Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance.
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ABSTRACT:
SUBMITTER: Gudiol C
PROVIDER: S-EPMC8044357 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:SettingNobel Medical College and Teaching Hospital, Biratnagar, Nepal.ObjectiveTo determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU).DesignThis hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records.ResultsSepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. Pseudomonas was the predominant organism isolated (n = 40; 78%), followed by coagulase negative staphylococcus (n = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (n = 170, 96%) improved, although 7 (4%) left against medical advice.ConclusionMost of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.
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Project description:From agriculture to public health to civil engineering, managing antimicrobial resistance presents a considerable challenge. The dynamics underlying resistance evolution reflect inherently spatial processes. Resistant pathogen strains increase in frequency when a strain that emerges in one locale can spread and replace pathogen subpopulations formerly sensitive to the antimicrobial agent. Moreover, the strength of selection for antimicrobial resistance is in part governed by the extent of antimicrobial use. Thus, altering how antimicrobials are used across a landscape can potentially shift the spatial context governing the dynamics of antimicrobial resistance and provide a potent management tool. Here, we model how the efficacy of adjusting antimicrobial use over space to manage antimicrobial resistance is mediated by competition among pathogen strains and the topology of pathogen metapopulations. For several pathogen migration scenarios, we derive critical thresholds for the spatial extent of antimicrobial use below which resistance cannot emerge, and relate these thresholds to (a) the ability to eradicate antimicrobial-sensitive pathogens locally and (b) the strength of the trade-off between resistance ability and competitive performance where antimicrobial use is absent. We find that in metapopulations where patches differ in connectedness, constraining antimicrobial use across space to mitigate resistance evolution only works if the migration of the resistant pathogen is modest; yet, this situation is reversed if the resistant strain has a high colonization rate, with variably connected metapopulations exhibiting less sensitivity to reducing antimicrobial use across space. Furthermore, when pathogens are alternately exposed to sites with and without the antimicrobial, bottlenecking resistant strains through sites without an antimicrobial is only likely to be effective under a strong competition-resistance trade-off. We therefore identify life-history constraints that are likely to suggest which pathogens can most effectively be controlled by a spatially targeted antimicrobial regime. We discuss implications of our results for managing and thinking about antimicrobial resistance evolution in spatially heterogeneous contexts.
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Project description:It is easy to capture and share clinical photographs and x-ray images using modern smartphones. This technology affords health-care providers the ability to rapidly collaborate and facilitate care for their patients. This improvement, however, has increased concerns regarding patient privacy and the safeguarding of protected health information. Health-care providers should understand the deidentification process for patient photographs because this process fundamentally changes the expectations and requirements for how providers are to handle this information. Properly deidentified patient photographs (and other data) are no longer considered identifiable protected health information and are not subject to the handling requirements mandated by the Health Insurance Portability and Accountability Act. This article addresses patient privacy concerns attendant to the acquisition, transmission, and sharing of clinical photographs among health-care providers. It provides guidelines for providers seeking to minimize the risk of noncompliance with privacy requirements as they adopt these new technologies into their practices.
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