Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality

2011 ◽  
Vol 139 (11) ◽  
pp. 1740-1749 ◽  
Author(s):  
M. TUMBARELLO ◽  
E. REPETTO ◽  
E. M. TRECARICHI ◽  
C. BERNARDINI ◽  
G. DE PASCALE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
University Hospitals ◽  
Central Venous ◽  
Initial Antimicrobial Therapy ◽  
Independent Risk Factors ◽  
Control Study

SUMMARYWe retrospectively studied patients diagnosed with P. aeruginosa bloodstream infections (BSIs) in two Italian university hospitals. Risk factors for the isolation of multidrug-resistant (MDR) or non-MDR P. aeruginosa in blood cultures were identified by a case-case-control study, and a cohort study evaluated the clinical outcomes of such infections. We identified 106 patients with P. aeruginosa BSI over the 2-year study period; 40 cases with MDR P. aeruginosa and 66 cases with non-MDR P. aeruginosa were compared to 212 controls. Independent risk factors for the isolation of MDR P. aeruginosa were: presence of central venous catheter (CVC), previous antibiotic therapy, and corticosteroid therapy. Independent risk factors for non-MDR P. aeruginosa were: previous BSI, neutrophil count <500/mm3, urinary catheterization, and presence of CVC. The 21-day mortality rate of all patients was 33·9%. The variables independently associated with 21-day mortality were presentation with septic shock, infection due to MDR P. aeruginosa, and inadequate initial antimicrobial therapy.

Risk Factors for Colonization or Infection Due to Methicillin-Resistant Staphylococcus Aureus in HIV-Positive Patients A Retrospective Case-Control Study

1999 ◽  
Vol 20 (01) ◽  
pp. 26-30 ◽  
Author(s):  
Michelle Onorato ◽  
Michael J. Borucki ◽  
Gwen Baillargeon ◽  
David P. Paar ◽  
Daniel H. Freeman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Case Control Study ◽  
Venous Catheter ◽  
Case Control ◽  
Central Venous ◽  
Methicillin Resistant ◽  
Hospital Days ◽  
Control Study

AbstractObjective:To determine the risk factors for colonization or infection with methicillin-resistantStaphylococcus aureusin human immunodeficiency virus (HIV)-infected patients.Design:Retrospective matched-pair case-control study.Setting:Continuity clinic and inpatient HIV service of a university medical center.Population:Patients with HIV infection from the general population of eastern and coastal Texas and from the Texas Department of Criminal Justice.Data Collection:Patient charts and the AIDS Care and Clinical Research Program Database were reviewed for the following: age, race, number of admissions, total hospital days, presence of a central venous catheter, serum albumin, total white blood cell count and absolute neutrophil count, invasive or surgical procedures, any cultures positive forS aureus, and a history of opportunistic illnesses, diabetes, or dermatologie diagnoses. Data also were collected on the administration of antibiotics, antiretroviral therapy, steroids, cancer chemotherapy, and subcutaneous medications.Results:In the univariate analysis, the presence of a central venous catheter, an underlying dermatologie disease, lower serum albumin, prior steroid therapy, and prior antibiotic therapy, particularly antistaphylococcal therapy or multiple courses of antibiotics, were associated with increased risk for colonization or infection with methicillin-resistantS aureus. Multivariate analysis yielded a model that included presence of a central venous catheter, underlying dermatologie disease, broad-spectrum antibiotic exposure, and number of hospital days as independent risk factors for colonization or infection with methicillin-resistantS aureus.Conclusions:In our HIV-infected patient population, prior hospitalization, exposure to broad-spectrum antibiotics, presence of a central venous catheter, and dermatologie disease were risk factors for acquisition of methicillin-resistantS aureus

scholarly journals Risk Factors For Stenotrophomonas Maltophilia Bacteremia In Oncology Patients: A Case–Control Study

2003 ◽  
Vol 24 (4) ◽  
pp. 269-274 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Jennie L. Mayfield ◽  
Teresa Garison ◽  
Patricia M. McLendon ◽  
John F. DiPersio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Stenotrophomonas Maltophilia ◽  
Case Control Study ◽  
Venous Catheter ◽  
Case Control ◽  
Central Venous ◽  
Oncology Patients ◽  
Control Study

AbstractObjective:To characterize risk factors for Stenotrophomonas maltophilia bloodstream infection in oncology patients.Design:A 3:1 case–control study.Setting:Stem Cell Transplant and Leukemic Center at Barnes–Jewish Hospital (St. Louis), a 1,442-bed, tertiary-care teaching hospital with a 26-bed transplantation ward.Method:From June 1999 to April 2001,13 patients with S. maltophilia bacteremia were compared with 39 control-patients who were on the transplantation unit on the same day as the case-patients' positive blood cultures. Information collected included patient demographics, medical history, history of transplantation, transplantation type, graft versus host disease, neutropenia, antibiotic use, chemotherapy, mucositis, diarrhea, the presence of central venous catheter(s), cultures, and concomitant infections.Results:Significant risk factors for S. maltophilia bacteremia included severe mucositis (7 [53.8%] of 13 vs 8 [20.5%] of 39; P = .034), diarrhea (7 [53.8%] of 13 vs 8 [20%] of 39; P = .034), and the use of metronidazole (9 [69.2%] of 13 vs 8 [20.5%] of 39; P = .002). In addition, the number of antibiotics used (median, 9 vs 5; P < .001), duration of mucositis (median, 29 vs 15 days; P = .032), and length of hospital stay (median, 34 vs 22 days; P = .017) were significantly different between case- and control-patients. Nine S. maltophilia isolates tested by pulsed-field gel electrophoresis were found to be distinctly different.Conclusion:Interventions to ameliorate the severity of mucositis, reduce antibiotic pressure, prevent diarrhea, and promote meticulous central venous catheter care may help prevent S. maltophilia bloodstream infection in oncology patients. The role of gastrointestinal tract colonization as a potential source of S. maltophilia bacteremia in oncology patients deserves further investigation.

scholarly journals A hospital-based matched case–control study to identify risk factors for clinical infection with OXA-48-producing Klebsiella pneumoniae in rectal carriers

2017 ◽  
Vol 145 (12) ◽  
pp. 2626-2630 ◽  
Author(s):  
A. MADUEÑO ◽  
J. GONZALEZ GARCIA ◽  
A. AGUIRRE-JAIME ◽  
M. LECUONA
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Case Control Study ◽  
Venous Catheter ◽  
Case Control ◽  
Clinical Infection ◽  
Hospital Units ◽  
Matched Case ◽  
Independent Risk Factors ◽  
Control Study

SUMMARYAsymptomatic colonisation of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is an important reservoir for transmission, which may precede infection. This retrospective observational case–control study was designed to identify risk factors for developing clinical infection with OXA-48-producing Klebsiella pneumoniae in rectal carriers during hospitalisation. Case patients (n = 76) had carbapenemase-producing K. pneumoniae (CPKP) infection and positive rectal culture for CPKP. Control patients (n = 174) were those with rectal colonisation with CPKP but without CPKP infection. Multivariate analysis identified the presence of a central venous catheter (OR 4·38; 95% CI 2·27–8·42; P = 0·008), the number of transfers between hospital units (OR 1·27; 95% CI (1·06–1·52); P < 0·001) and time at risk (OR 1·02 95% CI 1·01–1·03; P = 0·01) as independent risk factors for CPKP infection in rectal carriers. Awareness of these risk factors may help to identify patients at higher risk of developing CPKP infection.

scholarly journals 857A Case Control Study of the Risk Factors for Central Venous Catheter Related Mixed Candidemia Infection

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S246-S246
Author(s):  
Dantuluru Muralidhar Varma ◽  
Srikant Prasad Rao ◽  
Sudha Vidyasagar ◽  
Kalwaje Eshwara Vandana
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Case Control Study ◽  
Venous Catheter ◽  
Case Control ◽  
Central Venous ◽  
Control Study

scholarly journals Central Venous Catheter-Associated Blood Stream Infections Occurring in Canadian Intensive Care Units: A Six-Month Cohort Study

2006 ◽  
Vol 17 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
John Conly ◽  
Joanne Embree ◽  
Geoffrey Taylor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Parenteral Nutrition ◽  
Case Control Study ◽  
Venous Catheter ◽  
Case Control ◽  
Central Venous ◽  
Factors Associated ◽  
Control Study

OBJECTIVE:To determine the rate and risk factors associated with central venous catheter (CVC)-associated bloodstream infections (BSIs) in Canadian intensive care units (ICUs).DESIGN:A prospective, active six-month cohort with a nested case-control study.SETTING:Forty-one ICUs located in 19 Canadian hospitals.METHODS:Data were collected using a standardized format on all CVCs and patients when a CVC was inserted for more than 48 h. Results of microbiological studies and therapeutic interventions were recorded when a BSI occurred.RESULTS:There were 182 BSIs from 3696 CVC insertions in 2531 patients. Coagulase-negative staphylococci were responsible for 73% of the BSIs. Mean rates of CVC-associated BSIs per 1000 CVC days were 6.9, 6.8 and 5.0 in adult, neonatal and pediatric ICUs, respectively. Significant factors associated with BSI included duration of CVC insertion (OR=1.2, 95% CI 1.1 to 1.3), receiving total parenteral nutrition (OR=4.1, 95% CI 1.2 to 14.3) and having one or more CVCs (OR=3.1, 95% CI 1.5 to 6.5). In the case-control study, 80% of the variance in a backward elimination logistic regression analysis was explained by duration of CVC insertion (OR=1.2 per day), receiving chemotherapy (OR=6.1), more than one CVC insertion during the study (OR=3.5), insertion of a CVC with two or more lumens (OR=2.3), using the CVC to administer total parenteral nutrition (OR=1.6) and having a surgical wound other than a clean wound (OR=1.6).CONCLUSION:The present study identified risk factors explaining 80% of the variance associated with BSIs and is one of the largest reports on the rate of CVC-associated BSIs occurring in the ICU setting.

Risk factors associated with anthrax in cattle on smallholdings

2011 ◽  
Vol 140 (10) ◽  
pp. 1888-1895 ◽  
Author(s):  
P. K. BISWAS ◽  
M. Z. ISLAM ◽  
S. K. SHIL ◽  
R. K. CHAKRABORTY ◽  
S. S. U. AHMED ◽  
...  
Keyword(s):  
Risk Factors ◽  
Eichhornia Crassipes ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Study Data ◽  
Matched Pair ◽  
Matched Pair Analysis ◽  
Independent Risk Factors ◽  
Pair Analysis ◽  
Control Study

SUMMARYUnprecedented high rates of anthrax outbreaks have been observed recently in cattle and humans in Bangladesh, with 607 human cases in 2010. By enrolling 15 case and 15 control cattle smallholdings in the spatial zone in July–September 2010, we conducted a case-control study, data of which were analysed by matched-pair analysis and multivariable conditional logistic regression. Feeding animals with uprooted and unwashed grass [odds ratio (OR) 41·2, 95% confidence interval (CI) 3·7–458·8, P=0·003], and feeding water hyacinth (Eichhornia crassipes) (OR 22·2, 95% CI 1·2–418·7, P=0·039) were independent risk factors for anthrax in cattle.

Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study

2018 ◽  
Vol 57 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Ferhat Arslan ◽  
Hulya Caskurlu ◽  
Sema Sarı ◽  
Hayriye Cankar Dal ◽  
Sema Turan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Control Study ◽  
Absolute Risk ◽  
Subsequent Development ◽  
Bloodstream Infections ◽  
Case Control ◽  
Prior Exposure ◽  
Control Study

Abstract Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56–3.14); prior exposure to N-acetylcysteine, 0.11 (0.03–0.34) and prior surgical intervention, 1.26 (0.76–2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.

Carbapenem-ResistantKlebsiella pneumoniaein Post-Acute-Care Facilities in Israel

2011 ◽  
Vol 32 (9) ◽  
pp. 845-853 ◽  
Author(s):  
Debby Ben-David ◽  
Samira Masarwa ◽  
Shiri Navon-Venezia ◽  
Hagit Mishali ◽  
Ilan Fridental ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Case Control Study ◽  
Case Control ◽  
Antibiotic Exposure ◽  
Care Facilities ◽  
History Of ◽  
Independent Risk Factors ◽  
Acute Care Facilities ◽  
Control Study

Objective.To assess the prevalence of and risk factors for carbapenem-resistantKlebsiella pneumoniae(CRKP) carriage among patients in post-acute-care facilities (PACFs) in Israel.Design, Setting, and Patients.A cross-sectional prevalence survey was conducted in 12 PACFs. Rectal swab samples were obtained from 1,144 patients in 33 wards. Risk factors for CRKP carriage were assessed among the cohort. Next, a nested, matched case-control study was conducted to define individual risk factors for colonization. Finally, the cohort of patients with a history of CRKP carriage was characterized to determine risk factors for continuous carriage.Results.The prevalence of rectal carriage of CRKP among 1,004 patients without a history of CRKP carriage was 12.0%. Independent risk factors for CRKP carriage were prolonged length of stay (odds ratio [OR], 1.001;P< .001), sharing a room with a known carrier (OR, 3.09;P= .02), and increased prevalence of known carriers on the ward (OR, 1.02;P= .013). A policy of screening for carriage on admission was protective (OR, 0.41;P= .03). Risk factors identified in the nested case-control study were antibiotic exposure during the prior 3 months (OR, 1.66;P= .03) and colonization with other resistant pathogens (OR, 1.64;P= .03). Among 140 patients with a history of CRKP carriage, 47% were colonized. Independent risk factors for continued CRKP carriage were antibiotic exposure during the prior 3 months (OR, 3.05;P= .04), receipt of amoxicillin-clavulanate (OR, 4.18;P= .007), and screening within 90 days of the first culture growing CRKP (OR, 2.9;P= .012).Conclusions.We found a large reservoir of CRKP in PACFs. Infection-control polices and antibiotic exposure were associated with patient colonization.

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