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Sun H, Dong D, Zhao M, Jian J. Infection with multi‑drug resistant organisms in patients with limb fractures: Analysis of risk factors and pathogens. Biomed Rep 2024; 20:28. [PMID: 38259588 PMCID: PMC10801349 DOI: 10.3892/br.2023.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/17/2023] [Indexed: 01/24/2024] Open
Abstract
Infection with multi-drug resistant organisms (MDROs) has emerged as a global problem in medical institutions. Overuse of antibiotics is the main cause of drug resistance. Notably, the incidence of infection with MDROs increases in patients with limb fractures who have undergone invasive surgery. The present study aimed to analyze the risk factors for postoperative MDROs infection in a cohort of patients with limb fractures. A retrospective study was performed on the data of patients with fractures between January 2020 and August 2022. Postoperative surgical site infection occurred in 114 patients in total, of which 47 were infected with MDROs. Univariate logistic regression analysis and multivariate binary logistic regression were used to confirm the associations between independent risk factors and MDRO infection. A total of 155 bacteria were collected from patients with MDROs infection and patients with non-MDROs infection, of which 66.5% were gram-positive bacteria and 33.5% were gram-negative. Staphylococcus aureus accounted for 26.5% of the 155 pathogens. MDROs, such as methicillin-resistant S. aureus and extended-spectrum β-lactamases-positive gram-negative bacillus, were detected after antibiotic treatment. Univariate analysis indicated that the number of antibiotics administered, being bedridden, repeat infection, operative time and repeated operation were different in the two groups. In addition, univariate logistic analysis indicated that being bedridden (OR, 3.98; P=0.001), administration of >2 antibiotics (OR, 2.42; P=0.026), an operative time of >3 h (OR, 3.37; P=0.003), repeated infection (OR, 3.08; P=0.009) and repetition of procedures (OR, 2.25; P=0.039) were individual risk factors for MDRO infection. Multivariate analysis showed that being bedridden (OR, 2.66; P=0.037), repeated infection (OR, 4.00; P=0.005) and an operative time of >3 h (OR, 2.28; P=0.023) were risk factors of MDRO infection. In conclusion, constrained antibiotic use, shortened operative time and increased activity duration can effectively prevent surgical-site infection with MDROs in patients with fractures.
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Affiliation(s)
- Honggang Sun
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
| | - Dagao Dong
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
| | - Min Zhao
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
| | - Jie Jian
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
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Ren J, Duan S, Wu Y, Wen M, Zhang J, Liu Y, Zhu G. Multidrug-resistant bacterial infection in adult patients following cardiac surgery: clinical characteristics and risk factors. BMC Cardiovasc Disord 2023; 23:472. [PMID: 37735348 PMCID: PMC10512613 DOI: 10.1186/s12872-023-03488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The prevalence of infections with multidrug-resistant organism (MDRO) pose great challenges for anti-infective therapy. Previous research on MDRO infections after cardiac surgery was limited. Therefore, understanding and mastering the clinical characteristics and risk predictors of MDRO infection after cardiac surgery is of great significance for standardized management of perioperative patients. METHODS The medical records of adult patients with MDRO infection after cardiac surgery from January 2018 to October 2021 were collected, and patients were divided into MDR infection group (n = 176) and non-MDR infection group (n = 233). Univariate and multivariate regression analysis of variables was performed to determine the risk predictors of MDRO infection. RESULTS The incidence of MDRO infection was 8.6%. Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common, accounting for 37.3%, 23.5% and 18.0%, respectively. The main infection type were lower respiratory tract infection (LTRI = 29.0%). Univariate analysis showed that underwent coronary artery bypass graft (CABG) (P = 0.001) and secondary operation (P = 0.008), pre-infection exposure to vancomycin (P < 0.001) and linezolid (P = 0.002), combination antibiotics (P < 0.001), four antibiotics in combination (P = 0.005), glucocorticoid use (P = 0.029), preoperative hypoalbuminemia (P = 0.003) were risk factors for post-operative MDRO infection. Multivariate regression analysis showed that underwent CABG (OR = 1.228, 95%CI = 1.056∽1.427, P = 0.008), secondary operation (OR = 1.910, 95%CI = 1.131∽3.425, P = 0.015) and pre-infection exposure to linezolid (OR = 3.704, 95%CI = 1.291∽10.629, P = 0.005) were independent risk predictors for MDRO infection. The risk of MDRO infection increased with the length of stay in the ICU (P < 0.001) and the length of stay before diagnosis of infection (P = 0.003), and the difference was statistically significant. Meanwhile, the length of stay after infection (P = 0.005) and the total length of hospital stay (P < 0.001) were significantly longer in the MDRO infection group, and the all-cause mortality was numerically higher in the MDRO infection group (31.3% versus 23.2%). CONCLUSIONS The morbidity and mortality of MDRO infection was high in adult cardiac surgery, and many risk factors influence the occurrence of MDRO infection. In the future, clinicians should focus on high-risk patients, strengthen multidisciplinary collaboration on infection prevention and control measures, reduce the morbidity and mortality of MDRO infection, and improve the prognosis of in-hospital patients.
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Affiliation(s)
- Jianwei Ren
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China
| | - Shengchen Duan
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China
| | - Yuanxing Wu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China
| | - Mingxiu Wen
- Department of Cardiac Surgery, Beijing Anzhen Hospital Capital Medical University, Beijing, 100029, China
| | - Jianye Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital Capital Medical University, Beijing, 100029, China
| | - Yulei Liu
- Department of Microbiological laboratory, Beijing Anzhen Hospital Capital Medical University, Beijing, 100029, China
| | - Guangfa Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China.
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Antibiotic resistance pattern of Klebsiella pneumoniae a major problem for society. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns2.6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: Antibiotic resistance pattern of klebsiella pneumoniae a major problem for society. Methods: After ethical approval from the institutional ethical committee this study was done in the department of microbiology from April 2021 to march 2022 in genesis institute of dental science and research centre with collaboration of anil baghi hospital, firozpur, Punjab India. Demographic profile of all the patients like age, gender, history of any diseases was noted. All the sample like urine, sputum, blood, pleural fluid and urethral discharge were collected in the department for isolation and identification of K. pneumoniae. After 24hrs those were positive sample, further proceed for grams staining. B D Phoenix advanced automated microbiology system was used for identification and sensitivity of bacteria for 24hrs. Results: The study showed that highest number of patients having Klebsiella pneumonia were from 50-70 years having 20 (40%)patients followed by 30-50 years with 16 (32%), from Above 70 years 12 (24%) and below the age of 30 years having lowest number with two (4%) patients out of all patients. The number of male patients 33(66%) is more than females 17(34%).
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Costa JES, Nogueira KDS, Cunha CAD. Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications. Braz J Infect Dis 2020; 24:380-385. [PMID: 32866434 PMCID: PMC9392124 DOI: 10.1016/j.bjid.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/28/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gram-negative bacilli (GNB), notably Acinetobacter spp., Pseudomonas spp., and Klebsiella spp., are becoming increasingly resistant to carbapenems and are associated with high health care costs and mortality, becoming a global concern. OBJECTIVE To determine the prevalence rates of carbapenem resistance among Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. in the main sites of nosocomial infection at a tertiary care hospital in southern Brazil and the consequent therapeutic implications. METHODS Cultures processed at the institution's laboratory in 2017 were analyzed, and those positive for Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. were identified. Antibiograms were evaluated for meropenem sensitivity following the Clinical Laboratory Standards Institute guidelines. RESULTS Acinetobacter spp. had the lowest prevalence among the three GNB, and resistance of this pathogen to meropenem at different sites of infection ranged from 36% (blood) to 82% (respiratory tract). Pseudomonas spp. was highly prevalent at the respiratory tract (31%) and had a high resistance rate to meropenem in rectal swab samples (71%), but a relatively low frequency at infection sites (skin/soft tissue, 13%; blood, 25%). Klebsiella spp. was identified in 7.5% of the blood cultures and 15% of the urine cultures and was the chief colonizer among all pathogens, representing 54% of all rectal swab samples, of which 53% were meropenem resistant. At sites of infection, rates of Klebsiella spp. resistant to meropenem ranged from 19% (skin) to 55% (vascular catheter). CONCLUSIONS The prevalence of carbapenem-resistant GNB at our hospital was relatively low compared to national and international data; thus, meropenem remains a good therapeutic option against these bacteria. Other antibiotics effective against GNB, such as ceftazidime, cefepime, and piperacillin-tazobactam, can be used in most cases, while meropenem should be reserved for patients with sepsis. Strict contact precaution measures are still needed, given the high resistance rate observed at the colonizing site.
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Affiliation(s)
| | - Keite da Silva Nogueira
- Universidade Federal do Paraná, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Laboratório de Microbiologia, Curitiba, PR, Brazil
| | - Clóvis Arns da Cunha
- Universidade Federal do Paraná, Faculdade de Medicina, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
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Jara MC, Frediani AV, Zehetmeyer FK, Bruhn FRP, Müller MR, Miller RG, Nascente PDS. Multidrug-Resistant Hospital Bacteria: Epidemiological Factors and Susceptibility Profile. Microb Drug Resist 2020; 27:433-440. [PMID: 32706621 DOI: 10.1089/mdr.2019.0209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Increase in antimicrobial resistance to antibiotics is the product of the evolution and natural adaptation of microorganisms through mutations and genetic recombination caused by the indiscriminate use of antibiotics and the ineffective control and prevention of infection. The current study analyzes the profile of multiresistant hospital bacteria in two hospitals in Pelotas, state of Rio Grande do Sul, Brazil. Over the course of 4 months, patient's gender and age, hospital accommodation type, and sample site were evaluated. Two hundred and eighty-six microbiological culture antibiogram reports of hospitalized patients and outpatients of both sexes, between zero and 96 years of age, were analyzed. Bacterium Klebsiella pneumoniae was the most prevalent. The most resistant Gram-negative bacilli (GNB) were K. pneumoniae (27.5%); Acinetobacter baumannii (24.1%); Escherichia coli (14.7%); and Pseudomonas aeruginosa (14.5%). The most resistant Gram-positive cocci (GPC) were Enterococcus faecium (27.5%) and Staphylococcus aureus (25.5%). The classes of antibiotics with the greatest number of resistant GNB included penicillins (84.8%), quinolones (77.5%), and cephalosporins (75.7%). In the case of GPC, the most resistant were macrolides (95.4%); lincosamides (90.3%), and penicillins (77%). Among GNBs, polypeptides had the highest sensitivity rate (81.3%), whereas, among GPC, fusidanes, glycylcyclines, and lipopeptides had 100% sensitivity.
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Affiliation(s)
- Marisa Castro Jara
- Postgraduate Program in Biochemistry and Bioprospecting, Federal University of Pelotas, Pelotas, Brazil.,Department of Microbiology and Parasitology, Institute of Biology, Federal University of Pelotas, Pelotas, Brazil
| | - Andressa Vieira Frediani
- Department of Microbiology and Parasitology, Institute of Biology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Milene Ribeiro Müller
- Clinical Analysis Laboratory, HE-EBSERH, Federal University of Pelotas, Pelotas, Brazil
| | - Róger Giusti Miller
- Clinical Analysis Laboratory, HE-EBSERH, Federal University of Pelotas, Pelotas, Brazil
| | - Patrícia da Silva Nascente
- Postgraduate Program in Biochemistry and Bioprospecting, Federal University of Pelotas, Pelotas, Brazil.,Department of Microbiology and Parasitology, Institute of Biology, Federal University of Pelotas, Pelotas, Brazil
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