Browsing by Author "Silva, F.H.D.S."

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Antibiotic sensitivity patterns among extended spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections in Sri Lanka
(Sri Lanka Medical Association, 2016) Luke, W.A.N.V.; Fernando, S.C.; Wickremasinghe, R.D.S.S.; Sebastiampillai, B.S.; Gunathilake, M.P.M.L.; Miththinda, J.K.N.D.; Silva, F.H.D.S.; Premaratna, B.A.H.R.
INTRODUCTION AND OBJECTIVES: ESBLs are enzymes that confer resistance to all penicillins, cephalosporins, and aztreonam. ESBL producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. Documented antibiotic susceptibility of ESBL organisms include meropenem (95-100%) and aminoglycosides (45-60%). This study evaluated the antibiotic sensitivity patterns of ESBL-UTI in Sri Lanka. METHOD: Patients with ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital (CNTH) from January – June 2015 were recruited to the study. Their Urine culture and ABST reports were evaluated after obtaining informed written consent. RESULTS: Of 61 culture positive ESBL-UTIs, E. coli accounted for 53 (86.8%), followed by Klebsiella in the 8 (13.1%). The ESBL organisms were mostly sensitive to carbapenems; 58 (95%) to Meropenem and 45 (73.7%) to Imipenem. The other sensitivity patterns were 37 (60.6%) to Amikacin, and 28 (45.9%) to Nitrofurantoin. Meropenem resistance was observed in 3 (4.9%) and were E.coli. These three patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: It is evident from the above data that Carbapenems remain as the first line therapy for the majority of ESBL-UTI in the local setting. However 4.9 % prevalence of meropenem resistance is alarming compared to 0.4% prevalence in Pakistan and 0.02% prevalence in Germany. Such high prevalence of meropenem resistance should draw attention of clinicians and needs to implement measures to prevent emergence and spread of carbapenum resistant ESBL organisms in the country.
Attitudes of nurses in palliative care – A Sri Lankan study
(Sri Lanka Medical Association, 2016) Silva, F.H.D.S.; Luke, N.; Piyarathne, S.P.M.L.R.; de Silva, S.T.
INTRODUCTION AND OBJECTIVES: Care of terminally ill patients and their families by health care workers (HCW) is variable from person to person. The quality of care is influenced by attitudes that the provider holds towards the concept of palliation. There is no formal education or training of HCW in Sri Lanka. This study aimed to determine the attitudes of nurses towards the dying process of a patient in the context of palliative care. METHOD: Nurses working in general medical and surgical wards and critical care units at the Colombo North Teaching Hospital, Ragama were assessed with the Frommelt Attitudes Towards Care of the Dying (FATCOD) scale (a 30 item, 5 point Likert Scale) using a self administered questionnaire. A total of 105 volunteers (general ward – 53, critical care- 52) participated in this study. RESULTS: The total FATCOD score for nurses in general wards was 107.51 (+/- 12.3) while it was 110.64 (+/-15.4) for critical care nurses (range 30-150). The mean FATCOD score for nurses in general wards was 3.58 (+/- 0.49) while nurses in critical care units achieved 3.68 (+/- 0.52). There were no significant differences of the mean scores with regards to nursing grade or duration of service (p<0.05). Scores related to communication between nurses and patients/carers were observed to be low along with the score on family interference in patient care. CONCLUSIONS: The results of this study demonstrate lower scores in all questions when compared to studies done in developed countries. The importance of developing strategies to improve delivery of palliative care services is paramount.
Burnout among Intern Medical Officers in selected Teaching Hospitals: a cross-sectional descriptive study
(Sri Lanka Medical Association, 2016) de Silva, S.T.; Dahanayaka, N.; Ralapanawa, U.; Nishad, A.A.N.; Silva, F.H.D.S.; Shyamali, N.L.A.; Wanigasuriya, K.
INTRODUCTION: Burnout is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, occurring due to chronic emotional and interpersonal stressors. Burnout is well recognized among medical doctors. Identifying and, where possible, treating burnout is critical, as it has a major impact on the quality of life of doctors, patient safety and health outcomes. OBJECTIVES: Research on burnout in the medical community of Sri Lanka is scarce. Our objective was to determine the prevalence and risk factors for burnout among intern medical officers (IMOs), who are likely to be at high risk. METHOD: Consenting IMOs in Medical, Surgical, Paediatrics and Obstetric and Gynaecology Units of Teaching Hospitals in Colombo South, Colombo North, Peradeniya, Kandy and Karapitiya were administered three standard, validated, self-administered questionnaires on burnout. RESULTS: 124 IMOs participated; 79(62.9%) were females. Mean age was 27.4 years. Oldenburg Burnout Inventory: 75/124(60.5%) suffered from disengagement, and 77/124(62%) from exhaustion. Abbreviated Maslach Inventory: 47/124(38%) suffered from emotional exhaustion, 20/124(16.1%) from depersonalization, and 6/124(5%) from poor personal accomplishment. Work and lifestyle-related causes (ie heavy and monotonous work-load, lack of control over work-load, chaotic work environment, inadequate rest and sleep, lack of help, and absence of a supportive relationship) were significantly associated with higher burnout scores. CONCLUSIONS: Burnout appears to affect approximately 1 in 3 IMOs in our sample. Most work and lifestyle related risk factors for burnout are modifiable. Further studies are needed to identify causes of burnout among IMOs. A system to detect and treat burnout, particularly among IMOs, is an urgent
Factors associated with urinary tract infections caused by extended spectrum β-lactamase producing organisms (ESBL-UTI) among hospitalized patients in a tertiary care hospital
(Sri Lanka Medical Association, 2016) Fernando, S.C.; Wickramasinghe, R.D.S.S.; Luke, W.A.N.V.; Gunathilake, M.P.M.L.; Sebastiampillai, B.S.; Miththinda, J.K.N.D.; Silva, F.H.D.S.; Premaratna, B.A.H.R.
INTRODUCTION AND OBJECTIVES: Management of infections caused by ESBL producers is a challenge and expensive. Known associations for ESBL-UTI include recent hospitalizations, recent treatment with cephalosporins, quinolones or penicillin, age over 60 years, male gender, diabetes mellitus, recent Klebsiella pneumoniae infection and obstructive uropathy. Associations for ESBL-UTI in Sri Lanka are not known. METHOD: In order to identify associations of urinary tract infections (UTIs) caused by ESBL producers (ESBL-UTI),a descriptive cross-sectional study was carried out in patients with culture positive ESBL-UTIs admitted to the Professorial Medical unit, Colombo North Teaching Hospital. Patients’ medical records and an interviewer administered questionnaire were used to obtain data. RESULTS: There were 61 patients, 30 (49.1%) males with a mean age of 64.1 years. Of them, 54 (88.5%) had diabetes mellitus,38 (62.2%) had hypertension and 10 (16.3%) had chronic liver disease (CLD). 21 (34.4%) had acute pyelonephritis, 19 (31.1%) had evidence of chronic kidney disease,8 (13%) had obstructive uropathy by ultrasonography. A history of constipation was given in 27 (44.2%), hospitalization during the past 3 months in 30 (49.2%), urinary catheterization in 20 (32.7%) and antibiotic treatment within the past 3 months in 39 (63.9%). CONCLUSION: Most associations for ESBL-UTI in Sri Lanka were similar to that had been previously described. However the observed higher incidence of CLD, hypertension and CKD needs further evaluation. The fact that 50.8% did not have a history of recent hospitalization and 36.1% did not have recent antibiotic therapy suggest high community prevalence of ESBL producing organisms.
Factors influencing urinary tract infections caused by extended spectrum β-lactamase producing organisms among a cohort of hospitalized patients in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Luke, W.A.N.V.; Premaratna, B.A.H.R.; Fernando, S.C.; Silva, F.H.D.S.; Sebastiampillai, B.S.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.
BACKGROUND: Urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing organisms are a management challenge and a health care burden. OBJECTIVES: To describe factors that influence ESBL UTI among hospitalized patients. METHODS: Fifty two consecutive patients who were admitted with culture positive ESBL UTI to the Professorial Medical Units, Colombo North Teaching Hospital, Ragama over a period of 6 month since January 2015 were recruited. Data was collected by an interviewer administered questionnaire and patients medical records after obtaining informed written consent. RESULTS: Among all 52 ESBL UTI patients, 46 (88.5%) had diabetes mellitus, 32 (61.5%) hypertension, 10 (19.2%) chronic liver disease, 18 (34.6%) a history of constipation. Four (7.7%) patients each were detected to have either hydronephrosis, hydroureter or prostatomegaly in USS assessment. Thirty two (61.5%) had received antibiotic treatment within the last 3 months: 18 (34.6%) has had penicillins and 16 (30.8%), 3rd generation cephalosporins, Twenty four (46.2%) had hospitalization in the last 3 months and 16 (30.8%) had a history of urinary catheterization. CONCLUSIONS: Diabetes, recent antibiotic treatment, hospitalization and catheterization were observed to influence ESBL UTIs. However the fact that 53.8% patients who developed ESBL UTI did not have a history of recent hospitalization, suggests high existence of community acquired ESBL.
Hypoglycaemia among patients with type II diabetes mellitus: A retrospective study
(Sri Lanka Medical Association, 2013) Perera, U.D.C.A.; Silva, F.H.D.S.; de Silva, S.T.
INTRODUCTION AND OBJECTIVES; Although there is emphasis on strict glucose control in type II diabetes mellitus (T2DM), information about problems that occur due to hypoglycaemia, especially in resource-poor settings, is lacking. We aimed to determine the prevalence of symptomatic hypoglycaemia, awareness of hypoglycaemia and knowledge about avoiding, detecting and treating hypoglycaemia, in a cohort of patients with T2DM. Methods: A descriptive, retrospective study of patients with T2DM attending general medical clinics of the University Medical Unit, Teaching Hospital, Ragama was carried out for 7 months from May 2012 using an interviewer administered questionnaire. RESULTS: Three hundred patients were recruited. One hundred and two (34%) had experienced at least one hypoglycaemic episode, and more than 2 episodes were experienced by 88 (86.3%). Commonest symptoms were sweating (65.7%) and palpitations (54%). Neuroglycopaenic symptoms were experienced by 54 (52.9%) and 18 (17.6%) had "become unconscious. Thirty (29.4%) had required hospital admission. Sixty nine (67.6%) were on sulphonylurea alone or in combination with metfonnin. Sixty nine (67.6%) were unaware of hypoglycaemia. Main reasons for hypoglycaemia were missed meals 49 (48%) and associated illness 49 (23.5%). Two hundred and thirty eight (79.3%) knew how to treat hypoglycaemia and 151 (50.3%) had received information on hypoglycaemia from medical officers. Two hundred and sixty one (87%) were not using a glucometer and 223 (74%) were unaware of such a device, although 249 (83%) said they could afford one. CONCLUSIONS: Hypoglycaemia is a common but under-recognised symptom among T2DM patients. Severe or recurrent hypoglycaemia is associated with a high cost to the individual and to the health service. Raising awareness by health education, with emphasis on self-monitoring where possible, should receive priority.
Secondary bacteraemia in adult patients with prolonged dengue fever
(Sri Lanka Medical Association, 2015) Premaratna, R.; Dissanayake, D; Silva, F.H.D.S.; Dassanayake, M.; de Silva, H.J.
INTRODUCTION: Although dengue management guidelines do not advice on use of antibiotics in dengue shock syndrome, unrecognised bactraemia is likely to contribute to morbidity and mortality. OBJECTIVES: To assess the occurance of secondary bacteraemia in adult patients with prolonged dengue fever. METHODS: A prospective study was conducted recruiting patients with confirmed acute dengue infection who had prolonged fever (>5 days). Two sets of blood cultures were taken in such patients prior to institution of antibiotic therapy. Demographic, clinical, haematological and biochemical parameters were recorded. Development of ascites and pleural effusions were detected using ultrasonography. RESULTS: Fourty patients (52.5% males) with a mean age of 29.8 years (SD 13.6) were studied. The average duration of fever was 7.9 days (SD 1.8). Ten patients (25%) had bacterial isolates in their blood cultures; Staphylococcus aureus (n=2), coliforms (n=3), pseudomonas (n=1) and 4 had mixed growths. The culture positive group had severe body aches at admission and higher fever, third space fluid accumulation, a significant drop in platelets and a higher CRP. CONCLUSIONS: A quarter of dengue patients with prolonged fever had a bacterial isolate. Culture positive patients appeared more ill with body aches and had higher degrees of fever during the latter part of the illness. Increased vascular permeability may predispose to bacterial seepage into blood. Although white cell count is not helpful in detecting bacteraemia, low platelet count and elevation of CRP seem to be helpful.
Secondary Bacteraemia in Dengue patients with Prolonged Fever
(Sri Lanka Medical Association, 2013) Dissanayake, G.N.D.; Silva, F.H.D.S.; Dassanayake, M.; Premaratna, R.
INTRODUCTION AND OBJECTIVES: In dengue infection, fever usually lasts 5- 7 days. Less than 5% develop Dengue Shock Syndrome due to fluid leakage. Some of the patients with third space fluid accumulation (TSFA) continue to have prolonged high fever. Few studies have shown growth of bacterial species in blood cultures which suggest secondary bacteraemia. This is probably caused by translocation of gut bacteria by disruption of intestinal mucosal and vascular integrity. Clear understanding of secondary bacterial infections is necessary to treat the severe dengue infections effectively. Our objective was to assess the prevalence and risk of bacteraemia in patients with dengue who had prolonged fever. METHODS: A prospective, descriptive study was conducted at the Professorial Medical Unit of Colombo North Teaching Hospital, Ragama. Forty six patients with seropositive, acute dengue infection and prolonged fever (>5 days) were recruited. Two sets of blood cultures were obtained Haematological and biochemical tests were carried out. Clinical diagnosis of TSFA (ascites/ pleural effusions) were recorded. None of the patients were treated with antibiotics prior to obtaining blood cultures. RESULTS: Thirty (65.2%) patients had no evidence of fluid leakage and none of them had positive blood culture isolate. Of the 16 (34.8%) patients who had third space leakage, 10 (62-5%) patients had positive blood culture growths; Coliforms (3), Staphalococcus aureus (2), Pseudomonas sp.(l), mixed growths (4). CONCLUSIONS: Patients with prolonged fever and fluid leakage are at risk of developing secondary bacteraemia compared to those without fluid leakage.