital instead of assessing the quality of the health care system per se. Therefore, we analyse calls to and from hospitals in Trinidad and Tobago. This goes beyond just using patient records in that we are able to draw conclusions from a wider range of communication with a hospital (enquiries, arrangement of appointments, follow-up care, visitors, etc.), beyond patients’ hospital stays.

Molecular Analysis of Vancomycin-Resistant Enterococci Isolated from Regional Hospitals in Trinidad and Tobago.

Geographic spread of vancomycin-resistant enterococci (VRE) clones in cities, countries, or even continents has been identified by molecular techniques. This study aimed at characterizing virulent genes and determining genetic relatedness of 45 VRE isolates from Trinidad and Tobago using molecular tools, including polymerase chain reaction, pulsed-field gel electrophoresis (PFGE), and Random Amplification Polymorphic DNA (RAPD). The majority (84%) of the isolates were Enterococcus faecium possessing vanA gene while the rest (16%) were Enterococcus faecalis possessing vanB. The esp gene was found in all 45 VRE isolates while hyl genes were found only in E. faecium species. The E. faecium species expressed five distinct PFGE patterns. The predominant clones with similar or common patterns belonged to clones one and three, and each had 11 (29%) of the VRE isolates. Plasmid content was identified in representative isolates from each clonal group. By contrast, the E. faecalis species had one PFGE pattern suggesting the presence of an occult and limited clonal spread. The emergence of VRE in the country seems to be related to intra/interhospital dissemination of an epidemic clone carrying the vanA element. Therefore, infection control measures will be warranted to prevent any potential outbreak and spread of VRE in the country.

Global Registry of Acute Coronary Events (GRACE) Risk Score as a Predictor of In-hospital Mortality for Acute Coronary Syndrome in Trinidad and Tobago.

To determine whether risk stratification using the Global Registry of Acute Coronary Events (GRACE) risk score is a predictor of in-hospital mortality for patients with acute coronary syndrome (ACS) in a multi-ethnic Caribbean population. During a six-month period, all patients meeting the GRACE diagnostic criteria for one of the acute coronary syndromes were entered into a prospective single-centre study at one of the major public hospitals in Trinidad and Tobago. Clinical data, the GRACE risk score and in-hospital morbidity and mortality were recorded. Patients were placed into three GRACE risk categories: low, intermediate or high risk. There were 372 patients (mean age 63 years; males 56% and females 44%; hypertension 69%, diabetes mellitus 58%, positive smoking history 43%, previous myocardial infarction 34%), of which 25% were ST-segment elevation myocardial infarction, 56% non-ST-segment myocardial infarction and 19% unstable angina pectoris. In-hospital mortality was 8.3%. There were 35%, 33% and 32% of patients in the high, intermediate and low GRACE risk categories, respectively. The GRACE risk score demonstrated good discrimination (C statistic 0.82, 95% CI 0.755, 0879; p < 0.001) and good calibration (Hosmer-Lemeshow; p = 0.096) for in-hospital mortality in this ACS cohort. The GRACE risk score was found to be a reliable predictor of in-hospital mortality in this ACS population and therefore can be used to identify those high-risk patients who may benefit from aggressive management strategies, thereby allowing for more effective use of limited resources.

Vancomycin Resistant Enterococci Infections in Trinidad and Tobago

Aims: To document Vancomycin Resistant Enterococci (VRE) infections prevalence, risk factors, antimicrobial susceptibility patterns and evaluation of chromogenic plates in identifying VRE isolates in Trinidad and Tobago. Study Design : This was a cross sectional prospective observational and descriptive study . Place and Duration of Study: Study was carried out in all major regional hospitals in Trinidad & Tobago over a four year period, 2009 to 2013. Methodology : All cases of Enterococcus infections from major hospitals in the country were reviewed. Standardized questionnaire was used to analyze epidemiological and clinical data of VRE infected patients. Enterococcal speciation, minimum inhibitory concentrations (MIC) were evaluated using Microscan Walk Away 96SI (Siemens, USA). Isolates were further identified using 6.5% NaCl and pyrrolidonyl arylamidase activity according to CLSI guidelines. Brain Heart Infusion agar, Bile esculin azide agar containing 6 mg/L of vancomycin and chromogenic agar plates Chromagar VRE and chrom ID VRE were used to screen and confirm VRE isolates Results: A low (3.9%) VRE infections were encountered from 1,141 enterococcal infections

Molecular and Susceptibility Analysis of Toxigenic &amp;lt;i&amp;gt;Clostridium difficile&amp;lt;/i&amp;gt; Obtained from Adult Patients Suspected of CDI in Trinidad

Clostridium difficile is a Gram positive rod-shaped bacterium that produces two major toxins, A and B. The detection of the organism and its toxins has been widely carried out using specialized Enzyme-Linked Immunosorbent Assay (ELISA) kits; however these generally have been unsuccessful in identifying all Clostridium difficile positive samples. In this study, fifteen clinically symptomatic patients from three of the five major regional hospitals in Trinidad were investigated for Clostridium difficile infections. Stool samples were assessed by ELISA and cultured isolates were characterized using agar dilution antibiotic sensitivity assays, conventional Polymerase Chain Reaction (PCR), DNA sequencing and phylogenetic analysis of toxin A and B genes. All 15 patient stool samples and isolates were positive for toxigenic Clostridium difficile via ELISA and PCR respectively. All isolates were positive for the housekeeping tpi and Toxin B genes by PCR but only three of these were positive for the Toxin A gene. The Toxin B gene sequences showed 100% similarity levels among isolates while the Toxin A gene sequences showed 99% similarity among isolates. Phylogenetic analysis showed that the strains isolated in Trinidad most likely belonged to the same strain/group. Agar dilution sensitivity tests showed highest susceptibility to Pipercillin/Tazobactam and Meropenem (87%) and the highest resistance was seen with Cefotaxime in 93%. These results indicate that similar virulent strains of C. difficile are present in the Trinidad population and that pathogenic strains are more likely to be susceptible to Pipercillin/Tazobactam and Meropenem.