Risk Factor Assessment for the Acquisition of Fluoroquinolone-Resistant Isolates of Pseudomonas aeruginosa in a Community-Based Hospital

Background.Pseudomonas aeruginosa is one of the most common gram-negative hospital-acquired pathogens. Resistance of this organism to imipenem complicates treatment.Objective.To elucidate the risk factors for imipenem-resistant P. aeruginosa (IRPA) infection or colonization and to identify the effect of resistance on clinical and economic outcomes.Methods.Longitudinal trends in prevalence of IRPA from 2 centers were characterized during the period from 1989 through 2006. For P. aeruginosa isolates obtained during the period from 2001 through 2006, a case-control study was conducted to investigate the association between prior carbapenem use and IRPA infection or colonization, and a cohort study was performed to identify the effect of IRPA infection or colonization on mortality, length of stay after culture, and hospital cost after culture.Results.From 1989 through 2006, the proportion of P. aeruginosa isolates demonstrating resistance to imipenem increased from 13% to 20% (P< .001, trend). During the period from 2001 through 2006, there were 2,542 unique patients with P. aeruginosa isolates, and 253 (10.0%) had IRPA isolates. Prior carbapenem use was independently associated with IRPA infection or colonization (adjusted odds ratio [OR], 7.92 [95% confidence interval {CI}, 4.78-13.11]). Patients with an IRPA isolate recovered had higher in-hospital mortality than did patients with an imipenem-susceptible P. aeruginosa isolate (17.4% vs 13.4%; P = .01). IRPA infection or colonization was an independent risk factor for mortality among patients with isolates recovered from blood (adjusted OR, 5.43 [95% CI, 1.72-17.10]; P = .004) but not among patients with isolates recovered from other anatomic sites (adjusted OR, 0.78 [95% CI, 0.51-1.21]; P = .27). Isolation of IRPA was associated with longer hospital stay after culture (P<.001) and greater hospital cost after culture (P<.001) than was isolation of an imipenem-susceptible strain. In multivariable analysis, IRPA infection or colonization remained an independent risk factor for both longer hospital stay after culture (coefficient, 0.20 [95% CI, 0.04-0.36]; P = .02) and greater hospital cost after culture (coefficient, 0.30 [95% CI, 0.06-0.54]; P = .02).Conclusions.The prevalence of IRPA infection or colonization has increased significantly, with important implications for both clinical and economic outcomes. Interventions to curb this continued increase and strategies to optimize therapy are urgently needed.

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A Dynamic Risk Factor Assessment for Myocardial Infarction and Cardiac Arrest In Patients Undergoing Pancreatectomy

HPB ◽

10.1016/j.hpb.2021.10.002 ◽

2021 ◽

Author(s):

Aditya Munshi ◽

Charles J. Yeo ◽

Harish Lavu ◽

Marilena Petrou ◽

Gregoris Komodikis

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Risk Factor ◽

Risk Factor Assessment ◽

Dynamic Risk

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Abstract 14964: Sudden Cardiac Death in Current vs. Former Smokers

Circulation ◽

10.1161/circ.130.suppl_2.14964 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kyndaron Reinier ◽

Carmen Teodorescu ◽

Audrey Uy-Evanado ◽

Karen Gunson ◽

Jonathan Jui ◽

...

Keyword(s):

Risk Factor ◽

Sudden Cardiac Death ◽

Medical Records ◽

Cardiac Death ◽

Smoking Prevalence ◽

Smoking History ◽

Common Finding ◽

Behavioral Risk ◽

Community Based ◽

Former Smokers

Introduction: Smoking is a well-established risk factor for cardiovascular disease, but its role in sudden cardiac death (SCD) specifically has not been as well investigated. We sought to describe smoking prevalence among cases that suffered SCD in the general population. Hypothesis: We hypothesized that smoking prevalence would be high among SCD cases. Methods: Cases of SCD from an ongoing multiple-source community-based study of SCD in the northwest US (pop. approx. 1 million) were included if they were age ≥18 with smoking history available from medical records. We describe the prevalence of smoking in the SCD population, as well as characteristics of smokers vs. non-smokers. Results: From 2002 -2012, 1833 (76%) of 2402 SCD cases had pre-SCD medical records available, and smoking history was available for 1241 (68%) of these. While 2007-8 community data (Behavioral Risk Factor Surveillance Study) indicated that 16% of Oregonian adults were current smokers, among the SCD cases, 40% were current smokers, 31% former smokers, and 29% non-smokers. Men were more likely than women to be current smokers (42% vs. 37%) or former smokers (35% vs. 23%); 40% of women and 24% of men were non-smokers (p<0.0001). Among SCD cases, current smokers were significantly younger at the time of their SCD (57.8 ± 13.2 yrs) than former smokers (70.0 ± 12.9 yrs) or non-smokers (66.6 ± 17.9 yrs; p<0.0001), despite a similar number of years smoked among the current and former smokers (33 vs 29 years, p=0.22). Former smokers were more likely to have a history of myocardial infarction and documented CAD than current smokers (p<0.0001). Conclusions: In this community-based study of SCD, current and former smoking was a common finding; current smokers suffered SCD at a younger age than former smokers, despite less documented CAD and MI at the time of their arrest.

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