Risk Factors and Mortality in Pediatric Patients with Stenotrophomonas maltophilia Bacteremia

Background:Stenotrophomonas maltophilia (S. maltophilia) is an opportunistic and nosocomial pathogen that can cause an invasive and fatal infection, particularly in hospitalized and immunocompromised patients. However, little is known about the impact of S. maltophilia bacteremia in pediatric patients. Therefore, we aimed to identify risk factors for mortality, antibiotic susceptibility of S. maltophilia, and mortality rates in pediatric patients with S. maltophilia bacteremia. Methods: We conducted a retrospective cohort study by identifying all S. maltophilia–positive blood cultures in the microbiology laboratory database between January 2007 and December 2018 from hospitalized pediatric patients (age, 1–14 years) at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. After identifying patients with S. maltophilia bacteremia, medical charts were reviewed for demographics, clinical data, and outcome within 7 days of bacteremia diagnosis. Risk factors associated with mortality in S. maltophilia bacteremia patients were determined using univariate and multivariate analyses. Results: Overall, 68% of pediatric patients with S. maltophilia bacteremia were identified. The most common underlying primary diagnoses were malignancy (29.4%), congenital heart diseases (16.2%), anemia (14.7%), and primary immunodeficiency (11.8%). All infections were nosocomial infections, and (88.2%) bacteremia cases were central-line–associated bloodstream infections. The risk factors associated with mortality as determined by univariate analysis were ICU admission (P < .001), intubation (P = .001), neutropenia (P = .008), prior use of carbapenem (P = .002), thrombocytopenia (P = .006), and respiratory colonization (P < .001). On multivariate analysis, ICU admission (P = .007; 95% CI, 0.003–0.406) and neutropenia (P = .009; 95% CI, 0.013–0.537) were the major risk factors associated with mortality. S. maltophilia was the most susceptible to trimethoprim and sulfamethoxazole (TMP/SMX, 94.1%), followed by levofloxacin (85.7%). In addition, 36 patients received TMP/SMX as monotherapy, and 11 patients received it in combination with other antibiotics (fluoroquinolone, ceftazidime, or aminoglycoside). Hence, no statistically significant difference was observed in patient mortality. The overall mortality rate within 7 days of S. maltophilia bacteremia diagnosis was 33.8%. Conclusions:S. maltophilia bacteremia is a devastating emerging infection associated with high mortality among hospitalized children. Therefore, early diagnosis and prompt management based on local susceptibility data are crucial. Various risk factors, especially ICU admission and neutropenia, are associated with S. maltophilia bacteremia mortality.Funding: NoneDisclosures: None

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Stenotrophomonas maltophilia bacteremia in children: risk factors and mortality rate

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00888-w ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Mohammed Alsuhaibani ◽

Alanoud Aljarbou ◽

Sahar Althawadi ◽

Abdulrahman Alsweed ◽

Sami Al-Hajjar

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Stenotrophomonas Maltophilia ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Factors Associated ◽

Icu Admission ◽

Susceptibility Data ◽

Antibiotics Susceptibility ◽

The Impact

Abstract Purpose Stenotrophomonas maltophilia (S. maltophilia) is an opportunistic and nosocomial pathogen that can cause an invasive and fatal infection, particularly in hospitalized and immunocompromised patients. However, little is known about the impact of S. maltophilia bacteremia in pediatric patients. Therefore, we aimed to identify risk factors for mortality, antibiotics susceptibility to S. maltophilia, and mortality rates in pediatric patients with S. maltophilia bacteremia. Methods We conducted a retrospective cohort study by identifying all S. maltophilia positive blood cultures in the microbiology laboratory database between January 2007 and December 2018 from hospitalized pediatric patients (age 1–14 years). After identifying patients with S. maltophilia bacteremia, medical charts were reviewed for demographics, clinical data, and outcomes within seven days of bacteremia diagnosis. Risk factors associated with mortality in S. maltophilia bacteremia patients were determined using univariate and multivariate analyses. Findings Sixty-eight pediatric patients with S. maltophilia bacteremia were identified. All infections were nosocomial infections, and (88.2%) bacteremia cases were catheter-related bloodstream infections. On multivariate analysis, ICU admission prior to bacteremia episode and neutropenia were the major risk factors associated with mortality. S. maltophilia was the most susceptible to trimethoprim and sulfamethoxazole (TMP/SMX, 94.1%), followed by levofloxacin (85.7%). The overall mortality rate within seven days of S. maltophilia bacteremia diagnosis was 33.8%. Conclusion S. maltophilia bacteremia is a devastating emerging infection associated with high mortality among hospitalized children. Therefore, early diagnosis and prompt management based on local susceptibility data are crucial. Various risk factors, especially ICU admission prior to bacteremia episode and neutropenia, are associated with S. maltophilia bacteremia mortality.

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#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.048 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S15-S16

Author(s):

Miguel A Minero ◽

Asia Castro ◽

Martha Avilés-Robles

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Febrile Neutropenia ◽

Pediatric Oncology ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Oncology Patients ◽

Factors Associated ◽

Patients With Cancer ◽

The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

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Prevalence and associated factors for Pterygium in Han and Mongolian adults: across-sectional study in inner Mongolian, China

10.21203/rs.2.196/v1 ◽

2019 ◽

Author(s):

Yuhan Wang ◽

Guangliang Shan ◽

Linyang Gan ◽

Yonggang Qian ◽

Ting Chen ◽

...

Keyword(s):

Risk Factors ◽

Protective Factors ◽

Rural Areas ◽

Inner Mongolia ◽

Univariate Analysis ◽

Education Level ◽

Study Cohort ◽

Sectional Study ◽

Factors Associated ◽

Significant Difference

Abstract Background: To investigate the prevalence of and factors associated with pterygium in Han and Mongolian adults at four survey sites in Inner Mongolia, China. Methods: A population-based, cross-sectional study was conducted. Using a stratified sampling method, we eventually included 2,651 participants of at least30 years of age from a total of 3,468 eligible residents. Factors associated with pterygium were analysed using univariate analysis and logistic regression models. Results: There were 1,910 Han adults and 741 Mongolian adults included in this study. The mean± standard deviation of age for individuals in the study cohort was 48.93±11.06 years. The overall prevalence of pterygium was 6.4% (n=169), and the prevalences of bilateral and unilateral pterygium were 1.4% (n=38) and 4.8% (n=128), respectively. The most common grade of pterygium was Grade 2. After univariate analysis, eleven factors were considered in a multivariate analysis. The results indicated that age (P<0.001), education level (P<0.001), outdoor occupation (P=0.026), and time spent in rural areas (P<0.001) were significantly associated with pterygium, whereas gender and ethnicity were not risk factors. In subgroup analysis, BMI≥28 was a protective factor for Han individuals (OR 0.42, 95% CI 0.21-0.81, P=0.01), but a risk factor for Mongolian individuals (OR 2.39, 95% CI 1.02-5.58, P=0.044). The BF% in Han and Mongolian individuals had significant difference (P<0.001). Conclusions: Our results indicated that an outdoor occupation, old age and time spent in rural areas are risk factors for pterygium in Inner Mongolia. Living near an urban survey site (Hohhot and Tsining District) and having a higher education level are protective factors for pterygium. Ethnicity, gender, smoking, diabetes and high blood pressure are not associated with pterygium. Different dietary structures in Han and Mongolian adults may lead to different fat content of body and therefore contributes to the prevalence of pterygium. Keywords: Pterygium, prevalence, Han and Mongolian, risk factors, protective factors

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A Study in the Clinical Characteristics of Stenotrophomonas Maltophilia Bacteremia in Hematological Patients

Blood ◽

10.1182/blood.v126.23.4631.4631 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4631-4631

Author(s):

Haiyan Bao ◽

Jia Chen ◽

Xiaojin Wu ◽

Xiao Ma ◽

Chengcheng Fu ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Respiratory Failure ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Univariate Analysis ◽

P Value ◽

Hematological Diseases ◽

Factors Associated

Abstract Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P <0.05). In the multivariate analysis, respiratory failure and non-remission status after treatment forhematological diseases were independent prognostic factors for mortality. In vitro susceptibility was higher to ciprofloxacin(82.4%), ceftazidime(70.6%), sulbactam and cefoperazone(58.8%), which was shown in Table III. Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

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Abstract TP113: Intracranial Atherosclerotic Stenosis Prevalence in a North American Stroke Population

Stroke ◽

10.1161/str.48.suppl_1.tp113 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Yongkun Li ◽

Konark Malhotra ◽

Graham W Woolf ◽

Jason D Hinman ◽

Radoslav Raychev ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

North America ◽

Univariate Analysis ◽

Common Cause ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Significant Difference ◽

Stroke Center ◽

The Impact

Background and Purpose: Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke especially in Asia, but little is known about its prevalence in ischemic stroke patients in North America. We studied the prevalence of ICAS in a single comprehensive stroke center leveraging the routine acquisition of MRI and MR angiography (MRA). Methods: We retrospectively reviewed patients with ischemic stroke and transient ischemic attack who were admitted within seven days of onset from Jan 2014 to July 2016. Patients we excluded: 1) Age <18 years; 2) without intracranial angiography; 3) overt cardiogenic occlusion or risk factors. Data were retrieved including demographics, vascular risk factors, brain imaging including MRA, CTA, and /or DSA, and prior medical prevention of stroke. ICAS was defined as the proximal atherosclerotic stenosis or occlusion ≥50% in diameter. We estimated the prevalence of ICAS at this single stroke center. Results: 685 included patients were aged 20 to 101 years, 384(56.1%) were men, 520 (75.9%) were white, and 74(10.8%) were black. ICAS was prevalent in 41.6% of all included patients. Univariate analysis indicated that the prevalence of ICAS was significantly increased along with age, it was 39.3% for 41-60 years, and 43.8% for 61-80 years (P=0.034). But no significant difference was found between different races, it was 40.8% in Whites, and 40.5% in Blacks, and other races were 47.3%. Patients with ICAS had more severe stroke (NIHSS>3 vs NIHSS≤3: OR 2.729; 95%CI: 1.748-4.260; P<0.001). Higher levels of high-density lipoprotein cholesterol were associated with decreased odds of ICAS (OR 0.981; 95% CI: 0.968-0.995; P<0.006). Our data did not show hypertension, dyslipidemia and body mass index and smoking were associated with ICAS. Conclusions: The prevalence of ICAS in North America may be much higher than previous estimates. The impact of this common cause of recurrent stroke warrants further study, even in populations were cardiogenic embolic risk is common.

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Epidemiology of Nosocomial Carbapenem-resistant Klebsiella Pneumonia Bloodstream Infections in South China: Factors Related to the Patient Mortality

10.21203/rs.3.rs-33283/v1 ◽

2020 ◽

Author(s):

xiaona xie ◽

Xueding Cai ◽

Tingting Wan ◽

Lianyou Shao ◽

Lijiang Chen ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Bloodstream Infection ◽

South China ◽

Univariate Analysis ◽

Bloodstream Infections ◽

Klebsiella Pneumonia ◽

Carbapenem Resistant ◽

Significant Difference ◽

Healthcare Associated

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) causing Bloodstream infection (BSI) are associated with high rates of mortality. Nevertheless, only a few studies regarding the epidemiology of CRKP BSI in south China. The purpose of this study was to describe the epidemiology, clinical characteristics, and the mortality of risk factors associated with CRKP causing bloodstream infection.Methods: A retrospective study of patients with CRKP BSI was recruited from teaching hospital in south China from January 2016 to December 2018. Clinical data were collected from medical records.Results: In total, 90 patients with CRKP BSI were enrolled in the study, while 57% (51/90) of the CRKP BSI were obtained from ICU. Most CRKP BSIs originated from hospitals (81; 85%), while the rest (9; 10%) were healthcare-associated. In univariate analysis, gastrointestinal hemorrhage (p=0.029), Pitt bacteremia score (P=0.045), Charlson comorbidity index (p=0.018) and Corticosteroids use (p=0.036) and Septic shock (p=0.001) were associated with the risk factors for mortality. In a multivariate analysis, septic shock (adjusted odds ratio [aOR] 5.591, 95% confidence interval [CI] 1.405-22.246, P=0.015) and Corticosteroids use (aOR 4.148, 95% CI 1.331-12.928, P=0.014) were independently predictors of mortality.Conclusion: Our data showed that the morbidity and mortality of CRKP BSIs patient from ICU and non-ICU was no significant difference. Standardizing operation and improving nurse quality may play an important role in CRKP BSI patient in intensive care unit. Septic shock and Corticosteroids use were the independent factors of CRKP BSI patient mortality. However, the study did not show an association between invasive procedures and the development of CRKP BSI.

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Predicting lung fibrosis in post-COVID-19 patients after discharge with follow-up chest CT findings

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00495-0 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Rabab Yasin ◽

Ahmed Abdelhakim Kamel Gomaa ◽

Tamer Ghazy ◽

Shaimaa Abdelhamid Hassanein ◽

Reda Abdel latif Ibrahem ◽

...

Keyword(s):

Risk Factors ◽

Severity Score ◽

Lung Fibrosis ◽

Chest Ct ◽

High Resolution Computed Tomography ◽

Factors Associated ◽

Icu Admission ◽

Significant Difference ◽

Independent Risk Factors

Abstract Background Coronavirus disease has spread widely all over the world since the beginning of 2020, and this required rapid adequate management. High-resolution computed tomography (HRCT) has become an initial valuable tool for screening, diagnosis, and assessment of disease severity. This study aimed to assess the clinical, radiographic, and laboratory findings of COVID-19 with HRCT follow-up in discharged patients to predict lung fibrosis after COVID-19 infection in survived patients. Results This study included two-hundred and ten patients who were tested positive for the novel coronavirus by nasopharyngeal swap, admitted to the hospital, and discharged after recovery. Patients with at least a one-time chest CT scan after discharge were enrolled. According to the presence of fibrosis on follow-up CT after discharge, patients were classified into two groups and assigned as the “non-fibrotic group” (without evident fibrosis) and “fibrotic group” (with evident fibrosis). We compared between these two groups based on the recorded clinical data, patient demographic information (i.e., sex and age), length of stay (LOS) in the hospital, admission to the ICU, laboratory results (peak C-reactive protein [CRP] level, lowest lymphocyte level, serum ferritin, high-sensitivity troponin, d-dimer, administration of steroid), and CT features (CT severity score and CT consolidation/crazy-paving score). CT score includes the CT during the hospital stay with peak opacification and follow-up CT after discharge. The average CT follow-up time after discharge is 41.5 days (range, 20 to 65 days). There was a statistically significant difference between both groups (p ˂0.001). Further, a multivariate analysis was performed and found that the age of the patients, initial CT severity score, consolidation/crazy-paving score, and ICU admission were independent risk factors associated with the presence of post-COVID-19 fibrosis (p<0.05). Chest CT severity score shows a sensitivity of 86.1%, a specificity of 78%, and an accuracy of 81.9% at a cutoff point of 10.5. Conclusion The residual pulmonary fibrosis in COVID-19 survivors after discharge depends on many factors with the patient’s age, CT severity, consolidation/crazy-paving scores, and ICU admission as independent risk factors associated with the presence of post-COVID-19 fibrosis.

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Risk factors associated with recurrent cholangitis in pancreatic and hepatobiliary cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.428 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 428-428

Author(s):

Apurva Jain ◽

Juhee Song ◽

Milind M. Javle ◽

Marina C. George

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Acute Cholangitis ◽

Endoscopic Drainage ◽

Metallic Stent ◽

Factors Associated ◽

Increased Risk ◽

Covered Metallic Stent ◽

Significant Difference ◽

The Mean

428 Background: Acute cholangitis due to malignant biliary obstruction is frequent in patients with pancreatic and hepatobiliary cancers. Recurrent cholangitis (RC) results in repeated hospitalization and delayed cancer care. The risk factors associated with RC are not yet defined. Methods: A pilot review was done on 146 patients admitted with a diagnosis of cholangitis from 2005 to 2014. We included demographics, cancer stage, details of first admission (FA) and interventions. Univariate and multivariate Fine-Gray models were used for statistical analysis. Results: The mean age at FA was 62 yrs, 84 (58%) were males and 99 (68%) were white. Most common cancer was pancreatic 100(69%) and 27(19%) pts had primary cholangitis at FA. During FA, interventions were performed in 114(78%), of whom 51 (45%) had percutaneous drainage (PTBD) and 63 (55%) had endoscopic drainage (ED). Readmission with cholangitis was noted in 35 (24%) cases. Univariate analysis did not show a difference between PTBD and ED. However, subgroup analysis showed external only PTBD and covered metallic stent ED had lower risk of RC. These variables remained significant on multivariate analysis (Subdistribution HR= 0.00, p<.0001 for both). Multiple previous PTBD (≥2) before FA was significantly associated with increased risk of RC (Subdistribution HR= 2.64, p= 0.01) on univariate analysis. Conclusions: Having multiple previous PTBD is associated with recurrent cholangitis. Though no significant difference was noted between PTBD and ED, the subgroups indicated a trend towards less recurrent cholangitis with covered metallic stent. [Table: see text]

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Epidemiology of nosocomial carbapenem-resistant Klebsiella pneumonia bloodstream infections in south China: factors related to the patient mortality

10.21203/rs.2.22227/v1 ◽

2020 ◽

Author(s):

Xiaona Xie ◽

Xueding Cai ◽

Tingting Wan ◽

Lianyou Shao ◽

Lijiang Chen ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Bloodstream Infection ◽

South China ◽

Univariate Analysis ◽

Bloodstream Infections ◽

Klebsiella Pneumonia ◽

Carbapenem Resistant ◽

Significant Difference ◽

Healthcare Associated

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) causing Bloodstream infection (BSI) are associated with high rates of mortality . Nevertheless, only a few studies regarding the epidemiology of CRKP BSI in south China. The purpose of this study was to describe the epidemiology, clinical characteristics, and the mortality of risk factors associated with CRKP causing bloodstream infection. Methods: A retrospective study of patients with CRKP BSI was recruited from teaching hospital in south China from January 2016 to December 2018. Clinical data were collected from medical records. Results: In total, 90 patients with CRKP BSI were enrolled in the study, while 57% (51/90) of the CRKP BSI were obtained from ICU. Most CRKP BSIs originated from hospitals (81; 85%), while the rest (9; 10%) were healthcare-associated . In univariate analysis, gastrointestinal hemorrhage (p=0.029), Pitt bacteremia score (P=0.045), Charlson comorbidity index (p=0.018) and Corticosteroids use (p=0.036) and Septic shock (p=0.001) were associated with the risk factors for mortality. In a multivariate analysis, septic shock (adjusted odds ratio [aOR] 5.591, 95% confidence interval [CI] 1.405-22.246, P=0.015) and Corticosteroids use (aOR 4.148, 95% CI 1.331-12.928, P=0.014) were independently predictors of mortality.Conclusion: Our data showed that the morbidity and mortality of CRKP BSIs patient from ICU and non-ICU was no significant difference. Standardizing operation and improving nurse quality may play an important role in CRKP BSI patient in intensive care unit. Septic shock and Corticosteroids use were the independent factors of CRKP BSI patient mortality. However, the study did not show an association between invasive procedures and the development of CRKP BSI.

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Risk Factors of New Vertebral Compression Fracture After Percutaneous Kyphoplasty or Vertebroplasty: A Retrospective Study of 752 Patients

10.21203/rs.3.rs-1057960/v1 ◽

2021 ◽

Author(s):

Bo-bo Zhang ◽

Zhong-wei Song ◽

Ying Wang ◽

Zhi-wei Ren ◽

Wei-zhou Yang ◽

...

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Compression Fracture ◽

Osteoporosis Treatment ◽

Vertebral Compression Fractures ◽

Height Loss ◽

Mineral Density ◽

Compression Fractures ◽

Factors Associated ◽

Significant Difference

Abstract Summary Irregularly postoperative anti-osteoporosis treatment (AOT), number of treated vertebrae (NTV) ≥ 2, bone mineral density (BMD) ≤－3.0 SDs, body mass index (BMI) <18.5kg/m2 or BMI ≥ 24kg/m2, vertebral height loss ratio (VHLR)＞20% were strong risk factors associated with new vertebral compression fractures (NVCF) after percutaneous vertebroplasty or kyphoplasty (PVP/PKP) in patients with osteoporotic vertebral compression fractures (OVCF). There was no difference between NVCF occurred adjacent or remote after PKP/PVP intervention.Introduction NVCF have been connected to PVP/PKP surgery for patients with VCF. There are some debates about whether new vertebral body fractures are simply a result of the natural progression of osteoporosis or whether they should be regarded as a consequence of augmentation. We tried to investigate and identify the risk factors which may be relevant to NVCF after PVP/PKP surgery in OVCF patients.Methods The authors retrospectively analyzed the occurrence of NVCF in 752 patients treated with PVP or PKP for OVCF. Possible risk factors, such as age, gender, refracture time (RT), AOT, NTV, BMD, BMI, and VHLR, were assessed.All methods are carried out in accordance with relevant guidelines and regulations.Results Significant differences (P<0.05) were found between the NVCF and control groups with regard to AOT, number of treated vertebrae, BMD, BMI, and VHLR by univariate analysis. And irregularly AOT, NTV ≥ 2, BMD ≤－3.0 SDs, BMI < 18.5 kg/m2 or BMI ≥ 24kg/m2, VHLR＞20% were found to be the significant factors in multivariate analysis. To evaluate a direct and more precise effect of the procedures on untreated vertebrae, the NVCF group was subdivided into adjacent and remote fracture groups. All of factors have no significant difference between two subgroups.Conclusion In the current study, the incidence of NVCF after PVP/PKP is 9.58%. Irregularly AOT, NTV ≥ 2, BMD ≤－3.0 SDs, BMI <18.5kg/m2 or BMI ≥ 24kg/m2, VHLR＞20% were strong risk factors associated with NVCF after PVP/PKP in patients with OVCF. There was no difference between NVCF occurred adjacent or remote after PKP/PVP intervention and that might be the result of the osteoporosis itself. All of those should be addressed during preoperative communication and postoperative management.

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