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https://www.readbyqxmd.com/read/28638594/high-burden-of-antimicrobial-resistance-among-gram-negative-bacteria-causing-healthcare-associated-infections-in-a-critical-care-unit-of-nepal
#1
Narayan Prasad Parajuli, Subhash Prasad Acharya, Shyam Kumar Mishra, Keshab Parajuli, Basista Prasad Rijal, Bharat Mani Pokhrel
BACKGROUND: Healthcare associated infections (HCAI) and antimicrobial resistance are principal threats to the patients of intensive care units and are the major determining factors for patient outcome. They are associated with increased morbidity, mortality, excess hospitalization and financial costs. The present study is an attempt to investigate the spectrum and antimicrobial resistance of bacterial isolates involved in healthcare associated infections (HCAI) in the patients of a critical care unit at a tertiary care university hospital in Kathmandu, Nepal...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28634909/categorical-risk-perception-drives-variability-in-antibiotic-prescribing-in-the-emergency-department-a-mixed-methods-observational-study
#2
Eili Y Klein, Elena M Martinez, Larissa May, Mustapha Saheed, Valerie Reyna, David A Broniatowski
BACKGROUND: Adherence to evidence-based antibiotic therapy guidelines for treatment of upper respiratory tract infections (URIs) varies widely among clinicians. Understanding this variability is key for reducing inappropriate prescribing. OBJECTIVE: To measure how emergency department (ED) clinicians' perceptions of antibiotic prescribing risks affect their decision-making. DESIGN: Clinician survey based on fuzzy-trace theory, a theory of medical decision-making, combined with retrospective data on prescribing outcomes for URI/pneumonia visits in two EDs...
June 20, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28629728/antibiotic-resistance-determinants-and-clonal-relationships-among-multidrug-resistant-isolates-of-klebsiella-pneumoniae
#3
Santosh Kumar Singh, Mitali Mishra, Minu Sahoo, Shashank Patole, Suneeta Sahu, Sudhi Ranjan Misra, Harapriya Mohapatra
In the present study, we performed PCR based screening to determine the presence of antibiotic resistance genes and sequencing to find mutation in QRDR region among fourteen isolates of K. pneumoniae. Association analysis was conducted to detect the co-resistance among the isolates. Multi-locus sequence analysis was carried out to determine the clonal relationship among them. All the K. pneumoniae isolates showed resistance to multiple antibiotics and exhibited cross-resistance to antibiotics. Although few isolates co-harbored variants of β-lactamase genes, others carried qnrB on plasmid and mutations in Quinolone-Resistant Determining Region (QRDR)...
June 16, 2017: Microbial Pathogenesis
https://www.readbyqxmd.com/read/28628930/-rational-use-of-antibiotics-data-form-a-survey-from-2014-within-the-mrdo-network-compared-to-nationwide-data-from-2009
#4
Luba Lendowski, Peter Walger, Christoph Hoeser, Martin Exner, Claudia Roesing, Steffen Engelhart
Introduction To combat multi-resistant gram-negative bacteria as the cause of life-threatening infections, antibiotic stewardship activities are of great importance. Objective To detect weaknesses when prescribing antibiotics in hospitals and compare the situation between 2009 and 2014. Methods In 2014, a questionnaire was sent to all 380 physicians employed in 7 hospitals. Primary, secondary and tertiary care hospitals were included. Investigated were: demographic data, position, certified specialization, presence of antibiotic prescription rules and behavior to follow them...
June 19, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28625166/impact-of-gram-stain-results-on-initial-treatment-selection-in-patients-with-ventilator-associated-pneumonia-a-retrospective-analysis-of-two-treatment-algorithms
#5
Jumpei Yoshimura, Takahiro Kinoshita, Kazuma Yamakawa, Asako Matsushima, Naoki Nakamoto, Toshimitsu Hamasaki, Satoshi Fujimi
BACKGROUND: Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care units (ICUs). Several studies have suggested that the Gram stain of endotracheal aspirates is a useful method for accurately diagnosing VAP. However, the usefulness of the Gram stain in predicting which microorganisms cause VAP has not been established. The purpose of this study was to evaluate whether a Gram stain of endotracheal aspirates could be used to determine appropriate initial antimicrobial therapy for VAP...
June 19, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28621182/-non-intubated-uniportal-video-assisted-thoracic-surgery-vats-lobectomy-as-a-new-procedure-in-our-department
#6
József Furák, Zsolt Szabó, Theodor Horváth, Tibor Géczi, Balázs Pécsy, Tibor Németh, Aurél Ottlakán, Zsolt Molnár, György Lázár
AIM: Due to the emerging experience in VATS (video assisted thoracic surgery) lobectomies, in some centers the so called "non-intubated" VATS lobectomies (NITS - non-intubated thoracic surgery) gained increased authority, during which endotracheal intubation and muscle relaxation of the patient is not carried out, thus surgery is being performed with the patient breathing spontaneously. The recent study deals with our initial experience gained during uniportal NITS VATS lobectomies. PATIENTS AND METHOD: Between 24...
June 2017: Magyar Sebészet
https://www.readbyqxmd.com/read/28615012/moxifloxacin-monotherapy-versus-combination-therapy-in-patients-with-severe-community-acquired-pneumonia-evoked-ards
#7
Tim Rahmel, Sven Asmussen, Jan Karlik, Jörg Steinmann, Michael Adamzik, Jürgen Peters
BACKGROUND: We tested the hypothesis that moxifloxacin monotherapy is equally effective and safe as a betalactam antibiotic based combination therapy in patients with acute respiratory distress syndrome (ARDS) evoked by severe community acquired pneumonia (CAP). METHODS: In a retrospective chart review study of 229 patients with adult respiratory distress syndrome (ARDS) admitted to our intensive care unit between 2001 and 2011, 169 well-characterized patients were identified to suffer from severe CAP...
June 14, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28603413/identifying-the-heterogeneity-of-copd-by-v-p-spect-a-new-tool-for-improving-the-diagnosis-of-parenchymal-defects-and-grading-the-severity-of-small-airways-disease
#8
M Bajc, Y Chen, J Wang, X Y Li, W M Shen, C Z Wang, H Huang, A Lindqvist, X Y He
INTRODUCTION: Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. METHODS: 94 COPD patients (aged 43-86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I-IV) were examined with V/P SPECT and spirometry...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28602108/pharmacotherapy-for-community-acquired-pneumonia-in-the-elderly
#9
Diego Viasus, José A Núñez-Ramos, Samir A Viloria, Jordi Carratalà
Community-acquired pneumonia (CAP) is an increasing problem in the elderly that is associated with elevated morbidity and mortality. Given the expected increased life expectancy, this problem is only likely to worsen, so it has been considered that treatment effects must be examined separately in elderly adults with CAP. Areas covered: In this narrative review, we give an update of the available data of antibiotics for elderly patients with CAP. Clinical features, drug pharmacokinetics and pharmacodynamics, adverse effects, and outcomes differ in CAP depending on patient age...
July 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28601825/defining-and-measuring-suspicion-of-sepsis-an-analysis-of-routine-data
#10
Matthew Inada-Kim, Bethan Page, Imran Maqsood, Charles Vincent
OBJECTIVES: To define the target population of patients who have suspicion of sepsis (SOS) and to provide a basis for assessing the burden of SOS, and the evaluation of sepsis guidelines and improvement programmes. DESIGN: Retrospective analysis of routinely collected hospital administrative data. SETTING: Secondary care, eight National Health Service (NHS) Acute Trusts. PARTICIPANTS: Hospital Episode Statistics data for 2013-2014 was used to identify all admissions with a primary diagnosis listed in the 'suspicion of sepsis' (SOS) coding set...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28599967/challenging-surgical-dogma-in-the-management-of-proximal-esophageal-atresia-with-distal-tracheoesophageal-fistula-outcomes-from-the-midwest-pediatric-surgery-consortium
#11
Dave R Lal, Samir K Gadepalli, Cynthia D Downard, Daniel J Ostlie, Peter C Minneci, Ruth M Swedler, Thomas H Chelius, Laura Cassidy, Cooper T Rapp, Deborah Billmire, Steven Bruch, R Carland Burns, Katherine J Deans, Mary E Fallat, Jason D Fraser, Julia Grabowski, Ferdynand Hebel, Michael A Helmrath, Ronald B Hirschl, Rashmi Kabre, Jonathan Kohler, Matthew P Landman, Charles M Leys, Grace Z Mak, Jessica Raque, Beth Rymeski, Jacqueline M Saito, Shawn D St Peter, Daniel von Allmen, Brad W Warner, Thomas T Sato
PURPOSE: Perioperative management of infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) is frequently based on surgeon experience and dogma rather than evidence-based guidelines. This study examines whether commonly perceived important aspects of practice affect outcome in a contemporary multi-institutional cohort of patients undergoing primary repair for the most common type of esophageal atresia anomaly, proximal EA with distal TEF. METHODS: The Midwest Pediatric Surgery Consortium conducted a multicenter, retrospective study examining selected outcomes on infants diagnosed with proximal EA with distal TEF who underwent primary repair over a 5-year period (2009-2014), with a minimum 1-year follow up, across 11 centers...
June 1, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28596060/-medical-prevention-and-treatment-of-radiation-induced-pulmonary-complications
#12
A Vallard, C Rancoule, H Le Floch, J-B Guy, S Espenel, C Le Péchoux, É Deutsch, N Magné, C Chargari
Radiation-induced lung injuries mainly include the (acute or sub-acute) radiation pneumonitis, the lung fibrosis and the bronchiolitis obliterans organizing pneumonia (BOOP). The present review aims at describing the diagnostic process, the current physiopathological knowledge, and the available (non dosimetric) preventive and curative treatments. Radiation-induced lung injury is a diagnosis of exclusion, since clinical, radiological, or biological pathognomonic evidences do not exist. Investigations should necessarily include a thoracic high resolution CT-scan and lung function tests with a diffusing capacity of the lung for carbon monoxide...
June 5, 2017: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
https://www.readbyqxmd.com/read/28588423/dysphagia-screening-after-acute-stroke-a-quality-improvement-project-using-criteria-based-clinical-audit
#13
Jorun Sivertsen, Birgitte Graverholt, Birgitte Espehaug
BACKGROUND: Dysphagia is common after stroke and represents a major risk factor for developing aspiration pneumonia. Early detection can reduce the risk of pulmonary complications and death. Despite the fact that evidence-based guidelines recommend screening for swallowing deficit using a standardized screening tool, national audits has identified a gap between practice and this recommendation. The aim was to determine the level of adherence to an evidence-based recommendation on swallow assessment and to take actions to improve practice if necessary...
2017: BMC Nursing
https://www.readbyqxmd.com/read/28576117/clinical-failure-with-and-without-empiric-atypical-bacteria-coverage-in-hospitalized-adults-with-community-acquired-pneumonia-a-systematic-review-and-meta-analysis
#14
Khalid Eljaaly, Samah Alshehri, Ahmed Aljabri, Ivo Abraham, Mayar Al Mohajer, Andre C Kalil, David E Nix
BACKGROUND: Both typical and atypical bacteria can cause community-acquired pneumonia (CAP); however, the need for empiric atypical coverage remains controversial. Our objective was to evaluate the impact of antibiotic regimens with atypical coverage (a fluoroquinolone or combination of a macrolide/doxycycline with a β-lactam) to a regimen without atypical antibiotic coverage (β-lactam monotherapy) on rates of clinical failure (primary endpoint), mortality, bacteriologic failure, and adverse events, (secondary endpoints)...
June 2, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28573186/lifelong-prophylaxis-with-trimethoprim-sulfamethoxazole-for-prevention-of-outbreak-of-pneumocystis-jirovecii-pneumonia-in-kidney-transplant-recipients
#15
Norihiko Goto, Ai Takahashi-Nakazato, Kenta Futamura, Manabu Okada, Takayuki Yamamoto, Makoto Tsujita, Takahisa Hiramitsu, Shunji Narumi, Kiyoto Tsuchiya, Hiroyuki Gatanaga, Yoshihiko Watarai, Shinichi Oka
BACKGROUND: Outbreaks of Pneumocystis jirovecii pneumonia (PCP) in kidney transplant recipients are frequently reported worldwide. However, the general guidelines propose only short-term prophylaxis with trimethoprim-sulfamethoxazole after kidney transplantation. We experienced 3 PCP outbreaks in the last 10 years despite providing the recommended prophylaxis. The purpose of this study was to find a prophylaxis regimen that could successfully prevent future PCP outbreaks in immunosuppressed kidney transplant recipients...
May 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28572521/the-feeding-paradox-in-advanced-dementia-a-local-perspective
#16
J Kh Luk, F Hw Chan, E Hui, C Y Tse
Feeding problems are common in older people with advanced dementia. When eating difficulties arise tube feeding is often initiated, unless there is a valid advance directive that refuses enteral feeding. Tube feeding has many pitfalls and complications. To date, no benefits in terms of survival, nutrition, or prevention of aspiration pneumonia have been demonstrated. Careful hand feeding is an alternative to tube feeding with advanced dementia. In Hong Kong, the Hospital Authority has established clear ethical guidelines for careful hand feeding...
June 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28570350/impact-of-critical-care-air-transport-team-ccatt-ventilator-management-on-combat-mortality
#17
Joseph K Maddry, Alejandra G Mora, Shelia C Savell, Crystal A Perez, Phillip E Mason, James K Aden, Vikhyat S Bebarta
BACKGROUND: Aeromedical evacuation platforms such as Critical Care Air Transport Teams (CCATTs) play a vital role in the transport and care of critically injured and ill patients in the combat theater. Mechanical ventilation is used to support patients with failing respiratory function and patients requiring high levels of sedation. Mechanical ventilation, if not managed appropriately, can worsen or cause lung injury, as well as contribute to increased morbidity.The purpose of this study was to evaluate the impact of ARDSNet protocol compliance during aeromedical evacuation of ventilated combat injured patients...
May 30, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28567280/solar-powered-oxygen-systems-in-remote-health-centers-in-papua-new-guinea-a-large-scale-implementation-effectiveness-trial
#18
Trevor Duke, Ilomo Hwaihwanje, Magdalynn Kaupa, Jonah Karubi, Doreen Panauwe, Martin Sa'avu, Francis Pulsan, Peter Prasad, Freddy Maru, Henry Tenambo, Ambrose Kwaramb, Eleanor Neal, Hamish Graham, Rasa Izadnegahdar
BACKGROUND: Pneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses...
June 2017: Journal of Global Health
https://www.readbyqxmd.com/read/28566116/adherence-to-local-antimicrobial-guidelines-for-initial-treatment-of-community-acquired-infections
#19
Trine Langfeldt Hagen, Mathias Amdi Hertz, Gábor Balázs Uhrin, Michael Dalager-Pedersen, Henrik Carl Schønheyder, Henrik Nielsen
INTRODUCTION: Adherence to antimicrobial guidelines is key to ensuring a correct treatment of severe infections and to lessening misuse of broad-spectrum antimicrobials. We conducted a retrospective cross-sectional study at the Emergency Department of Aalborg University Hospital, North Denmark Region. Our aim was to examine adherence to local antimicrobial guidelines in the empirical treatment of community-acquired infections and to identity any predictors of guideline non-adherence. METHODS: We identified 1,555 patients who had blood cultures performed and were admitted to the medical emergency department in 2016...
June 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28562556/low-utility-of-blood-culture-in-pediatric-community-acquired-pneumonia-an-observational-study-on-2705-patients-admitted-to-the-emergency-department
#20
Jae Hyun Kwon, Jung Heon Kim, Jeong-Yong Lee, Youn-Jung Kim, Chang Hwan Sohn, Kyoung Soo Lim, Won Young Kim
To investigate the utility of blood cultures performed on previously healthy children and adolescents with community-acquired pneumonia (CAP) at a tertiary care hospital emergency department (ED).We reviewed 3235 patients with CAP aged 6 months to 18 years who underwent blood cultures at the ED from 2009 through 2016. CAP was defined according to the International Classification of Diseases, 10th Revision codes for pneumonia and the requirement of antibiotic treatment plus any of the following: radiologically confirmed, hospitalized, or moderate to severe disease...
June 2017: Medicine (Baltimore)
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