Impact of Antibiotic-Resistant Pathogens Colonizing the Respiratory Secretions of Patients in an Extended-Care Area of the Emergency Department

Dantas, Sônia Regina Pérez Evangelista; Moretti-Branchini, Maria Luiza

doi:10.1086/502210

Cited by 16 publications

(12 citation statements)

References 22 publications

(14 reference statements)

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“…were the dominant MDR pathogens among the case patients. The mortality rate was significantly higher for the cases than for the controls (27% and 12.7%, respectively; P Ͻ 0.01), although susceptibility to carbapenems was allowed in the case group (16).…”

Section: Carbapenem-resistant Acinetobacter Sppmentioning

confidence: 89%

Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli

Giske

Monnet

Cars

et al. 2008

Antimicrob Agents Chemother

549

360

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5During the last decade, the efforts to combat multidrugresistant (MDR) microorganisms mainly focused on gram-positive bacteria, namely, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. While a large number of hospitals have implemented more rigorous infection control measures, drug companies have developed novel antimicrobial agents to combat these bacteria, resulting in several new compounds with novel mechanisms of action, e.g., linezolid and daptomycin (66). Paralleling the developments in gram-positive bacteria, infections caused by MDR gram-negative bacilli have become a growing problem (71). In a recent report the Infectious Diseases Society of America specifically addressed three categories of MDR gram-negative bacilli, namely, extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella spp., MDR Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter spp. (70). Unfortunately, and contrary to what happened with gram-positive bacteria, no antibiotic from a new class has been developed specifically for MDR gram-negative bacilli. It might be argued that the glycylcycline tigecycline is an exception from the statement made above, but although this drug has in vitro activity against many MDR gram-negative bacilli, the drug was not developed specifically for the purpose of treating infections caused by such bacteria (64). Moreover, there are now a growing number of reports of cases of infections caused by gram-negative organisms for which no adequate therapeutic options exist (20). This return to the preantibiotic era has become a reality in many parts of the world (14, 55, 80). The present report aims at estimating the prevalence of infections due to MDR gramnegative bacilli, as well as the consequences with respect to mortality, hospital length of stay (LOS), and increased hospital costs.The topics covered in this report are resistance to extendedspectrum cephalosporins in E. coli and Klebsiella pneumoniae, MDR (resistance to three or more antipseudomonal agents) (17) in P. aeruginosa, and carbapenem resistance in Acinetobacter spp. PubMed (www.ncbi.nih.gov; accessed on 31 October 2007) searches were performed by using the following search terms: (Escherichia coli OR Klebsiella pneumoniae) AND ESBL, (Escherichia coli OR Klebsiella pneumoniae) AND cephalosporin resistance, Pseudomonas AND multidrug resistance, Acinetobacter AND carbapenem resistance, antibiotic resistance AND (Pseudomonas OR Acinetobacter OR Escherichia coli OR Klebsiella) AND mortality, antibiotic resistance AND (Pseudomonas OR Acinetobacter OR Escherichia coli OR Klebsiella) AND length of stay, and antibiotic resistance AND (Pseudomonas OR Acinetobacter OR Escherichia coli OR Klebsiella) AND cost. The searches were performed to address the issues of prevalence, mortality, increased LOS, and increased hospital costs. Following the review of all abstracts, a total of 85 papers were considered relevant and were evaluated for the preparation of this report. All included papers on the clinica...

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Section: Carbapenem-resistant Acinetobacter Sppmentioning

confidence: 89%

Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli

Giske

Monnet

Cars

et al. 2008

Antimicrob Agents Chemother

549

360

View full text Add to dashboard Cite

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“…There are many benefits in avoiding unnecessary transfers to ED, for both the resident and healthcare services. As previously discussed, ED visits are associated with increased morbidity and mortality in older people . In addition, residents' utilise limited ED treatment space for extended periods waiting on investigations .…”

Section: Discussionmentioning

confidence: 99%

Resident transfers from aged care facilities to emergency departments: Can they be avoided?

Morphet

Innes

Griffiths

et al. 2015

Emerg Medicine Australasia

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ObjectiveResidents from aged care facilities make up a considerable proportion of ED presentations. There is evidence that many residents transferred from aged care facilities to EDs could be managed by primary care services. The present study aimed to describe the characteristics of residents transferred from residential aged care facilities to EDs, and to evaluate the appropriateness and cost of these presentations.MethodsA retrospective review of ED records was undertaken for residents transferred from residential aged care facilities to two EDs in Melbourne, Victoria, in 2012. Data examined included residents' mode and time of arrival to ED, presenting complaint, triage category, procedures within ED, diagnosis, length of stay, and disposition. Data were examined against a previously established tool to identify resident transfers that might be ‘potentially avoidable’.ResultsThere were 2880 resident transfers included in the sample, of which 408 transfers were randomly selected for scrutiny of documentation. Seventy‐one residents (17.4%) were identified as being potentially avoidable transfers.ConclusionMany resident transfers might have been avoided with better primary care services in place. Future strategies to improve resident care might include aged care staff skill mix and the availability of outreach or primary care services.

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“…Another Brazilian study has found that patients colonized or infected with multidrug-resistant bacterial organisms had a higher length of stay than controls in the ER, and a higher associated mortality [27]. The presence of colonized patients in a chronically overcrowded and understaffed ER may represent another substantial obstacle to implementing hospital infection control measures [28], especially where resources are limited, and thus requiring specifically customized strategies.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in brazil

et al. 2010

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BackgroundThere are few studies in Brazil that address baseline prevalence of MRSA colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization. We report a prospective study in a tertiary-care, university-affiliated hospital to implement a new MRSA control policy at the institution.MethodsA cohort of randomly selected patients admitted to emergency and clinical wards at our hospital was followed until discharge. Nasal swabs were taken for identification of MRSA-colonized patients and detection of SCCmecA in positive cultures, at admission and weekly thereafter. Multivariate analysis using a log-binomial analysis was used to identify risk factors for colonization.ResultsAfter screening 297 adult patients and 176 pediatric patients, the prevalence of MRSA at admission was 6.1% (95%CI, 3.6% to 9.4%), in the adult population and 2.3% (95%CI, 0.6% to 5.7%), for children. From multivariate analysis, the risk factors associated with colonization in adults were: age above 60 years (P = 0.019) and hospitalization in the previous year (P = 0.022). Incidence analysis was performed in 276 MRSA-negative patients (175 adults and 101 children). Acquisition rate was 5.5/1,000 patient-days for adults (95%CI, 3.4 to 8.5/1,000 patients-days), and 1.1/1,000 patient-days for children (95%CI, 0.1 to 4.0/1,000 patients-days).ConclusionsThe identification of MRSA carriers is a step towards establishing a control policy for MRSA, and helps to identify measures needed to reduce colonization pressure and to decrease the high acquisition rate in hospitalized patients.

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Impact of Antibiotic-Resistant Pathogens Colonizing the Respiratory Secretions of Patients in an Extended-Care Area of the Emergency Department

Abstract: Prolonged stay in the ED posed a risk for colonization with MROs and for contracting nosocomial infections, both of which were associated with increased mortality. Patients colonized with antibiotic-resistant A. baumannii may serve as a reservoir for spread in this hospital.

Cited by 16 publications

References 22 publications

Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli

Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli

Resident transfers from aged care facilities to emergency departments: Can they be avoided?

Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in brazil

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