Case-Crossover Study of Burkholderia cepacia Complex Bloodstream Infection Associated with Contaminated Intravenous Bromopride

2010 ◽  
Vol 31 (05) ◽  
pp. 516-521 ◽  
Author(s):  
Ianick Souto Martins ◽  
Flávia Lúcia Piffano Costa Pellegrino ◽  
Andrea d'Avila Freitas ◽  
Marisa da Silva Santos ◽  
Giovanna lanini d'Alemeida Ferraiuoli ◽  
...  
Keyword(s):  
Crossover Study ◽  
Burkholderia Cepacia ◽  
Control Period ◽  
Bloodstream Infections ◽  
University Hospital ◽  
Burkholderia Cepacia Complex ◽  
Microbiological Analysis ◽  
Strain Typing ◽  
Case Crossover ◽  
Case Period

Objective. To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI). Design and Setting. Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006. Patients. Twenty-five patients with BCC-BSI. Design. After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar χ2 adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using Spel. Results. The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals. Conclusion. Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.

Abstract 20635: Dipeptidyl-Peptidiase 4 Inhibitors and the Risk of Heart Failure - A Nationwide Case-Crossover Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yi-Cheng Chang ◽  
Chia-Hsuin Chang ◽  
Jou Wei Lin ◽  
Lee-Ming Chuang ◽  
Mei-Shu Lai
Keyword(s):  
Heart Failure ◽  
Crossover Study ◽  
Index Date ◽  
Control Period ◽  
Hypoglycemic Agents ◽  
Dpp4 Inhibitors ◽  
Case Crossover ◽  
Increased Risk ◽  
Case Period ◽  
And Control

Introduction: Dipeptidyl-peptidiase 4 (DPP4) inhibitors, a new type of oral hypoglycemic agents, have been widely used in the treatment of type 2 diabetes mellitus (DM). However, recent studies showed that the use of DPP4 inhibitors, especially saxagliptin, could be associated with an increased risk of heart failure (HF). Methods: We conducted a retrospective case-crossover study by identifying DM patients aged 20 years and above hospitalized for HF between 2009 and 2011 from Taiwan National Health Insurance Database. Diagnosis codes from inpatient claims databases were used to ascertain the index date of hospitalization. For each patient, we defined case period as 1 to 30 days before the index date and control period as 91 to 120 days before the index date. The use of DPP4 inhibitors during the case and control periods were identified from the pharmacy claims database. Odds ratios (OR) and 95% confidence intervals (CIs) were estimated by a conditional logistic regression model. Results: A total of 47,506 patients hospitalized for HF (48.2% mean and 51.8% women) was included in the analysis (mean age: 72.7±12.4 years). Among them, 2,874 patients (6.05%) used sitagliptin in the case period, and 2,318 (4.88%) did in the control period. Use of other DPP4 inhibitors, i.e., saxagliptin and vildagliptin, was rare. The analysis of the discordant medication in the two periods showed that sitagliptin use was associated with an increased risk of HF (OR: 2.85, 95% CI: 2.46-3.30). Additional analyses using different time frames as the control period showed similar results. In contrast, there was no increased risk for HF in the use of sulfonylureas or metformin. Conclusions: The nationwide case-crossover study demonstrated that sitagliptin was associated with an increased risk of hospitalization for HF. Further studies are needed to examine whether the potential risk of HF is a class effect of DPP4 inhibitors.

scholarly journals Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e036186
Author(s):  
Lasantha Jayasinghe ◽  
André Bittar ◽  
Rina Dutta ◽  
Robert Stewart
Keyword(s):  
Suicide Attempt ◽  
Electronic Health Records ◽  
Crossover Study ◽  
Control Period ◽  
Mental Healthcare ◽  
Health Records ◽  
Case Crossover ◽  
Case Period ◽  
Time Periods ◽  
Electronic Health

ObjectiveClinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt.DesignA case–crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR.SettingElectronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data.Participants1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1–30 days prior to admission) and the control period (61–90 days prior to admission).Outcome measuresThe number of quoted phrases in the control as compared with the case period.ResultsBoth attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30).ConclusionsThis study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text.

Ralstonia pickettii and Burkholderia cepacia complex bloodstream infections related to infusion of contaminated water for injection

2005 ◽  
Vol 60 (1) ◽  
pp. 51-55 ◽  
Author(s):  
B.M. Moreira ◽  
M.B.G.P. Leobons ◽  
F.L.P.C. Pellegrino ◽  
M. Santos ◽  
L.M. Teixeira ◽  
...  
Keyword(s):  
Burkholderia Cepacia ◽  
Bloodstream Infections ◽  
Burkholderia Cepacia Complex ◽  
Contaminated Water ◽  
Ralstonia Pickettii

scholarly journals Changes in drinking as predictors of changes in sickness absence: a case-crossover study

2017 ◽  
Vol 72 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Jenni Ervasti ◽  
Mika Kivimäki ◽  
Jaana Pentti ◽  
Jaana I Halonen ◽  
Jussi Vahtera ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Sickness Absence ◽  
Control Period ◽  
Heavy Drinking ◽  
Short Term ◽  
Case Crossover ◽  
Increased Risk ◽  
Case Period ◽  
Drinking Session

BackgroundWe investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design.MethodsFinnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey.ResultsPeriods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence.ConclusionIncrease in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk.

scholarly journals Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

2016 ◽  
Vol 54 (12) ◽  
pp. 3007-3009 ◽  
Author(s):  
Elizabeth Story-Roller ◽  
Melvin P. Weinstein
Keyword(s):  
Blood Culture ◽  
Crossover Study ◽  
Clinical Care ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
University Hospital ◽  
Contamination Rate ◽  
Nursing Unit ◽  
Skin Antisepsis ◽  
Randomized Crossover Study

Blood cultures (BCs) are the standard method for diagnosis of bloodstream infections (BSIs). However, the average BC contamination rate (CR) in U.S. hospitals is 2.9%, potentially resulting in unnecessary antibiotic use and excessive therapy costs. Several studies have compared various skin antisepsis agents without a clear consensus as to which agent is most effective in reducing contamination. A prospective, randomized crossover study directly comparing blood culture contamination rates using chlorhexidine versus iodine tincture for skin antisepsis was performed at Robert Wood Johnson University Hospital (RWJUH). Eight nursing units at RWJUH were provided with blood culture kits containing either chlorhexidine (CH) or iodine tincture (IT) for skin antisepsis prior to all blood culture venipunctures, which were obtained by nurses or clinical care technicians. At quarterly intervals, the antiseptic agent used on each nursing unit was switched. Analyses of positive BCs were performed to distinguish true BSIs from contaminants. Of the 6,095 total BC sets obtained from the participating nursing units, 667 (10.94%) were positive and 238 (3.90%) were judged by the investigators to be contaminated. Of the 3,130 BCs obtained using IT, 340 (10.86%) were positive and 123 (3.93%) were contaminated. Of 2,965 BCs obtained using CH, 327 (11.03%) were positive and 115 (3.88%) were contaminated. The rates of contaminated BCs were not statistically significant between the two antiseptic agents (P= 1.0). We conclude that CH and IT are equivalent agents for blood culture skin antisepsis.

scholarly journals Burkholderia cepacia complex bacteremia outbreaks among non-cystic fibrosis patients in the pediatric unit of the university hospital

2019 ◽  
Author(s):  
Sinan Tüfekci ◽  
Birol Şafak ◽  
Özgür Kızılca ◽  
Ayşin Nalbantoğlu ◽  
Burçin Nalbantoğlu ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Nosocomial Infections ◽  
Burkholderia Cepacia ◽  
Blood Cultures ◽  
High Fever ◽  
Control Measures ◽  
University Hospital ◽  
Burkholderia Cepacia Complex ◽  
Multi Drug Resistance ◽  
Intravascular Catheters

AbstractIntroductionBurkholderia cepacia complex (Bcc) leads to severe nosocomial infections particularly in the patients who have intravascular catheters and cystic fibrosis. The present study aims at investigation of Bcc outbreaks in non-cystic fibrosis patients.Material and MethodsA total of 6 patients who were hospitalized at General Pediatrics Department were included in the study. Blood cultures which yielded positive signals were incubated at 5% blood sheep agar, chocolate agar and Eosin Methylene Blue agar. All fields which could be the source of the infection at the clinic were examined. Isolates confirmation with Pulsed-Field Gel Electrophoresis (PFGE) tests were performed.ResultsThe first patient aged 14.5 years was hospitalized due to left renal agenesis, urinary tract infection and renal failure. Bcc growing was detected in blood culture which was obtained due to high fever at the 3rd day of hospitalization. New patient hospitalizations were stopped due to Bcc growing in blood cultures which was obtained due to high fever in the remaining five patients. No growing was detected in samples obtained from the clinic and the patient rooms. PFGE patterns were similar in all clinical isolates of Bcc indicating that the outbreak had originated from the same origin.ConclusionsBcc infection should always be kept in mind in nosocomial outbreaks due to multi-drug resistance and the need for hospitalization at intensive care unit. Control measures should be taken for prevention of nosocomial infections and required investigations should be done for detection of the source of the infection.

scholarly journals Multistate Outbreak of Burkholderia cepacia Complex Bloodstream Infections After Exposure to Contaminated Saline Flush Syringes: United States, 2016–2017

2018 ◽  
Vol 69 (3) ◽  
pp. 445-449 ◽  
Author(s):  
Richard B Brooks ◽  
Patrick K Mitchell ◽  
Jeffrey R Miller ◽  
Amber M Vasquez ◽  
Jessica Havlicek ◽  
...  
Keyword(s):  
Public Health ◽  
Burkholderia Cepacia ◽  
Skilled Nursing Facility ◽  
Bloodstream Infections ◽  
Rapid Identification ◽  
Burkholderia Cepacia Complex ◽  
Nursing Facilities ◽  
Healthcare Facilities ◽  
Health Authorities ◽  
Public Health Authorities

Abstract Background Burkholderia cepacia complex (Bcc) has caused healthcare-associated outbreaks, often in association with contaminated products. The identification of 4 Bcc bloodstream infections in patients residing at a single skilled nursing facility (SNF) within 1 week led to an epidemiological investigation to identify additional cases and the outbreak source. Methods A case was initially defined via a blood culture yielding Bcc in a SNF resident receiving intravenous therapy after 1 August 2016. Multistate notifications were issued to identify additional cases. Public health authorities performed site visits at facilities with cases to conduct chart reviews and identify possible sources. Pulsed-field gel electrophoresis (PFGE) was performed on isolates from cases and suspect products. Facilities involved in manufacturing suspect products were inspected to assess possible root causes. Results An outbreak of 162 Bcc bloodstream infections across 59 nursing facilities in 5 states occurred during September 2016–January 2017. Isolates from patients and pre-filled saline flush syringes were closely related by PFGE, identifying contaminated flushes as the outbreak source and prompting a nationwide recall. Inspections of facilities at the saline flush manufacturer identified deficiencies that might have led to the failure to sterilize a specific case containing a partial lot of the product. Conclusions Communication and coordination among key stakeholders, including healthcare facilities, public health authorities, and state and federal agencies, led to the rapid identification of an outbreak source and likely prevented many additional infections. Effective processes to ensure the sterilization of injectable products are essential to prevent similar outbreaks in the future.

scholarly journals Changes in antithrombotic treatment in patients with abdominal aortic aneurysmal disease and incident atrial fibrillation: a population-based case-crossover analyses

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Nicolajsen ◽  
P B Nielsen ◽  
N Eldrup ◽  
M Jensen ◽  
S Z Goldhaber ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antithrombotic Therapy ◽  
Control Period ◽  
Population Based ◽  
Platelet Inhibitors ◽  
Antithrombotic Treatment ◽  
Case Crossover ◽  
Before And After ◽  
Case Period ◽  
Study Population

Abstract Background Abdominal aortic aneurysmal (AAA) disease is associated with a high risk of cardiovascular events, and prophylaxis with platelet-inhibitors are recommended at diagnosis. Incident atrial fibrillation (AF) changes that indication to oral anticoagulative (OAC) therapy. However, it is unknown to what extent the recommended change of indication is reflected in the actual antithrombotic treatment in clinical practice. Purpose To evaluate the antithrombotic therapy after an incident diagnosis of atrial fibrillation in patients with established AAA. Methods In this population-based case-crossover study, using nationwide Danish registries, we identified all patients registered with a diagnosis of AAA between 1997 and 2018, and a subsequent diagnosis of AF. The case-crossover analysis was performed to compare the within-subject antithrombotic therapy in 1-year time-periods before and after AF diagnosis in the study population. A blanking period of 30 days before AF-diagnosis was applied to avoid bias from potentially delayed hospital diagnosis of AF (Figure 1.1). We excluded patients with no eligible reference window due to recent cohort entry and patients with no AF-related indication for shift to OAC (CHA2DS2-VASc score of <1 in men and <2 in women). Odds ratios (OR) with 95% confidence intervals (CIs) comparing antithrombotic therapy before and after AF diagnosis was calculated using McNemars test for matched pair's data. Subgroup analyses of patients diagnosed with AAA between 2011 and 2018 were performed to evaluate changes after introduction of current antithrombotic treatment regimens and direct oral anticoagulants. Results A total of 3052 patients were included in the case-crossover analyses. Mean age was 77.8 years and 22.3% were females. Median time from AAA to AF diagnosis was 4.6 years (IQR; 2.6–7.8). Stroke risk in the study population was high with a median CHA2DS2-VASc score of 4 (IQR: 3–5). In the case-period after AF diagnosis, 1004 prescription claims of platelet-inhibitors were registered compared with 1461 claims in the control-period before AF diagnosis, corresponding to a matched OR of 0.31 (95% CI, 0.26–0.36) (Figure 1.2). Conversely, there were 1392 prescription claims for OAC in the case-period compared with 355 in the control-period, corresponding to an OR of 15.75 (95% CI, 12.38–20.31). When restricting the study-population to patients diagnosed with AAA during 2011–2018, the OR was 0.11 (95% CI, 0.07–0.16) for a prescription claim of platelet-inhibitors and 17.7 (95% CI, 11.22–29.17) for OAC before and after AF diagnosis (Figure 1.2). Conclusion In patients with established AAA and high risk of stroke, incident AF was associated with low likelihood of treatment with platelet-inhibitor and a high likelihood of OAC-treatment compared with before AF. This association was further strengthened in patients diagnosed after 2011. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Obel Family Foundation, DenmarkThe Augustinus Foundation, DenmarkThe sponsors played no role in the study design; data collection, analysis, or interpretation; abstract writing; or in the decision to submit the abstract. Figure 1

Primary Prevention of Myocardial Infarction in Rheumatoid Arthritis Using Aspirin: A Case-crossover Study and a Propensity Score–matched Cohort Study

2017 ◽  
Vol 44 (4) ◽  
pp. 418-424 ◽  
Author(s):  
Josefina Durán ◽  
Christine Peloquin ◽  
Yuqing Zhang ◽  
David T. Felson
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Cohort Study ◽  
Primary Prevention ◽  
Protective Effect ◽  
Crossover Study ◽  
Control Period ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Case Crossover

Objective.Subjects with rheumatoid arthritis (RA) are at higher risk of developing cardiovascular disease, which is their leading cause of death. Conflicting evidence exists regarding the efficacy of aspirin (ASA) as primary prevention. We evaluated whether a protective association exists between ASA and myocardial infarction (MI) in RA subjects.Methods.In the United Kingdom, persons age ≥ 60 years receive free ASA by prescription and 75% of use is by prescription. Subjects ≥ 60 years with RA in the population-based The Health Improvement Network database constituted our study population. We excluded patients with history of MI, angina, stroke, peripheral vascular disease, or coronary artery procedures. Our main outcome was the occurrence of fatal and nonfatal MI. We performed a case-crossover study with each subject contributing a hazard period and a control period 90 days prior to the MI. In addition, to minimize confounding by indication, a propensity score (PS)–matched cohort study was performed, considering all patients with RA with an incident prescription of low-dose ASA as our exposed group.Results.We did not find a protective effect in the case-crossover study (OR 1.83, 95% CI 0.71–4.71), with 55 subjects exposed in the hazard period and 44 in the control period. Similarly, among 1836 subjects included in the PS-matched cohort study (918 ASA users and 918 ASA non-users), we did not find a protective effect of low ASA on MI (HR 1.39, 95% CI 0.87–2.23).Conclusion.We did not find a protective effect of ASA on MI in patients with RA when used as primary prophylaxis.

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