scholarly journals Determination of Risk Factors Associated With Isolation of Linezolid-Resistant Strains of Vancomycin-Resistant Enterococcus

2007 ◽  
Vol 28 (12) ◽  
pp. 1382-1388 ◽  
Author(s):  
Jason M. Pogue ◽  
David L. Paterson ◽  
A. William Pasculle ◽  
Brian A. Potoski
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Horizontal Transmission ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Control Measures ◽  
Control Group ◽  
Solid Organ ◽  
Factors Associated ◽  
Vancomycin Resistant

Objective.To identify independent risk factors associated with isolation of linezolid-resistant, vancomycin-resistant Enterococcus (VRE).Design.A retrospective, case-case-control study.Setting.A tertiary care, academic medical center.Methods.VRE isolates from clinical cultures were retrospectively analyzed for linezolid resistance during our 18-month study period. Clinical data were obtained from electronic patient records, and the risk factors associated with isolation of linezolid-resistant VRE were determined by comparison of 2 case groups with a control group.Results.A total of 20% of the VRE isolates analyzed during the study period were linezolid resistant, and resistant isolates were most commonly recovered from the urine (40% of resistant isolates). Risk factors found to be associated with isolation of linezolid-resistant VRE were peripheral vascular disease and/or the receipt of a solid organ transplant, total parenteral nutrition, piperacillin-tazobactam, and/or cefepime. Only 25% of patients from whom linezolid-resistant VRE was isolated had previous linezolid exposure, and in the multivariate model this was not found to be a risk factor associated with the isolation of linezolid-resistant VRE.Conclusions.The results of this analysis suggest that there is horizontal transmission of linezolid-resistant VRE in our institution and highlight the need for improved infection control measures. Furthermore, the high incidence of linezolid-resistant VRE demands a reassessment of our empirical antibiotic selection for patients infected with VRE.

Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

2006 ◽  
Vol 27 (9) ◽  
pp. 893-900 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Mark G. Weiner ◽  
Irving Nachamkin ◽  
Warren B. Bilker ◽  
Angela Sheridan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Medical Center ◽  
Tertiary Care ◽  
Economic Outcomes ◽  
Control Group ◽  
Case Group ◽  
Tertiary Care Medical Center ◽  
Imipenem Resistance ◽  
The Impact

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Puerto Rico Associated with a Novel Carbapenemase Variant

2010 ◽  
Vol 31 (05) ◽  
pp. 476-484 ◽  
Author(s):  
Christopher J. Gregory ◽  
Eloisa Llata ◽  
Nicholas Stine ◽  
Carolyn Gould ◽  
Luis Manuel Santiago ◽  
...  
Keyword(s):  
Risk Factors ◽  
Puerto Rico ◽  
Klebsiella Pneumoniae ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Control Measures ◽  
Control Group ◽  
Surveillance Culture ◽  
Carbapenem Resistant

Background.Carbapenem-resistantKlebsiella pneumoniae(CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality.Objective.To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak.Design.Two case-control studies.Setting.A 328-bed tertiary care teaching hospital.Patients.Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptibleK. pneumoniae(CSKP) hospitalized during the same period.Methods.We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced theblaKPCgene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis.Results.In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with noK. pneumoniae.Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novelK. pneumoniaecarbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak.Conclusions.Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.

scholarly journals Risk Factors for Long-Term Vancomycin-Resistant Enterococci Persistence—A Prospective Longitudinal Study

2019 ◽  
Vol 7 (10) ◽  
pp. 400 ◽  
Author(s):  
Correa-Martinez ◽  
Stollenwerk ◽  
Kossow ◽  
Schaumburg ◽  
Mellmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Control ◽  
Control Measures ◽  
Factors Associated ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
History Of ◽  
Vancomycin Resistant ◽  
Prospective Longitudinal

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that require effective infection control measures, representing a challenge for healthcare systems. This study aimed at identifying risk factors associated with prolonged VRE carriage and determining the rate of clearance that allows the discontinuation of contact precautions. During a 2-year study, screening was performed in patients with a history of VRE or at risk of becoming colonized. After bacterial identification and antibiotic susceptibility testing, glycopeptide resistance was confirmed by PCR. Isolates were compared via whole genome sequence-based typing. Risk factors were recorded, and follow-up screening was performed upon readmission, defining patients as long-term carriers if still colonized ≥10 weeks after first detection. Of 1059 patients positive for VRE, carriage status was assessed upon readmission in 463 patients. VRE was cleared in 56.4% of the cases. Risk factors associated with long-term persistence were hospital stays (frequency, length), hemato-oncological disease, systemic treatment with steroids, and use of antibiotics. No specific genotypic clustering was observed in patients with VRE clearance or persistence. VRE clearance is possibly underestimated. The identification of risk factors favoring long-term carriage may contribute to a targeted implementation of infection control measures upon readmission of patients with history of VRE.

scholarly journals Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

2021 ◽  
pp. 219256822110357
Author(s):  
Eric Y. Montgomery ◽  
Mark N. Pernik ◽  
Zachary D. Johnson ◽  
Luke J. Dosselman ◽  
Zachary K. Christian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Medical Center ◽  
Lumbar Fusion ◽  
Academic Medical Center ◽  
Opioid Use ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Chronic Opioid Use

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

Prevalence of and Risk Factors for Colonization With Methicillin-ResistantStaphylococcus aureusat the Time of Hospital Admission

2003 ◽  
Vol 24 (6) ◽  
pp. 409-414 ◽  
Author(s):  
John A. Jernigan ◽  
Amy L. Pullen ◽  
Laura Flowers ◽  
Michael Bell ◽  
William R. Jarvis
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
Healthcare Facilities ◽  
Academic Medical ◽  
Mrsa Colonization ◽  
Control Study

AbstractObjectives:To determine the prevalence of methicillin-resistantStaphylococcus aureus(MRSA) colonization among patients presenting for hospital admission and to identify risk factors for MRSA colonization.Design:Surveillance cultures were performed at the time of hospital admission to identify patients colonized with S.aureus.A case-control study was performed to identify risk factors for MRSA colonization.Setting:A tertiary-care academic medical center.Patients:Adults presenting for hospital admission (N = 974).Results:S.aureuswas isolated from 205 (21%) of the patients for whom cultures were performed. Methicillin-sensitive S.aureuswas isolated from 179 (18.4%) of the patients, and MRSA was isolated from 26 (2.7%) of the patients. All 26 MRSA-colonized patients had been admitted to a healthcare facility in the preceding year, had at least one chronic illness, or both. In multivariate analyses comparing MRSA-colonized patients with control-patients, admission to a nursing home (odds ratio [OR], 16.5; 95% confidence interval [CI95], 1.4 to 192.1;P= .025) or a hospitalization of 5 days or longer during the preceding year (OR, 3.91; CI95, 1.1 to 13.9;P= .035) were independent predictors of MRSA colonization.Conclusions:Patients colonized with MRSA admitted to this hospital likely acquired the organism during previous encounters with healthcare facilities. There was no evidence that MRSA colonization occurs commonly among low-risk individuals in this community. These data suggest that evaluation of recent healthcare exposures is essential if true community acquisition of MRSA is to be confirmed.

scholarly journals 1705. Clinical Characteristics and Outcomes of Cryptococcosis in a Tertiary Care Center in Kentucky, 2005 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S624-S625
Author(s):  
Mahesh Bhatt ◽  
Julie A Ribes ◽  
Vaneet Arora ◽  
Thein Myint
Keyword(s):  
Liver Disease ◽  
Cryptococcal Meningitis ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Positive Culture ◽  
Solid Organ ◽  
India Ink

Abstract Background Cryptococcosis is an invasive fungal infection that causes pneumonia and extrapulmonary infection. This study explores its presentations, diagnostic tests, and outcome in different groups over a 12-year period at an academic medical center. Methods This was a retrospective study of the patients treated at University of Kentucky HealthCare from October 16, 2005 to October 15, 2017. Inclusion criteria were positive cryptococcal antigen (Ag), positive culture, or presence of yeast morphologically consistent with Cryptococcus on cyto- or histopathology. Patients were divided into HIV-infected, solid-organ transplant (SOT) recipients, and non-HIV/non-transplant groups. Cryptococcal meningitis comprised of either positive CSF Ag, culture, cytology or histopathology. Results A total of 114 patients were identified; 23 HIV-infected, 11 SOT recipients and 80 non-HIV/non-transplant patients (Table 1). Cryptococcus neoformans was the most common yeast isolated (91.8%). Cryptococcal meningitis was seen in 56% of total patients whereas 27% had isolated cryptococcal pneumonia (P < 0.01). Blood cultures and serum Ag were positive in 34% and 70%, respectively. Only 8.7% of HIV-infected patients had isolated pulmonary cryptococcosis compared with 36.4% in SOT recipients (P < 0.01). In patients with cryptococcal meningitis, abnormal CSF cell count, protein, or glucose was noted in 85.3%; India ink was positive in 61.3% and CSF culture was positive in 73.4% (Table 2, Figure 1). CSF cryptococcal Ag was detected in 95.6% cases if CSF cultures were positive, whereas serum Ag was positive in only 85.1% of meningitis cases. Mortality was seen in 48.6% (17/35) of patients with cirrhosis/liver disease, compared with 21.5% (17/79) of non-cirrhosis/liver disease (P = 0.003). Transplant group had 54.5% mortality compared with 26.1% in HIV group (P = 0.016). Conclusion Cryptococcal meningitis was the most common presentation for cryptococcal disease in all three groups. Isolated pulmonary disease was least common in the HIV-infected group. Inpatient mortality rate was higher in patients with cirrhosis/liver disease and transplant group compared with those without cirrhosis/liver disease and HIV group, respectively. It is imperative to rule out meningitis in immunosuppressed patients with cryptococcal pneumonia. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic

2021 ◽  
pp. 088506662110017
Author(s):  
Ashish Bhargava ◽  
Susanna M. Szpunar ◽  
Mamta Sharma ◽  
Elisa Akagi Fukushima ◽  
Sami Hoshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Laboratory Data ◽  
Case Fatality ◽  
Early Interventions ◽  
Care Hospital

Background: Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes. Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan. Methods: We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center. Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included. Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC)), initial vital signs, admission laboratory markers and management data were collected. The primary outcome was in-hospital mortality. Results: Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4%. The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0%) were male. The patients who died were significantly older (mean [SD] age, 70.4 [14.1] years vs 61.7 [16.1] years; P < 0.0001), more likely to have congestive heart failure (35 [20.3%] vs 47 [12.0%]; P = 0.009), dementia (47 [27.3%] vs 48 [12.2%]; P < 0.0001), hemiplegia (18 [10.5%] vs 18 [4.8%]; P = 0.01) and a diagnosis of malignancy (16 [9.3%] vs 18 [4.6%]; P = 0.03).From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, P = 0.003), CWIC score (OR = 1.1, P = 0.023), qSOFA (OR = 1.7, P < 0.0001), WBC counts (OR = 1.1 , P = 0.002), lymphocytopenia (OR = 2.0, P = 0.003), thrombocytopenia (OR = 1.9, P = 0.019), albumin (OR = 0.6 , P = 0.014), and AST levels (OR = 2.0, P = 0.004) on admission. Conclusions: This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic. After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality. Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.

Chloramphenicol Resistance in Vancomycin-Resistant Enterococcal Bacteremia: Impact of Prior Fluoroquinolone Use?

2004 ◽  
Vol 25 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Carolyn V. Gould ◽  
Neil O. Fishman ◽  
Irving Nachamkin ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Medical Center ◽  
Tertiary Care ◽  
Case Control ◽  
Close Monitoring ◽  
Chi Square ◽  
Chloramphenicol Resistance ◽  
Vancomycin Resistant ◽  
Control Study

AbstractObjective:The prevalence of vancomycin-resistant enterococci (VRE) has increased markedly during the past decade. Few data exist regarding the epidemiology of resistance of VRE to chloramphenicol, one of the few therapeutic options.Design:Survey and case-control study.Setting:A 725-bed, tertiary-care academie medical center and a 344-bed urban community hospital.Patients:Hospitalized patients with blood cultures demonstrating VRE.Methods:We examined the trends in the prevalence of chloramphenicol resistance in VRE blood isolates at our institution from 1991 through 2002 and conducted a case-control study to identify risk factors for chloramphenicol resistance among these isolates.Results:From 1991 through 2002, the annual prevalence of chloramphenicol-resistant VRE increased from 0% to 12% (P < .001, chi-square test for trend). Twenty-two case-patients with chloramphenicol-resistant VRE bloodstream isolates were compared with 79 randomly selected control-patients with chloramphenicol-susceptible VRE. Independent risk factors for chloramphenicol-resistant VRE were prior chloramphenicol use (odds ratio [OR], 10.9; 95% confidence interval [CI95], 1.72-68.91; P = .01) and prior fluoroquinolone use (OR, 4.74; CI95, 1.15-19.42; P = .03). Chloramphenicol-resistant VRE isolates were more likely to be susceptible to beta-lactams and resistant to tetracycline than were chloramphenicol-susceptible VRE isolates.Conclusions:Significant increases in the prevalence of chloramphenicol-resistant VRE may limit the future utility of chloramphenicol in the treatment of VRE infections, and close monitoring of susceptibility trends should continue. The association between fluoroquinolone use and chloramphenicol-resistant VRE, reflecting possible co-selection of resistance, suggests that recent dramatic increases in fluoroquinolone use may have broader implications than previously recognized.

scholarly journals SARS-CoV-2 Infection in Healthcare Personnel and Their Household Contacts at a Tertiary Academic Medical Center: Protocol for a Longitudinal Cohort Study (Preprint)

2020 ◽  
Author(s):  
Emily J Ciccone ◽  
Paul N Zivich ◽  
Evans K Lodge ◽  
Deanna Zhu ◽  
Elle Law ◽  
...  
Keyword(s):  
Risk Factors ◽  
Personal Protective Equipment ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Well Being ◽  
Healthcare Personnel ◽  
Protective Equipment ◽  
Household Contacts ◽  
Tertiary Care Medical Center

BACKGROUND Healthcare personnel are at high risk for exposure to the SARS-CoV-2 virus. While personal protective equipment may mitigate this risk, prospective data collection on its use and other risk factors for seroconversion in this population is needed. OBJECTIVE The primary objectives of this study are to (1) determine the incidence of and risk factors for SARS-CoV-2 infection among healthcare personnel at a tertiary medical center and (2) actively monitor personal protective equipment use, interactions between study participants via electronic sensors, secondary cases in households, and participant mental health and well-being. METHODS To achieve these objectives, we designed a prospective, observational study of SARS-CoV-2 infection among healthcare personnel and their household contacts at an academic tertiary care medical center. Enrolled healthcare personnel completed frequent surveys on symptoms and work activities and provided serum and nasal samples for SARS-CoV-2 testing every two weeks. Additionally, interactions between participants and their movement within the clinical environment were captured with a smartphone app and Bluetooth sensors. Finally, a subset of participants' households was randomly selected every two weeks for further investigation, and enrolled households provided serum and nasal samples via at-home collection kits. RESULTS As of September 30, 2020, 164 healthcare personnel and 33 household participants have been enrolled. Recruitment and follow-up are ongoing and expected to continue until March 2021. CONCLUSIONS Much remains to be learned regarding risk of SARS-CoV-2 infection among healthcare personnel and their household contacts. Through use of a multi-faceted study design enrolling a well-characterized cohort, we will collect critical information regarding SARS-CoV-2 transmission in the healthcare setting and its linkage to the community.

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