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Pathogen distribution and drug resistance in a burn ward: a three-year retrospective analysis of a single center in China.

ABSTRACT: To investigate the spread of multiple-resistant strain in a burn ward to inform clinical administration of antibiotic drugs, burn wound treatment and decision-making for infection control. A 3-year retrospective analysis was conducted. Specimens from wounds, blood, catheter, sputum, urine and stool collected from inpatients of the Second Affiliated Hospital of Zhejiang University of Medicine between January 1, 2011 and December 31, 2013 were cultured and strains were identified by automatic bacteria analysis. Sensitivity to 30 commonly used antibiotics was assessed by K-B disk diffusion. A total of 2212 strains of pathogenic bacteria or fungi were isolated (33.9% Gram-positive and 52.7% Gram-negative bacteria and 13.4% fungi), including 1466 from wound extracts, 128 from blood culture, 335 from urine culture, 5 from stool culture, 153 from sputum culture and 125 from catheters. The most frequently detected pathogens in wound secretions were Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The Gram-positive bacteria Staphylococcus epidermidis, Enterococcus faecalis and Enterococcus faecium, and the Gram-negative bacteria Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Stenotrophomonas maltophilia, Proteus mirabilis were also frequently detected. The most frequently detected strains of fungi were Candida albicans; tropicalis, glabrata and parapsilosis, and all were highly sensitive to itraconazole, fluconazole and voriconazole but resistant to ketoconazole. Attention should be paid to MRSA, multi-resistant A. baumanni, ESBL-producing enterobacteriaceae and Carbapenem-resistant P. aeruginosa. Understanding the distribution of bacterial infections in Chinese hospitals will be crucial to reduce hospital-acquired infection and drug resistance.

SUBMITTER: Cen H

PROVIDER: S-EPMC4694455 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Pathogen distribution and drug resistance in a burn ward: a three-year retrospective analysis of a single center in China.

Cen Hanghui H Wu Zhenbo Z Wang Fan F Han Chunmao C

International journal of clinical and experimental medicine 20151015 10

To investigate the spread of multiple-resistant strain in a burn ward to inform clinical administration of antibiotic drugs, burn wound treatment and decision-making for infection control. A 3-year retrospective analysis was conducted. Specimens from wounds, blood, catheter, sputum, urine and stool collected from inpatients of the Second Affiliated Hospital of Zhejiang University of Medicine between January 1, 2011 and December 31, 2013 were cultured and strains were identified by automatic bact ...[more]

PMID: 26770555

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Project description:Background:Burns are one of the major traumas that may affect older individuals. The purpose of this study was to investigate the epidemiological and clinical characteristics of geriatric burns at a major center in south-west China. Methods:This retrospective study was conducted at the Institute of Burn Research, Southwest Hospital of Army Medical University between 2010 and 2016, and the data collected from medical records included admission date, age, gender, premorbid disease, burn etiology, injured anatomical location, burn area and depth, inhalation injury, number of surgeries, length of stay (LOS), clinical outcome, and medical cost. Results:Of the 693 older burn patients included, 60.75% were male and 56.85% were aged 60-69 years. Burns peaked in December-March and June. Flame was the most common cause of burns, making up 51.95% of all cases, and also dominated in the burn patients aged 60-69 years. Limbs were the most common anatomical sites of burns (69.41%), and the median total body surface area (TBSA) was 5% (interquartile range [IQR]: 2%-15%). The percentage of the patients who underwent surgeries and number of surgeries significantly increased in the cases of contact burns, younger age and full-thickness burns. Six deaths resulted in a mortality of 0.9%. The median LOS was 16 days (IQR: 8-29 days), and the main risk factors were more surgeries, better outcomes, and full-thickness burns. The median cost was 20,228 CNY (IQR: 10,457- 46,581.5 CNY), and major risk factors included longer LOS, larger TBSA, and more surgeries. Furthermore, compared to the earlier data from our center, the proportion of older adults among all burns (7.50% vs. 4.15%), proportion of flame burns (51.95% vs. 33.90%), and mean age (69.05 years vs. 65.10 years) were significantly higher, while the proportion of premorbidities (16.9% vs. 83.9%), mortality (0.9% vs. 7.5%) and median TBSA (5% vs. 21%) were significantly lower. Conclusions:This study suggested that closer attention should be paid to prevent burn injuries in older people aged 60-69 years, especially males, regarding incidents in the summer and winter, and flame burns. Moreover, tailored intervention strategies based on related risk factors should be under special consideration.

Project description:The aim of the study was to review the surgical trends in breast cancer treatment in China over the past 15 years and to explore the possible factors related to the choice of surgical modality.The medical records of 18,502 patients with unilateral early stage breast cancer who underwent surgery from January 1999 to December 2013 at our institute were retrospectively reviewed. The utilization of different surgical modalities and the associated clinicopathological factors were analyzed. Furthermore, the prognostic role of surgical modality was also evaluated.The median patient age was 50.0 years. According to the pTNM staging system, 12.5% of the patients were classified as stage 0; 30.2% as stage I; 40.0% as stage II; and 17.3% as stage III. In total, 9.3% of the patients could not be staged. Overall, 67.1% of the breast cancer cases were estrogen receptor (ER) positive. The pattern of breast cancer surgery has changed tremendously over the past 15 years (P?<?0.001). The pattern of mastectomy has shifted from radical mastectomy to modified radical mastectomy and simple mastectomy + sentinel lymph node biopsy. A total of 81.7% of the patients underwent mastectomy without immediate reconstruction, 15.2% underwent breast-conserving surgery (BCS), and 3.7% received immediate breast reconstruction after mastectomy. Age, TNM staging, and pathological characteristics greatly affected the choice of surgical modality. The 5-year recurrence-free survival (RFS) rates for the mastectomy, BCS, and reconstruction groups were 87.6%, 93.2%, and 91.7%, respectively (P?<?0.001); the RFS rate was likely affected by distant recurrence instead of loco-regional recurrence. We also identified improved RFS over time, stratified by surgical modality and tumor stage. Multivariate Cox-regression analysis revealed that time of treatment, tumor stage, tumor grade, LVI status, and ER status were independent prognostic factors for RFS in our cohort, whereas surgical modality was not.Mastectomy remains the most prevalent surgical modality used to manage early stage breast cancer in China, although the utilization of BCS has increased in the past decade. However, surgical management was not a prognostic factor for RFS. The selection of appropriate patients depended on the assessment of multiple clinicopathological factors, which is essential for making surgical decisions.

Project description:INTRODUCTION:Antiepileptic drugs, which are also called anticonvulsants, are used in the therapy and prophylaxis of epileptic seizures. The purpose of this paper was to investigate the relevant epidemiological data and to determine which of these drugs was the most frequent cause of intoxication. Another purpose of this study was to determine the neurological, cardiac, and biochemical problems caused by antiepileptics. MATERIAL AND METHOD:This retrospective study included 95 consecutive patients under 18 years of age with antiepileptic intoxication, presenting to and being followed-up in, the Toxicology Unit between January 2010 and February 2013. The data were obtained by screening the patient files. RESULTS:Of the cases, 67 (70.5%) were self-poisoned by first generation antiepileptics (FGAEs) and 28 (29.5%) by second generation antiepileptics (SGAEs). The Glasgow Coma Scale (GCS) scores and the serum lactate levels of the patients poisoned by FGAEs and SGAEs on admission to emergency department were 15 (25th: 12; 75th: 15; 95th: 15; IQR: 3) and 1.9 (25th: 1.4; 75th: 3.1; 95th: 5.6; IQR: 1.7), and 15 (25th: 14.3; 75th: 15; 95th: 15; IQR: 0.75) and 1.07 (25th: 0.9; 75th: 1.6; 95th: 5.5; IQR: 0.71), respectively. The serum lactate levels of patients poisoned by FGAEs were significantly higher (p < 0.001). Among the cases poisoned by carbamazepine, the most frequent cause of intoxication, the GCS score was significantly lower and serum lactate level was significantly higher in the group with high serum levels of carbamazepine (p = 0.004 and p < 0.001, respectively). In cases poisoned by valproic acid (VPA), the second frequent cause of intoxication, there was neither a significant association between the serum VPA level and the GCS score, nor between the serum lactate level and the systolic blood pressure (p = 0.470, p = 0.897, and p = 0.088, respectively). However, there was a positive correlation between the serum VPA level and the serum ammonia level (kk = 0.742, p < 0.001). CONCLUSION:First generation antiepileptics are more toxic than SGAEs. In patients with serum carbamazepine level, particularly those over 30 mg/L, serious disorders of consciousness, cardiovascular toxicity, and metabolic disorders may occur. In VPA intoxication, there is a positive correlation between the serum VPA levels and ammonia levels. On account of this finding, one should be more careful about hyperammonemic hepatic encephalopathy as the serum VPA level rises.

Project description:BACKGROUND: Rabies is one of the oldest known and most feared human diseases. Epidemiological studies provide basic information about the burden of the disease and underline the importance of prevention and control interventions. However, there have been limited studies conducted regarding the incidence of rabies and associated factors in Ethiopia, in general, and in this study area, in particular. Therefore, the aim of this study was to assess the incidence of human rabies exposure and associated factors at the Gondar Health Center, Ethiopia. METHODS: A retrospective cross-sectional study was conducted at the Gondar Health Center where post-exposure prophylaxis (PEP) for rabies was available for the whole population in the North Gondar Zone catchment area. Data of human rabies exposure cases between 2011 and 2013 were collected from the rabies PEP registration book using data abstraction sheets. The data was entered and analyzed using SPSS version 16 statistical software. RESULT: A total of 261 cases of human rabies exposure were reported to the Gondar Health Center from 2011 to 2013. The sex and age specific distribution showed that the majority of these cases were among males (142/226, 62.8%) and children under 15 years of age (87/226, 38.5%). A predominant number of cases were observed in individuals from rural areas (161/220, 73.2%), and during fall and winter seasons (67/222, 30.18%). A significant number of people exposed to rabies (23.2%) came to the health center for PEP two or more weeks after the injury. The incidence of human rabies exposure cases was 4.6, 2.61, and 1.27 per 100, 000 population in 2011, 2012, and 2013, respectively. Being male and living in an urban setting were found to be risk factors for human rabies exposure in 2011. CONCLUSION: A significant number of human rabies exposure cases were reported to the Gondar Health Center. Being male and living in an urban setting were found to be associated with rabies exposure. A community-based follow-up study is recommended to more accurately estimate the incidence of human rabies exposure.

Dataset Information

Pathogen distribution and drug resistance in a burn ward: a three-year retrospective analysis of a single center in China.

Publications

Pathogen distribution and drug resistance in a burn ward: a three-year retrospective analysis of a single center in China.

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