Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.
BackgroundData surrounding antibiotic stewardship (AMS) in burn and chronic wound centers in low- and middle-income countries (LMIC) are limited. Given the long-term nature of the wounds, increased risk of infection and the potential for further infections being treated with antibiotics, burn and chronic wound centers represent a unique opportunity for antimicrobial stewardship.MethodsThree hospitals that maintain long-term burn or chronic wound wards were selected in two regions in Nepal. A post-prescription review and feedback program (PPRF) was instituted in these departments, and locally salient antibiotic practice guidelines were developed based on international and local standards by the research team and local experts. Chosen physicians at each facility were trained as master physician champions. Champions subsequently trained physicians in their wards and ensured that guidelines were followed by prescribing physicians. Baseline and post-intervention phases covered 5 months each during 2018–2019. During the post-intervention phase, physician champions reviewed antimicrobial use at 72 hours and made one of the three recommendations if the antibiotic course was deemed unjustified: changing the antibiotic, stopping the antibiotic course, or de-escalation of the antibiotic.Results482 patients were enrolled throughout the duration of the study, with 241 patients in each of the baseline and post-intervention periods. The average length of stay was 8.0 days in baseline (range 3–48 days) vs. 6.4 days (range 3–70 days) during post-intervention. Between baseline and post-intervention, IV antibiotics decreased from 1,161 antibiotic-days per 1,000 patient-days (PD/1,000) to 1,137 PD/1,000. Oral antibiotics decreased from 101 PD/1,000 to 77 PD/1,000. In addition, cephalosporins decreased from 526 PD/1,000 to 474 PD/1,000, and aminoglycosides decreased from 264 PD/1,000 to 117 PD/1,000.ConclusionAppropriate antimicrobial use is vital in patients with a long length of stays in the hospital to reduce the development of multi-drug-resistant organisms. This intervention showed that a post-prescription review and feedback model can have impact in chronic wound and burn centers in Nepal and be further adapted for use in other LMIC.Disclosures All authors: No reported disclosures.
Introduction: Cholelithiasis is one of the most common problems affecting the gastrointestinal tract. The objective of the study was to find the incidence of cases converted to open cholecystectomy from laparoscopic cholecystectomy and find the association with other intra-operative and preoperative findings. Methods: This is a prospective observational study. One hundred elective laparoscopic cholecystectomy cases in the institution of the study were the study sample. Pre-operative and intra-operative findings were noted. Conversion in surgery from laparoscopic cholecystectomy to open cholecystectomy was also recorded and the association was tested through Fisher’s exact test. Results: The rate of conversion from laparoscopic cholecystectomy to open cholecystectomy was 5%. which was significantly related to sex, time duration of the surgery, bleeding, and anatomical difficulties. Conclusions: The conversion rate is only 5% which was significantly associated with sex, time duration of surgery, intraoperative bleeding, and anatomical difficulties.
Background: Inguinal hernia is one of the most common surgical conditions in children. Herniotomy is the surgery performed for a pediatric hernia and hydrocele. This study was done to know the demography and outcome of pediatric herniotomy at our center. Materials and methods: A prospective study on patients who underwent herniotomy from 10th May 2016 to 9th May 2017 was conducted at the Department of Surgery, Western Regional Hospital. Results: During this study 112 patients underwent herniotomy out of which 98 were boys while 14 were girls. 59(52.67%) patients had unilateral hernia, 40(35.71%) had unilateral hydrocele and 13(11.6%) had bilateral condition among which 8 had hernia and 5 had hydrocele. 69(61.6%) patients presented with a right-sided, 30(26.7%) with left-sided, and 13(11.6%) with bilateral conditions. 13 patients (11.6%) presented at the emergency with irreducible hernia. Two among the patient who underwent emergency herniotomy developed postoperative wound infection and one among the elective surgery had recurrence. Conclusion: Pediatric inguinal hernias and hydroceles are often difficult to diagnose clinically. Herniotomy is often performed by junior consultants who have no specific training in pediatric surgery. Timely planning of surgery is required to minimize preoperative complications.
Objective: To evaluate the efficacy of tamsulosin in the treatment of distal ureteric calculi. Materials and Methods: Forty patients, who meet the inclusion criteria, were selected for the prospective study. All these patients received tamsulosin 0.4 mg once before bed time for fourteen days to observe the effectiveness, side effects and stone expulsion rate. Results: The average time of stone expulsion was 8.03±2.80 days. The successful medical expulsion was seen in 82.50%. About 7.5% complained of dizziness and headache, 2.5% complained of fatigue and postural hypotension. Conclusion: The use of tamsulosin was safe, effective and was associated with fewer side effects. Successful stone expulsion rate was observed in in selected cases.
Background:Inguinal herniorrhaphy is a common general surgical operation. The repair of recurrent hernia is difficult surgery due to obscured and distorted anatomy and risk of further recurrence. The aim of this study is to determine the outcome in terms of operative time, hospital stay, return to work, complications and recurrence of open pre-peritoneal repair for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. Materials And Method: It is a prospective observational study conducted at Western Regional Hospital, Pokhara from 2013 to 2016 . A total of eight patients including referred from other centers were included. Pre-peritoneal repair was performed on recurrent hernias after Lichtenstein tensionfree hernioplasty. Age, sex, operating time, hospital stay, time to return work, postoperative complications and recurrence of patients were noted. Statistical analysis was done using SPSS-21. Patients were called for follow up in 2 weeks, 3 months and 12 months time. Results: Out of eight patients, seven were male, one was female with mean age of 59.5 years. Recurrence was common on direct inguinal hernia (six patients) who had previous Lichtenstein hernioplasty. Mean operative time was 43.13 minutes (35 to 50 minutes), mean hospital stay was 2.5 days (2 to 4 days) and mean time to return to work was 8.12 days (7 to 10 days). There was hematoma formation in one patient. Conclusion: Pre-peritoneal mesh repair is easy, safe, with less operative time, short hospital stay, low recurrence and complication rate for recurrent inguinal hernia after Lichtenstein hernioplasty.
Background: Burn injury is one of the major causes of morbidity and mortality in our country. Study of epidemiological characteristics of burn injury helps in planning of the prevention and upgradation of its treatment facility. Material and Methods: This is a hospital based retrospective epidemiological study of the burn patients admitted in our center from September 2018 to April 2019. Results: In total 52 patients were included in this study. There was a slight preponderance of female patients over male patients. Mean age of the patients was 34.77± 29.16 years. Eighty percentage of burn injury occurred inside house. Majority of burn cases were scald burn followed by flame burn. Percentage total body surface area involved in burn had a mean of 14.183 ± 8.224. Lower extremity was the most commonly involved area. Total duration of hospital stay was 18.21 ± 13.656 days. Out of total patients only four patients needed admission in Intensive Care Unit (ICU). Regarding outcome, 88.5% patients survived while 9.6% patients died and 1.9% patient went on discharge on request. Conclusion: Burn injury is a preventable condition with high rate of morbidity and mortality. Burn patients have prolonged hospital stay as recovery is slow. Awareness programs for prevention of burn injury are needed to decrease the incidence of the burn injury.
Background: Endoscopy of the gastrointestinal tract is seen as an essential diagnostic tool because it can provide an in-depth visual assessment of gastrointestinal mucosa and allows for tissue sampling. This study aims to find out the histological diagnosis of various tissues biopsied from the lower GIT endoscopically. Materials and methods: It is a retrospective observational study conducted in the Department of Pathology, Fewa City Hospital and Research Center, Pokhara, Nepal from March 2021 to February 2022. Results: Total number of samples taken into the study was 174. Nonspecific inflammation was the commonest lesion in ileal, colon, and rectal biopsies. Conclusions: Lower GI tract is targeted to a wide range of diseases, ranging from inflammatory to malignant entities. Endoscopy and biopsy for suspected lesions is a trusted approach for investigating and managing GI tract pathologies.
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