Assessment of venous thromboembolism risk and adequacy of prophylaxis in selected acute care medical centres in Arabian Gulf States: results from the ENDORSE study

OBJECTIVES: To assess the prevalence of venous thromboembolism (VTE) risk in acutely ill surgical and medical patients in selected acute care centres in the Arabian Gulf States, and to determine the proportion of at-risk patients who received effective prophylaxis in accordance with 2004 American College of Chest Physicians (ACCP) guidelines. MATERIALS AND METHODS: Eight hospitals from 3 countries (Kuwait, Kingdom of Saudi Arabia, and United Arab Emirates) contributed to the global ENDORSE (Epidemiological International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study. Medical records were reviewed for all the in-patients aged \u3e / = 40 years admitted to medical wards, and in patients aged \u3e / = 18 admitted to surgical wards. The VTE risk and recommended prophylaxis were assessed according to the 2004 ACCP guidelines. RESULTS: Of 1,291 evaluable patients, 801 were considered at risk of VTE; 391 (48.8%) surgical patients and 410 (51.2%) medical patients. Of the 801 patients, 322 (40.2%) received ACCP-recommended VTE prophylaxis; 159 (40.7%) of surgical patients and 163 (39.8%) of medical patients. CONCLUSIONS: The data showed that VTE prophylaxis was underutilized in high-risk hospitalized patients. We recommend that active measures should be implemented in acute care centres in these Arabian Gulf countries to ensure identification of patients at risk of VTE and institute the appropriate prophylaxis

Promoting cross-regional collaboration in antimicrobial stewardship: Findings of an infectious diseases working group survey in Arab countries of the Middle East.

Abstract Background Antimicrobial resistance is a significant global issue that presents an increasing threat to patients' wellbeing. Although a global concern, the emergence of multi-drug resistant organisms is of particular significance in the Middle East. In recent years, this region has seen an alarming increase in antimicrobial resistance presenting a major challenge to physicians managing various infectious diseases. Methods A Working Group comprising experts in infectious diseases from Arab countries of Middle East assembled to review similarities and differences in antimicrobial practices and management of multi-drug resistant organisms across the region and assess the barriers to achieving cross-regional collaboration. The Working Group conducted an anonymous online survey to evaluate current practice and understanding of management of multi-drug resistant organisms across the region. Results A total of 122 physicians from Arab countries of the Middle East responded to the survey. Their responses demonstrated heterogeneity between countries in awareness of local epidemiology, management of multi-drug resistant organisms and antimicrobial stewardship practices. The Working Group recognized similarities and differences in the management of multi-drug resistant organisms across the region, and these were validated by the data collected in the survey. Overall, the similarities across the region reflect several key issues that can have an impact on the management of multi-drug resistant organisms and the prevention of antimicrobial resistance. Conclusions This paper highlights the urgency of addressing antimicrobial resistance in Arab countries of the Middle East. The Working Group identified key barriers to effective management which may guide the development of future coherent strategies to promote effective antimicrobial stewardship in the region. Here, we outline a call to action for the region, with a need to focus on training and education, capacity building, infrastructure, regional research, and regional surveillance

Clinical Profile of Mortality and Treatment Profile of Survival in Patients with COVID-19 Pneumonia Admitted to Dubai Hospital

Background: Most COVID-19 studies conclude old age and coexisting illnesses as mortality determinants owing to different populations or methodologies, or omitting factors affecting outcomes. Methods: We analyzed COVID-19 patients’ data (N = 391) of Dubai Hospital between January 1, 2020 and June 30, 2020. Results: Only 19 patients (4.8%) were UAE nationals, while 372 (95.2%) were expatriates. Median age was 48 (interquartile range, 40–56) years; 22% were <40 years, and only 16.6% were female. Cough was the most common symptom (78.7%), fever was 77.4%, and gastrointestinal symptoms were least common (13.8%). Approximately 95% had elevated C-reactive protein (CRP) and D-dimers (79%), lymphocytopenia 47.3%, and thrombocytopenia 13.8%. Mortality was 30% for the total sample and 50% in ICU patients. ICU patients were older than non-ICU (age; 49.6 ± 10.9 vs. 46.7 ± 12.7 years, p = 0.04). Eighty-five percent of ICU patients required invasive mechanical ventilation, 78% vasopressors, 88% sedation, 84% muscle paralysis, while none require any of these in the medical group. Survivors had fewer patients with sedatives (p = 0.01). The median length of stay in the hospital was 19 days, ICU stays 14 days, and ventilator 11 days. The Mann-Whitney test showed that survivors spent more days in the ICU (median [IQR] 18 [6.5–29.5] vs. 11 [4–18], p value 0.003) and the hospital (32 [14.5–49.5] vs. 14 [7–21], p value 0.001) than nonsurvivors. Ferritin and D-dimers were higher in nonsurvivors, but CRP was lower in nonsurvivors (ferritin (ng/mL) median (IQR) 1,434 (661.5–2206.5) versus 1,362 (630–2,094), p value = 0.017, CRP (mg/L) 118.7 (53.4–184) versus 134.9 (66.5–203.2), p value 0.001 and D-dimer (µg/mL) 1.54 (0–3.13) versus 1.09 (0–2.51), p value = 0.001). Multiple logistic regression analysis determined age, fever on admission, use of oxygen, mechanical ventilation, and steroids as predictors of survival. Conclusions: COVID-19 patients were young males with pre-existing conditions. Ferritin, CRP, and D-dimers were higher in nonsurvivors. Treatment with chloroquine, antivirals, and anticoagulation was not different between survivors and nonsurvivors. Steroid use was a survival predictor

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically