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Research paper thumbnail of Bloodstream Infections Associated with Intensive Care Unit at a Multiprofile Hospital, Tbilisi, Georgia

PubMed, Sep 1, 2018

Bloodstream infections (BSIs) are associated with a high mortality rate, additional hospital days... more Bloodstream infections (BSIs) are associated with a high mortality rate, additional hospital days and excess hospital costs. Intensive Care Unit (ICU) patients are at high risk of nosocomial BSIs because of their weakened condition caused by underlying disease, frequent invasive diagnostic and therapeutic procedures. Catheterization is the most common cause of hospital-acquired BSIs. The major causes of catheter-related BSI (CRBSI) are microorganisms from the patient's and medical personnel's skin and contamination of the catheter hub. From July 1, 2015 through June 30, 2016, were collected blood cultures from patients fulfilling the criteria for systemic inflammatory response syndrome in a tertiary care hospital ICU in Tbilisi. Blood culturing procedures and techniques and antimicrobial susceptibility testing, following methods set out by EUCAST. From microbiologically studied 84 blood samples 21 (25%) were positive for growth, 19 (90.5%) samples were monomicrobial, whereas 2 (9.5%) samples were polymicrobial. On the basis of microbiological, clinical and epidemiological data 21 patients were diagnosed as ICU associated BSI. Among them 16 (76.2%) patients were diagnosed primary BSI and CLABSI, four (23.8%) patients - secondary BSI; three of them were caused with ventilator-associated pneumonia, one - with catheter-associated urinary tract infection. The most common microorganism isolated from ICU associated BSI cases were Coagulase-negative staphylococci (30,4%), A. baumannii (21.7%) and K. pneumoniae (17.4%). Preventing BSIs should be a priority for hospitals and for this they must be introduced to modern methods infection prevention and control.

Research paper thumbnail of Epidemiology of Carbapenem-Resistant Klebsiella Pneumoniae in Intensive Care Units of Multiprofile Hospitals in Tbilisi, Georgia

PubMed, Sep 12, 2018

Klebsiella pneumoniae is one of the most frequent cause of health care associated infections. Dis... more Klebsiella pneumoniae is one of the most frequent cause of health care associated infections. Dissemination of carbapenem-resistant (CR) K. pneumoniae infections significantly trend toward patient morbidity, length of stay and mortality. The aim of this research was to study prevalence and risk-factors of CR K. pneumoniae in Georgia. To identify risk factors for hospital-acquired carbapenem-resistant (CR) K. pneumoniae, from January 1, 2017 through February 28, 2018, an observational case-control study was performed in the ICUs of two tertiary-care hospitals in Tbilisi (High Medical Technology Centre and Ghudushauri National Medical Centre). All isolated K. pneumoniae cultures were tested on antibiotic susceptibility tests (AST). AST was performed by disk diffusion methods and E-test for MIC detection. For the first time CR K. pneumoniae isolates were screened for the presence of KPC, VIM, IMP, NDM and OXA carbapenemase in a PCR. Totally, 46 cultures of K. pneumoniae were isolated. Among them 20 (43.5%) were resistant to carbapenems. Most frequently CR K. pneumoniae cultures were isolated in patients with ventilator associated pneumonia (75%). Main risk factors of carbapenem-resistant from invasive procedures were: mechanical ventilation (OR 30.4, 95% CI 3.504-263.752, p=0.0003), nasogastric tube (OR 17.0, 95% CI 3.202-90.257, p=0.0002), central venous catheter (OR 10.06, 95% CI 1.152-87.849, p=0.028) and previous use of antibiotics (OR 10.059, 95% CI 1.152-87.849, p=0.028), especially carbapenem and 3rd generation cephalosporin. Predominant is OXA-producing K. pneumoniae, NDM-producing K. pneumoniae is relatively rare. To control dissemination of CR K. pneumoniae infection prevention and control should be toughened in medical facilities, and screening for early detection of patients with CR K. pneumoniae should be done.

Research paper thumbnail of Mitigating antimicrobial resistance (AMR) using implementation research: a development funder’s approach

JAC-Antimicrobial Resistance

Despite the escalating burden of antimicrobial resistance (AMR), the global response has not suff... more Despite the escalating burden of antimicrobial resistance (AMR), the global response has not sufficiently matched the scale and scope of the issue, especially in low- and middle-income countries (LMICs). While many countries have adopted national action plans to combat AMR, their implementation has lagged due to resource constraints, dysfunctional multisectoral coordination mechanisms and, importantly, an under-recognized lack of technical capacity to adapt evidence-based AMR mitigation interventions to local contexts. AMR interventions should be tailored, context-specific, cost-effective and sustainable. The implementation and subsequent scale-up of these interventions require multidisciplinary intervention-implementation research (IIR). IIR involves both quantitative and qualitative approaches, occurs across a three-phase continuum (proof of concept, proof of implementation and informing scale-up), and across four context domains (inner setting, outer setting, stakeholders and the...

Research paper thumbnail of Pilot istraživanje Clostridium difficile infekcija u bolesnika s proljevom u zdravstvenim ustanovama u Tbilisiju, Gruzija

Clostridium difficile infection community-associated healthcare-associated diarrhoea Klju~ne rije... more Clostridium difficile infection community-associated healthcare-associated diarrhoea Klju~ne rije~i infekcije uzrokovane Clostridium difficile infekcija ste~ena u zajednici infekcija povezana sa zdravstvenom skrbi proljev

Research paper thumbnail of Pilot surveillance of Clostridium difficile infections among patients with diarrhoea in medical facilities of Tbilisi, Georgia

  1. Department of Communicable Diseases, National Center for Disease Control and Public Health, Tb... more 1) Department of Communicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia 2) R.G. Lugar Center for Public Health Research, National Center for Disease Control and Public Health, Tbilisi, Georgia 3) Department of Infectious Diseases, Tbilisi State Medical University, Tbilisi, Georgia 4) High Technology Medical Center, University Clinic, Tbilisi, Georgia 5) University of Rochester Medical Center, Rochester, New York, USA 6) Division of Foodborne, Waterborne and Environmental Diseases, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA

Research paper thumbnail of Janibacter species with evidence of genomic polymorphism isolated from resected heart valve in a patient with aortic stenosis

Infectious Disease Reports

The authors report isolation and identification of two strains of bacteria belonging to the genus... more The authors report isolation and identification of two strains of bacteria belonging to the genus Janibacter from a human patient with aortic stenosis from a rural area of the country of Georgia. The microorganisms were isolated from aortic heart valve. Two isolates with slightly distinct colony morphologies were harvested after sub-culturing from an original agar plate. Preliminary identification of the isolates is based on amplification and sequencing of a fragment of 16SrRNA. Whole genome sequencing was performed using the Illumina MiSeq instrument. Both isolates were identified as undistinguished strains of the genus Janibacter. Characterization of whole genome sequences of each culture has revealed a 15% difference in gene profile between the cultures and confirmed that both strains belong to the genus Janibacter with the closest match to J. terrae. Genomic comparison of cultures of Janibacter obtained from human cases and from environmental sources presents a promising directi...

Research paper thumbnail of Bloodstream Infections Associated with Intensive Care Unit at a Multiprofile Hospital, Tbilisi, Georgia

PubMed, Sep 1, 2018

Bloodstream infections (BSIs) are associated with a high mortality rate, additional hospital days... more Bloodstream infections (BSIs) are associated with a high mortality rate, additional hospital days and excess hospital costs. Intensive Care Unit (ICU) patients are at high risk of nosocomial BSIs because of their weakened condition caused by underlying disease, frequent invasive diagnostic and therapeutic procedures. Catheterization is the most common cause of hospital-acquired BSIs. The major causes of catheter-related BSI (CRBSI) are microorganisms from the patient's and medical personnel's skin and contamination of the catheter hub. From July 1, 2015 through June 30, 2016, were collected blood cultures from patients fulfilling the criteria for systemic inflammatory response syndrome in a tertiary care hospital ICU in Tbilisi. Blood culturing procedures and techniques and antimicrobial susceptibility testing, following methods set out by EUCAST. From microbiologically studied 84 blood samples 21 (25%) were positive for growth, 19 (90.5%) samples were monomicrobial, whereas 2 (9.5%) samples were polymicrobial. On the basis of microbiological, clinical and epidemiological data 21 patients were diagnosed as ICU associated BSI. Among them 16 (76.2%) patients were diagnosed primary BSI and CLABSI, four (23.8%) patients - secondary BSI; three of them were caused with ventilator-associated pneumonia, one - with catheter-associated urinary tract infection. The most common microorganism isolated from ICU associated BSI cases were Coagulase-negative staphylococci (30,4%), A. baumannii (21.7%) and K. pneumoniae (17.4%). Preventing BSIs should be a priority for hospitals and for this they must be introduced to modern methods infection prevention and control.

Research paper thumbnail of Epidemiology of Carbapenem-Resistant Klebsiella Pneumoniae in Intensive Care Units of Multiprofile Hospitals in Tbilisi, Georgia

PubMed, Sep 12, 2018

Klebsiella pneumoniae is one of the most frequent cause of health care associated infections. Dis... more Klebsiella pneumoniae is one of the most frequent cause of health care associated infections. Dissemination of carbapenem-resistant (CR) K. pneumoniae infections significantly trend toward patient morbidity, length of stay and mortality. The aim of this research was to study prevalence and risk-factors of CR K. pneumoniae in Georgia. To identify risk factors for hospital-acquired carbapenem-resistant (CR) K. pneumoniae, from January 1, 2017 through February 28, 2018, an observational case-control study was performed in the ICUs of two tertiary-care hospitals in Tbilisi (High Medical Technology Centre and Ghudushauri National Medical Centre). All isolated K. pneumoniae cultures were tested on antibiotic susceptibility tests (AST). AST was performed by disk diffusion methods and E-test for MIC detection. For the first time CR K. pneumoniae isolates were screened for the presence of KPC, VIM, IMP, NDM and OXA carbapenemase in a PCR. Totally, 46 cultures of K. pneumoniae were isolated. Among them 20 (43.5%) were resistant to carbapenems. Most frequently CR K. pneumoniae cultures were isolated in patients with ventilator associated pneumonia (75%). Main risk factors of carbapenem-resistant from invasive procedures were: mechanical ventilation (OR 30.4, 95% CI 3.504-263.752, p=0.0003), nasogastric tube (OR 17.0, 95% CI 3.202-90.257, p=0.0002), central venous catheter (OR 10.06, 95% CI 1.152-87.849, p=0.028) and previous use of antibiotics (OR 10.059, 95% CI 1.152-87.849, p=0.028), especially carbapenem and 3rd generation cephalosporin. Predominant is OXA-producing K. pneumoniae, NDM-producing K. pneumoniae is relatively rare. To control dissemination of CR K. pneumoniae infection prevention and control should be toughened in medical facilities, and screening for early detection of patients with CR K. pneumoniae should be done.

Research paper thumbnail of Mitigating antimicrobial resistance (AMR) using implementation research: a development funder’s approach

JAC-Antimicrobial Resistance

Despite the escalating burden of antimicrobial resistance (AMR), the global response has not suff... more Despite the escalating burden of antimicrobial resistance (AMR), the global response has not sufficiently matched the scale and scope of the issue, especially in low- and middle-income countries (LMICs). While many countries have adopted national action plans to combat AMR, their implementation has lagged due to resource constraints, dysfunctional multisectoral coordination mechanisms and, importantly, an under-recognized lack of technical capacity to adapt evidence-based AMR mitigation interventions to local contexts. AMR interventions should be tailored, context-specific, cost-effective and sustainable. The implementation and subsequent scale-up of these interventions require multidisciplinary intervention-implementation research (IIR). IIR involves both quantitative and qualitative approaches, occurs across a three-phase continuum (proof of concept, proof of implementation and informing scale-up), and across four context domains (inner setting, outer setting, stakeholders and the...

Research paper thumbnail of Pilot istraživanje Clostridium difficile infekcija u bolesnika s proljevom u zdravstvenim ustanovama u Tbilisiju, Gruzija

Clostridium difficile infection community-associated healthcare-associated diarrhoea Klju~ne rije... more Clostridium difficile infection community-associated healthcare-associated diarrhoea Klju~ne rije~i infekcije uzrokovane Clostridium difficile infekcija ste~ena u zajednici infekcija povezana sa zdravstvenom skrbi proljev

Research paper thumbnail of Pilot surveillance of Clostridium difficile infections among patients with diarrhoea in medical facilities of Tbilisi, Georgia

  1. Department of Communicable Diseases, National Center for Disease Control and Public Health, Tb... more 1) Department of Communicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia 2) R.G. Lugar Center for Public Health Research, National Center for Disease Control and Public Health, Tbilisi, Georgia 3) Department of Infectious Diseases, Tbilisi State Medical University, Tbilisi, Georgia 4) High Technology Medical Center, University Clinic, Tbilisi, Georgia 5) University of Rochester Medical Center, Rochester, New York, USA 6) Division of Foodborne, Waterborne and Environmental Diseases, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA

Research paper thumbnail of Janibacter species with evidence of genomic polymorphism isolated from resected heart valve in a patient with aortic stenosis

Infectious Disease Reports

The authors report isolation and identification of two strains of bacteria belonging to the genus... more The authors report isolation and identification of two strains of bacteria belonging to the genus Janibacter from a human patient with aortic stenosis from a rural area of the country of Georgia. The microorganisms were isolated from aortic heart valve. Two isolates with slightly distinct colony morphologies were harvested after sub-culturing from an original agar plate. Preliminary identification of the isolates is based on amplification and sequencing of a fragment of 16SrRNA. Whole genome sequencing was performed using the Illumina MiSeq instrument. Both isolates were identified as undistinguished strains of the genus Janibacter. Characterization of whole genome sequences of each culture has revealed a 15% difference in gene profile between the cultures and confirmed that both strains belong to the genus Janibacter with the closest match to J. terrae. Genomic comparison of cultures of Janibacter obtained from human cases and from environmental sources presents a promising directi...