Prevalence of third-generation cephalosporin-resistant Enterobacterales colonization on hospital admission and ESBL genotype-specific risk factors: a cross-sectional study in six German university hospitals

2020 ◽  
Vol 75 (6) ◽  
pp. 1631-1638
Author(s):  
Anna M Rohde ◽  
Janine Zweigner ◽  
Miriam Wiese-Posselt ◽  
Frank Schwab ◽  
Michael Behnke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hospital Stay ◽  
Generation Cephalosporin ◽  
Resistant Bacteria ◽  
Third Generation ◽  
University Hospitals ◽  
Term Care ◽  
Specific Risk ◽  
M 14

Abstract Objectives To assess the admission prevalence of third-generation cephalosporin-resistant Enterobacterales (3GCREB) and to assess whether risk factors vary by β-lactamase genotype. Methods Adult patients were recruited within 72 h of admission to general wards of six university hospitals in 2014 and 2015. Rectal swabs were screened for 3GCREB and isolates were analysed phenotypically and genotypically. Patients were questioned on potential risk factors. Multivariable analyses were performed to identify risk factors for 3GCREB colonization and for specific β-lactamases. Results Of 8753 patients screened, 828 were 3GCREB positive (9.5%). Eight hundred and thirteen isolates were available for genotyping. CTX-M-15 was the most common ESBL (38.0%), followed by CTX-M-1 (22.5%), CTX-M-14 (8.7%), CTX-M-27 (7.5%) and SHV-ESBL (4.4%). AmpC was found in 11.9%. Interestingly, 18 Escherichia coli isolates were AmpC positive, 12 of which (67%) contained AmpC on a gene of plasmid origin [CMY (n = 10), DHA (n = 2)]. Risk factors for 3GCREB colonization varied by genotype. Recent antibiotic exposure and prior colonization by antibiotic-resistant bacteria were risk factors for all β-lactamases except CTX-M-14 and CTX-M-27. Travel outside Europe was a risk factor for CTX-M-15 and CTX-M-27 [adjusted OR (aOR) 3.49, 95% CI 2.88–4.24 and aOR 2.73, 95% CI 1.68–4.43]. A previous stay in a long-term care facility was associated with CTX-M-14 (aOR 3.01, 95% CI 1.98–4.59). A preceding hospital stay in Germany increased the risk of CTX-M-15 (aOR 1.27, 95% CI 1.14–1.41), while a prior hospital stay in other European countries increased the risk of SHV-ESBL colonization (aOR 3.85, 95% CI 1.67–8.92). Conclusions The detection of different ESBL types is associated with specific risk factor sets that might represent distinct sources of colonization and ESBL-specific dissemination routes.

Abstract O.13: Kawasaki disease in the Maghreb community in Quebec

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Arbia A Gorrab ◽  
Asma Abed Bouaziz ◽  
Linda Spigelblatt ◽  
Anne Fournier ◽  
Nagib Dahdah
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Kawasaki Disease ◽  
University Hospitals ◽  
Specific Population ◽  
History Of ◽  
Statistics Canada ◽  
Artery Disease ◽  
Children Under 5

Background: The real incidence of Kawasaki disease (KD) in the Maghreb countries (Morocco, Algeria, and Tunisia) is unknown. It is estimated low according to the literature. However, the number of Maghrebi children living in Quebec (Qc) affected by KD seems important. We sought to determine the incidence of KD among Maghrebi children in Qc, Canada, and to study its epidemiological and clinical features and to clarify possible risk factors related or superimposed to their immigration. Methods: A retrospective study of KD in Maghrebi children living in Qc (n=24) (1996-2013), compared to reports from Fes, Morocco (n=23) a doctoral thesis published in 2010 (2001-2009) and from Tunisia (n=31) collected in five university hospitals with four from the Great Tunis and one from Nabeul city (1996-2013). There are no reports available from Algeria. The “country of origin” specific population in the Province of Qc was obtained from Statistics Canada. Results: The annualized incidence rate (AIR) of KD among Maghrebi children in Qc was 9.58/100,000 children under 5 years(Standard-Denominator (SD)).This is 6 times higher in Qc (5.57/SD and 19.02/SD among Tunisian and Moroccan descents) vs Tunisia (Nabeul Governorate) and Morocco (Fes) (0.95/SD and 3.15/SD). Personal and family history of allergy were significantly higher in Qc 42% (10/24) and 75% (18/24), respectively, whereas these features were reported near 0% in both reports from Morocco and Tunisia. The prevalence of incomplete KD criteria was relatively high in the 3 series 46% (11/24) in Qc vs 43% (10/23) and 35% (11/31); (p=NS). Diagnosis was late (gt day 10 of fever) in 1/24(4%) in Qc vs 7/23 (30%) in Morocco and 11/31 (35%) in Tunisia; (p 0.01). IVIG were administered in the acute phase to all patients in Qc, 5/23 in Morocco and 28/31 in Tunisia. However coronary complications were more common in Qc 42% (10/24) vs 22% (5/23) vs 19% (6/31) (p=0.02). Aneurysms were significantly associated with the incomplete form in the 3 groups (p=0.01). Conclusions: The observed AIR of KD in the Maghreb community in Qc is higher than the countries of origin where underdiagnosis is possible. Atopy may still be a risk factor in Qc. The coronary artery disease seems linked not only to therapeutic delay but also to the underlying terrain.

General, Interpersonal, and Gender Role Specific Risk Factors of Postpartum Depressive Symptoms in Fathers

2019 ◽  
Vol 38 (7) ◽  
pp. 545-567
Author(s):  
Hanne N⊘rr Fentz ◽  
Marianne Simonsen ◽  
Tea Trillingsgaard
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Gender Role ◽  
Postnatal Depression ◽  
Negative Consequences ◽  
Postnatal Depressive Symptoms ◽  
Specific Risk ◽  
Paternal Depressive Symptoms ◽  
Study Results

Introduction: Paternal postnatal depression has significant negative consequences for the family and child. Still, only little attention has been paid to potential unique risk factors of depression in fathers and the theoretical grounding of such research is sparse. Method: This study examined prenatal risk factors derived from three theoretical models: the cognitive vulnerability-stress model, the interpersonal model, and the gender role risk model of paternal postnatal depression. The sample consisted of 211 expectant fathers, of whom 5.7% scored above the clinical cut-off on the Edinburgh Postnatal Depression Scale, and 235 mothers were included as a reference group. Participants filled in questionnaires during pregnancy and four months postpartum. Results: The study results suggest that prenatal depressive score is the strongest risk factor for both paternal and maternal postnatal depressive symptoms. In addition, childhood separation from parents, unemployment, financial strain, and doubts about having the child were unique risk factors for paternal depressive symptoms, while lower marital satisfaction was a unique risk factor for maternal depression. Discussion: These findings highlight that beyond the strong role of prenatal depressive symptoms for both genders, specific risk factors for father depression exist. This may be informative to health care professionals in increasing the reach and prevention of depression in new fathers.

scholarly journals Lack of ideas about quantity and methods to deal with quantity as a risk factor for dyscalculia in children

2020 ◽  
pp. 359-369
Author(s):  
Nadežda Cyrulik
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Early Detection ◽  
Learning Difficulties ◽  
Specific Risk

The article substantiates the need for early detection in children of a disorder of arithmetic skills (dyscalculia). Specific risk factors for the occurrence of dyscalculia are considered, presents results of a study of the characteristics of ideas about the number and methods of action with the number in the prenumeric activity of pupils with learning difficulties.

scholarly journals A Multi-Centre Survey on Hospital Malnutrition: Result of PNSI Study

2020 ◽  
Author(s):  
Somayeh Poudineh ◽  
Forough Shayesteh ◽  
Jamshid Kermanchi ◽  
Ali-Akbar Haghdoost ◽  
Parisa Torabi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Malignant Disease ◽  
Heart Surgery ◽  
Length Of Hospital Stay ◽  
Male Gender ◽  
Adverse Outcomes ◽  
University Hospitals ◽  
Cross Sectional ◽  
Independent Risk Factors

Abstract Background: Disease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university hospitals. Methods: Persian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA). Results: In total, 2306 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.7±14 years and 25.2±6 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.9% of the patients, 26.2% and 21% of whom were among the admitted and discharged patients, respectively. The prevalence of malnutrition was higher in burns (78%) and heart surgery (58%) patients. Malnutrition was not associated with age (P=0.1). Multivariate analysis presented male gender (OR=1.023, P<0.001), malignant disease (OR=1.409, P<0.001), length of hospital stay (OR=1.206, P<0.001), and polypharmacy (OR=1.066, P<0.001) as independent risk factors for malnutrition.Conclusion: One out of four patients in the studied university hospitals was suffering from malnutrition; thus, appropriate measures should be taken to ameliorate this condition. Male gender, malignant disease, length of hospital stay, and polypharmacy were identified as independent risk factors for malnutrition.

scholarly journals Characterization of AmpC-hyperproducing Escherichia coli from humans and dairy farms collected in parallel in the same geographical region

2020 ◽  
Vol 75 (9) ◽  
pp. 2471-2479 ◽  
Author(s):  
Maryam Alzayn ◽  
Jacqueline Findlay ◽  
Hannah Schubert ◽  
Oliver Mounsey ◽  
Virginia C Gould ◽  
...  
Keyword(s):  
Risk Factors ◽  
Phylogenetic Analysis ◽  
Human Population ◽  
Dairy Farms ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
E Coli ◽  
Increased Risk ◽  
Amoxicillin Clavulanate ◽  
Cephalosporin Resistance

Abstract Objectives To characterize putative AmpC-hyperproducing third-generation cephalosporin-resistant E. coli from dairy farms and their phylogenetic relationships; to identify risk factors for their presence; and to assess evidence for their zoonotic transmission into the local human population. Methods Proteomics was used to explain differences in antimicrobial susceptibility. WGS allowed phylogenetic analysis. Multilevel, multivariable logistic regression modelling was used to identify risk factors. Results Increased use of amoxicillin/clavulanate was associated with an increased risk of finding AmpC hyperproducers on farms. Expansion of cephalosporin resistance in AmpC hyperproducers was seen in farm isolates with marR mutations (conferring cefoperazone resistance) or when AmpC was mutated (conferring fourth-generation cephalosporin and cefoperazone resistance). Phylogenetic analysis confirmed the dominance of ST88 amongst farm AmpC hyperproducers but there was no evidence for acquisition of farm isolates by members of the local human population. Conclusions Clear evidence was found for recent farm-to-farm transmission of AmpC-hyperproducing E. coli and of adaptive mutations to expand resistance. Whilst there was no evidence of isolates entering the local human population, efforts to reduce third-generation cephalosporin resistance on dairy farms must address the high prevalence of AmpC hyperproducers. The finding that amoxicillin/clavulanate use was associated with an increased risk of finding AmpC hyperproducers is important because this is not currently categorized as a highest-priority critically important antimicrobial and so is not currently targeted for specific usage restrictions in the UK.

scholarly journals Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors

2016 ◽  
Vol 71 (10) ◽  
pp. 2957-2963 ◽  
Author(s):  
A. Hamprecht ◽  
A. M. Rohde ◽  
M. Behnke ◽  
S. Feihl ◽  
P. Gastmeier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Admission Prevalence

Critical risk factors in international construction projects

2020 ◽  
Vol 27 (5) ◽  
pp. 1169-1190 ◽  
Author(s):  
Satish Kumar Viswanathan ◽  
Kumar Neeraj Jha
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Construction Projects ◽  
International Market ◽  
The Body ◽  
Content Type ◽  
Specific Risk Factor ◽  
International Construction ◽  
Specific Risk ◽  
Overall Performance

Purpose International construction projects encompass various risks, and it is essential to evaluate and manage them to achieve project and firms’ success. As approaches to addressing international market risks vary from one country to another, the purpose of this paper is to identify the critical risk factors of embarking on international construction projects according to Indian experiences. Design/methodology/approach After primarily verifying the identified 26 risk variables, a questionnaire survey was conducted to draw upon the views of experts who possess international project experience. The 105 responses were analyzed using univariate and multivariate techniques. An analysis of variance identified the significant variables that influence overall performance on international construction projects, which were then grouped according to underlying relationships using factor analysis to determine the specific risk factors. Furthermore, considering these risk factors as independent variables and overall project performance as a dependent variable, a stepwise regression analysis was carried out to identify relatively critical risk factors. Findings The results revealed that of the identified four risk factors, the project-specific risk factor emerged as the foremost critical risk factor, the economic and market-specific risk factor was the second most critical risk factor, the firm-specific risk factor was the third most critical risk factor and the political-specific risk factor was the least critical risk factor. These findings were also validated appropriately. Research limitations/implications This study was limited to the data acquired from Indian construction firms, predominantly consultants and contractors. Though the survey respondents possessed adequate familiarity in international construction, commonly perceived limitations in self-reported surveys such as the lack of conscientious responses and reporting bias were not an exception in this research. Practical implications The risk factors and their criticality – as identified in this study – can aid the multinational firms and international aspirants to prioritize the critical aspects and develop a suitable risk mitigation strategy to achieve greater project success in international market. Originality/value By investigating the various risk factors that influence overall performance of international construction projects, this research considerably contributes to the body of knowledge pertaining to international construction risk management that will enable firms from India and similar developing nations to emphasize on critical risk factors.

scholarly journals Risk Factors for Emergence of Resistance to Broad-Spectrum Cephalosporins among Enterobacterspp

2001 ◽  
Vol 45 (9) ◽  
pp. 2628-2630 ◽  
Author(s):  
Keith S. Kaye ◽  
Sara Cosgrove ◽  
Anthony Harris ◽  
George M. Eliopoulos ◽  
Yehuda Carmeli
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Broad Spectrum ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Independent Risk Factors ◽  
Emergence Of Resistance

ABSTRACT Among 477 patients with susceptible Enterobacter spp., 49 subsequently harbored third-generation cephalosporin-resistantEnterobacter spp. Broad-spectrum cephalosporins were independent risk factors for resistance (relative risk [OR] = 2.3, P = 0.01); quinolone therapy was protective (OR = 0.4, P = 0.03). There were trends toward decreased risk for resistance among patients receiving broad-spectrum cephalosporins and either aminoglycosides or imipenem. Of the patients receiving broad-spectrum cephalosporins, 19% developed resistance.

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