Mortality associated with carbapenem-susceptible and Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa bacteremia

BACKGROUND: Studies on various Gram-negative bacteria suggest that resistance to carbapenem antibiotics is responsible for increased mortality in patients; however, results are not conclusive. We first assessed the 28-day in-hospital all-cause mortality in patients with Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa (VIM-PA) bacteremia compared to patients with VIM-negative, carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia. Second, we identified determinants for mortality and survival. METHODS: All patients with a positive blood culture with VIM-PA or CS-PA between January 2004 and January 2016 were included. Kaplan-Meier survival curves were constructed, and survivors and non-survivors were compared on relevant clinical parameters using univariate analyses, and multivariable analyses using a Cox-proportional hazard model. RESULTS: In total, 249 patients were included, of which 58 (23.3%) died. Seventeen out of 40 (42.5%) patients with VIM-PA died, compared to 41 out of 209 (19.6%) patients with CS-PA (difference = 22.9%, P-value = 0.001). Assumed acquisition of the bacterium at the intensive care unit was significantly associated with mortality (HR = 3.32, 95%CI = 1.60-6.87), and having had adequate antibiotic therapy in days 1-14 after the positive blood culture was identified as a determinant for survival (HR = 0.03, 95%CI = 0.01-0.06). VIM-PA vs CS-PA was not identified as an independent risk factor for mortality. CONCLUSIONS: The crude mortality rate was significantly higher in patients with a VIM-PA bacteremia compared to patients with a CS-PA bacteremia; however, when analyzing the data in a multivariable model this difference was non-significant. Awareness of the presence of P. aeruginosa in the hospital environment that may be transmitted to patients and rapid microbiological diagnostics are essential for timely administration of appropriate antibiotics. Acquisition of P. aeruginosa should be prevented, independent of resistance profile

Mortality related to Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa: Assessment by a novel clinical tool

Background: Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa (VIM-PA) can cause nosocomial infections and may be responsible for increased mortality. Multidrug resistance in VIM-PA complicates treatment. We aimed to assess the contribution of VIM-PA to mortality in patients in a large tertiary care hospital in the Net

The effect of distractions in the operating room during endourological procedures

Contains fulltext : 98421.pdf (publisher's version ) (Closed access)BACKGROUND: Professionals working in the operating room (OR) are subject to various distractions that can be detrimental to their task performance and the quality of their work. This study aimed to quantify the frequency, nature, and effect on performance of (potentially) distracting events occurring during endourological procedures and additionally explored urologists' and residents' perspectives on experienced ill effects due to distracting factors. METHODS: First, observational data were collected prospectively during endourological procedures in one OR of a teaching hospital. A seven-point ordinal scale was used to measure the level of observed interference with the main task of the surgical team. Second, semistructured interviews were conducted with eight urologists and seven urology residents in two hospitals to obtain their perspectives on the impact of distracting factors. RESULTS: Seventy-eight procedures were observed. A median of 20 distracting events occurred per procedure, which corresponds to an overall rate of one distracting event every 1.8 min. Equipment problems and procedure-related and medically irrelevant communication were the most frequently observed causes of interruptions and identified as the most distracting factors in the interviews. Occurrence of distracting factors in difficult situations requiring high levels of concentration was perceived by all interviewees as disturbing and negatively impacting performance. The majority of interviewees (13/15) thought distracting factors impacted more strongly on residents' compared to urologists' performance due to their different levels of experience. CONCLUSION: Distracting events occur frequently in the OR. Equipment problems and communication, the latter both procedure-related and medically irrelevant, have the largest impact on the sterile team and regularly interrupt procedures. Distracting stimuli can influence performance negatively and should therefore be minimized. Further research is required to determine the direct effect of distraction on patient safety

A Simulator for Teaching Transrectal Ultrasound Procedures How Useful and Realistic Is It?

Introduction: We describe a new simulator for teaching transrectal ultrasound (TRUS) and present the results of a preliminary evaluation of the simulator's realism and usefulness for training. Methods: A simulator for abdominal ultrasound was adjusted by the developer to enable simulation of TRUS by providing an opening for inserting a dummy rectal probe. To enable TRUS simulation, data from ultrasound prostate imaging of eight real patients obtained with our regular ultrasound machine were transferred to the simulator by connecting the computer of the simulator to the ultrasound machine. These data were used to create images in the TRUS simulator. Residents and urologists used the simulator to perform TRUS in one of the eight patient cases and judged the simulator's realism and usefulness. Results: We were able to construct an initial urological module for the TRUS simulator. The images shown on the monitor of the simulator are quite realistic. The simulator can be used without difficulty to collect data, to create cases, and to perform TRUS. The absence of an option for prostate biopsy and the lack of tissue resistance were mentioned as two important shortcomings. Forty-seven participants rated the simulator's overall realism and usefulness for training purposes as 3.8 (standard deviation: 0.7) and 4.0 (standard deviation: 0.8) on a five-point Likert scale, respectively. Conclusions: The simulator we describe can be used as a training tool for TRUS. It enables training with different patient cases and minimizes the burden to patients. Simulation of prostate biopsies should be added to increase the model's usefulness

Learn laparoscopic surgery without a patient

Traditionally, trainee surgeons have learnt many surgical procedures in the operating theatre directly on the patient, under the supervision of an experienced surgeon. However, for ethical, practical and legal reasons, there is a need to create training programs outside the operating theatre. The Netherlands Healthcare Inspectorate (IGZ) requires that measures be taken to improve training in laparoscopic skills by January 2009. The relevant surgical specialties need to collaborate on the development of uniform guidelines. It is time-consuming and costly to validate simulators and training programs. The ‘Fundamentals of Laparoscopic Surgery’ program is a training program developed in the United States of America which consists of theoretical and practical modules. It has been validated in various stages. Aspects of this program could be applied in Dutch training programs for basic laparoscopic skills.<br/

Zonder patiënt laparoscopisch leren opereren

Traditionally, trainee surgeons have learnt many surgical procedures in the operating theatre directly on the patient, under the supervision of an experienced surgeon. However, for ethical, practical and legal reasons, there is a need to create training programs outside the operating theatre. The Netherlands Healthcare Inspectorate (IGZ) requires that measures be taken to improve training in laparoscopic skills by January 2009. The relevant surgical specialties need to collaborate on the development of uniform guidelines. It is time-consuming and costly to validate simulators and training programs. The ‘Fundamentals of Laparoscopic Surgery’ program is a training program developed in the United States of America which consists of theoretical and practical modules. It has been validated in various stages. Aspects of this program could be applied in Dutch training programs for basic laparoscopic skills