Health care-associated infections in pre-transplant liver intensive care unit: Perspectives and challenges

Hassan, Elham Ahmed; Elsherbiny, Nahla M; El-Rehim, Abeer S. Abd; Soliman, Asmaa; Ahmed, A. M.

doi:10.1016/j.jiph.2017.09.006

“…The increased risk of post‐transplant infection in those with pre‐transplant infection may be partially explained by shared risk factors. Infections during both periods were associated with longer pre‐transplant length of stay, and duration of hospitalization is a known risk factor to infection in both before and after liver transplant . However, pre‐transplant infection remained a significant risk factor for post‐transplant infection even when controlling for other confounding variables.…”

Section: Discussionmentioning

confidence: 91%

Pre‐ and post‐transplant bacterial infections in liver transplant recipients

Heldman

¹

,

Ngo²,

Dorschner

³

et al. 2019

Transplant Infectious Dis

View full text Add to dashboard Cite

Background Early (<1 month) bacterial infection after liver transplant is a major cause of morbidity and mortality among liver transplant recipients. We investigated the impact of pre‐transplant bacterial infection on early post‐transplant bacterial infection incidence and outcomes. Methods A retrospective cohort study identified all patients who underwent liver transplantation between January 1, 2011, and December 31, 2012, at a single tertiary center in the United States. Infections occurring within the 30 days prior to transplant and within the 30 following transplant were identified. Information regarding pre‐transplant morbidity and post‐transplant outcomes was collected. Results One‐hundred seventy‐four patients were included in the study. Forty patients (23%) experienced a total of 50 pre‐transplant infections. Fifty‐two (30%) developed a total of 62 post‐transplant infections. Patients with a pre‐transplant infection were more likely to develop a post‐transplant infection compared to patients without a pre‐transplant infection (48% [19 of 40] vs. 25% [33 of 134], respectively, P = .006). Patients with a pre‐transplant infection had a longer mean post‐transplant length of stay compared to those without a pre‐transplant infection (16.3 days vs. 10.4 days, respectively, P < .001), but survival at 30 days was similar in both groups (95% [38 of 40] vs. 97% [130 of 134, respectively, P = .56). Conclusions Among liver transplant recipients, pre‐transplant infection is an important risk factor for early post‐transplant bacterial infections. Pre‐transplant infection is associated with increased early morbidity but not mortality after transplant.

show abstract

“…Statistical methods were in general poorly detailed, and mostly summarized in terms of descriptive statistics. Only three studies described the use of multivariate analysis -usually logistic regression -to control for confounding (45,147,168).…”

Section: Appraisal Of Risk Of Biasmentioning

confidence: 99%

Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: A systematic review

Truppa

¹

,

Abo‐Shehada

²

2020

Preprint

View full text Add to dashboard Cite

Background: In spite of the evident general negative effects of armed conflict on countries’ health systems and populations’ health outcomes, little is known about similar impacts of conflicts on the spread of antimicrobial resistances (AMR). This review was to address this evidence gap and describe:1. Patterns of AMR in the Middle East (ME) and resistance profiles of pathogens included in the Global AMR Surveillance System (GLASS) supported by the World Health Organization;2. Differences in proportions of AMR isolates between conflict and non-conflict countries. Methods: A systematic literature review was conducted following PRISMA guidelines and searching five electronic databases. Subject heading and free text were searched for “antimicrobial resistances” and “Middle East”, to identify observational studies on AMR published from January 2011 to June 2018. Data were extracted from included articles on a predefined set of variables. Percentages of AMR were analysed as median and interquartile ranges. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: A total of 132 articles met the inclusion criteria. Included studies showed heterogeneity in study design, laboratory methods and standards for interpretation of results, and an overall high risk of bias. Main findings were the following:1. High proportions of carbapenem resistance in Acinetobacter spp. (median 74.2%: range), and both carbapenem resistance (median 8.1% and 15.4% for E. coli and K. pneumoniae respectively) and ESBL-production (median 32.3% and 27.9% for E. coli and K. pneumoniae respectively) amongst Enterobacteriaceae. S. aureus isolates showed a median methicillin resistance percentage of 45.1%, while vancomycin resistance was almost absent. A median of 50% of the strains of S. pneumoniae showed non-susceptibility to penicillin. 2. Similar trends were observed in conflict and non-conflict affected countries.Conclusions: There is a lack of standardization in the methodological approach to AMR research in the Middle East. The proportion of antibiotic resistances among specific GLASS pathogens is high, particularly among Acinetobacter spp.

show abstract

“…The study design was clearly stated in 29 out of the 132 articles included ( Only one study reported sample size calculation and employed representative population although not powered for the prevalence detected nor for the comparison between the sub-groups performed (95). Measures of sampling variation in the results were reported by only four studies (95,161,165,168).…”

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

“…Statistical methods were in general poorly detailed, and mostly summarized in terms of descriptive statistics. Only three studies described the use of multivariate analysis -usually logistic regressionto control for confounding (45,147,168). None of the studies took missing data into account in the analysis nor in the discussion, and similarly limitations and potential sources of bias were never mentioned in the discussion, with the exception of one surveillance study performed in Lebanon The cohort studies included in the review (52,131,161) showed overall lower risk of bias compared to other study designs.…”

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

Antimicrobial resistance and conflict in the Middle East: A systematic review

Truppa¹,

Abo‐Shehada²

2020

Preprint

0

View full text Add to dashboard Cite

Background: In spite of the evident general negative effects of armed conflict on countries’ health systems and populations’ health outcomes, little is known about similar impacts of conflicts on the spread of antimicrobial resistances (AMR). This review was to address this evidence gap and describe:1. Patterns of AMR in the Middle East (ME) and resistance profiles of pathogens included in the Global AMR Surveillance System (GLASS) supported by the World Health Organization;2. Differences in proportions of AMR isolates between conflict and non-conflict countries. Methods: A systematic literature review was conducted following PRISMA guidelines and searching five electronic databases. Subject heading and free text were searched for “antimicrobial resistances” and “Middle East”, to identify observational studies on AMR published from January 2011 to June 2018. Data were extracted from included articles on a predefined set of variables. Percentages of AMR were analysed as median and interquartile ranges. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: A total of 132 articles met the inclusion criteria. Included studies showed heterogeneity in study design, laboratory methods and standards for interpretation of results, and an overall high risk of bias. Main findings were the following:1. High proportions of carbapenem resistance in Acinetobacter spp. (median 74.2%: range), and both carbapenem resistance (median 8.1% and 15.4% for E. coli and K. pneumoniae respectively) and ESBL-production (median 32.3% and 27.9% for E. coli and K. pneumoniae respectively) amongst Enterobacteriaceae. S. aureus isolates showed a median methicillin resistance percentage of 45.1%, while vancomycin resistance was almost absent. A median of 50% of the strains of S. pneumoniae showed non-susceptibility to penicillin. 2. Similar trends were observed in conflict and non-conflict affected countries.Conclusions: There is a lack of standardization in the methodological approach to AMR research in the Middle East. The proportion of antibiotic resistances among specific GLASS pathogens is high, particularly among Acinetobacter spp.

show abstract

Health care-associated infections in pre-transplant liver intensive care unit: Perspectives and challenges

Abstract: High HAI rate among ESLD patients is a matter of worry. Effective surveillance program, active infection control measures and national antibiotic policies are necessary to reduce the burden of HAIs.

Cited by 17 publications

References 27 publications

Pre‐ and post‐transplant bacterial infections in liver transplant recipients

Pre‐ and post‐transplant bacterial infections in liver transplant recipients

Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: A systematic review

Antimicrobial resistance and conflict in the Middle East: A systematic review

Contact Info

Product

Resources

About