scholarly journals Risk Factors for Positive Follow-Up Blood Cultures in Gram-Negative Bacilli Bacteremia: Implications for Selecting Who Needs Follow-Up Blood Cultures

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Hayato Mitaka ◽  
Tessa Gomez ◽  
Young Im Lee ◽  
David C Perlman
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Blood Cultures ◽  
Gram Negative ◽  
Intravascular Devices

Abstract Background The value of follow-up blood cultures (FUBCs) to document clearance of bacteremia due to Gram-negative bacilli (GNB) has not been well established. Although previous studies suggested that the yield of FUBCs for GNB bacteremia is low, it remains to be elucidated for whom FUBC may be beneficial and for whom it is unnecessary. Methods A retrospective cohort study was performed at 4 acute care hospitals to identify risk factors for positive FUBCs with GNB bacteremia and to better guide clinicians’ decisions as to which patients may or may not benefit from FUBCs. Participants included adult patients with GNB bacteremia who had FUBCs and were admitted between January 2017 and December 2018. The primary outcomes were the factors associated with positive FUBCs and the yield of FUBCs with and without the factors. Results Of 306 patients with GNB bacteremia who had FUBCs, 9.2% (95% confidence interval, 6.2%–13.0%) had the same GNB in FUBCs. In the multivariate logistic regression analysis, end-stage renal disease on hemodialysis, intravascular device, and bacteremia due to extended-spectrum β-lactamase or carbapenemase-producing organism were identified as independent predictors of positive FUBCs with GNB bacteremia. Approximately 7 FUBCs and 30 FUBCs were needed for patients with ≥1 or no risk factors, respectively, to yield 1 positive result. SummaryThis multi-site retrospective cohort study found that among patients with gram-negative bacilli (GNB) bacteremia, having ESRD on hemodialysis, intravascular devices, or bacteremia due to multi-drug resistant GNB were each independently associated with having a positive follow-up blood culture. Conclusions Follow-up blood culture may not be necessary for all patients with GNB bacteremia and has the highest yield in patients with 1 or more risk factors.

scholarly journals Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julinha M. Thelen ◽  
A. G. ( Noud) Buenen ◽  
Marjan van Apeldoorn ◽  
Heiman F. Wertheim ◽  
Mirjam H. A. Hermans ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Culture ◽  
The Netherlands ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Influenza A ◽  
Blood Cultures ◽  
Influenza B ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. Methods We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. Results A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1). Conclusions We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.

scholarly journals Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248817
Author(s):  
Anthony D. Bai ◽  
Neal Irfan ◽  
Cheryl Main ◽  
Philippe El-Helou ◽  
Dominik Mertz
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Clinical Pathway ◽  
Retrospective Cohort ◽  
Negative Likelihood Ratio ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

Background It is unclear if a local audit would be useful in providing guidance on how to improve local practice of empiric antibiotic therapy. We performed an audit of antibiotic therapy in bacteremia to evaluate the proportion and risk factors for inadequate empiric antibiotic coverage. Methods This retrospective cohort study included patients with positive blood cultures across 3 hospitals in Hamilton, Ontario, Canada during October of 2019. Antibiotic therapy was considered empiric if it was administered within 24 hours after blood culture collection. Adequate coverage was defined as when the isolate from blood culture was tested to be susceptible to the empiric antibiotic. A multivariable logistic regression model was used to predict inadequate empiric coverage. Diagnostic accuracy of a clinical pathway based on patient risk factors was compared to clinician’s decision in predicting which bacteria to empirically cover. Results Of 201 bacteremia cases, empiric coverage was inadequate in 56 (27.9%) cases. Risk factors for inadequate empiric coverage included unknown source at initiation of antibiotic therapy (adjusted odds ratio (aOR) of 2.76 95% CI 1.27–6.01, P = 0.010) and prior antibiotic therapy within 90 days (aOR of 2.46 95% CI 1.30–4.74, P = 0.006). A clinical pathway that considered community-associated infection as low risk for Pseudomonas was better at ruling out Pseudomonas bacteremia with a negative likelihood ratio of 0.17 (95% CI 0.03–1.10) compared to clinician’s decision with negative likelihood ratio of 0.34 (95% CI 0.10–1.22). Conclusions An audit of antibiotic therapy in bacteremia is feasible and may provide useful feedback on how to locally improve empiric antibiotic therapy.

Treatment Outcomes of Childhood Tuberculosis in Three Districts of Balochistan, Pakistan: Findings from a Retrospective Cohort Study

2020 ◽  
Author(s):  
Abid Abdullah ◽  
Nafees Ahmad ◽  
Muhammad Atif ◽  
Shereen Khan ◽  
Abdul Wahid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Treatment Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
P Value ◽  
Childhood Tb ◽  
Study Sites ◽  
Lost To Follow Up

Abstract Background This study aimed to evaluate treatment outcomes and factors associated unsuccessful outcomes among pediatric tuberculosis (TB) patients (age ≤14 years). Methods This was a retrospective cohort study conducted at three districts (Quetta, Zhob and Killa Abdullah) of Balochistan, Pakistan. All childhood TB patients enrolled for treatment at Bolan Medical Complex Hospital (BMCH) Quetta and District Headquarter Hospitals of Zhob and Killa Abdullah from 1 January 2016 to 31 December 2018 were included in the study and followed until their treatment outcomes were reported. Data were collected through a purpose developed standardized data collection form and analyzed by using SPSS 20. A p-value &lt;0.05 was considered statistically significant. Results Out of 5152 TB patients enrolled at the study sites, 2184 (42.4%) were children. Among them, 1941 childhood TB patients had complete medical record were included in the study. Majority of the study participants were &lt;5 years old (66.6%) and had pulmonary TB (PTB; 65%). A total of 45 (2.3%) patients were cured, 1680 (86.6%) completed treatment, 195 (10%) lost to follow-up, 15 (0.8%) died, 5 (0.3%) failed treatment and 1 (0.1%) was not evaluated for outcomes. In multivariate binary logistic regression analysis, treatment at BMCH Quetta (OR = 25.671, p-value &lt; 0.001), rural residence (OR = 3.126, p-value &lt; 0.001) and extra-PTB (OR = 1.619, p-value = 0.004) emerged as risk factors for unsuccessful outcomes. Conclusion The study sites collectively reached the World Health Organization’s target of treatment success (&gt;85%). Lost to follow-up was the major reason for unsuccessful outcomes. Special attention to patients with identified risk factors for unsuccessful outcomes may improve outcomes further.

scholarly journals Risk factors correlated with antibiotic-induced carbapenem resistant in Gram-negative bacilli in China: a retrospective cohort study

2020 ◽  
Author(s):  
Jing Chen ◽  
Qian Xiang ◽  
Jia-yu Wu ◽  
Min-hong Cai ◽  
Chen Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Risk Model ◽  
Length Of Hospital Stay ◽  
Health Concern ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Kaplan Meier

Abstract Background: Increasing resistance to carbapenem, particularly common in Gram-negative bacilli (GNB), has become a growing public health concern around the world. The objective of this study was to investigate risk factors associated with antibiotic-induced carbapenem resistant in Gram-negative bacilli (CR-GNB) among inpatients. Methods: A retrospective cohort study was conducted in one of the largest tertiary A-level hospitals including patients with GNB cultured from any of the clinical specimens who had been admitted for more than 2 calendar days from January 2017 to June 2019. Kaplan-Meier analysis and Cox proportional hazard model were used to estimate the hazard of CR-GNB induction by antibiotics. Results: 2490 patients including 7 cohorts were included. After cox proportional risk model analysis, carbapenems, β-lactamase inhibitors, and cephalosporins had significantly higher hazards than other types of antimicrobial (P<0.001). But even without using any antimicrobials, the hazard would increase with the length of hospital stay. On multivariate analysis, carbapenem was the most principal hazard factor for antibiotic-induced CR-GNB (hazard ratio [HR], 2.968; 95% confidence interval [CI], 1.706～5.162), followed by ICU admission (HR, 1.815; 95% CI, 1.507～2.186), cephalosporin (HR, 1.605; 95% CI, 1.288～1.999), tracheotomy (HR, 1.563; 95% CI, 1.251～1.952) and β-lactamase inhibitor (HR, 1.542; 95% CI, 1.237～1.921). However, quinolone effects on antibiotic-induced CR-GNB were not statistically significant. Conclusions: Prior carbapenem was a strong risk factor for antibiotic-induced CR-GNB, but quinolone was not associated with that. Rational use of carbapenems should be implemented and antimicrobial stewardship policies should be adjusted according to the characteristics of each hospital.

scholarly journals Associations Between Malignancy and Cardiovascular Complications Following Emergency Laparotomy – a Retrospective Cohort Study

2020 ◽  
Author(s):  
Rasmus Peuliche Vogelsang ◽  
Jacob Hartmann Søby ◽  
Mai-Britt Tolstrup ◽  
Jakob Burcharth ◽  
Sarah Ekeløf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Malignant Disease ◽  
Multivariate Logistic Regression Analysis ◽  
Cardiovascular Complications ◽  
Emergency Laparotomy ◽  
Asa Score ◽  
Increased Risk

Abstract Background Several studies have shown a possible causal relationship between the occurrence of systemic inflammation in patients with malignant disease and increased risk of cardiovascular events. Our objective was to estimate the association between malignant disease and postoperative cardiovascular complications. Secondarily, we aimed to identify risk factors for postoperative cardiovascular complications. Methods We conducted a retrospective cohort study of all patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016 at the Department of Surgery at Zealand University Hospital, Denmark. Complications were graded according to the Clavien-Dindo (CD) classification of surgical complications. A multivariate logistic regression analysis was performed to estimate the association between malignant disease and cardiovascular complications within 30 days of emergency laparotomy and to identify other risk factors for postoperative cardiovascular complications after emergency laparotomy. Results We identified 1188 patients ≥ 18 years undergoing emergency laparotomy between 2010 and 2016, in which 254 (21%) had malignant disease. Within 30 days of emergency laparotomy, 89 (9.5%) of patients without malignancy died, as compared with 45 (18%) of patients with malignancy (p < 0.001). Severe cardiovascular complication graded CD 3–5 occurred in 93 (8%) of all patients within 30 days of emergency laparotomy. We found no association between malignancy and postoperative cardiovascular complications. Increasing age and ASA physical status classification system (ASA) score ≥ III were the only independent risk factors of cardiovascular complications graded CD 3–5. Conclusions Malignancy was not associated with postoperative cardiovascular complications after emergency laparotomy. Risk factors for major cardiovascular complications after emergency abdominal surgery were age and ASA score ≥ III.

scholarly journals Incidence of non-communicable diseases (NCDs) in HIV patients on ART in a developing country: Case of Zimbabwe’s Chitungwiza Central Hospital—A retrospective cohort study (2010–2019)

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252180
Author(s):  
Alexander Cheza ◽  
Boikhutso Tlou ◽  
Danai Tavonga Zhou
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Communicable Diseases ◽  
People Living With Hiv ◽  
Central Hospital ◽  
Hiv Patients ◽  
Non Communicable Diseases

Introduction The incidence of non-communicable diseases (NCDs) has been reported to be rising over the years leading up to 2010. In Zimbabwe, there are few studies done to examine the incidence of NCDs in people living with HIV (PLHIV) on anti-retroviral treatment (ART). Objective To determine the incidence of NCDs in HIV patients on ART at the Chitungwiza Central Hospital over ten years and the associated risk factors. Methods This was a retrospective cohort study using data from 203 patients enrolled on ART at the Chitungwiza Central Hospital between 2010 and 2019. All 500 records were considered and the selection was based on participants’ consenting to the study and their strict adherence to ART without absconding. The incidence of NCDs was determined and generalized estimating equations (GEE) were used to estimate the association between NCDs and the selected risk factors. Findings Data collected at the study’s baseline (2010) showed that the most prevalent NCD was hypertension, found in (18/203) 8.9% of the study participants, followed by diabetes (6.9%), then followed by cardiovascular diseases (CVD) (3.9%), and the least common NCD was cancer (1.9%). Incidences of all of these NCDs showed an increasing trend as the time of follow-up progressed. The factors found to be significantly associated with the development of NCDs were gender (p = 0.002) and follow-up time (p<0.001). Geographical location was a significant risk factor as urban patients were more likely to develop hypertension as compared to the peri-urban patients (p = 0.001). Conclusions NCDs and HIV comorbidity is common with women more likely than males to develop NCDs as they advance in age. There is need to devise targeted intervention approach to the respective NCDs and risk factors since they affect differently in relation to the demographic details of the participants. Recommendations This paper recommends a multi-stakeholder approach to the management of NCDs, with researchers, clinicians and the government and its various arms taking a leading role.

scholarly journals DOP41 Low-grade dysplasia prognosis and predictive factors for advanced neoplasia progression in the 21st century: A large multi-centre retrospective cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S078-S079
Author(s):  
M Kabir ◽  
K Curtius ◽  
I Al-Bakir ◽  
J Hartono ◽  
M Johnson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Endoscopic Resection ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Study Endpoint ◽  
Low Grade ◽  
Advanced Neoplasia ◽  
Low Grade Dysplasia

Abstract Background Recent advances in ulcerative colitis (UC) endoscopic surveillance such as high-definition imaging and greater chromoendoscopy (CE) use have led to an increase in detection and resection of visible dysplasia. An updated study of prognosis of low-grade dysplasia (LGD) is needed to address uncertainty as to the accuracy of progression rates based on historical studies. Methods This retrospective cohort study involved four UK IBD centres. Hospital and endoscopy pathology databases were searched between 1 January 2001 and 30 December 2018 to identify adult patients with UC who had their first LGD diagnosis diagnosed within the extent of colitis. Only patients followed up with at least one colonoscopy or colectomy by 30 August 2019 were included. The study endpoint was time to high-grade dysplasia (HGD) or cancer (CRC), i.e. advanced neoplasia (AN), or end of follow-up. Survival analyses were performed using Kaplan–Meier estimation and Cox proportional hazards (PH) models. Results In total, 460 patients met the inclusion criteria and were followed up for a median of 4.1 years (IQR 6), equating to 2,232 patient-years. A mean of 3.7 (range 0–17) subsequent colonoscopies was performed per patient. Seventy-seven per cent of patients had CE surveillance. Complete endoscopic resection was achieved in 94% and 64% of the polypoid and non-polypoid LGD, respectively. There was progression to AN in 88 cases (19%) during follow-up. There was no significant difference in AN progression between centres. Unresectable non-polypoid or invisible LGD carried the greatest risk of AN development (Figure 1). On univariate Cox PH analysis, CE use was protective against AN progression (HR 0.5; 95% CI 0.3–1.0; p = 0.04). However, only highly significant predictors of LGD progression to AN on univariate analysis (Bonferroni adjusted p &lt; 0.003), were entered into the multivariate model: Cumulative risk of AN increased with the number of risk factors (Figure 2). Conclusion This is the largest study examining prognosis of LGD, based on endoscopic features, in this century. Five-year cumulative incidence of AN is low after complete endoscopic resection of visible LGD without surrounding dysplasia. Lesion size of 1 cm or more, invisibility, multifocality and unresectability of LGD are significant risk factors for progression to AN. These factors should be taken into consideration when discussing management options with patients.

scholarly journals Blood Cultures for the Diagnosis of Infective Endocarditis: What Is the Benefit of Prolonged Incubation?

2021 ◽  
Vol 10 (24) ◽  
pp. 5824
Author(s):  
Vincent Fihman ◽  
Hélène Faury ◽  
Amina Moussafeur ◽  
Raphaelle Huguet ◽  
Adrien Galy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Retrospective Cohort ◽  
Blood Cultures ◽  
University Hospital ◽  
Infectious Endocarditis ◽  
Prolonged Incubation ◽  
Cutibacterium Acnes

To assess the need for prolonged incubation of blood culture bottles beyond five days for the diagnosis of infectious endocarditis (IE), we conducted a retrospective cohort study of 6109 sets of two blood culture bottles involving 1211 patients admitted to the Henri Mondor University Hospital for suspicion of IE between 1 January 2016 and 31 December 2019. Among the 322 patients with IE, 194 had positive blood cultures in our centre. Only one patient with a time-to-positivity blood culture of more than 120 h (5 days) was found. The main cause for the 22 patients with positive blood cultures after five days was contamination with Cutibacterium acnes. Our results do not support extending the duration of incubation of blood culture bottles beyond five days for the diagnosis of infectious endocarditis, with the exception of patients with risk factors for C. acnes infection.

High tibial osteotomy performed with PEEK implant demonstrated a failure rate of 28%

2020 ◽  
pp. jisakos-2019-000394
Author(s):  
Melek Inal Hansen ◽  
Jeppe Staghøj ◽  
Nissa Khan ◽  
Lars Blønd ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Failure Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secondary Outcome ◽  
Consecutive Series ◽  
Tibial Osteotomy ◽  
Asa Score

ObjectivesOpening-wedge high tibia osteotomies (HTO) can be technically challenging. The HTO iBalance system was designed to reduce vascular complications and to avoid secondary plate removal. The purpose of the study was to evaluate the performance of the HTO iBalance system in patients with symptomatic medial osteoarthritis and varus malalignment.MethodsThe study was performed as a retrospective cohort study investigating a consecutive series of patients who underwent HTO with the iBalance system performed by a single surgeon from August 2013 to March 2016 at Zealand University Hospital, Koege, and Aleris-Hamlet Hospital. The primary outcome was the degree of realignment. The secondary outcome was Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up was performed at mean (SD) 25 (9.7) months. Weight-bearing long-leg standing radiographs were taken before surgery and at follow-up. Failure was defined as collapse of the HTO defined as a correction <50% of the intended correction at time of follow-up. Logistic regression was used to identify risk factors for failure.Results44 patients and a total of 47 knees were included in this study. Preoperatively the mechanical axis was a mean (SD) 5.8° (2.9) varus and postoperatively 2.3° (3.7) varus . The HTO failed in 13 of 47 knees (28%). Patients with failure showed no statistically significant differences to non-failure in any KOOS subscore (p>0.05). American Society of Anesthesiologists (ASA) score (p=0.01) and body mass index (BMI) (p=0.05) were correlated with failure, whereas bone transplantation and smoking were not.ConclusionIn this study, the failure rate of HTO was 28%. High BMI and ASA-score were the only risk factors associated with failure while bone grafting and smoking were not.Level of evidenceRetrospective cohort study, level III.

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