ICU Wards Research Articles

1672. Antimicrobial Activity of Cefepime-Taniborbactam and Comparators Against Clinical Isolates from ICU and Non-ICU Patients; 2018-2020 Global Surveillance

Abstract Background Taniborbactam is a novel cyclic boronate-based broad-spectrum β-lactamase inhibitor with selective direct inhibitory activity against both serine- and metallo-β-lactamases. Taniborbactam restores the activity of cefepime against many difficult to treat organisms, including cephalosporin- and carbapenem-resistant Enterobacterales (EB) and P. aeruginosa (PA). The activity of cefepime-taniborbactam (FTB) and comparator agents was evaluated against clinical isolates of EB and PA from a 2018-2020 global surveillance study. Methods 16,742 isolates of EB and PA were collected from patients in wards designated ICU and non-ICU in 2018-2020. MICs of FTB and comparators were determined by the CLSI reference method. Resistant (R) phenotypes were based on 2022 CLSI breakpoints. Multidrug resistant (MDR) was defined as resistance to at least one agent from ≥3 drug classes. Provisional susceptible (S) breakpoints of ≤8 µg/mL and ≤16 µg/mL were applied for FTB for comparative purposes only. Results FTB had potent activity against EB, with MIC90s of 0.25 µg/mL for isolates from non-ICU patients and 0.5 µg/mL for isolates from ICU patients (Table). At least 99.2% of all EB from both wards were inhibited by ≤8 µg/mL FTB. FTB maintained activity against R phenotypes of EB in both ward types, with 90.3% to 98.1% of isolates inhibited at ≤8 µg/mL. FTB had potent activity against PA, with MIC90 values of 8 µg/mL and inhibiting ≥94.0% of isolates at ≤8 µg/mL for both ICU and non-ICU isolates. FTB maintained activity against R phenotypes of PA in both ward types, with 71.0% to 83.7% of isolates inhibited at ≤8 µg/mL and 84.7% to 92.5% inhibited at ≤16 µg/mL. %S to comparator agents against the R subsets ranged from 1.6% to 92.6% for EB, and 36.0% to 68.4% for PA. Against the particularly challenging subset of MDR PA from ICU patients, FTB was the most active agent tested as it inhibited 73.5/84.7% of isolates at ≤8/≤16 µg/mL compared to 43.1%S to CZA and 36.0%S to C/T. Conclusion Cefepime-taniborbactam demonstrated potent in vitro activity against EB and PA from ICU and non-ICU wards, including resistant subsets of isolates. This supports the continued development of FTB as a potential new treatment option for infections due to resistant Gram-negative pathogens. Disclosures All Authors: No reported disclosures.

The healthcare system and client failures contributing to maternal mortality in rural Kenya

BackgroundThe global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government’s provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya.MethodsAn explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains.ResultsIdentified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients’ ANC non-adherence.ConclusionIn conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.

Decreased echinocandin susceptibility in Candida parapsilosis causing candidemia and emergence of a pan-echinocandin resistant case in China

ABSTRACT Candida parapsilosis is becoming a predominant non-albicans cause of invasive candidiasis (IC). Echinocandins are the preferred choice for IC treatment and prophylaxis. Resistance to echinocandins in C. parapsilosis has emerged in several countries, but little is known about the susceptibility profile in China or about mechanisms of resistance. Here, we investigated the echinocandin susceptibilities of 2523 C. parapsilosis isolates collected from China and further explored the resistance mechanism among echinocandin-resistant isolates. Anidulafungin exhibited the highest MICs (MIC50/90, 1 and 2 µg/mL; GM, 0.948 µg/mL), while caspofungin showed better activity (0.5 and 1 µg/mL; 0.498 µg/mL). Significantly higher echinocandin MICs were observed among blood-derived isolates compared to others, especially for caspofungin (GM, 1.348 µg/mL vs 0.478 µg/mL). Isolates from ICU and surgical wards also showed higher MICs. Twenty isolates showed intermediate phenotypes for at least one echinocandin. One was resistant to all three echinocandins, fluconazole and voriconazole, which caused breakthrough IC during long-term exposure to micafungin. WGS revealed this isolate carried a mutation S656P in hotspot1 region of Fks1. Bioinformatics analyses suggested that this mutation might lead to an altered protein conformation. CRISPR Cas9-mediated introduction of this mutation into a susceptible reference C. parapsilosis strain increased MICs of all echinocandins 64-fold, with similar results found in the subspecies, C. orthopsilosis and C. metapsilosis. This is the first report of a multi-azole resistant and pan-echinocandin resistant C. parapsilosis isolate, and the identification of a FKS1 S656P conferring pan-echinocandin resistance. Our study underscores the necessity of rigorous management of antifungal use and of monitoring for antifungal susceptibility.

Detection of Extended-spectrum Beta-lactamases (ESBLs), Carbapenemase, Metallo-β-lactamase Production Bacteria and Antibiotic Susceptibility Pattern in Hospitalized Patients with Ventilator-associated Pneumonia

Background: Due to the increase in microbial resistance, nosocomial multidrug resistance infections, including ventilator-associated pneumonia (VAP), are presently one of the main causes of death in hospitals since they are difficult to treat. Objectives: This study aimed to investigate the bacterial etiology of VAP and their microbial resistance pattern in Dezful Hospital, southwest of Iran. Methods: In this cross-sectional study, 131 bacterial isolates were isolated from the respiratory secretions of the patients with VAP in ICU wards. Antibiotic susceptibility testing (AST) of all isolates was carried out after the identification. Then the extended-spectrum beta-lactamases (ESBLs), carbapenemase, and metallobetalactamase were identified by phenotyping and genotyping. Results: The most frequent isolates were Staphylococcus aureus (30.5%), Acinetobacter baumannii (25.2%), and Klebsiella pneumoniae (24.4%). All strains of S. aureus were sensitive to vancomycin, ticoplanin, quinupristin-dalfopristin, and linezolid. Escherichia coli and Klebsiella showed high resistance to cephalosporins. More than 93% of Acinetobacter isolates were resistant to carbapenem and quinolones. The overall prevalence of ESBLs and carbapenemase producing bacteria were 80.43% and 73.6%, respectively. The most frequent ESBLs gene was blaCTX-M gene (78.3%) followed by blaAMP-C gene (67.5%), blaSHV gene (64.8%), and blaTEM gene (54%). Conclusions: In sum, there was a possibility that the treatment of nosocomial multidrug resistant infections such as VAP would become a major challenge. Therefore, it was recommended that AST results should always be considered when selecting the appropriate treatment regimen. Furthermore, it was found important to emphasize the principles of antibiotic stewardship and to constantly monitor the pattern of microbial susceptibility.

Antimicrobial Resistance, Integron Carriage, and Fluoroquinolone Resistance Genes in Acinetobacte baumannii Isolates

Background: Acinetobacte is the leading cause of pneumonia and sepsis in the ICU ward. Accordingly, in the present study, the antibiotic susceptibility pattern, presence, and dissemination of different classes of integrons and fluoroquinolone resistance genes were investigated among A. baumannii isolates. Methods: In this descriptive, cross-sectional study, during a period of 24 months (2018 - 2020), 100 isolates of A. baumannii were isolated from different clinical specimens of patients admitted to the two teaching hospital in Ardabil province in the northwest of Iran. Kirby -Bauer disk diffusion, PCR, and sequencing methods were used for antimicrobial susceptibility testing and gene and mutation verification. Results: The resistance rates to all tested antibiotics were found to be between 78% and 100%. No isolate was resistant to polymyxin B. Multidrug-resistant (MDR) rate among tested clinical isolates was about 99%. The prevalence of class 1, 2, and 3 integrons was found to be 70%, 21%, and 0%, respectively. The aadA1 cassette gene was detected in all class 1 integron-carrying strains. Conclusions: High-level antibiotic resistance and a high prevalence of integrons were observed among these clinical isolates. Our findings highlighted the need for continuous monitoring of resistant isolates.

Relative Caregivers’ Satisfaction towards Nursing Care of Neuro Patients in Hospital Universiti Sains Malaysia (USM)

Over the past decade, the provision of medical care had received increased attention in the general critical care community [1]. In the neurointensive care unit (neuro ICU), it is important to build a good rapport with their family member as the patient unable to decide for themselves. Assessing relative satisfaction level toward nursing care of neuro patients provides a way to determine whether the nursing care goals were attained. Directly measuring this in patients in the neuro ICU is difficult because of their clinical status. Thus, relative (surrogate) satisfaction is used as a proxy measure [3].
 
 The satisfaction survey, Family Satisfaction-ICU (FS-ICU), has been thoroughly validated in the general critical care population [2]. The survey has been used in many countries which helped in improving the satisfaction of care of the relative caregivers with nursing care [4]. The assessment of the level of satisfaction among relative caregivers towards nursing care is important to enhance the decision-making for the patients. The current study aimed to assess the level of satisfaction among relative caregivers towards nursing care of neuro patients and to determine the relationship between the satisfaction among relative caregivers towards nursing care and decision-making related to patient care in neuro ICU, Hospital USM.
 The study was conducted in the neuro ICU ward, Hospital USM. A cross-sectional study was conducted among 80 respondents using the Malay version of the Family Satisfaction Intensive Care Unit (FS-ICU) questionnaire. The statistical analysis was conducted using descriptive statistics and the Pearson correlation test. There are three items to measure the satisfaction level among relative caregivers towards nursing care which are concern and quality of care toward patients; the service and efforts in meeting their needs; and skills, care, and the atmosphere in the ICU. These items were given the score of 1-5 (very dissatisfied) and 6-10 (very satisfied).
 
 In this study, a total of 80 patients’ relatives were included. The sociodemographic characteristics and the frequency of distribution among participants and their percentage were shown in Table 1. The items for service and effort in meeting their needs (Question 1-6) showed the highest mean score, 9.21 (SD=0.58). Next, the concern and quality of care towards patients (Question 7-12) stated a mean score of 9.20 (SD=0.56), and the items for skills, care, and the atmosphere in the ICU (Question 13-18) stated a mean score of 8.71 (SD=0.71). Taken together, the relative caregivers were satisfied with the treatment and care for the patient. The scores of a single item of the FS-ICU were presented in Table 2. There was a significant correlation between the satisfaction level among relative caregivers towards nursing care and decision-making related to patient care in the neuro ICU, Hospital USM (r = 0.805, p < 0.001) (Table 3).
 A previous study reported a significant improvement in client satisfaction scores when a proper education of staff and the development of good strategies for addressing the concerns of family members were applied [5]. Furthermore, the delivery of nursing care was improved by identifying the right communication technique for patients’ care with their relatives [5]. The nurses also created an awareness of good communication with patients’ family members to reduce their anxiety regarding patients’ current progress of treatment [5]. In general, collaboration in deciding has been promoted to incorporate patient and family preferences into the customized treatment plan for an individual [6]. Taken together, a high satisfaction level with the collaboration in decision-making shown in this study might use to enhance the opportunity to improve the satisfaction level among relative caregivers in the ICU.
 
 In conclusion, relative caregivers’ satisfaction has become an important measurement in improving the quality of care for patients in neuro ICU wards. They are expecting the nurses to give the best quality of care to their family members’ despite being unable to express their wishes, lack of knowledge, and fear. Hence, nurses play a major role in understanding the relatives’ concerns and needs in determining the best decision-making for the patients.

Study on comparison of severity markers in first wave and second wave of COVID-19 in tertiary care centre

Background: Haematological parameters have an important role in the early detection of the COVID19 disease. This study is aimed to study the hematological severity markers of COVID19 infected patients in first wave versus second wave in a tertiary care centre. Methods: This is a retrospective study done in government medical college/government general hospital, Suryapet. We collected the information regarding patient’s data from hospital records who were admitted in the hospital during first wave in September 2020 and compared it with the patients admitted in the second wave in May 2021. Results: In our study, a total of 341 patients with COVID19 infection admitted in our hospital were included. 136patients were admitted in first wave and 205 patients were admitted in the second wave. Out of 136 patients in first wave, 95 were admitted in non-ICU ward and 41 were included in ICU ward. We found that there is increased Absolute Neutrophil count, decreased Absolute Lymphocyte count and Platelet counts in second wave ICU patients. Conclusion: We conclude that based on the haematological parameters disease severity was more pronounced in second wave, especially ICU patients than first wave.

Epidemiological analysis of septic shock in the plateau region of China.

PurposeLittle epidemiological data exist on patients with severe infection in the plateau region of China, and the data that do exist are lacking in quality. Using the medical records of patients with severe infection in the Department of Intensive Medicine (intensive care unit; ICU) of the People's Hospital of Tibet Autonomous Region, this study analyzed the epidemiological and clinical characteristics of patients with septic shock in plateau area (Tibet), with the ultimate aim of reducing the incidence and mortality from this condition.MethodsClinical data on 137 patients with septic shock in the studied ICU from November 2017 to October 2019 were retrospectively analyzed using SPSS, Version 21.0.ResultsAmong the 137 patients with septic shock, there were 47 survivors and 90 in-hospital or post-discharge deaths. There were 91 male patients and 46 female patients. The incidence of septic shock was 11.3%, and mortality rate was 65.7%. Median age was 55 years old, median APACHE-II score on the day of admission was 17, median SOFA score was 11, and median number of organ injuries was one. APACHE-II score (P = 0.02), SOFA score (P < 0.001), and the number of organ injuries (P < 0.001) were higher among patients who died than among survivors. The infections were mainly pulmonary and abdominal, and the main pathogen was gram-negative bacteria.ConclusionThe incidence and mortality of septic shock in ICU wards in Tibet are very high. The APACHE-II score, SOFA score, and the number of organ damage on the first day after diagnosis are independent risk factors for septic shock. To some extent, this study reflects the epidemiological characteristics of septic shock in the plateau region of China (≥ 3,650 m above sea level) and provides data that can support the prevention and treatment of sepsis in the future. More and deeper epidemiological studies of septic shock are necessary.

Microbiological and drug resistance patterns of bronchoalveolar lavage samples taken from hospitalized patients in Iran.

Pulmonary diseases are amongst the most common causes of premature death and distressing disorders worldwide. This study aimed to detect the fastidious and routine infectious agents, and their drug resistance patterns in bronchoalveolar lavage (BAL) samples. A total of 44 BAL samples were collected by bronchoscopy from patients with respiratory disorders hospitalized at 2 teaching hospitals in Ilam, Iran. The samples were cultured on routine bacterial culture media to identify the bacterial agents and calculate the colony count. Antibiotic susceptibility was determined by disk diffusion method according to the CLSI protocol. PCR was used to detect the fastidious bacteria Mycoplasma pneumoniae and Chlamydia pneumoniae using the 16srRNA specific primers and Legionella pneumophila using the mip specific primers. Overall, 100 bacterial isolates were isolated by culture from the 44 BAL samples including: Staphylococcus aureus (24, 31.2%), Streptococcus pyogenes (18, 23.4%), Enterococcus spp. (11, 14.3%), Acinetobacter baumannii (11, 14.3%), Pseudomonas aeruginosa (11, 14.3%), Enterococcus spp. (10, 13%), Micrococcus spp. (5, 6.5%), Staphylococcus epidermidis (5, 6.5%) and Klebsiella pneumoniae (5, 6.5%). PCR detected 4 positive samples (9.1%) for Chlamydia pneumoniae but no positive cases for Mycoplasma pneumoniae and Legionella pneumophila. Acinetobacter baumannii showed the highest resistance rate (81.8%) to aztreonam and ceftazidime. Seventy-five percent of the Staphylococcus aureus isolates were resistant to cefoxitin (MRSA) and 83.3% had the mecA gene. Vancomycin resistance was observed in 27.3% of the Enterococcus species (VRE). Resistance to piperacillin, cefotaxime, ciprofloxacin and imipenem was observed in 54.5%, 45.5%, and 36.4% of the Pseudomonas aeruginosa isolates, respectively. The frequency of organisms isolated from the ICU was higher (46%) than from other wards. The presence of MRSA, cephalosporins-resistant Enterobacteriaceae as well as Pseudomonas aeruginosa and Acinetobacter baumannii resistant against piperacillin, imipenem, cefotaxime, aztreonam and ciprofloxacin amongst different wards, especially the ICU ward of the surveyed hospitals, is a major healthcare concern and it is necessary to wisely scrutinize the preventive strategies for antibiotic resistant infections.

TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines

Abstract Aims The National Emergency Laparotomy Audit (NELA) has been pivotal in improving the care of patients undergoing emergency laparotomy. One key recommendation is ‘high-risk’ patients are managed on ICU post-operatively. We aimed to identify if there was a difference in outcomes between ‘high-risk patients’ (predicated NELA mortality &amp;gt;5%) managed on ICU or a surgical ward post-operatively. Methods We retrospectively analysed all patients registered to our hospitals NELA database from January 2019-September 2021, assessing if ‘high-risk’ patients were managed on ICU or general surgery wards post-operatively and the difference in outcomes between these two groups. Results 249 patients were included (138 Female). Over 80% of ‘high-risk’ patients were admitted to a ICU bed over the three-year period, as per NELA guidelines. 46 high-risk patients were managed on the ward post-operatively. Although there was no difference in age between the two groups, those admitted to ICU had a significantly higher predicated NELA mortality and higher mortality rate. Conclusions NELA predicted mortality helps to guide which patients may need a higher level of post-operative care. However, this study indicates that for some patients with a predicted mortality of 5–10%, ward-based care may be appropriate. In the context of increasingly stretched ICU resources, we believe further research is needed to identify whether some patients with a NELA mortality over 5% would be appropriate for ward management.

Impact of robotic surgery on patient flow and resource use intensity in ovarian cancer.

There is an emerging focus on the role of robotic surgery in ovarian cancer. To date, the operational and cost implications of the procedure remain unknown. The objective of the current study was to evaluate the impact of integrating minimally invasive robotic surgery on patient flow, resource utilization, and hospital costs associated with the treatment of ovarian cancer during the in-hospital and post-discharge processes. 261 patients operated for the primary treatment of ovarian cancer between January 2006 and November 2014 at a university-affiliated tertiary hospital were included in this study. Outcomes were compared by surgical approach (robotic vs. open surgery) as well as pre- and post-implementation of the robotics platform for use in ovarian cancer. The in-hospital patient flow and number of emergency room visits within 3months of surgery were evaluated using multi-state Markov models and generalized linear regression models, respectively. Robotic surgery cases were associated with lower rates of postoperative complications, resulted in a more expedited postoperative patient flow (e.g., shorter time in the recovery room, ICU, and inpatient ward), and were between $10,376 and $7,421 less expensive than the average laparotomy, depending on whether or not depreciation and amortization of the robotic platform were included. After discharge, patients who underwent robotic surgery were less likely to return to the ER (IRR 0.42, p = 0.02, and IRR 0.47, p = 0.055, in the univariate and multivariable models, respectively). With appropriate use of the technology, the addition of robotics to the medical armamentarium for the management of ovarian cancer, when clinically feasible, can bring about operational efficiencies and entails cost savings.

Epidemiologic and Antifungal Susceptibility Profile of Candiduria Among Patients Hospitalized in The Nephrology and Intensive Care Unit Wards, Tehran, Iran

Background: One of the most prevalent infections in hospitalized patients is candiduria. As the prevalence of this infection is increasing, new epidemiologic and therapeutic data can be used as a guide for the management of patients. Objectives: This research aimed to determine the epidemiological and antifungal susceptibility profile of candiduria. Methods: A total of 104 patients admitted to the nephrology and ICU wards of Bu Ali and Labbafinezhad hospitals in Tehran, Iran, were studied in this cross-sectional investigation. Urine samples were examined using direct smear, culture, and PCR-sequencing techniques. The culture plates were subjected to colony count. The clinical and laboratory standards institute (CLSI) document M27 4th ed was used to assess susceptibility to amphotericin B, itraconazole, caspofungin, and fluconazole. Results: Out of 104 patients, 26 (25%) were diagnosed with candiduria. Most patients were between the ages of 64 - 79 years (n = 9, 34.61%) and female (n = 17, 23.94%). Stroke and urinary catheterization were the most common underlying diseases. Candida glabrata (n = 10, 38.64%) was the most common cause of candiduria. Caspofungin and amphotericin B were the most effective antifungal medicines. Conclusions: Candida glabrata has been identified as the most common cause of candiduria. Due to the increasing antifungal resistance in this species, proper treatment of patients is a crucial concern. Caspofungin exhibited potent antifungal activity against all tested isolates. Still, regardless of its favorable in vitro activity, due to its poor glomerular filtration or tubular secretion in vivo, it has sub-therapeutic antifungal concentrations in the urine.

Evaluation of serum levels of IL-6 and adiponectin in COVID-19 patients and their relationship with disease severity

Background. The SARS-CoV-2 pandemic has prompted researchers around the world to identify risk factors associated with disease severity and mortality. Results suggest that COVID-19 mortality might be due to a cytokine storm involving IL-6, and that obesity can be considered a risk factor for COVID-19 prevalence, severity, and mortality. The current study aimed to evaluate the serum levels of IL-6 and adiponectin in patients and their relationship with disease progression. Materials and methods. ELISA was used to assess the levels of IL-6 and adiponectin in serum samples from a control group and from patients with COVID-19 at the time of admission to ICU or non-ICU wards. The results were analyzed using the MannWhitney and Spearman tests. Results. Mean serum levels of adiponectin in patients admitted to ICU (10.1815.4 ng/ml) were significantly higher than patients admitted to non-ICU wards (3.143 ng/ml, p = 0.001). Mean serum IL-6 levels showed a similar pattern, however the difference was not statistically significant (p = 0.18). In addition, a significant direct correlation was observed between adiponectin expression and IL-6 (R = 0.2, p = 0.03). Conclusion. The results of this study show that serum levels of adiponectin in COVID-19 patients with severe lung involvement were significantly higher than those with less lung involvement. This finding is of high importance mainly due to the critical role of the lungs in adiponectin signaling, and as a result, adiponectin disorders may be associated with pulmonary complications in COVID-19 patients.

A 4-Year Prospective Study on Anti-fungal and Reserved Antimicrobial Drugs under Antimicrobial Stewardship Program

Introduction: In 2018 and 2021, CIMS hospital conducted an audit to analyse the quality of antifungal use. We conducted a follow-up audit after four years of the antifungal stewardship programme (AFS) to evaluate the program’s long-term effects. We assessed antifungal usage in Medical &amp; surgical Patients receiving systemic antifungals using a preset score. Antibiotics and its classes designated as antimicrobial reserved products are intended to be used only in the treatment of confirmed or suspected infections caused by multidrug-resistant organisms. Materials and Methods: The research was conducted in a medical &amp; surgical unit at tertiary care hospital during a four-year period. The sensitivity pattern was identified after the laboratory data were processed. Some of the newer AMs were labelled as “Reserve,” requiring the completion of an authorization form prior to prescription. Results: Patients treated with antimicrobial drugs in medical and ICU wards were assessed. The results of both the audits revealed that there was a decrease in the irrational cases of both reserved antimicrobial and antifungal cases in successive years. The year 2020 showed fewer irrational cases of antifungals. Conclusion: With time the use of correct dosage regimen, proper route of administration and proper handling of patients has led to decrease in the irrational cases of antimicrobials.

P196 CHANGE IN THE DAILY HOSPITALIZATION RATE FOR ACUTE MYOCARDIAL INFARCTION IN THE VENETO REGION FROM 2006 TO 2018

Abstract Background Acute myocardial infarction (AMI) continues to represent the leading cause of cardiovascular mortality in Italy, with important prognostic and health consequences both in the short and long term. The aim of the study is to evaluate the long–term variation in the daily hospitalization rate for AMI in the Veneto region. Materials and Methods Data regarding the total number of hospitalizations due to AMIbetween 2006 and 2018 were extracted from the periodic epidemiological reports of the Veneto region which can be consulted on the website www.ser–veneto.it and then re–elaborated and analyze. In particular, changes in daily hospitalization rates for AMI were calculated, then sub–classified into AMI with ST–segment elevation myocardial infacrction (STEMI) and without (NSTEMI). The trend of change in daily hospitalization rates was assessed with the Jonckheere–Terpstra test, using the SPSS statistical software version 19.0 (SPSS; SPSS Inc., USA). Results During the study period, in the Veneto region 87,490 hospitalizations for AMI [48,165 (55.0%) STEMI and 32,325 (45.0%) NSTEMI], of which 75.7% were managed in Cardiology / ICU wards were registered. The overall average daily hospitalization rate for AMI over the entire period was 18.3 ± 0.6 admissions / day [range 17.5 / 19.8] with a decrease of 11.4% / year (p = 0.009). Among these, patients admitted for STEMI were hospiutalized for 10.1 ± 1.2 / day [range 8.6–12.4]; however their daily hospitalization rate decreased by 32.4% / year (p &amp;lt; 0.001). Conversely, 8.2 ± 0.8 patients with NSTEMI / day were hospitalized in the observation period [range 7–8.9]. showing a growing hospitalization trend in the period considered (+ 20.9% / year, p &amp;lt; 0.001) (Figure 1). Conclusions The daily hospitalization rate for AMI in the Veneto region has overall decreased in recent years, however, there has been a significant increase in daily hospitalizations for NSTEMI. The high number of daily hospitalizations requires close synergy between the cardiology departments of the region in order to ensure adequate care for patients with acute cardiac events in the area.

Comparison of superior and inferior vena cava diameter variation measured with transthoracic echocardiography to predict fluid responsiveness in mechanically ventilated patients after abdominal surgery

BackgroundThe volume status of patients after major abdominal surgery constantly varies owing to postoperative diverse issues comprising fluid loss or capillary leakage secondary to systemic inflammatory reaction syndrome, et.al, the precise fluid responsiveness assessment is crucial for those patients. The purpose of this study is to validate the transthoracic ultrasonographic measurement of superior and inferior vena cava variation in predicting fluid responsiveness of mechanically ventilated patients after surgery.MethodsA total of 70 patients undergoing the scheduled major abdominal surgeries in the anesthesia ICU ward were included. The superior vena cava (SVC) collapsibility index (SVCCI), the inferior vena cava distensibility index (dIVC), SVC variation over the cardiac cycle (SVCV), and cardiac output (CO) were measured by transthoracic ultrasonography were recorded before and after fluid challenge test of 5 ml/kg crystalloid within 15 min. The responders were defined as a 15% or more increment in CO.ResultsThirty patients (42.9%) responded to fluid challenge, while the remnant forty patients (57.1%) did not. The areas under the ROC curve (AUC) of SVCCI, dIVC and SVCV were 0.885 (95% CI, 0.786–0.949; P < 0.0001) and 0.727 (95% CI, 0.608–0.827; P < 0.001) and 0.751 (95% CI, 0.633–0.847; P < 0.0001), respectively. AUCdIVC and AUCSVCV were significantly lower when compared with AUCSVCCI (P < 0.05). The optimal cutoff values were 19% for SVCCI, 14% for dIVC, and 15% for SVCV. The gray zone for SVCCI was 20%-25% and included 15.7% of patients, while 7%-27% for dIVC including 62.9% of patients and 9%-21% for SVCV including 50% of patients.ConclusionSuperior vena cava-related parameters measured by transthoracic ultrasound are reliable indices to predict fluid responsiveness. The accuracy of SVCCI in mechanically ventilated patients after abdominal surgery is better than that of dIVC and SVCV.Trial registrationChiCTR-INR-17013093. The initial registration date was 24/10/2017.

Risk factors for healthcare-associated infection among children in a low-and middle-income country

BackgroundHealthcare-associated infections (HAI) are one of significant causes of morbidity and mortality. Evaluating risk factors associated with HAI are important to improve clinical outcomes. We aimed to evaluate the risk factors of HAI in children in a low-to middle-income country.MethodsA prospective cohort study was conducted during 43 months at a teaching hospital in Yogyakarta, Indonesia. All consecutive patients admitted to pediatric ICU and pediatric wards > 48 h were eligible. Those eligible patients were observed daily to identify the presence of HAI based on CDC criteria. The risk factors of HAI were identified. Multivariable logistic regression was used to identify independent risk factors.ResultsTotal of 2612 patients were recruited. Of 467 were diagnosed as HAI. The cumulative incidence of HAI was 17.9%. In the multivariable analysis; length of stay > 7 days, severe sepsis, use of urine catheter, central venous catheter (CVC), non-standardized antibiotics, and aged < 1 year were independently associated with increased risk of HAI with adjusted OR (95%CI): 5.6 (4.3–7.3), 1.9 (1.3–2.9), 1.9 (1.3–2.6), 1.8 (1.1–2.9), 1.6 (1.2–2.0), and 1.4 (1.1–1.8), respectively.ConclusionsThis study found that length of stay > 7 days, use of urine catheter and CVC, non-standardized antibiotic use, aged < 1 year, and had a diagnosis of severe sepsis increased risk of HAI.

Nepalese Nurses Experiences of Workplace Violence During COVID-19 Pandemic

Introduction: Work-Place Violence (WPV) against the nurses is frequent and is often accepted as a part of their job. These front line healthcare workers were more vulnerable to WPV during the corona virus pandemic (COVID-19). The present study aims to explore WPV experience of the Nepalese nurses during the first wave of COVID-19 pandemic. Methods: A cross sectional qualitative study was conducted between June and December, 2020 among the nurses working at Bir Hospital after getting institutional ethical approval. A phenomenological approach was used to explore the experiences of the nurses. Purposive sampling was done to recruit the participants from COVID ICU, COVID Isolation and COVID wards. Data were collected using In-depth Interview (IDI) guidelines from nine participants. Each interview took about 20-40 minutes. The interviews were recorded using a recorder and note taking was also done. Themes were generated from the transcripts of the interviews by the researchers. Results: Nepalese nurses experienced varied forms of violence during the first wave of COVID-19. Experiences of the nurses were expressed mainly under five main themes; tolerance towards the aggressive patient, anxious to attend patient and visitors, family rejection, stigmatized by society and disrespect towards nurses. Conclusions: Nurses faced different forms of WPV from the patient, society and the government during the first wave of COVID-19. Proper safety and security guidelines for the nurses during such pandemic should be developed to minimize such risks in the future as well as recognigation should be given for their contribution during such health emergencies.

Fecal carriage of ESBL-producing gut flora isolated from patients and families: Molecular pattern and risk factor

Antimicrobial resistance (AMR) is considered a global public health threat. The prevalence of fecal carriage of ESBL-producing gut flora is increasing in healthcare facilities and communities. Antibiotic usage is believed as one of the major drivers of AMR both in healthcare facilities and communities. However, few data analyze fecal carriage of ESBL-producing gut flora in patients and healthy individuals simultaneously in Indonesia. Detection of fecal carriage of ESBL-producing gut flora is important to prevent the outbreak and suppress the spread. This study's aim is to analyze the molecular patterns and antibiotic use as risk factors for fecal carriage of ESBL-producing gut flora isolated from patients and their families. One hundred rectal swabs were collected from ICU and medical ward patients and their families. The samples were then cultivated in MacConkey agar containing cefotaxime 2 g/ml. Colonies grew on MacConkey agar and were then confirmed as ESBL producers using a modified double-disk diffusion method. The genes of ESBL-producing isolates were detected using PCR. Antibiotic usage history was taken from medical records and questionnaires. Statistical analysis was performed to detect the correlation between antibiotic use and ESBL-producing gut flora carriage. The total carriage rate was 82 (82%) of 100 participants. The highest rate was among ICU patients (n=19/29, 95%). Mostly detected gene was blaCTX-M (n=62/90, 68.9%). There was no significant correlation between antibiotic use and carriage of ESBL-producing gut flora among patients and families.

No VTE Recurrence After 1-Year Follow-Up of Hospitalized Patients With COVID-19 and a VTE Event: A Prospective Study

No VTE Recurrence After 1-Year Follow-Up of Hospitalized Patients With COVID-19 and a VTE Event: A Prospective Study