Investigation of an Outbreak of Gram-Negative Bacteremia Among Hematology-Oncology Outpatients

AbstractObjective:To identify risk factors associated with an outbreak of gram-negative bacteremia (GNB).Setting:A university hospital.Patients:Hematology-oncology outpatients.Design:Retrospective case-control study.Results:Thirty-eight patients developed GNB; 13 patients experienced more than one episode, and eight blood cultures grew more than one gram-negative organism. The most frequently isolated organisms were Stenotrophomonas maltophilia, Klebsiella pneumoniae, Acinetobacter baumannii, and Acinetobacter johnsonii. When the GNB patients (cases) were compared with randomly selected hematology-oncology patients (controls), central venous catheter (CVC) self-care (71% vs 39%; P=.02), and duration of recent hospital stay (median, 15 vs 4 days; P=.01) were identified as risk factors. In a logistic regression model, duration of recent hospital stay was the only risk factor significantly associated with GNB (odds ratio, 1.05; 95% confidence interval, 1.01-1.08; P<.02).Conclusions:Hematology-oncology patients providing their own CVC care who have recently been hospitalized for more than 2 weeks may be at increased risk of GNB. CVCs should be protected from possible environmental contamination in hematology-oncology patients. Patients providing their own CVC care should undergo continued rigorous education regarding proper CVC care.

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Association between Neuroleptics and Venous Thromboembolism: A Case-Control Study.

Blood ◽

10.1182/blood.v104.11.2601.2601 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2601-2601

Author(s):

Karine Lacut ◽

Gregoire Le Gal ◽

Emmanuel Oger ◽

Dominique Mottier

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Antipsychotic Drugs ◽

Case Control Study ◽

Case Control ◽

University Hospital ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

Control Study

Abstract Background: Preliminary reports suggest that use of antipsychotic drugs is associated with an increased risk of venous thromboembolism (VTE), but others did not confirm these results. Objective: To evaluate the relationship between antipsychotic drugs and VTE. Design: Case-control study (EDITH) designed to investigate genetic and environmental risk factors of VTE. Setting: Brest University Hospital. Participants: 857 patients consecutively hospitalized for a documented venous thromboembolic event were included between May 2000 and May 2004. Controls were matched on age, sex and the main risk factors of venous thromboembolism (cancer, surgery, pregnancy…). Results: The mean age of patients was 67.7 year. No significant difference was found between cases and controls concerning the main characteristics, except for smocking and body mass index. Among cases, 89 (10.4%) were current users of neuroleptics compared to 35 (4.8%) among controls. Current use of neuroleptics was associated with a significant increased risk of venous thromboembolism (OR = 2.32, 95% CI: 1.55–3.48). Excluding neuroleptics used for non psychiatric disorders, and after adjustment on the main confounding factors, this association remained significant (OR = 3.48, 95% CI: 2.00–6.04). No difference was found between the different chemical categories of neuroleptics, but the number of patients in some groups had limited statistical power to demonstrate significant differences. Biological mechanisms of action have been proposed to explain this relation. Analyses are ongoing for anti-phospholipid antibodies and homocysteine. Conclusion: In this case-control study of hospitalized patients, neuroleptics use was associated with a significant increased risk of venous thromboembolism. These results are concordant with previous reports. Nevertheless, further investigations are needed to explain wich mechanisms may be involved in such association and before use of neuroleptics can be definitely considered as risk factor for venous thromboembolism.

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Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00984-16 ◽

2016 ◽

Vol 60 (11) ◽

pp. 6673-6678 ◽

Cited By ~ 12

Author(s):

Ji-Yong Lee ◽

Cheol-In Kang ◽

Jae-Hoon Ko ◽

Woo Joo Lee ◽

Hye-Ri Seok ◽

...

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Respiratory Infections ◽

Hematologic Malignancy ◽

Tertiary Hospital ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Content Type ◽

Gram Negative Bacteremia ◽

Infection Types

ABSTRACTWith the increasing use of carbapenems, carbapenem-resistant Gram-negative bacteria have become a major concern in health care-associated infections. The present study was performed to evaluate the clinical and microbiological features of breakthrough Gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. A case-control study was performed at a tertiary hospital from 2005 to 2014. Case patients were defined as individuals whose blood cultures grew Gram-negative bacteria while the patients were receiving carbapenems for at least 48 h before breakthrough GNB. Age-, sex-, and date-matched controls were selected from patients who received carbapenem for at least 48 h and did not develop breakthrough GNB during carbapenem treatment. A total of 101 cases of breakthrough GNB were identified and compared to 100 controls. The causative microorganisms for breakthrough GNB wereStenotrophomonas maltophilia(n= 33),Acinetobacter baumannii(n= 32),Pseudomonas aeruginosa(n= 21), and others (n= 15). Approximately 90% ofS. maltophiliaisolates were susceptible to levofloxacin and trimethoprim-sulfamethoxazole. The most common infection types were primary bacteremia (38.6%) and respiratory infections (35.6%). More than half of the patients died within a week after bacteremia, and the 30-day mortality rate was 70.3%. In a multivariate analysis, a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization by causative microorganisms were significantly associated with breakthrough GNB. Our data suggest thatS. maltophilia,A. baumannii, andP. aeruginosaare the major pathogens of breakthrough GNB during carbapenem therapy, in association with a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization.

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The Wessex Recent In-Patient Suicide Study, 2

The British Journal of Psychiatry ◽

10.1192/bjp.178.6.537 ◽

2001 ◽

Vol 178 (6) ◽

pp. 537-542 ◽

Cited By ~ 63

Author(s):

Elizabeth A. King ◽

David S. Baldwin ◽

Julia M. A. Sinclair ◽

Michael J. Campbell

Keyword(s):

Risk Factors ◽

Care Delivery ◽

Psychiatric Patients ◽

Retrospective Case ◽

Patient Suicide ◽

Increased Risk ◽

History Of ◽

Self Harm ◽

Low Sensitivity ◽

Control Study

BackgroundPsychiatric patients have an elevated risk of suicide while in hospital.AimsTo compare social, clinical and health-care delivery factors in in-patient and out-patient suicides and their controls.MethodRetrospective case-control study of 59 in-patients and 106 controls, matched for age, gender, diagnosis and admission date. Odds ratios were calculated using conditional multiple logistic regression.ResultsThere were seven independent increased-risk factors: history of deliberate self-harm, admission under the Mental Health Act, involvement of the police in admission, depressive symptoms, violence towards property, going absent without leave and a significant care professional being on leave. When compared with out-patient suicides, in-patients were more often female and male in-patients had a psychotic illness. Unlike the out-patient suicides, social factors were not found to be significant.ConclusionsThe characteristics of inpatient and out-patient suicides differ. Identified risk factors have relatively low sensitivity and specificity.

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2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1961 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S782-S782 ◽

Cited By ~ 1

Author(s):

Raymond K C Fong ◽

Stephen G Donoghue ◽

Humaira Shafi ◽

Seow Yen Tan ◽

Wee Boon Lee ◽

...

Keyword(s):

Risk Factors ◽

Renal Impairment ◽

Univariate Analysis ◽

Outpatient Setting ◽

Retrospective Case ◽

Neurotoxic Effects ◽

Gram Negative Bacteremia ◽

History Of ◽

Baseline Characteristics ◽

Control Study

Abstract Background Numerous reports have emerged about the neurotoxic effects of ertapenem. A recent study supports carbapenem use for the treatment of extended spectrum β-lactamase (ESBL)- producing Gram-negative bacteremia. This will likely bolster the use of ertapenem as it is a convenient choice to complete antibiotic treatment in an outpatient setting. This study aims to review the incidence of neurotoxicity with ertapenem and the risk factors associated with it. Methods A retrospective nested cohort study was conducted in Changi General Hospital in Singapore from January 2015 to Decemeber 2016. All patients who received at least 24 hours of ertapenem were identified. Those who exhibited ertapenem-associated neurotoxic effects were selected as cases while those who did not were included in the pool of controls and randomly selected at a 1:3 ratio. Results A total of 544 patients were treated with ertapenem in our hospital during this 2-year period. Twenty-five patients (incidence 4.6%) developed neurotoxic manifestations and 75 patients were included as controls. Acute confusion was the commonest reaction (n = 19, 76%) followed by hallucinations (n = 8, 32%) and seizures (n = 5, 20%). Baseline characteristics were similar in both groups; the median age of the cases was 79 years (IQR 71–83 years) and 14 (56%) were males. The median duration of ertapenem use before neurotoxicity occurred was 7 days (IQR 5–11days). The median Naranjo ADR probability score for cases was 7 (range 5 to 7) which suggests a probable relationship. Univariate analysis showed that renal impairment (with CrCl< 60 mL/minute) (OR 3.31, 95% CI 1.03–10.64), a history of a vulnerable brain (including stroke and epilepsy etc)(OR 2.61 95% CI 1.03–6.61) increased the risk of neurotoxicity. Neurotoxicity was also significantly associated with longer hospitalization (median 21 days, p = 0.03). Conclusion Our study suggests that renal impairment or a history of vulnerable brain may increase the risk for ertapenem-associated neurotoxicity. Hence, caution should be exercised when ertapenem is used to treat these individuals. Future prospective studies to further evaluate risk and to derive a prediction scoring system may help to reduce the incidence of neurotoxic adverse events with ertapenem use. Disclosures All authors: No reported disclosures.

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

Infection Control and Hospital Epidemiology ◽

10.1086/502197 ◽

2003 ◽

Vol 24 (4) ◽

pp. 269-274 ◽

Cited By ~ 47

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.

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Healthcare-associated infections among pediatric oncology patients in Pakistan: risk factors and outcome

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1705 ◽

2011 ◽

Vol 6 (05) ◽

pp. 416-421 ◽

Cited By ~ 3

Author(s):

Naveed- ur-Rehman Siddiqui ◽

Rabia Wali ◽

Anwar- ul Haque ◽

Zehra Fadoo

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Pediatric Oncology ◽

Healthcare Associated Infections ◽

Gram Positive ◽

Oncology Patients ◽

Gram Negative ◽

Factors Associated ◽

Increased Risk ◽

Healthcare Associated

Introduction: Pediatric oncology patients are at increased risk of contracting healthcare-associated infections (HAIs), which are responsible for increased morbidity and mortality rates as well as treatment costs. This study aimed to identify the frequency of HAIs among pediatric oncology patients and their outcome. Methodology: Pediatric oncology patients admitted between January 2009 and June 2010 in a pediatric ward at Aga Khan University Hospital, Karachi, Pakistan, who developed HAIs, were analyzed. Results: A total of 90 HAIs were identified in 32 patients in 70 admissions. The HAI rate among pediatric oncology patients was 3.1/100 admission episodes. Bloodstream infections (63 episodes, 90.0%) were the most common, followed by urinary tract infection (two episodes, 2.9%). Gram-positive infections were seen in 54 (60%) patients, followed by Gram-negative infection in 34 (37.8%), and fungi in 2 (2.8%) cases. Coagulase negative staphylococci was the most common Gram-positive and Escherichia coli and Pseudomonas aeruginosa were most common Gram-negative infections. Mortality rate among pediatric oncology patients who developed HAIs was 12.5% (4/32). Total parental nutrition use and length of stay longer than 30 days were the identified risk factors associated with increased mortality among pediatric oncology patients who developed HAIs. Conclusion: We report an HAI rate among pediatric oncology patients of 3.1/100 admission episodes with a mortality rate of 12.5% in Pakistan. Further studies should be done, especially in the developing world, to identify the risk factors associated with increased mortality among pediatric oncology patients so that adequate measures can be taken to reduce the mortality among these patients.

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COVID-19 ASSOCIATED MUCORMYCOSIS: A CASE-CONTROL STUDY

10.1101/2021.08.16.21262109 ◽

2021 ◽

Author(s):

Dulari Gupta ◽

Rahul Kulkarni ◽

Shripad Pujari ◽

Atul Mulay

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Case Control Study ◽

Tertiary Care ◽

Multivariate Regression Analysis ◽

Case Control ◽

Retrospective Case ◽

Time Period ◽

Increased Risk ◽

Control Study

Background: India has seen a surge in COVID-19 associated mucormycosis (CAM) cases during the second wave of the pandemic. We conducted a study to determine independent risk factors for CAM. Methods: We performed a retrospective case control study in a tertiary care private hospital in Pune, India. Fifty-two cases of CAM were compared with 166 concurrent controls randomly selected from the COVID-19 admissions during the same time period. Association of demographic factors, comorbidities, cumulative steroid dose used (calculated as dexamethasone equivalent), maximum respiratory support required, use of injectable/oral anticoagulation, and use of aspirin with CAM was assessed by univariate and multivariate logistic regression. Results: A total of 218 subjects (52 cases; 166 controls) were studied. Any diabetes (pre-existing diabetes and new onset diabetes during COVID-19) was noted in a significantly higher proportion of cases (73.1%, 45.8% P<0.001) and cumulative dexamethasone dose used in cases was significantly greater (97.72 mg vs 60 mg; P=0.016). In a multivariate regression analysis cumulate dexamethasone dose >120 mg (OR 9.03, confidence interval 1.75-46.59, P=0.009) and any diabetes (OR 4.78, confidence interval 1.46-15.65, P=0.01) were found to be risk factors for CAM. While use of anticoagulation (OR 0.01, confidence interval 0.00-0.09, P<0.001) and use of aspirin (OR 0.02, confidence interval 0.01-0.07, P<0.001) were found to be protective against CAM. Conclusion: Diabetes mellitus and cumulative dose of dexamethasone greater than 120 mg (or equivalent dose of other corticosteroid) were associated with an increased risk of CAM while use of aspirin and anticoagulation were associated with a lower risk.

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Commuting Accidents among Non-Physician Staff of a Large University Hospital Center from 2012 to 2016: A Case-Control Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17092982 ◽

2020 ◽

Vol 17 (9) ◽

pp. 2982

Author(s):

Alexandre Ponsin ◽

Emmanuel Fort ◽

Martine Hours ◽

Barbara Charbotel ◽

Marie-Agnès Denis

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Conditional Logistic Regression ◽

Case Control ◽

University Hospital ◽

Multiple Model ◽

Work Related ◽

Increased Risk ◽

Gender And Age ◽

Control Study

Road risks (commuting and on-duty accidents) have been responsible for 44% of work-related fatalities compensated by the French system of Social Security in 2012 and still represented 37% in 2018. Our objective was to assess risk factors for commuting accidents among the non-physician staff in a French university hospital. We conducted a case-control study of commuting accidents from 2012 to 2016. Cases were identified and controls were randomly selected from the hospital’s personnel file with matches by year of the accident, gender and age. Risk factors were assessed using conditional logistic regression analysis. An increased risk was observed for 2 × 8 hour shifts, crude OR = 1.40 (95% CI = 1.05–1.86) compared to daytime schedules, but not confirmed in the multiple model. Being a duty officer and not working the day before the accident were associated with increased risk of accidents with adjusted OR = 1.9 (95% CI = 1.1; 3.3) and OR = 1.5, (95% CI = 1.1; 2.1), respectively. The risk increased as the distance between home and work increased, such as adjusted OR = 2.2 (95% CI = 1.4; 3.4) for a distance of >3.6 to 9 km, OR = 2.6, (95% CI = 1.7; 4.0) for a distance of >9 km to 19 km, and OR = 4.2, (95% CI = 2.8; 6.2) for >19 km vs. <3.6 km. The distance between home and work, not working the day before the accident, and certain categories of personnel were related to commuting accidents.

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Risk factors associated with progressive myelomalacia in dogs with complete sensorimotor loss following intervertebral disc extrusion: a retrospective case-control study

BMC Veterinary Research ◽

10.1186/s12917-019-2186-0 ◽

2019 ◽

Vol 15 (1) ◽

Cited By ~ 3

Author(s):

Aude Castel ◽

Natasha J. Olby ◽

Hongyu Ru ◽

Christopher L. Mariani ◽

Karen R. Muñana ◽

...

Keyword(s):

Risk Factors ◽

Intervertebral Disc ◽

Pain Perception ◽

Case Control Study ◽

Case Control ◽

Control Group ◽

Retrospective Case ◽

Increased Risk ◽

Control Study ◽

Disc Extrusion

Abstract Background Progressive myelomalacia (PMM) is a usually fatal complication of acute intervertebral disc extrusion (IVDE) in dogs but its risk factors are poorly understood. The objective of this retrospective case-control study was to identify risk factors for PMM by comparing dogs with complete sensorimotor loss following IVDE that did and did not develop the disease after surgery. We also investigated whether any risk factors for PMM influenced return of ambulation. Medical records of client-owned dogs with paraplegia and loss of pain perception that underwent surgery for IVDE from 1998 to 2016, were reviewed. Dogs were categorized as PMM yes or no based on clinical progression or histopathology. Walking outcome at 6 months was established. Signalment, onset and duration of signs (categorized), steroids, non-steroidal anti-inflammatory drugs (yes or no), site of IVDE (lumbar intumescence or thoracolumbar) and longitudinal extent of IVDE were retrieved and their associations with PMM and walking outcome were examined using logistic regression. Results One hundred and ninety seven dogs were included, 45 with and 152 without PMM. A 6-month-outcome was available in 178 dogs (all 45 PMM dogs and 133 control dogs); 86 recovered walking (all in the control group). Disc extrusions at the lumbar intumescence were associated with PMM (p = 0.01, OR: 3.02, CI: 1.3–7.2). Surgery performed more than 12 h after loss of ambulation was associated with PMM (OR = 3.4; CI = 1.1–10.5, p = 0.03 for 12-24 h and OR = 4.6; CI = 1.3–16.6, p = 0.02 for the > 24 h categories when compared with the ≤12 h category). Treatment with corticosteroids was negatively associated with PMM (OR: 3.1; CI: 1.3–7.6, p = 0.01). The only variable to affect walking outcome was longitudinal extent of IVDE (OR = 2.6; CI = 1.3–5.3, p = 0.006). Conclusion Dogs with lumbar intumescence IVDE are at increased risk of PMM. Timing of surgery and corticosteroid use warrant further investigations. PMM and recovery of walking are influenced by different factors.

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