Usage Of Broad-spectrum Antibiotics Research Articles

Rapid Determination of Antibiotic Resistance in Klebsiella pneumoniae by a Novel Antibiotic Susceptibility Testing Method Using SYBR Green I and Propidium Iodide Double Staining.

Due to the broad-spectrum antibiotic usage and empirical treatments, the pathogenic bacterium, Klebsiella pneumoniae, has shown extremely high detection rates at hospitals with an increasing antibiotic resistance. Therefore, rapid detection of the antibiotic resistance is urgently required and essential for effective treatments. In this study, we evaluated the performance of a newly developed method for ultra-rapid detection of antibiotic resistance in 30–60 min in K. pneumoniae by using the SYBR Green I and propidium iodide (PI) staining. A total of 100 clinical isolates were tested for antibiotic resistance using four different antibiotics (ceftriaxone, cefepime, meropenem, and ciprofloxacin). The results showed that the SYBR Green I/PI rapid antibiotic susceptibility test (AST) could reliably detect antibiotic resistance to the four drugs in 60 min, and the results were highly concordant with the conventional AST (i.e., Kirby-Bauer method and broth microdilution method) for detection of ceftriaxone, cefepime, meropenem, and ciprofloxacin resistance with a high accuracy of 99, 96, 96, and 93%, respectively. Therefore, the rapid AST established in our study helps to enable targeted therapy to save lives and reduce the empirical use of antibiotics and ultimately the health and economic burdens of antibiotic resistance.

PREVALENCE OF CLOSTRIDIUM DIFFICILE INFECTION IN PATIENTS EXPOSED TO ANTIBIOTICS IN PREVIOUS 6 WEEKS AND ADMITTED WITH DIARRHEA IN A TERTIARY CARE HOSPITAL.

Clostridium difficile is a signicant cause of morbidity and mortality among hospitalized patients, and the incidence of C. difficile infection (CDI) has dramatically increased due to frequent usage of broadspectrum antibiotics in these patients. The wide variation in the spectrum of clinical manifestations of CDI makes the diagnosis difcult. Further, the wide range of variability in the sensitivity and specicity of the various diagnostic methods and the high cost of these methods add to the difculty. It is a spore-forming gram-positive anaerobic organism. Until the 1970s, it was considered as a microorganism that is rarely present in normal intestinal microbiota. But it was not until 1978 that C. difcile was identied as a cause of [1] pseudomembranous colitis . Since then, C. difcile has been recognized as a common cause of antibiotic associated diarrhoea and nosocomial diarrhoea. The incidence of C. difcile infection (CDI) varies from place to place. In India, it is known to infect up to 25 % of [2] people taking antibiotics

Superadded Coinfections and Antibiotic Resistance in the Context of COVID-19: Where do We Stand?

Purpose of reviewPoor outcomes in the current coronavirus disease 2019 (COVID-19) pandemic have been attributed to superadded bacterial coinfections. The World Health Organization has reported overzealous usage of broad-spectrum antibiotics during this current pandemic raising concerns of increasing antimicrobial resistance? Therefore, the knowledge of coinfection and the common pathogens during these challenging times is essential for antibiotic stewardship practices.Recent findingsThe incidence of reported superimposed bacterial and viral coinfections in COVID-19 patients is around 0.04 to 17%. However, more than 70% of patients have received broad-spectrum antibiotics. The presence of a simultaneous coinfection can be suspected in patients with neutrophilic lymphocytosis and elevated procalcitonin in the setting of COVID-19. Multiplex polymerase chain reaction (PCR) panels, with its short turnaround time, aid in the definitive diagnosis of possible coinfection. Acinetobacter baumanii, Mycoplasma pneumonia, influenza virus, Aspergillus, Candida, etc., are commonly implicated pathogens.SummaryRapid characterization of coinfection and avoidance of overzealous use of broad-spectrum antibiotics in COVID-19 patients are the key to prevent antibiotic resistance during this pandemic.How to cite this articleKayarat B, Khanna P, Sarkar S. Superadded Coinfections and Antibiotic Resistance in the Context of COVID-19: Where do We Stand? Indian J Crit Care Med 2021;25(6):699–703.

Emergency Department Observes 83% Reduction in Blood Culture Contamination with Initial Specimen Diversion Technology Adoption

Background Blood culture attempts to reduce unfavorable outcomes for patients with bloodstream infections by guiding antibiotic therapy. False positive blood culture results are frequent (a 3% contamination rate is considered standard) and associated with unnecessary broad-spectrum antibiotic usage, extended hospital stays and elevated clinical costs. Diversion of the initial portion of a blood sample (which can host deep skin flora associated with venipuncture-dislodged skin fragments) is proposed to address an avenue for contamination unaddressed by conventional blood culture protocol. Methods Blood culture sets were obtained from adult patients during an 18-month observation period in a 32-bed emergency department in California for a non-randomized prospective controlled cohort study. Blood cultures were obtained using either conventional methods (venipuncture and intravenous catheter start) or with initial specimen diversion technology (in tandem with venipuncture and intravenous catheter start). Blood culture bottle tops were disinfected with alcohol pads and patient skin was prepared with a 30-second chlorhexidine gluconate solution scrub. Samples were considered contaminated if skin flora were present in either the aerobic or anaerobic bottle of a single blood culture set. Results Conventional methods were utilized to collect 3,170 blood cultures, from which 77 (2.43%) were contaminated, while initial specimen diversion technology was utilized to collect 2,168 blood cultures, from which 9 (0.42%) were contaminated. Conclusions Use of initial specimen diversion technology was associated with an 83% lower rate of blood culture contamination compared to conventional methods, sustained for 18 months. Lower rates of blood culture contamination translate to reduced administration of unnecessary antibiotics (diagnostic stewardship and antimicrobial stewardship), reduced patient length of stay, and reduced clinical expenditures.

Antibiotics prescriptions for pneumonia analyzed by claim information in Japan

OBJECTIVE Japan is an aging society, and pneumonia is the leading cause of death, but the suitability of antibiotics for treating community-acquired pneumonia (CAP) in Japan is not clear. The purpose of this study was to investigate antibacterial drugs for treating CAP according to age. MATERIALS AND METHODS Using the Japanese national database from 2011 to 2014, we analyzed the usage of antibiotics for CAP according to age. RESULTS The numbers of claim information were 9,386, and 70% of the patients were aged ≥ 75 years. Sulbactam/ampicillin (SBT/ABPC) or ceftriaxone (CTRX) was used in 60%, but broad-spectrum antibiotics, combination therapy, and anti-mycoplasma antibiotics were used in 15 - 28% of all age groups. The 30-day survival rate did not differ between SBT/ABPC or CTRX vs. others. There was no difference in 30-day mortality and risk in any group between the ages of 15 and 64 years. On the other hand, the use of anti-mycoplasma antibiotics reduced the 30-day mortality by 0.50 times (p < 0.01), and the use of two or more antibiotics increased the 30-day mortality by 1.45 times (p = 0.02) at age ≥ 65 years. CONCLUSION Approximately half of the antibiotics used for CAP requiring hospitalization consisted of CTRX or SBT/ABPC as recommended by the Japanese Respiratory Society (JRS) guidelines. On the other hand, the usage of broad-spectrum antibiotics and combination therapy were relatively frequent at all ages, although their use does not always contribute to survival. Our data provide basic information for analyzing the outcome of pneumonia treatment in terms of an antimicrobial resistance action plan in Japan.

An ASP implementation in district hospitals in Sarawak without clinical specialist: A 4 years data on antibiotic consumption post implementation

Background: Antimicrobial resistance (AMR) is a global health threat. Prompt and co-ordinated actions are needed, thus Antimicrobial Stewardship Program (ASP) need to be implemented in any health-care institution. Methods and materials: A state-wide surveillance on injectable antibiotic consumption was performed in district hospitals without clinical specialist in Sarawak, Borneo Island since 2012. The antibiotics under surveillance were amoxicillin-clavulanate, ampicillin-sulbactam, ciprofloxacin, third-generation cephalosporins, cefepime, piperacillin-tazobactam, vancomycin, aminoglycosides and carbapenems. Antibiotic consumption was measured in Defined Daily Dose (DDD) per 1000 patient-days. A front-end ASP approach through state-wide formulary restriction and pre-authorization on the aforementioned antibiotics was implemented in February 2014. Results: There was an immediate impact, which was seen as early as in year 2014 itself. Mean total injectable antibiotic consumption was reduced by 15.6%, from 140.07 to 118.17 in the year 2013 and 2014 respectively. From 2015 to 2018, the average mean total antibiotic consumption was 121.76, albeit a small inter-year fluctuation of less than 15% and represented a small 3% (121.76 vs. 118.17) increase from year 2014. Analysis of individual antibiotics pre and post implementation (2013 vs. 2014) showed greatest reduction for vancomycin (88.2%) followed by piperacillin-tazobactam (75.4%), ciprofloxacin (70.7%), aminoglycosides (67.7%), cefuroxime (23.8%) and third-generation cephalosporins (18.3%). However, amoxycillin-clavulanate which needed pre-authorization only if used beyond 5 days duration showed a 6% increase in consumption from the year 2014 to 2015. There was an increase in cefuroxime consumption by 7.7% (2015 vs. 2016) and 16.5% (2016 vs. 2017) respectively, as well as third-generation cephalosporin by 9.6% (2015 vs. 2016). During this period, there was disruption in amoxicillin-clavulanate supply. The consumption of other antibiotics remained stable. There were no vancomycin and carbapenems consumption from year 2015 and 2017 onwards respectively. Conclusion: Our result showed that formulary restriction and pre-authorization method can be implemented to immediately control the usage of broad spectrum antibiotics in such setting and it was sustainable. However, it did not effectively bring down the overall antibiotic consumption, suggesting that we need to look at strategies that influence prescriber's decision to start antibiotics.

Sensitive Detection of Broad-Spectrum Bacteria with Small-Molecule Fluorescent Excimer Chemosensors.

Antibiotic resistance is a major problem for world health, triggered by the unnecessary usage of broad-spectrum antibiotics on purportedly infected patients. Current clinical standards require lengthy protocols for the detection of bacterial species in sterile physiological fluids. In this work, a class of small-molecule fluorescent chemosensors termed ProxyPhos was shown to be capable of rapid, sensitive, and facile detection of broad-spectrum bacteria. The sensors act via a turn-on fluorescent excimer mechanism, where close-proximity binding of multiple sensor units amplifies a red shift emission signal. ProxyPhos sensors were able to detect down to 10 CFUs of model strains by flow cytometry assays and showed selectivity over mammalian cells in a bacterial coculture through fluorescence microscopy. The studies reveal that the zinc(II)-chelates cyclen and cyclam are novel and effective binding units for the detection of both Gram-negative and Gram-positive bacterial strains. Mode of action studies revealed that the chemosensors detect Gram-negative and Gram-positive strains with two distinct mechanisms. Preliminary studies applying ProxyPhos sensors to sterile physiological fluids (cerebrospinal fluid) in flow cytometry assays were successful. The results suggest that ProxyPhos sensors can be developed as a rapid, inexpensive, and robust tool for the "yes-no" detection of broad-spectrum bacteria in sterile fluids.

Engaging Internal Medicine Hospitalists in Antimicrobial Stewardship—a Systematic Review

The purpose of this article is to critically assess the literature on engaging internal medicine hospitalists in antimicrobial stewardship. Few studies exist that describe hospitalist-led antimicrobial stewardship initiatives. Most studies in this review employed quasi-experimental or quality improvement methods. Across the studies included in our analysis, those with interventions that focused on single disease processes (e.g., pneumonia, UTI, SSTI) had a more robust impact on their selected outcomes. In the reviewed literature, engaging internal medicine hospitalists in antimicrobial stewardship efforts resulted in improved antimicrobial appropriateness and decreased broad-spectrum antibiotic usage. Despite being identified as key stakeholders and potential leaders in antimicrobial stewardship efforts, there is a paucity of literature to guide the best incorporation of hospitalists in this work.

Ventilator-associated Events in Children: Controversies and Research Needs.

Ventilator-associated Events in Children: Controversies and Research Needs.

Rapid Detection of Respiratory Pathogen 33 in Cases of Acute Respiratory Tract Infection

OBJECTIVES: To determine the efficacy of respiratory pathogen (RP) 33 test for detecting specific RP that cause acute respiratory infection in a short turnaround time. MATERIAL AND METHODS: A retrospective study of RP 33 test was performed from June 2018 to June 2019 of twenty symptomatic participants aged > 18 years old, medical evaluation and laboratory test were carried out at OPD Chest Center in Bangkok Hospital and laboratory test should be conducted during the duration of the study. Subjects were immune-competent and manifested signs and symptoms of acute respiratory infections. Seventeen participants were subjected to additional tests such as blood culture and sputum culture, acid fast bacilli (AFB) test, bronchial washing, Influenza AB viruses, and respiratory syncytial virus (RSV) and Quantiferon test for a definitive diagnosis. RESULT: All 20 participants were included in the study, 10 male and 10 female with a mean age of 64 ± 8.4 years. RP 33 test often takes a shorter turnaround time compared to microbial culture, a mean time of 20 ± 7.767 hours compared to 72 hours from sputum culture or blood culture as demonstrated on our test. Among the twenty participants there were twelve (60%) detected cases, five (25%) of which revealed multiple types of etiologic agent indicating co-infection. For bacterial etiology, nine cases were established: three cases of Staphylococcus Aureus were found, three cases of Klebsiella Pneumonia, one case of Streptococcus Pneumonia. Viral etiology was confirmed in nine cases, the leading pathogen of viral etiology is human Rhinovirus with three cases, two cases of influenza A virus, one case of influenza B virus, one case of Human Corona virus OC43, one case of human Parainfluenza virus 4 and one case of human Metapneumo virus A/B. There were eight (40%) cases of undetected results that needed additional diagnostic tests (sputum culture and sensitivity (Sputum C/S), acid fast bacilli test (AFB test), hemoculture and sensitivity (hemo C/S), bronchial washing, influenza AB&RSV and Quantiferon (TB QFT TB) test) to identify etiologic agent. CONCLUSION: RP 33 test, a multiplex real time polymerase chain reaction (PCR), provided a commendable implication. RP 33 test provided prompt and optimal diagnostic evaluations in ruling out etiologies of respiratory-related infections, particularly acute respiratory infections, thus delivering definitive and precise clinical care to patients leading to minimal usage of broad spectrum antibiotics.

1125. In with the Out-patient Antimicrobial Stewardship Initiative: A Collaboration between a Children’s Hospital Antimicrobial Stewardship Program and a Nonaffiliated Pediatric Private Practice

BackgroundWhile antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient stewardship in pediatric patients is scarce. To the best of our knowledge, this is the first study describing the impact that an established inpatient pediatric antimicrobial stewardship program (ASP) has had on antimicrobial prescribing practices in a multi-site (14 locations) nonacademic, nonaffiliated pediatric outpatient practice. This study’s main objective was to compare the prescribing patterns for urinary tract infections (UTIs) at baseline (before education was provided on local uropathogen resistance patterns, implications of broad-spectrum antibiotic usage, national practice guidelines, cost, etc.) and after antimicrobial stewardship education and interventions.MethodsPrescribing patterns for UTIs at baseline were reviewed and assessed for appropriateness by the inpatient ASP the summer of 2018. Following this review, education was provided to the outpatient prescribers that included discussion on local uropathogen resistance patterns, UTI guidelines, antimicrobial properties, risk for adverse effects, appropriate antimicrobial selections and dosing for UTIs. After education was provided prescribing patterns from the various sites and prescribers was reviewed on a quarterly basis. Email reminders were also sent out to providers reminding them to use cephalexin as first-line treatment. Unblinded peer comparison was utilized as a behavioral intervention in which all prescribers received reports comparing their antibiotic prescribing rates for UTIs to their peers.ResultsThe rate by which cephalexin was prescribed for UTIs has steadily improved from 4.02% of all prescriptions for UTIs during the reporting period of December 2017 - February 28, 2018 to 67.55% during the reporting period January 1 - March 31, 2019.ConclusionCollaboration between an established inpatient pediatric ASP and a nonaffiliate, multi-site private pediatric outpatient practice resulted in decreased utilization of broad-spectrum antibiotics and optimization of empiric treatment of urinary tract infections based on local resistance patterns.Disclosures All authors: No reported disclosures

Ventilator associated pneumonia due to carbapenem resistant microorganisms in children.

Infections due to carbapenem resistant pathogens have become a major health threat especially for hospitalized patients. Acinetobacter baumanii (AB) and Pseudomonas aeruginosa (PA) are important pathogens causing ventilator-associated pneumonia (VAP) with a trend of high resistance to carbapenems. The aim of this study is to investigate the risk factors for VAP due to carbapenem resistant Acinetobacter baumanii (CRAB) and Pseudomonas aeruginosa (CRPA) in children. Between 2009 and 2013, an active, prospective observational study was conducted in Gazi University Hospital. Patients from Pediatric Intensive Care Unit (PICU), between 1 month and 12 years of age with VAP due to AB and PA were included. During this period, 74 children experienced 126 VAP episodes due to Acinetobacter baumanii (N.=58) and Pseudomonas aeruginosa (N.=68). Among these, 93.1% (N.=54) of AB and 51.5% (N.=35) of PA were carbapenem resistant. In univariate analysis, length of stay in PICU until the diagnosis of VAP, presence of central venous catheters, prior use of cefepime, ciprofloxacin, colistin, and teicoplanin were associated with VAP due to CRPA (P=0.02, P=0.02, P=0.006, P=0.01, P=0.001, and P=0.009 respectively). Significant association was not found between the development of VAP due to CRAB and the investigated risk factors. Regression analyses revealed previous use of cefepime (OR, 2.11; 95% CI, 0.016-0.595, P=0.039) and colistin (OR: 2.33; 95% CI: 0.061-0.789, P=0.023) to be independently associated with VAP due to CRPA. This study suggests that broad spectrum antibiotic usage was the most important risk factor for the development of VAP due to CRPA.

Profile of fungal blood stream infection (BSI) in neonate at tertiary care hospital in South India

Background: Advancement in neonatal care has led to remarkable improvement in survival of new-born. Fungal infections in new born are an important health problem associated with substantial morbidity and mortality. The objective of this study was to assess the prevalence and epidemiology of neonatal fungal blood stream infection and to analyze risk factor associated with mortality due to fungal septicemia.Methods: This is a retrospective study of all neonatal fungal cases admitted from July 2016 to June 2017 to a tertiary care hospital in South India.Results: Isolation rate of fungal blood stream infection was 3.3%. Risk factors observed for candida blood stream infection were Broad spectrum antibiotic usage &gt;7 days (91.18%) followed by central line &gt;7 days (58.9%) and total parenteral nutrition (50.68%). Poor weight gain (71.23%), respiratory distress (68.4%) are common clinical presentation. Mortality among candida blood stream infection was 29 (39.72%). On step-wise logistic regression analysis, prolonged rupture of membrane and endotracheal tube placement for more than 7 days were significant independent predictors of mortality in neonatal candida blood stream infection.Conclusions: Candida blood stream infection is significant problem in our unit. It occurs in 3.3 %of neonates admitted in our unit and accounts for 34% of blood culture positive sepsis. Non-albican candidiasis is the predominant agent causing candida blood stream infection. Fungal prophylaxis may be recommended in neonates with risk factors like birth weight less than 1500 gms, those requiring ventilation for more than 7 days, those on total parenteral nutrition for more than 7 days and those on prolonged broad-spectrum antibiotics. It reemphasizes the need for aseptic insertion, maintenance, early identification of catheter related infection and early removal of central line.

Disparate effects of antibiotics on hypertension.

Gut microbiota are associated with a variety of complex polygenic diseases. The usage of broad-spectrum antibiotics by patients affected by such diseases is an important environmental factor to consider, because antibiotics, which are widely prescribed to curb pathological bacterial infections, also indiscriminately eliminate gut commensal microbiota. However, the extent to which antibiotics reshape gut microbiota and per se contribute to these complex diseases is understudied. Because genetics play an important role in predisposing individuals to these modern diseases, we hypothesize that the extent to which antibiotics influence complex diseases depends on the host genome and metagenome. The current study tests this hypothesis in the context of hypertension, which is a serious risk factor for cardiovascular diseases. A 3 × 2 factorial design was used to test the blood pressure (BP) and microbiotal effects of three different antibiotics, neomycin, minocycline, and vancomycin, on two well-known, preclinical, genetic models of hypertension, the Dahl salt-sensitive (S) rat and the spontaneously hypertensive rat (SHR), both of which develop hypertension, but for different genetic reasons. Regardless of the class, oral administration of antibiotics increased systolic blood pressure of the S rat, while minocycline and vancomycin, but not neomycin, lowered systolic blood pressure in the SHR. These disparate BP effects were accompanied by significant alterations in gut microbiota. Our study highlights the need to consider an individualized approach for the usage of antibiotics among hypertensives, as their BP could be affected differentially based on their individual genetic and microbiotal communities.

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds.

To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds). Retrospective, single-centre observational study between March 2015 and February 2016. A new quaternary referral centre. Adults referred for antimicrobial rounds outside of the intensive care and haematology units. Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system. The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam. Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased. The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

Severe IUGR and Long Duration of Antibiotic Treatment may Overcome the Benefits of Appropriate Feeeding Strategies to Prevent Necrotising Enterocolitis

Aim: To compare the characteristic features of premature neonates who developednecrotizing enterocolitis (NEC)or notand review the risks for NEC in our neonatal intensive care unit. Materials and Method: Ninety four premature neonates with gestational age ≤ 35 weeks and/or birth weight ≤1500 g were included into the study. Characteristic features of the study neonates were compared. Results: NECoccurred in 15.9% of the study population . Seventy nine neonates who did not develop NEC and 15 neonates who developed stage II and III NEC were compared. The rate of intrauterine growth restriction (IUGR), late onset sepsis and therefore broad-spectrum antibiotic usage were significantly higher in the group who developed NEC. At the time of diagnosis 93 % of NEC positive patients were on full feeds either with breast milk only or breast milk + fortifier, none of them were formula fed, 7 % of the cases were never fed. Surgery was performed in all stage III NEC patients and overall mortality rate was 33%. Conclusion: Our findings suggest that together with exclusive breast feeding regimen, other strategies to prevent NEC should be implemented in this high risk preterm neonates.

Mortality rate associated with hospital acquired infections among burn patients

Hospital acquired infections (HAIs) are the major contributors of mortality associated with burn injuries. The aim of this research was to document the antecedents affiliated with major burn injuries, hospitalization and mortality in burn patients. We performed a single center prospective study of patients admitted during 3 months period (April-June 2014) in burn wards of government hospital. There were 100 patients in this investigation which were observed weekly. The inclusion criterion was based on the shifting of patients from emergency to the wards after initial treatment of more than 24 h. Variables included were age and gender of the patient, the percent total body surface area (%TBSA) burn, the cause of the burn. Mean age of patients was 30.29 years. More females (55.67%) were admitted than males (44.32%). The total body surface area (%TBSA) burnt were from 15%- 95% respectively moreover children were more sensitive to hospital acquired infections (HAIs) and mortality rate was 34% in children with mean age of 5 years and disability of body parts were 42% among 75% were females. Whereas the most common (HAIs) were primary bloodstream (PBS) with mean value of 30.50, wound infections (WIS) were at second prevalence with mean value of 27.50, followed by sepsis (S) and pneumonia (P) 10.33, eye infections (EIs) 4.833 and urinary tract infections (UTIs) 2.667. Factors significantly (p-value= 0.000) associated with increased duration of hospitalization caught HAIs mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt. It concluded that the mortality was very much dependent on age and gender of the patient, burn causes, affected area as well as % TBSA burnt are considerable factors in determining the relationship of HAIs and whether the patients will survive or knuckle to injuries. Better compliance techniques, stricter control over disinfection and sterilization practices and usage of broad spectrum antibiotics, and reduction of the environmental contamination are required to reduce the HAIs rates among burn patients.

Extensive Adipose Tissue Necrosis with Pressure Necrosis Following Pfannenstiel Incision: A Complication of Infected Parietal wound Hematoma

Abstract Hematomas are postoperative complications that may arise from Pfannenstiel incisions. They usually resolve spontaneously or drained according to their extent. Obesity and diabetes may lead to infection and worsen the outcome. A 30-year-old woman presented with a large parietal wall hematoma 10 days after hysterotomy through a Pfannenstiel incision for missed abortion with bleeding placenta previa. The hematoma progressed, became infected and let to extensive subcutaneous fat necrosis with pressure necrosis that drained infected non-clotted altered blood through the main incision and another one as well. Extensive debridement was required, and packing with gauze was used to allow second intention closure. Satisfactory healing was achieved after 3 months of treatment without skin grafting. This case highlights the need for strict hemostasis with limited dissection of the upper flap of the rectus sheath and usage of broad-spectrum antibiotics, especially in obese and diabetic patients.

Clinical analysis of 8 cases of neonatal septicemia caused by Candida haemulonii in neonatal intensive care unit

To study the clinical characteristics, antibiotics sensitivity, outcome and risk factors of neonatal septicemia caused by Candida haemulonii. A retrospective analysis was performed on clinical characteristics and antibiotics sensitivity after 8 cases of neonatal septicemia caused by Candida haemulonii were identified; each of these patients had at least one positive result of bacterial culture for Candida haemulonii. The 8 cases born at gestational age of 178-260 d, weighing 835-2 055 g, developed the infection from May to July at 10-34 d after hospitalization. Among the 8 patients, 7 were cured, 1 died during hospitalization after the treatments were given up because of serious complications. The 8 patients with septicemia caused by Candida haemulonii had similar clinical chariacteristics to those of other neonatal candidemia, such as apnea, fever, abdominal distension, jaundice etc. They had abnormal auxiliary examination with increased C-reactive protein (CRP), declined platelet (PLT) count to different degrees. All of the 8 patients had peripherally inserted central catheter (PICC) and broad-spectrum antibiotics were applied. C. haemulonii as an emergent fungal pathogen had varying degrees of resistance to fluconazole, amphotericin B, itraconazole, or ketone, but was susceptible to voriconazole. The characteristics of neonatal septicemia caused by Candida haemulonii were similar to those caused by other candida, and the main risk factors are the low birth weight, PICC, and usage of broad-spectrum antibiotics. It mainly occurred in May to July which is hot and humid season.

Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers.

Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines. To evaluate risk factors for treatment of ASB. Retrospective observational study. A tertiary academic hospital, county hospital, and community hospital. Hospitalized adults with bacteriuria. Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria. Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%. ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.