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Surgical bacterial infections and antimicrobial susceptibility patterns at Lilongwe Central Hospital
RM Banda, AS Muula, GR Gwaza, DC Namarika, KC Ng'oma, FE Chintolo, H Yamakazi, AP Muyco
Malawi Medical Journal , 2001,
Abstract: A cross sectional study was done between October 1999 and February 2000 to determine antimicrobial susceptibility patterns of consecutive bacterial isolates of 102 clinical samples among surgical in-patients at Lilongwe Central hospital (LCH), Malawi. Antimicrobial susceptibility was determined using comparative disc diffusion techniques. 83 (81.4%) samples were culture positive for bacterial growth while 19 (18.6%) grew nothing. Of the 93 culture positive specimens, Staphylococcus aureus was the predominant organism 43(51.8%) followed by Proteus species 8(9.6%) and E. coli 7(8.4%). Overall, 98.6% of all isolates tested against ciprofloxacin were susceptible, and against gentamicin and flucloxacin were 84.8% and 66.7% respectively. 59.3% of isolates tested against chloramphenicol were resistant. We recommend a review on the use of chloramphenicol as first-line antimicrobial therapy among surgical in-patients at Lilongwe Central Hospital. We also recommend restricted use of antimicrobials so as to minimise development of drug resistance. Periodic susceptibility studies are necessary to guide judicious use of antibiotics. Malawi Medical Journal Vol 13, No.3 (Sept 2001): pp27-29
Impacto de un programa de control en los consumos de antibióticos en pacientes quirúrgicos Impact of a control program on the antimicrobial consumption by surgical patients
Rafael Pinilla González,Juan J Pisonero Socías,Humberto Guanche Garcell,Irene Fiterre Lancis
Revista Cubana de Cirugía , 2013,
Abstract: Introducción: los antimicrobianos son un recurso terapéutico esencial en pacientes quirúrgicos, los cuales frecuentemente son utilizados de forma inapropiada.Objetivo: demostrar los cambios en los patrones de consumo de antimicrobianos relacionados con un programa de control. Métodos: se realizó un estudio de intervención en los servicios quirúrgicos del Hospital Docente Clinicoquirúrgico "Joaquín Albarrán"desde mayo 2008 a diciembre 2010, el cual incluyó evaluaciones de calidad de prescripción y retroalimentación al equipo asistencial, sesiones educacionales, revisión de las políticas de uso de antimicrobianos y consulta con el comité de antibióticos. Se registran los consumos mensuales de antimicrobianos utilizados expresados en dosis prescritas por 1 000 días pacientes (DDP). Resultados: los antibióticos más utilizados fueron las cefalosporinas, metronidazol, ciprofloxacina, penicilinas y cotrimoxazol. Se destaca el mayor consumo de ceftriaxona (94,4 DDP) y cefazolina (88,3 DDP), con evidente disminución en los consumos de cefalosporinas de primera, tercera y cuarta generación, mientras que la cefuroxima incrementa los consumos desde 23,8 (2008) a 35,7 DDP (2010). La penicilina sódica (36,0 DDP), amoxicillina (7,2 DDP) y la amoxicillina con sulbactam (5,8 DDP) constituyen las penicilinas más utilizadas. Disminuyen los consumos de metronidazol de 312,4 a 75,7 DDP, de ciprofloxacina de 220,8 a 52,4 DDP, de cloranfenicol de 27,9 a 3,5 DDP y de cotrimoxazol de 99,4 a 26,6 DDP, en los a os 2008 y 2010 respectivamente. Conclusión: es evidente que el programa de control implementado en los servicios quirúrgicos ha producido cambios en los patrones de consumo lo que evidencia mejora en la calidad de prescripción. Introduction: Antimicrobials is an essential therapeutic resource in surgical patients, but they are frequently used in an inappropriate way. Objective: To demonstrate the changes in the antimicrobial consumption patterns related with a control program. Methods: Intervention study conducted in the surgical services of "Joaquin Albarrán" hospital in the period of May 2008 to December 2010. It included evaluations of quality of prescription and of feedback in the medical assistance team, educational sessions, checking of antimicrobial use policies and consultations with the antibiotic regulatory committee. The monthly antimicrobial consumption rates were registered and expressed as dose prescribed per 1000 patient-days. Results: The most frequently used antibiotics were cephalosporins, metronidazole, ciprofloxacin, penicillin and cotrimoxazole. The hi
A multicenter point-prevalence study: antimicrobial prescription frequencies in hospitalized patients in turkey
Gaye Usluer, Ilhan Ozgunes, Hakan Leblebicioglu, the Turkish Antibiotic Utilization Study Group
Annals of Clinical Microbiology and Antimicrobials , 2005, DOI: 10.1186/1476-0711-4-16
Abstract: Data on the use of antimicrobial agents in eighteen tertiary care hospitals were collected on March 20th 2002.One or more antimicrobials were ordered in 2900 (30.6 %)of 9471 hospitalized patients. The reasons of hospitalization of the patients receiving antimicrobials were medical treatment (42.5 %), elective surgery (39.6 %), treatment of infectious disease (17.1 %) and emergent surgical procedures (10.4 %). The highest consumption frequencies were found in surgical (81.6 %) and medical (55.2 %) intensive care units. The 48.8 % of antimicrobials were given for treatment and 44.2 % for prophylactic use. The most common reasons for treatment were found as lower respiratory tract, urinary tract, surgical wound infections and febrile neutropenia. Antimicrobials were ordered empirically in 78.4 % of patients. The proven infection ratio was found as 30.7 %. The 56.4 % and 13.4 % of orders were evaluated as clinically and microbiologically appropriate respectively.These results suggest that antimicrobial prescription and empirical treatment ratios were high and inappropriate at inpatient groups.Since antimicrobial chemotherapy was introduced in medical practice, there have been calls for its rational use. Appropriate antimicrobial treatment greatly improves the prognosis of infectious diseases. There has been a very significant reduction in morbidity and mortality associated with the use of antimicrobials since they were first introduced [1]. However, the overuse of antimicrobials may increase the risks of drug resistant pathogens, side effects and costs of medical care. The right agent at the right dose and dosing interval and right duration can achieve both a favorable clinical outcome and prevent the selection of resistance. It was reported that 20–50% of antimicrobial use in humans was questionable or inappropriate [1,2]. Accurate information about prescribing patterns in hospitals is valuable in improving the quality of antimicrobial prescriptions.Only very limited d
Aetiology and antimicrobial resistance of healthcare-acquired surgical site infections occurring after hospital discharge
Elsa Hasi?,Selma Uzunovi?-Kamberovi?
South Eastern Europe Health Sciences Journal , 2011,
Abstract: Aim To investigate aetiology and antimicrobial resistance of causative agents of healthcare-acquired surgical site infections (SSI) occurring after hospital discharge in the patients of Zenica-doboj Canton within the period 2002–2007.Methods Antimicrobial resistance data of etiological agents of SSI were retrospectively analysed. Antimicrobial susceptibility testing was performed by disc-diffusion method according to Clinical Laboratory Standards Institute.Results 196 wound samples of which 5 were surgical wounds were received for the analysis. Gram-negative bacteria were the more frequent causative agent in 35 (63.6%), compared to Staphylococcus aureus, which was isolated in 20 (36.4%) cases of SSI. Methicillin–resistant S. aureus (MRSA) was isolated from nine (45%) out of 20 S. aureus positive samples. Klebsiella spp. were the most frequently isolated gram-negative bacteria, 17 (48.6%) samples. MRSA isolates have shown the higher prevalence of resistance to all antibiotics tested than MSSA isolates, except for vancomycin and sulfomethoxazol-trimethoprim. High resistance rate to ciprofloxacin, 45% and 28% in both MRSA and MSSA isolates, as well as resistance to imipenem was noted, 23% and 19%, respectively. Klebsiella spp. displayed high resistance rates to all antibiotic tested, and it ranged from 12% for imipenem to 65% for sulfomethoxazol-trimethoprim. Conclusion Because of the frequency of complications, prolonged hospitalization and high costs, and ever increasing resistance to antibiotics, health-care surgical site infections are very important problem in contemporary medicine. Accordingly, there is the need to establish active monitoring of SSI in Bosnia and Herzegovina as well as continuous surveillance in order to prevent these infections.
An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients
Christina M Katsios, Lisa Burry, Sandra Nelson, Tanaz Jivraj, Stephen E Lapinsky, Randy S Wax, Michael Christian, Sangeeta Mehta, Chaim M Bell, Andrew M Morris
Critical Care , 2012, DOI: 10.1186/cc11854
Abstract: We retrospectively analyzed consecutive patients with positive bacterial cultures admitted to a 16-bed medical-surgical ICU over 2-month periods before and after ASP introduction (April through May 2008 and 2009, respectively). We evaluated the antimicrobial treatment of positive sterile- versus nonsterile-site cultures, specified a priori. We reviewed patient charts for clinician documentation of three specific details regarding antimicrobials: an explicit statement of antimicrobial regimen/indication, duration, and de-escalation. We also analyzed cost and defined daily doses (DDDs) (a World Health Organization (WHO) standardized metric of use) before and after ASP.Patient demographic data between the pre-ASP (n = 139) and post-ASP (n = 130) periods were similar. No difference was found in the percentage of positive cultures from sterile sites between the pre-ASP period and post-ASP period (44.9% versus 40.2%; P = 0.401). A significant increase was noted in the treatment of sterile-site cultures after ASP (64% versus 83%; P = 0.01) and a reduction in the treatment of nonsterile-site cultures (71% versus 46%; P = 0.0002). These differences were statistically significant when treatment decisions were analyzed both at an individual patient level and at an individual culture level. Increased explicit antimicrobial regimen documentation was observed after ASP (26% versus 71%; P < 0.0001). Also observed were increases in formally documented stop dates (53% versus 71%; P < 0.0001), regimen de-escalation (15% versus 23%; P = 0.026), and an overall reduction in cost and mean DDDs after ASP implementation.Introduction of an ASP in the ICU was associated with improved microbiologically targeted therapy based on sterile or nonsterile cultures and improved documentation of antimicrobial use in the medical record.Antimicrobial use in the intensive care unit (ICU) is seemingly ubiquitous. An international, prospective, point prevalence study of more than 1,200 ICUs documented tha
Frequency and antimicrobial resistance of aerobic bacteria isolated from surgical sites in humans and animals in Nsukka, Southeast Nigeria
K. F. Chah, C. A. Eze, B. N Oluoha
Nigerian Veterinary Journal , 2003,
Abstract: This study was carried out to evaluate the frequency of occurrence and antimicrobial resistance of aerobic bacteria isolated from surgical sites in human and animal patients in Nsukka, southeast Nigeria. Wound swabs from 132 patients (96 humans and 36 animals) were cultured for bacterial isolation. Antimicrobial resistance profile of the isolates was evaluated by the agar disc diffusion method. A total of 134 bacterial isolates were obtained from 114 samples that yielded growth. Staphylococcus aureus (26.1%) was the most prevalent agent isolated from humans, followed by E. coli (17.4%), Proteus spp (17.4%), Enterococcus spp (13.0%) and coagulase negative Staphylococcus [CNS] (10.9%). In animals, the most common agents isolated were E. coli (19.0%) and Proteus spp (19.0%), followed by S. aureus (14.3%), Enterococcus spp (14.3%) and CNS (9.5%). A high proportion of Gram-negative isolates were resistant to cephalexin (80%), cotrimoxazole (80%), ampicillin (73.3%), gentamicin (70%) and nalidixic acid (70%) while majority of the Gram-positive bacteria were resistant to streptomycin (40.5%) and erythromycin (40.5%). Isolates demonstrated low resistance rate to ciprofloxacin. This study has provided information that may be needed in designing empirical treatment regimens for post-operative infections in Nsukka area. Key Words: Bacteria, isolation, surgical site, antimicrobial, resistance. (Nigerian Veterinary Journal: 2003 24(1): 1-9)
Surgical site Infection among postoperative patients of tertiary care centre in Central India - A prospective study  [cached]
Anand Saxena
Asian Journal of Biomedical and Pharmaceutical Sciences , 2013,
Abstract: Surgical site infection is a one of the most common postoperative complication and causes significant postoperative morbidity and mortality. WHO described Hospital acquired infections as one of the major infectious diseases having huge economic impact. There are many factors that affect the susceptibility of any wound to infection. This study was aimed to determine the incidence of surgical site infections (SSI) and to study other factors that can affect the infection rate.This is a 2 year prospective study carried on 300 patients operated in Surgery department. The various parameters studied were age of patient, presence of Diabetes, anemia, preoperative hospital stay, details of timing of antimicrobial prophylaxis, surgical wound infection, type of surgery (emergency and elective surgery), duration of surgery, the wound classes, etc.Surgical site infection was found to be 14.33% with higher infection rate in males and patients above 50 years of age. Staphylococcus aureus (37.83%) is most commonly identified organism in culture. As the preoperative stay increases, chances of SSI increases. SSI rate is more with emergency surgery than elective surgery. Obesity, Diabetes and Anemia are additional risk factors in surgical site infection.
Postoperative Nosocomial Infections and Antimicrobial Resistance Pattern of Bacteria Isolates among Patients Admitted at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia
W Mulu, G Kibru, G Beyene, M Damtie
Ethiopian Journal of Health Sciences , 2012,
Abstract: Background: Nosocomial infection constitutes a major public health problem worldwide. Increasing antibiotic resistance of pathogens associated with nosocomial infections also becomes a major therapeutic challenge for physicians. Thus, the aim of this study was to identify post operative bacterial infections and determine their current antimicrobial resistance to commonly prescribed drugs. Methods: A cross sectional study was conducted on patients under gone operation from October 2010 to January 2011 and followed for development of clinical signs and symptoms of surgical site and blood stream infection until the time of discharge. Structured questionnaire was used to collect socio demographic characteristics. Wound swab and venous blood samples were collected and processed for bacterial isolation and antimicrobial susceptibility testing following standard bacteriological techniques. Results: Out of 294 patients who had clean and clean-contaminated operation, 10.9% were confirmed of bacterial nosocomial infections. The rate of nosocomial infections among clean and clean-contaminated operations was 3.3% and 12.8% respectively. Nosocomial surgical site and blood stream infection rate was 10.2% and 2.4% correspondingly. A total of 42 bacterial pathogens were identified of which S. aureus was the leading isolates accounting 26.2% followed by E. coli and Coagulase negative Staphylococcus species each 21.4%. Nearly 100% of Gram positive and 95.5% of Gram negative bacterial isolates showed resistance against two or more antimicrobial drugs. Conclusions: Multiple drug resistance of isolates to antimicrobials was alarmingly high so that any empirical prophylaxis and treatment needs careful selection of effective drugs. To minimize such infections, adherence of strict aseptic surgical procedures and proper management of wounds is required.
Antimicrobial susceptibility pattern of bacterial isolates from surgical wound infections in Tertiary Care Hospital in Allahabad, India
Amit Kumar Verma, AK Kapoor, Anodita Bhargava
Internet Journal of Medical Update - EJOURNAL , 2012,
Abstract: The aim of present study to analyze the occurrence and in-vitro antimicrobial susceptibility of bacterial pathogens isolated from surgical wound infections. Specimens from a total of 129 patients undergoing either emergency or elective surgery were collected from infected sites or stitch lines and inoculated onto appropriate media. The bacterial cultures were identified utilizing standard microbiological and biochemical methods. Isolates were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Statistical analysis was performed using the chi-square test. Of 129 patients investigated (62 emergency and 67 elective surgery cases), bacterial isolates were isolated with almost equal frequency both from emergency and elective surgery cases. Of 108 (83.72%) culture positive samples, 62 (57.41%) were Gram negative, 39 (36.11%) Gram positive, and 7 (6.48%) showed multiple organisms. Of total 115 bacteria isolated (101 single and 7 double organisms culture positive), 33 (28.69%) were Escherichia coli and were also the commonest; followed by Staphylococcus aureus, 30 (26.09%) cases. S. aureus and Streptococcus spp. showed maximum susceptibility (100%) to linezolid and vancomycin. Maximum susceptibility of E. coli was observed to ciprofloxacin (75.7%), followed by gentamicin (54.5%); of Klebsiella spp. to ceftriaxone and gentamicin (66.6% each), of Proteus spp. to gentamicin (70%) followed by ciprofloxacin (60%), and of Pseudomonas aeruginosa to piperacillin (100%) and tobramycin (71.4%). E. coli and S. aureus were the most common and Salmonella spp. and Acinetobacter spp. were the least common organism causing surgical site infections. The definitive therapy included ciprofloxacin and gentamicin for E. coli; linezolid and vancomycin for S. aureus and Streptococcus spp; ceftriaxone and ciprofloxacin for Klebsiella spp., Citrobacter spp., acinetobacter spp and Salmonella spp. KEYWORDS: Antimicrobial susceptibility pattern; Bacterial isolates; Gram negative; Gram positive organisms Internet Journal of Medical Update 2012 January;7(1):27-34
Antimicrobial susceptibility pattern of bacterial isolates from surgical wound infections in Tertiary Care Hospital in Allahabad, India  [PDF]
Amit Kumar Verma,A K Kapoor,Anodita Bhargava
Internet Journal of Medical Update - EJOURNAL , 2012,
Abstract: The aim of present study to analyze the occurrence and in-vitro antimicrobial susceptibility of bacterial pathogens isolated from surgical wound infections. Specimens from a total of 129 patients undergoing either emergency or elective surgery were collected from infected sites or stitch lines and inoculated onto appropriate media. The bacterial cultures were identified utilizing standard microbiological and biochemical methods. Isolates were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Statistical analysis was performed using the chi-square test. Of 129 patients investigated (62 emergency and 67 elective surgery cases), bacterial isolates were isolated with almost equal frequency both from emergency and elective surgery cases. Of 108 (83.72%) culture positive samples, 62 (57.41%) were Gram negative, 39 (36.11%) Gram positive, and 7 (6.48%) showed multiple organisms. Of total 115 bacteria isolated (101 single and 7 double organisms culture positive), 33 (28.69%) were Escherichia coli and were also the commonest; followed by Staphylococcus aureus, 30 (26.09%) cases. S. aureus and Streptococcus spp. showed maximum susceptibility (100%) to linezolid and vancomycin. Maximum susceptibility of E. coli was observed to ciprofloxacin (75.7%), followed by gentamicin (54.5%); of Klebsiella spp. to ceftriaxone and gentamicin (66.6% each), of Proteus spp. to gentamicin (70%) followed by ciprofloxacin (60%), and of Pseudomonas aeruginosa to piperacillin (100%) and tobramycin (71.4%). E. coli and S. aureus were the most common and Salmonella spp. and Acinetobacter spp. were the least common organism causing surgical site infections. The definitive therapy included ciprofloxacin and gentamicin for E. coli; linezolid and vancomycin for S. aureus and Streptococcus spp; ceftriaxone and ciprofloxacin for Klebsiella spp., Citrobacter spp., acinetobacter spp and Salmonella spp.
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