Cardiac implantable electronic device infection: prevalence and risk factors

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of CIED implantation procedures has increased dramatically in recent decades due to population aging and expansion of indications. At the same time, the number of CIED-associated complications has increased too. Infection is a very important and heavy complication of CIED implantation, which significantly increases mortality and morbidity. Aim and objectives This study aimed to estimate the risk of CIED-infection in a group of patients who received an aggressive scheme of postprocedural antibiotic therapy and compare with the risk of infection in another group, where a mild antibiotic therapy scheme was used. The study objectives were to assess the incidence and prevalence of CIED-related infection in patients operated in a tertiary cardiovascular center, as well as identify infection-related risk factors. Methods A retrospective, observational, cross-sectional study was performed. The study sample included 355 patients, who underwent CIED-related procedure in a single center between 01.12.2017 and 30.07.2020. Two antibiotic prophylaxis and wound follow-up protocols (mild and aggressive) were used. In this study, we compared the effectiveness of both methods to prevent a CIED related infection. Patient’s demographic data, clinical features, comorbidities, the device and procedure-related information were also assessed for having a relationship with CIED infection rate. Data entry and statistical analyses were performed with SPSS version 23 software. Binomial logistic regression analyses were performed for adjusted analyses. Results The prevalence of infection was 3.5% in the group with mild scheme and 1.13% in the group with the aggressive scheme. The difference in two subgroups was not significant (p = 0,149). In the whole sample the prevalence of infection was 1,69%. According to this study severe renal failure with glomerular filtration rate (GFR)<30 mL/min (OR = 32.6, CI = 2.5-420.8, p = 0.008), chronic obstructive pulmonary disease (OR = 8.2, CI = 1.4-47.6, p = 0.019), and thyroid disfunction (OR = 7.065, CI = 1.2-40.6, p = 0.028) were found as significant predictors for having CIED infection. In participants who underwent a reimplantation and in those with postoperative hematoma the odds of having infection was respectively 6.2 fold (CI = 1.086-35.5, p = 0.04) and 48.8 fold (CI = 8.4-285.9, p = 0.028) higher, compared to patients with primary implantation and absence of hematoma. Age of participants with CIED-infection (mean age = 52.5 ) was younger compared to patients without infection (mean age = 61.2, p = 0.039). Conclusion According to our study the risk of infection in our center is comparable to recorded prevalence in other countries. There is no statistically significant difference on CIED infection between mild and aggressive antibiotic therapy schemes. Recommendations The routine use of aggressive antibiotic therapy is not justified and carries a risk of microbial resistance, as well as additional healthcare costs.

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Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights from the Prevention of Arrhythmia Device infection Trial (PADIT)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab513 ◽

2021 ◽

Author(s):

Yves Longtin ◽

Philippe Gervais ◽

David H Birnie ◽

Jia Wang ◽

Marco Alings ◽

...

Keyword(s):

Electronic Device ◽

Risk Of Infection ◽

Cardiac Implantable Electronic Device ◽

Coagulase Negative Staphylococci ◽

Exact Test ◽

Post Hoc Analysis ◽

Perioperative Prophylaxis ◽

Device Infection ◽

Significant Difference ◽

Post Hoc

Abstract Background The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the peri-operative administration of cefazolin, vancomycin, bacitracin and cephalexin did not significantly decrease the risk of infection. Our objective is to compare the microbiology of infections between study arms in PADIT. Methods Post-hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher’s exact test. Results Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS, 82/209; 39.2%) and S. aureus (75/209; 35.9%). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs. 46.6%, p=0.04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs. 26.8%, respectively; p=0.05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs. 64.3%; p=0.10) or vancomycin (90.8% vs. 90.2%; p=0.90). Conclusions Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections.

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Prevalence and risk factors of pulmonary hypertension among adult patients with HIV infection in Ethiopia

Pulmonary Circulation ◽

10.1177/2045894020971518 ◽

2020 ◽

Vol 10 (4) ◽

pp. 204589402097151

Author(s):

Dawit Kebede Huluka ◽

Desalew Mekonnen ◽

Sintayehu Abebe ◽

Amha Meshesha ◽

Dufera Mekonnen ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Communicable Disease ◽

Previous History ◽

Systolic Pressure ◽

Chronic Obstructive ◽

Heart Catheterization ◽

People Living With Hiv ◽

Significant Difference ◽

Living With Hiv

Globally, non-communicable diseases are increasing in people living with HIV. Pulmonary hypertension is a rare non-communicable disease in people living with HIV with a reported prevalence of <1%. However, data on pulmonary hypertension in people living with HIV from Africa are scarce and are non-existent from Ethiopia. This study aimed to examine the prevalence and severity of echocardiographic pulmonary hypertension and risk factors associated with pulmonary hypertension in people living with HIV in Ethiopia. A total of 315 consecutive adult people living with HIV followed at the Tikur Anbessa Specialized Hospital HIV Referral Clinic were enrolled from June 2018 to February 2019. Those with established pulmonary hypertension of known causes were excluded. A structured questionnaire was used to collect data on demographics, respiratory symptoms, physical findings, physician-diagnosed lung disease, and possible risk factors. Pulmonary hypertension was defined by a tricuspid regurgitant velocity of ≥2.9 m/sec on transthoracic echocardiography. A tricuspid regurgitant velocity ≥3.5, which translates into a pulmonary arterial pressure/right ventricular systolic pressure of ≥50 mmHg, was considered moderate-to-severe pulmonary hypertension. The mean age of the participants was 44.5 ± 9.8 years and 229 (72.7%) were females. Pulmonary hypertension was diagnosed in 44 (14.0%) of participants, of whom 9 (20.5%) had moderate-to-severe disease. In those with pulmonary hypertension, 17 (38.6%) were symptomatic: exertional dyspnea, cough, and leg swelling were seen in 12 (27.3%), 9 (20.5%), and 4 (9.1%), respectively. There was no significant difference in those with pulmonary hypertension compared to those without the disease by gender, cigarette smoking, previous history of pulmonary tuberculosis treatment, physician-diagnosed chronic obstructive pulmonary disease or bronchial asthma, duration of anti-retroviral therapy therapy or anti-retroviral regimen type. Pulmonary hypertension looks to be a frequent complication in people living with HIV in Ethiopia and is often associated with significant cardiopulmonary symptoms. Further studies using right heart catheterization are needed to better determine the etiology and prevalence of pulmonary hypertension in people living with HIV in Ethiopia compared to other countries.

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Risk Factors for Soil-Transmitted Helminthiasis in Preschool Children Living in Farmland, North Sumatera, Indonesia

Journal of Tropical Medicine ◽

10.1155/2018/6706413 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Sri Novianty ◽

Yazid Dimyati ◽

Syahril Pasaribu ◽

Ayodhia Pitaloka Pasaribu

Keyword(s):

Risk Factors ◽

Preschool Children ◽

Demographic Data ◽

Significant Risk ◽

Hand Washing ◽

World Health ◽

Life Strategy ◽

Infection Prevalence ◽

Cross Sectional ◽

Soil Transmitted Helminthiasis

Background. Disease burden from soil-transmitted helminthiasis (STH) is mainly attributed to its chronic and insidious impact on health and quality of life. Strategy recommended by World Health Organization (WHO) to control it was previously focused on school-aged children, but now preschool-aged children are involved. This study was intended to determine STH infection risk factors in preschool children.Methods. A cross-sectional study was conducted in Suka Village, North Sumatera, Indonesia, from October to December 2016. Subjects were children aged 1 to 5 years without history of taking antihelminthic. Subjects were obtained by consecutive sampling. Demographic data and risk factors for helminthiasis were collected using questionnaire-based interview. Subjects were divided into two groups, positive and negative STH infection, based on Kato Katz method. Analysis was done using chi-square and logistic regression test.pvalue < 0.05 was considered significant.Results. We enrolled 90 subjects in this study, with the mean age being 31.7 months. STH infection prevalence was 34.4%. Statistical analysis revealed that mother/caregiver hand washing habit (p=0.007), mother/caregiver nail trimming habit (p=0.018), and children nail trimming habit (p=0.022) were significant risk factors for STH infection.Conclusion. Mother/caregiver hand washing habit is the most influential risk factor for STH infection in preschool children.

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Dietary Patterns and Oxidative Stress in a Population of Women with Breast Cancer in the North-Western Regions of Algeria (Saida and El-Bayadh)

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v10i6.4543 ◽

2020 ◽

Vol 10 (6) ◽

pp. 24-30

Author(s):

Noureddine Halla ◽

Kebir Boucherit ◽

Kadda Hachem ◽

Amouria Asmouni ◽

Hanane Derrab ◽

...

Keyword(s):

Breast Cancer ◽

Oxidative Stress ◽

Risk Factors ◽

Dietary Patterns ◽

Demographic Data ◽

The Body ◽

Cancer Risk Factors ◽

The North ◽

Significant Difference ◽

North Western

Objective: The aim of this work is the study of risk factors for breast cancer in a population of women in the north-western regions of Algeria (Saida and El-Bayadh) Methodology: A case-control study was carried out on 40 women including 20 cancerous women and 20 control women, in order to determine the dietary patterns and general characteristics of the population studied and to compare the hematological and biochemical parameters, and markers of oxidative/antioxidant status between control women and breast cancer women. Results: The results obtained show that there is no significant difference in the average age however the body mass index was significantly increased in cancer women, revealing overweight (p <0.05), compared to control women. The marital status of the target population is predominantly a married woman status and the level of education shows a relatively low level in breast cancer cases compared to women controls. The illiteracy rate is exceptionally high in cancer women compared to controls (35% versus 20%). In addition, the levels of glucose, creatinine, HDL and ALAT are similar between the two groups of women. The contents of urea, cholesterol, triglyceride, LDL, ASAT, malondialdehyde and uric acid are significantly increased in women with breast cancer compared to women controls. But the vitamin C content is significantly reduced in cancer women compared to control women. Conclusion: We conclude from this study that there is an association between breast cancer and lipid alteration, oxidative stress, age, increase in BMI, socio-demographic data, professional situation, age, means of menstruation and menopause, and ultimately the lifestyle. All these factors are risk factors for breast cancer in the region of Saida and El-Bayadh. Keywords: Breast Cancer, Risk Factors, Dietary Patterns, Oxidative Stress.

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Risk Factors Analysis of Pulmonary Cement Embolism during Percutaneous Vertebroplasty or Kyphoplasty for Osteoporotic Vertebral Compression Fracture.

10.21203/rs.3.rs-309630/v1 ◽

2021 ◽

Author(s):

Dexin Zou ◽

Shengjie Dong ◽

Wei Du ◽

Bing Sun ◽

Xifa Wu

Keyword(s):

Risk Factors ◽

Vertebral Compression Fracture ◽

Demographic Data ◽

Multiple Logistic Regression Analysis ◽

Compression Fracture ◽

Osteoporotic Vertebral Compression Fracture ◽

Increased Risk ◽

Significant Difference ◽

Cement Embolism ◽

Pulmonary Ct

Abstract Objective: The purpose of this research is to evaluate the risk factors and incidence of PCE during PKP or PVP for osteoporotic vertebral compression fracture (OVCF) based on postoperative computed tomography (CT).Methods: A total of 2344 patients who underwent PVP or PKP due to OVCF in our spine centre were analyzed retrospectively. According to the detection of postoperative pulmonary CT, the patients were divided into two groups: pulmonary cement embolism group (PCE group) and non pulmonary cement embolism group (NPCE group). Demographic data in both groups were compared using the χ2 test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was carried out to identify risk factors that were significantly related to the PCE resulting from cement leakage.Results: PCE was found in 34 patients (1.9% 34/1782) with pulmonary CT examination after operation. There was no statistically significant difference in the parameters such as age, gender, body mass index (BMI) and cement volume in the two groups. Patients with three or more involved vertebrae had a significantly increased risk to suffer from PCE than those with one involved vertebra (p=0.046 OR 2.412 [95% CI 1.017-5.722]). Patients who suffered thoracic fracture had a significantly increased risk to suffer from PCE than those suffered thoracolumbar fracture (p=0.001 OR 0.241 [95% CI 0.105-0.550]). And significantly increased PCE risk also was observed in thoracic fracture compared with Lumbar fracture patients (p=0.028 OR 0.094 [95% CI 0.114-0.779]). The risk of PCE within two weeks after fracture was significantly higher than that after two weeks of fracture (p=0.000 OR 0.178 [95% CI 0.074-0.429]). Patients who underwent PVP surgery had a significantly increased PCE risk than those underwent PKP surgery (p=0.001 OR 0.187 [95% CI 0.069-0.509])Conclusion: The real incidence of PCE is underestimated due to the lack of routine postoperative pulmonary imaging examination. The number of Involved vertebrae, fracture location, operation timing and operation methods are independent risk factors for PCE.

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Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism: a Retrospective Study Based on 145 Cases

10.21203/rs.3.rs-244842/v1 ◽

2021 ◽

Author(s):

Ziyuan Chen ◽

Pengfei Wang ◽

Mengzhou Zhang ◽

Shuheng Wen ◽

Hao Cheng ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Thromboembolism ◽

Demographic Data ◽

Pulmonary Arteries ◽

Weight Ratio ◽

Heart Weight ◽

Time Interval ◽

Unexpected Death ◽

Forensic Practice ◽

Significant Difference

Abstract Pulmonary thromboembolism (PTE) is a common cause of sudden unexpected death in forensic practice following deep vein thrombosis (DVT). It remains easy to overlook the special procedure used for the detection of PTE during autopsies; therefore, the relationship between PTE and the associated risk factors is in need of analysis. In the present study, 145 fatal cases of PTE found during autopsies performed from 2004 to 2019 at the Center of Forensic Investigation of China Medical University were retrospectively evaluated; the demographic data, risk factors, original location of DVT, and time interval from the formation of DVT to PTE were analyzed. In addition, the difference in lung-to-heart weight ratio between the PTE and disease-free accident groups was calculated with matching for gender and age. The 40–59 age group accounted for more than half of the total cases (51.03%). Immobilization, trauma or fracture (especially of the pelvis, femur, tibia, or fibula), surgery, pregnancy and cesarean section, mental disorders and the use of antipsychotics were the top 5 high-risk factors for fatal PTE. Among the victims, 92.9% (130/140) died within 60 days of the first exposure to risk factors. Most DVT were formed and shed in lower limb veins, especially popliteal veins and their branches, which caused 87.6% of the thrombi distributed in bilateral pulmonary arteries. No significant difference in the lung-to-heart weight ratio was found between the PTE and control groups. The present study provides valuable information for the prevention and treatment of thrombosis during clinical events and may also be important for alerting forensic examiners to conduct special PTE detection in cases with potential risk factors.

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PO 8609 PREVALENCE AND RISK FACTORS FOR GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY IN TWO P. VIVAX MALARIA-ENDEMIC AREAS IN SUDAN

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.164 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A62.2-A62

Author(s):

Muzamil Mahdi Abdel Hamid ◽

Musab Albsheer ◽

Mohamed Muneer ◽

Lina Altinae ◽

Andrew A Lover

Keyword(s):

Risk Factors ◽

G6pd Deficiency ◽

Demographic Data ◽

Univariate Analysis ◽

G6pd Activity ◽

Radical Cure ◽

Major Health Problem ◽

Significant Difference ◽

Endemic Areas ◽

Glucose 6 Phosphate Dehydrogenase

BackgroundPlasmodium vivax malaria is a major health problem in Sudan and the parasite has become widely distributed in the recent years. The WHO recommends the use of primaquine as radical cure for liver dormant stage, the hypnozoite. However, prior its use, a test for Glucose-6-phosphate Dehydrogenase (G6PD) should be performed. The objective of the current study was to determine prevalence and risk factors for G6PD deficiency in two P. vivax malaria-endemic areas in Sudan.MethodsA cross-sectional study recruiting 557 subjects from two malaria-endemic areas in Sudan was conducted. Demographic data and blood samples were collected. G6PD activity was measured by spectrometry using SPINREACT enzymatic-UV kit.ResultsThe measured G6PD activities for both sites ranged from 0.6 to 37.7 U/g Hb, with a median value of 12.8 U/g Hb. There was a significant difference in enzyme activity by study site (p<0.001), but not by sex (p=0.91). Overall, across the two study sites, 22 (3.9%) is G6PDd (<30%). Prevalence of G6PDd (<30%) in Khartoum is 1.8% (4/230) compared to 4.8% (16/327) in New Hafla. In univariate analysis predictors of G6PDd were study site (odds ratio of G6PD activity <3.8, Khartoum relative to New Halfa=0.22 (95% CI: 0.08 to 0.66), p=0.006), and recent antibiotic use (OR=2.45 (95% CI: 1.1 to 5.5), p=0.027). In multivariate analysis, the only factor that was significant was the individual’s weight in kilograms, with an OR of 0.97 (95% CI 0.95 to 0.99, p=0.014).ConclusionG6PD deficiency is less prevalent among Sudanese population and this indicates that the use of primaquine for radical cure of P. vivax malaria is safe.

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Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes

Journal of Arrhythmia ◽

10.1002/joa3.12123 ◽

2018 ◽

Vol 34 (6) ◽

pp. 632-639 ◽

Cited By ~ 2

Author(s):

Theerawat Korkerdsup ◽

Tachapong Ngarmukos ◽

Somnuek Sungkanuparph ◽

Angsana Phuphuakrat

Keyword(s):

Risk Factors ◽

Electronic Device ◽

Cardiac Implantable Electronic Device ◽

Referral Center ◽

Device Infection

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Frequency and Risk Factors of Red Blood Cell Alloimmunization in Thalassemia Major Patients in Markazi province

Iranian Journal of Pediatric Hematology & Oncology ◽

10.18502/ijpho.v9i1.293 ◽

2019 ◽

Author(s):

Aziz Eghbali MD ◽

Roghaieh.Rahimi-Afzal MD ◽

Sarvenaz Mehrabi MD ◽

Seyed Amir Sanatkar MD ◽

Morteza Mousavi-Hasanzadeh MD

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Genetic Disorders ◽

Demographic Data ◽

Thalassemia Major ◽

Blood Groups ◽

The Body ◽

Factors Associated ◽

Significant Difference ◽

The Mean

Background: Thalassemia is one of the most common genetic disorders throughout the world. Blood transfusion plays an important role in the treatment of thalassemia but it leads to numerous complications such as iron overload and alloimmunization. This study evaluated the frequency and risk factors associated with alloimmunization in thalassemia major patients living in Markazi province, Iran. Materials and Methods: In this descriptive study, 48 thalassemia major patients who underwent blood transfusion at Amirkabir hospital were included. Patients' demographic data were recorded using a questionnaire. In order to perform alloimmunization screening and autoantibody assessment, patients were referred to Tehran Blood Transfusion Organization Laboratory. Results: The current study was performed on 48 patients with thalassemia major,. The mean age of patients was 12.5 ± 8.3 years. Among patients 26 (54.16%) were male and 22 (45.83%) were female, 13 patients (27.08%) had alloantibodies. Among 48 patients, 19 (39.58%) had undergone splenectomy. The patients' age of the first blood transfusion ranged from 1 month to 14 months and the mean age of the first blood transfusion was 9.5 ± 7.08 months. The blood transfusion intervals in patients were from 21 days to 40 days and the blood volume received at each transfusion session was 10-15 cc/kg of the body weight. In the current study, the data analysis indicated no significant correlation between alloantibodies and RH phenotype (P=0.43), patients' gender (P=0.9), or blood groups (P=0.4); whereas, a significant correlation was found between alloantibodies and splenectomy (P=0.02) as an increase in the prevalence of alloantibodies was reported in splenectomised patients. Conclusion: No significant difference was found between the patients with and without alloantibodies in terms of the prevalence of Rh phenotype, gender, and blood groups. However, there was a significant difference between the patients with and without alloantibodies in terms of splenectomy. Key words: Allo-immunization, Risk factors, Thalassemia major

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Risk factors of overactive bladder syndrome and its relation to sexual function in menopausal women

Urologia Journal ◽

10.1177/0391560317750484 ◽

2018 ◽

Vol 85 (1) ◽

pp. 10-14 ◽

Cited By ~ 5

Author(s):

Sevil Hakimi ◽

Elham Aminian ◽

Sakineh Mohammad- Alizadeh Charandabi ◽

Parvin Bastani ◽

Marzieh Mohammadi

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Overactive Bladder ◽

Sexual Function ◽

Demographic Data ◽

Overactive Bladder Syndrome ◽

Or Education ◽

Menopausal Women ◽

Significant Difference

Background: Overactive bladder syndrome is a common and annoying complication worldwide that could negatively affect the quality of life of afflicted individuals. We aimed to determine the prevalence and risk factors of overactive bladder syndrome and its relation to sexual function in healthy menopausal women. Methods: This cross-sectional study was done on 340 women aged 45-60 years in Tabriz, northwest Iran, during 2015-2016. Data were collected using a demographic data questionnaire, the Overactive Bladder Syndrome Score, and the McCoy Female Sexuality Questionnaire. Results: Fifty-six (16.5%), 63 (18.5%), and 10 (2.9%) of the participating women had mild, moderate, and severe overactive bladder syndrome, respectively. Predictors of overactive bladder included: night sweats, central prolapse, episiotomy, varicose disease, illiteracy or education at the primary level, systolic blood pressure >140 mmHg and lack of physical activity. We found a significant difference between the women with and without overactive bladder with respect to the total score and sub-domain scores related to sex partner (p = 0.029) and sexual interest (p = 0.049). Conclusions: The prevalence of overactive bladder was quite high in this study. Since sexual dysfunction is not an easy topic to talk about and can affect women’s quality of life, physicians should consider talking about these issues besides urinary issues to all middle-aged women.

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