EVOLUTION OF THE ENDOGEN FLORA SUSCEPTIBILITY PROFILES AMONG MEDICAL STUDENTS IN ACCORDANCE WITH THEIR YEAR OF STUDY G E B R A E L S A L I B A, M D, M P H C L I N H D F 2017 U N I V E R S I T É S A I N T J O S E P H USJ
WHERE TO CLASS HEALTHCARE PROFESSIONALS REGARDING THE RISK OF INFECTION?
WHERE TO CLASS HEALTHCARE PROFESSIONALS REGARDING THE RISK OF INFECTION? Relatively few papers in the literature None in Lebanon?
WHERE TO CLASS HEALTHCARE PROFESSIONALS REGARDING THE RISK OF INFECTION? Community based Risk of undertreating resistant bacterial infections Increased morbiditymortality Hospital based Risk of overuse of broad spectrum antibiotics Increased antibiotic selection pressure Increased cost Increased Length of Inhospital Stay
FACULTY OF MEDICINE AT SAINT JOSEPH UNIVERSITY Pilot study Aiming to evaluate the risk of bacterial resistance among healthcare professionals Study the evolution trend of the bacterial flora among medical students in accordance with their year of study Progressive inhospital program of clinical rotations starting the end of their second year of study At their sixth year of study, they are permanently rotating within the hospital wards
FACULTY OF MEDICINE AT SAINT JOSEPH UNIVERSITY Hypothesis: first year students are epidemiologically fair representers of the community regarding the risk of bacterial resistance Do their peers of higher grades maintain the same risk level or do their bacterial flora evolve as they get more and more involved in patient care?
MATERIALS AND METHODS Each student enrolled had: Nasal Swabbing for detection of MRSA (screening for other resistant organisms at this site was not performed) Rectal Swabbing for detection of ESBL producing enterobacteriae (screening for other resistant organisms at this site was not performed)
MATERIALS AND METHODS Nasal Swab Screening for MRSA 1 swab spread over oxacilline impregnated culture medium Rectal Swab Screening for ESBL 2 swabs spread over ceftazidime and cefotaxime impregnated culture mediums respectively
INCLUSION - EXCLUSION Inclusion criteria: Being a med student enrolled at the faculty of medicine at Université Saint Joseph Exclusion criteria: Failing to sign a clear consent Failing to fulfill the study questionnaire
RESULTS
184 STUDENTS ENROLLED Year of Study N of Students 1st 23 2nd 24 3rd 6 4th 19 5th 39 6th 52 7th 21 % of Students Beirut 36,5% Mount Lebanon 43% North 5% South 5,5% Nabatieh 3% Bekaa 4% Abroad 3% Men Women 110 74
MRSA COLONISATION Year Of Study MRSA (Nasal Swabbing) 1st 0/23 2nd 0/24 3rd 0/6 4th 0/19 5th 0/39 6th 0/52 7th 0/21
ESBL COLONISATION Year Of Study ESBL (Rectal Swabbing) % of Students 1st 2/23 9% 2nd 5/24 21% 3rd 0/6 0% 4th 5/19 26% 5th 15/39 38,5% 6th 17/52 33% 7th 6/21 28,5%
STATISTICAL ANALYSIS UNIVARIATE
ESBL COLONISATION 1 ST VERSUS 2 ND -7 TH YEAR STUDENTS Pearson s Chi-squared Test Significant Statistical Difference p=0.033
ESBL COLONISATION 1 ST VERSUS 6 TH -7 TH YEAR STUDENTS Pearson s Chi-squared Test Significant Statistical Difference p=0.029
ESBL COLONISATION 2 ND -5 TH VERSUS 6 TH -7 TH YEAR STUDENTS Pearson s Chi-squared Test No Significant Statistical Difference p=0.67
ESBL COLONISATION 1 ST 2 ND VERSUS 3 RD -7 TH YEAR STUDENTS Pearson s Chi-squared Test Significant Statistical Difference p=0.028
ESBL COLONISATION 1 ST 2 ND VERSUS 6 TH -7 TH YEAR STUDENTS Pearson s Chi-squared Test Significant Statistical Difference Significant Statistical Difference p=0.028 p=0.04
OBSERVATIONS No MRSA case detected in 184 students enrolled!!! Students do significantly acquire resistant gram negative bacteria as they get more involved in inhospital programs (direct patient care) Evolution Cutoff is probably earlier than suspected As early as the students start their inhospital traineeship Interesting to conduct similar studies among nurses and practical nurses
STUDY WEAK POINTS Due to Financial restrictions Screening for other resistant bacteria was disregarded Pseudomonas, Acinetobacter, Vancomycin R Enterococci, Relatively low involvement of the students into the study 184/595 31% Less than the third of the student total population Very low participation of the 3 rd year med students!!!!
PRACTICAL IMPACTS Where to Class Healthcare Professionals Regarding the Risk of Infection? 1- Healthcare professionals presenting with light to moderate infections Consider antibiotics choice on a case by case ground basis Balance Risk of Resistance Selection versus Risk of morbidity 2- Healthcare professionals presenting with severe infections Broaden the spectrum of antibiotics as early as possible to cover multi-resistant bacteria Prioritize Risk of Morbidity- Mortality over Risk of Resistance Selection
WHERE TO CLASS HEALTHCARE PROFESSIONALS REGARDING THE RISK OF INFECTION? Healthcare Professionals are a High Risk Population Regarding the Risk of Developping Infections with Resistant Bacteria
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