Molecular Epidemiology and Risk Factors for Colonization by Vancomycin-ResistantEnterococcusin Patients with Hematologic Malignancies

2011 ◽  
Vol 32 (5) ◽  
pp. 490-496 ◽  
Author(s):  
N. G. Almyroudis ◽  
A. J. Lesse ◽  
T. Hahn ◽  
G. Samonis ◽  
P. A. Hazamy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Molecular Epidemiology ◽  
Hospital Admissions ◽  
Severity Of Illness ◽  
Hematologic Malignancies ◽  
Observation Time ◽  
Patient Specific ◽  
Common Source ◽  
Retrospective Case ◽  
Hematopoietic Stem

Objective.To study the molecular epidemiology of vancomycin-resistantEnterococcus(VRE) colonization and to identify modifiable risk factors among patients with hematologic malignancies.Setting.A hematology-oncology unit with high prevalence of VRE colonization.Participants.Patients with hematologic malignancies and hematopoietic stem cell transplantation recipients admitted to the hospital.Methods.Patients underwent weekly surveillance by means of perianal swabs for VRE colonization and, if colonized, were placed in contact isolation. We studied the molecular epidemiology in fecal and blood isolates by pulsed-field gel electrophoresis over a 1-year period. We performed a retrospective case-control study over a 3-year period. Cases were defined as patients colonized by VRE, and controls were defined as patients negative for VRE colonization. Case patients and control patients were matched by admitting service and length of observation time.Results.Molecular genotyping demonstrated the primarily polyclonal nature of VRE isolates. Colonization occurred at a median of 14 days. Colonized patients were characterized by longer hospital admissions. Previous use of ceftazidime was associated with VRE colonization (P< .001), while use of intravenous vancomycin and antibiotics with anaerobic activity did not emerge as a risk factor. There was no association with neutropenia or presence of colonic mucosal disruption, and severity of illness was similar in both groups.Conclusion.Molecular studies showed that in the majority of VRE-colonized patients the strains were unique, arguing that VRE acquisition was sporadic rather than resulting from a common source of transmission. Patient-specific factors, including prior antibiotic exposure, rather than breaches in infection control likely predict for risk of fecal VRE colonization.

Clinical Risk Score for Prediction of Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Bloodstream Isolates

2016 ◽  
Vol 38 (3) ◽  
pp. 266-272 ◽  
Author(s):  
Matthew R. Augustine ◽  
Traci L. Testerman ◽  
Julie Ann Justo ◽  
P. Brandon Bookstaver ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Characteristic Curve ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Patient Specific ◽  
Retrospective Case ◽  
Extended Spectrum ◽  
High Discrimination ◽  
Independent Risk Factors

OBJECTIVETo develop a risk score to predict probability of bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE).DESIGNRetrospective case-control study.SETTINGTwo large community hospitals.PATIENTSHospitalized adults with Enterobacteriaceae BSI between January 1, 2010, and June 30, 2015.METHODSMultivariate logistic regression was used to identify independent risk factors for ESBLE BSI. Point allocation in extended-spectrum β-lactamase prediction score (ESBL-PS) was based on regression coefficients.RESULTSAmong 910 patients with Enterobacteriaceae BSI, 42 (4.6%) had ESBLE bloodstream isolates. Most ESBLE BSIs were community onset (33 of 42; 79%), and 25 (60%) were due to Escherichia coli. Independent risk factors for ESBLE BSI and point allocation in ESBL-PS included outpatient procedures within 1 month (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 3.1–22.9; 1 point), prior infections or colonization with ESBLE within 12 months (aOR, 26.8; 95% CI, 7.0–108.2; 4 points), and number of prior courses of β-lactams and/or fluoroquinolones used within 3 months of BSI: 1 course (aOR, 6.3; 95% CI, 2.7–14.7; 1 point), ≥2 courses (aOR, 22.0; 95% CI, 8.6–57.1; 3 points). The area under the receiver operating characteristic curve for the ESBL-PS model was 0.86. Patients with ESBL-PSs of 0, 1, 3, and 4 had estimated probabilities of ESBLE BSI of 0.7%, 5%, 24%, and 44%, respectively. Using ESBL-PS ≥3 to indicate high risk provided a negative predictive value of 97%.CONCLUSIONSESBL-PS estimated patient-specific risk of ESBLE BSI with high discrimination. Incorporation of ESBL-PS with acute severity of illness may improve adequacy of empirical antimicrobial therapy and reduce carbapenem utilization.Infect Control Hosp Epidemiol 2017;38:266–272

scholarly journals Risk Factors and Outcomes of Bacteremia Caused by Carbapenem Resistant Enterobacterales Compared to Carbapenem Susceptible Enterobacterales

2021 ◽  
Author(s):  
Fasih Ali Ahmed ◽  
Omair Ahmed ◽  
Sameer Ahmad Khan ◽  
Naveera Khan ◽  
Sara Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Severity Of Illness ◽  
Central Line ◽  
Common Source ◽  
Care Hospital ◽  
Cross Sectional ◽  
Carbapenem Resistant ◽  
Tract Infections

Abstract BackgroundDue to shrinking therapeutic options, infections due to Carbapenem-resistant Enterobacterales (CRE) are an urgent threat in healthcare systems. We compared the risk factors and outcomes of bacteremia secondary to CRE with bacteremia secondary to carbapenem susceptible Enterobacterales (CSE).MethodsWe conducted a retrospective cross-sectional study on patients admitted to a tertiary care hospital in Karachi, Pakistan between 2013 and 2016. Patients with CRE bacteremia were matched to those with CSE bacteremia while excluding those with polymicrobial cultures.ResultsA total of 131 patients were enrolled (65 CRE and 66 CSE) with the mean age of 51.8 years and 57.1 years in CRE and CSE groups respectively. Compared with CSE, CRE bacteremia was more likely to occur in patients with Diabetes Mellitus or those with a tracheostomy (P = 0.002 and 0.014, respectively). The most common source of CRE bacteremia was central line associated (24.6% of all cases) as opposed to urinary tract infections in those with CSE bacteremia (62.1% of all cases). Fewer patients with CRE bacteremia received appropriate antibiotics (72.3% vs. 81.8%). Mortality was significantly higher in the CRE group (41.5% vs. 12.1%, P = 0.001) even when adjusted for the severity of illness using the PITT-bacteremia score. Increased mortality was also associated with central venous catheterization in both groups. The median length of hospital stay was longer in patients with CRE (8 vs. 6 days, P = 0.021)ConclusionCRE bacteremia was associated with central lines and led to significantly higher mortality and length of stay.

scholarly journals Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

2020 ◽  
Author(s):  
Tilman Graulich ◽  
Pascal Graeff ◽  
Ashish Jaiman ◽  
Stine Nicolaides ◽  
Tarek Omar Pacha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posterior Wall ◽  
Patient Specific ◽  
Bipolar Hemiarthroplasty ◽  
Retrospective Case ◽  
Wall Angle ◽  
Acetabular Morphology ◽  
Duration Of Surgery ◽  
Ct Data ◽  
Sector Angle

Abstract Purpose Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p < 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p < 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty

scholarly journals 1120. Clostridium difficile Infection Risk Factors, Severity, and Outcomes in Patients Infected with NAP1/027 Strain in a Non-Epidemic Setting

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S336-S336
Author(s):  
Julie Nahar
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Severity Of Illness ◽  
Healthcare Facility ◽  
Control Analysis ◽  
Retrospective Case ◽  
The North ◽  
Infection Risk Factors ◽  
Positive Stool Sample ◽  
Case Control Analysis

Abstract Background Evidence surrounding outcomes with the North American pulsed-field gel electrophoresis type 1 (NAP1) Clostridium difficile (CDI) strain remains conflicting. We compared risk factors, severity of illness, and mortality of patients infected with NAP1 strain compared with patients with non-NAP1 strains in our multihospital health system. Methods This is a retrospective case–control analysis of patients admitted to one of five hospitals (one academic and four community hospitals) and diagnosed with CDI from April 2014 through July 2017. CDI definition included three or more stools per day with positive stool sample polymerase chain reaction (PCR) testing for C. difficile. Results A total of 490 patients met inclusion, of which 155 had the NAP1 strain and 335 patients were infected with non-NAP1 strains. More patients with NAP1 were older, female, had CHF, and presented from a healthcare facility as opposed to from the community (all P &lt; 0.05). No difference in 90-day antibiotic class use was found. NAP1 patients had increased ICU admission (12.3 vs. 6.0%, P = 0.016), a shorter length of stay (10.8 vs. 13.4 days, P = 0.037), abnormal CT findings (P &lt; 0.023), and trend toward more ID consults (P = 0.067). Per IDSA classification, 61.9% in the NAP1 CDI group had severe CDI as opposed to 49.6% in the non-NAP1 study group. (P ≤ 0.038). There was no observed difference in inpatient mortality (7.7 vs. 5.7%, P = 0.381). Conclusion CDI caused by NAP1 strain did result in increased severity but did not result in increased mortality compared with CDI caused by non-NAP1 strains. Evidence continues to mount that while the NAP1 strain may affect severity, its effect on mortality remains in question. Disclosures All authors: No reported disclosures.

Long Term Psycho-Social Aspects and Risk Factors for Severe Infections, Ocular, Pulmonary, Bone, Thyroid and Other Complications after Allogeneic Hematopoietic Stem Cell Transplantation for Children with Hematologic Malignancies.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3371-3371
Author(s):  
Christèle Ferry ◽  
Gladys Gemayel ◽  
Vanderson Rocha ◽  
Myriam Labopin ◽  
Hélène Esperou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Conditioning Regimen ◽  
Hematologic Malignancies ◽  
Social Aspects ◽  
Pulmonary Dysfunction ◽  
Hematopoietic Stem ◽  
Severe Infections

Abstract Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective therapy for children with hematologic malignancies. However, many long term complications are observed with a longer follow-up. Few data is available analyzing psycho-social aspects and risk factors of various long term complications in a same cohort of children. We have reviewed the charts of 112 children younger than 16 years, transplanted for hematologic malignancies between 1985 and 2000 at Saint Louis Hospital, and who survived at least 1 year after transplant. Landmark analysis and cumulative incidence using death and relapse as competing events were used to calculate incidences of complications after one year of HSCT. Univariate analysis used the Fine and Gray test and multivariate Cox model was used with chronic GVHD (cGVHD) as time dependent variable. Results: Median age at transplant was 8.3 years (0.73–15 years), median follow-up from 1 year after transplantation was 8 years (0.3–16.5). Most frequently, children had acute leukemia (n=101, 90%) and 92 patients were transplanted with an HLA-identical sibling donor.Total body irradiation (TBI) was used in 87 patients as part of conditioning regimen and fractionated TBI was used since march 1994 in 37 patients. At 10 years, overall survival was 75±5%, transplant related mortality (TRM) was 18%±4 and relapse 14±3%. Ten year cumulative incidence of severe infections (mostly bacterial) was 31%±4 (n=33); it was 44±4% for cataract (n=48); 20±4% for pulmonary dysfunction (mostly restrictive abnormalities) (n=20); 29±5% for osteoarticular complications (mostly osteonecrosis) (n=27); 36±4% for hypothyroidism (n=36); 11±3% for cardiac complications and 7±3% for secondary malignancies (n=8). The number of complications per patient increased with time, from 1 at a median observation time of 73 months to 3 at a median of 120 months. Factors related to patient, disease, donor and transplant characteristics were analyzed in univariate and multivariate analysis for complications with at least 20 events. There was a trend of higher risk of TRM (p=0.06), osteoarticular complications (p=0.09) and infections (p=0.07) for patients presenting cGVHD. cGVHD was significantly associated with higher risk of pulmonary dysfunction (p=0.02). However, single dose TBI (sTBI) or only TBI was the most important factor among other factors that increased the risk of cataract (p<0.001), pulmonary (p=0.004), osteoarticular (p=0.04) and thyroid complications (p<0.0001).Concerning psychological health and social issues; half of the patients had psychological disturbance, 13 patients had signs of depression, 16 history of eating behavior disorders. Half of the patients who had more than 18 years had an employment, 36 patients achieved normal scholarship, 69 had scholar difficulties and 12 patients achieved superior level studies. In conclusion with a longer follow-up in survivors of HSCT long term complications become an important issue. These complications reached no plateau even after 10 years. Development of less toxic conditioning regimen, avoid sTBI and probably better control of cGVHD may prevent late effects and improve quality of life of long term survivors.

Clinicopathologic Characteristics Of Secondary Malignancies In Survivors Of Allogeneic Hematopoietic Stem Cell Transplantation In Patients With Hematologic Malignancies

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5496-5496
Author(s):  
Chakra P Chaulagain ◽  
Esha Kaul ◽  
Monika Pilichowska ◽  
Andreas K. Klein ◽  
Kellie Sprague ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Oral Cavity ◽  
Stem Cell Transplantation ◽  
Hematologic Malignancies ◽  
High Grade ◽  
Secondary Malignancies ◽  
Hematopoietic Stem ◽  
Papillary Urothelial Carcinoma

Abstract Allogeneic hematopoietic stem cell transplantation (SCT) is known to cure hematologic malignancies (HM). However, the risk of secondary malignancies (SM) is increased in long-term survivors. We report a series of 10 patients (pt) who developed SM and pre-malignant lesions post-SCT with predominance of squamous cell carcinomas (SCC) of oral cavity and esophagus. Ten pt with median age 40 yrs(range 21-60) at SCT were diagnosed with 13 SM in a median follow up (f/u) of 8 yrs(range 1.5-13). Five pt developed oral and esophageal SCC (4 tongue, 1 esophagus). Four of the 5 pt had chronic GVHD & squamous dysplasia (SD) at the primary site 1 to 5 yrs prior to the diagnosis of SCC. Surgical pathology in 4 pt with oral SCC showed multifocal invasive SCC, high grade SD, SCC-in-situ and positive margin for invasive SCC. Three pt developed recurrences & 2 died. The details on individual pt are presented below (Table 1). Pt 1 was 46 y/o M at SCT, developed 2 SCC (tongue and floor of mouth, pT1N0) 3 yrs post-SCT. He received chemotherapy; radiotherapy withheld due to severe oral GVHD. He has developed 4 recurrences in 2 years of f/u. Pt 2 was a 40 y/o M at SCT, developed 2 SCC (pT1N1) of tonsil & tongue 8 yrs post-SCT. He is 8 yrs out of SCC after chemoradiation (CRT). Pt 3 was a 35 y/o F at SCT, developed SCC (pT2N0) of tongue 8 yrs post-SCT. She received CRT & died 4 yrs later after recurrences. Pt 4 was a 54 y/o F at SCT, developed stage II ER+, PR+ and Her-2+ breast cancer 8 yrs post-SCT. She did not tolerate trastuzumab & anastrazole due to flare up of GVHD. She developed pT4aN2b SCC of tongue 12 yrs post-SCT & died after 4 months. Pt 5 was 31 y/o M at SCT, developed stage IIIA SCC of esophagus after 13 yrs. He had esophageal GVHD & high grade SD with +CMV 5 yrs prior to the diagnosis of SCC. He is currently receiving CRT. Pt 6 was 60 y/o M at SCT, developed stage IIIB non-small cell lung cancer (NSCLC) 1.5 yr post-SCT. He received radiation alone due to bronchiolitis obliterans syndrome (BOS). He has no evidence of recurrence at 2 yrs f/u. Pt 7 was a 38 y/o F at SCT, developed papillary urothelial carcinoma (pT1) 10 yrs post-SCT. She was treated with TURBT and remains free of cancer at 4 yrs. Pt 8 was a 35 y/o F at SCT, developed HPV- oral SD 6 yr post-SCT and died of BOS. Pt 9 was a 21 y/o F at SCT, developed vaginal and cervical SD 7 yr post-SCT and transferred care out of country. Pt 10 was 53 y/o F at SCT, developed skin cancers. LBCL indicates large B cell lymphoma; RIC, reduced intensity conditioning; MSD, matched sibling donor; MUD, matched unrelated donor; SCC, squamous cell carcinoma; BCC, basal cell carcinoma; PUC, papillary urothelial carcinoma; LVI, lymphovascular invasion; PNI, perineural invasion; SD, squamous dysplasia; SP, squamous papilloma; NPB, no prior biopsy; PY, pack year; NP, not performed; C, cyclosporine; P, prednisone; M, mycophenolate. Our observation shows that the SCC of oral cavity and esophagus is a common SM in post-SCT patients for HM. SCC was often multifocal, negative surgical margin was not obtainable and employing standard therapy was difficult due to severe GVHD and other comorbidities. Aggressive recurrence was common. One out of 2 tumor samples tested was positive for HPV. Traditional risk factors of SCC (e.g. tobacco, alcohol) were either absent or remotely present suggesting potential implications of SCT specific risk factors (e.g. conditioning regimen, GVHD, immunosuppressants, viral infections). Patients and physicians should be aware of this association and lifelong vigilance and appropriate referral for screening and early biopsy should be considered in survivors of SCT. Disclosures: No relevant conflicts of interest to declare.

Discontinuation of Systematic Surveillance and Contact Precautions for Vancomycin-ResistantEnterococcus(VRE) and Its Impact on the Incidence of VREfaeciumBacteremia in Patients with Hematologic Malignancies

2016 ◽  
Vol 37 (4) ◽  
pp. 398-403 ◽  
Author(s):  
Nikolaos G. Almyroudis ◽  
Ryosuke Osawa ◽  
George Samonis ◽  
M. Wetzler ◽  
Eunice S. Wang ◽  
...  
Keyword(s):  
Stem Cell ◽  
Clostridium Difficile ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Molecular Epidemiology ◽  
Cell Transplantation ◽  
Hematologic Malignancies ◽  
Hematopoietic Stem ◽  
Contact Precautions ◽  
High Prevalence

OBJECTIVETo study the effect of discontinuation of systematic surveillance for vancomycin-resistantEnterococcus(VRE) and contact isolation of colonized patients on the incidence of VRE bacteremiaSETTINGA hematology-oncology unit with high prevalence of VRE colonization characterized by predominantly sporadic molecular epidemiologyPARTICIPANTSInpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantationMETHODSThe incidence of VRE bacteremia was measured prospectively during 2 different 3-year time periods; the first during active VRE surveillance and contact precautions and the second after discontinuation of these policies. We assessed the collateral impact of this policy change on the incidence of bacteremia due to methicillin-resistantStaphylococcus aureus(MRSA) andClostridium difficileinfection even though we maintained contact precautions for these organisms. Incidence of infectious events was measured as number of events per 1,000 patients days per month. Time series analysis was used to evaluate trends.RESULTSThe incidence of VRE bacteremia remained stable after discontinuation of VRE surveillance and contact precautions. The incidence of MRSA bacteremia andClostridium difficileinfection for which we continued contact precautions also remained stable. Aggregated antibiotic utilization and nursing hours per patient days were similar between the 2 study periods.CONCLUSIONActive surveillance and contact precautions for VRE colonization did not appear to prevent VRE bacteremia in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation with high prevalence of VRE characterized by predominantly sporadic molecular epidemiology.Infect. Control Hosp. Epidemiol.2016;37(4):398–403

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