contoh case control jurnal infection.pptx

contoh case control jurnal.pptx

1. A case–control study of infections caused by Klebsiella pneumoniae producing New Delhi metallo beta-lactamase-1: Predictors and outcomes Tugas kuliah Clinical Microbiology

2. Introduction Antimicrobial-resistant bacteria are a major global cause of death. Carbapenemase -producing bacteria are key agents of resistance. Klebsiella pneumoniae NDM-1 (KP-NDM-1): highly drug-resistant, already reported in Mexico. Study Aim :  Identify risk factors for hospital-acquired KP-NDM-1 infections in a tertiary-care hospital in Mexico.

3. Methods Design :  Retrospective case–control study (Jan 2012 – Feb 2018). Setting :  Hospital Civil de Guadalajara “Fray Antonio Alcalde,” 899-bed tertiary teaching hospital. Cases :  139 patients with positive culture for  K. pneumoniae  NDM-1. Controls :  486 patients from the same ward and period, without NDM-1 infection. Exclusion :  Patients hospitalized <48 hours. Infection Criteria :  Defined using CDC/NHSN surveillance standards. Data Collected :  Demographics, prior hospitalizations, antibiotic use, clinical outcomes. Severity Scores :  SOFA, APACHE II, and Glasgow Coma Scale were applied .

4. Microbiological & Molecular Analysis Identification :  MALDI-TOF MS (Bruker Biotyper ). Susceptibility testing :  VITEK 2 system. Carbapenemase detection :   CarbaNP test (CLSI guidelines) Genetic analysis :  DNA extracted → PCR for carbapenemase genes Class A:  blaKPC Class B:  blaVIM , blaIMP , blaNDM Class D:  blaOXA-48 Confirmation:  Sequencing of selected PCR products. Data analysis:  SPSS v24, logistic regression for ORs; t-test and chi-square for group comparisons (p < 0.05 = significant).

5. RESULTS Patients: 139 cases (KP-NDM-1) vs 486 controls. Age & sex: Similar between groups. Comorbidities: Comparable, except acute renal failure → higher in cases. Severity scores: GCS, SOFA, APACHE → worse in cases. Lab findings: Higher alkaline phosphatase & CRP in cases. Hospital stay: Longer in cases → 43 vs 15 days (p < 0.001). Mortality: Higher in cases → 36% vs 8.4% (p < 0.001). buatkan versi narrative

6. Multivariate Analysis

7. Discussion

8. Conclusion K. pneumoniae  NDM-1 was the most frequent carbapenemase in this population, unlike other regions where KPC is more common. Limited treatment options make NDM-positive bacteria a serious clinical threat. Key predictors of KP-NDM-1 infection: Previous antibiotic use Urinary catheter Central venous catheter Mechanical ventilation Prolonged ICU stay

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