835. Comparison of the outcomes of patients with KPC and NDM-1-producing Enterobacteriaceae

Abstract Background Carbapenemase-producing Enterobacteriaceae infections are associated with high mortality. We aimed to compare the clinical outcomes of patients with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae and those with New-Delhi-Metallo-beta-lactamase-1 (NDM-1)-producing Enterobacteriaceae. Methods We performed a retrospective cohort study of all adult patients (> 16 years old) with KPC or NDM-1-producing Enterobacteriaceae isolates in a 2,700-bed tertiary referral hospital in Seoul, South Korea between 2010 and 2019. Primary outcomes were infection within 30 days and 30-day mortality after the first isolation of KPC or NDM-1-producing Enterobacteriaceae. Results A total of 859 patients were identified during the study period. Of them, 475 (55%) were KPC group and 384 (45%) were NDM-1 group. KPC group tended to develop infection within 30 days after first isolation more frequently than NDM-1 group (31% vs. 26%; P = 0.07). Thirty-day mortality was significantly higher in KPC group compared to NDM-1 group (KPC, 17% (81/475) versus NDM-1, 9% (33/384), P < 0.001). Multivariate analysis revealed that APACHE II score (adjusted odds ratio [aOR], 1.12; P < 0.001), solid cancer (aOR, 2.56; P < 0.001), previous carbapenem therapy (aOR, 1.93; P = 0.004), development of infection of KPC or NDM-1-producing Enterobacteriaceae within 30 days (aOR, 2.63; P < 0.001), and KPC-producing Enterobacteriaceae (aOR, 1.62; P = 0.045) were independent risk factors for 30-day mortality. Table 1. Results of analyses of risk factors for 30-day mortality from initial positive culture date in patients with KPC or NDM-1- producing Enterobacteriaceae Figure 1. Kaplan–Meier survival estimates of patients with KPC or NDM-1-producing Enterobacteriaceae for 30-day mortality after first isolation: KPC (continuous line) versus NDM (dotted line). (log-rank test). Conclusion Our study suggests that KPC-producing Enterobacteriaceae is associated with poorer outcome compared to NDM-1-producing Enterobacteriaceae. Therefore, patients with KPC-producing Enterobacteriaceae colonization should be monitored carefully for development of infection, and appropriate antibiotics should be initiated as soon as possible. Disclosures All Authors: No reported disclosures

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Elevated Serum IL-17 Expression at Cessation Associated with Graves’ Disease Relapse

International Journal of Endocrinology ◽

10.1155/2018/5689030 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Jianhui Li ◽

Xiaohua Sun ◽

Danzhen Yao ◽

Jinying Xia

Keyword(s):

Risk Factors ◽

Elevated Serum ◽

Antithyroid Drug ◽

Therapeutic Modality ◽

Rank Test ◽

Graves Disease ◽

Interleukin 17 ◽

High Relapse Rate ◽

Log Rank Test ◽

Kaplan Meier

Background. Antithyroid drug (ATD) treatment occupies the cornerstone therapeutic modality of Graves’ disease (GD) with a high relapse rate after discontinuation. This study aimed to assess potential risk factors for GD relapse especially serum interleukin-17 (IL-17) expression. Methods. Consecutive newly diagnosed GD patients who were scheduled to undergo ATD therapy from May 2011 to May 2014 were prospectively enrolled. Risk factors for GD relapse were analyzed by univariate and multivariate Cox proportional hazard analyses. The association between serum IL-17 expression at cessation and GD relapse was analyzed with relapse-free survival (RFS) by the Kaplan–Meier survival analysis and log-rank test. Results. Of the 117 patients, 72 (61.5%) maintained a remission for 12 months after ATD withdrawal and 45 (38.5%) demonstrated GD relapse. The final multivariate Cox analysis indicated elevated IL-17 expression at cessation to be an independent risk factor for GD relapse within 12 months after ATD withdrawal (HR: 3.04, 95% CI: 1.14–7.67, p=0.021). Patients with higher expressions of IL-17 (≥median value) at cessation demonstrated a significantly higher RFS than those with lower levels by the Kaplan–Meier analysis and log-rank test (p=0.028). Conclusions. This present study indicated elevated serum IL-17 expression at cessation to be a predictor for GD relapse within 12 months.

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The Impacts of Aspergillosis on Outcome, Burden and Risks for Mortality in Influenza Patients with Critical Illness

Journal of Fungi ◽

10.3390/jof7110922 ◽

2021 ◽

Vol 7 (11) ◽

pp. 922

Author(s):

Chien-Ming Chao ◽

Chih-Cheng Lai ◽

Hsuan-Fu Ou ◽

Chung-Han Ho ◽

Khee-Siang Chan ◽

...

Keyword(s):

Risk Factors ◽

Economic Burden ◽

Invasive Pulmonary Aspergillosis ◽

Medical Expenditure ◽

Apache Ii Score ◽

Solid Cancer ◽

Severe Influenza ◽

Group 3 ◽

Group 2 ◽

Group 1

Previous studies have revealed higher mortality rates in patients with severe influenza who are coinfected with invasive pulmonary aspergillosis (IPA) than in those without IPA coinfection; nonetheless, the clinical impact of IPA on economic burden and risk factors for mortality in critically ill influenza patients remains undefined. The study was retrospectively conducted in three institutes. From 2016 through 2018, all adult patients with severe influenza admitted to an intensive care unit (ICU) were identified. All patients were classified as group 1, patients with concomitant severe influenza and IPA; group 2, severe influenza patients without IPA; and group 3, severe influenza patients without testing for IPA. Overall, there were 201 patients enrolled, including group 1 (n = 40), group 2 (n = 50), and group 3 (n = 111). Group 1 patients had a significantly higher mortality rate (20/40, 50%) than that of group 2 (6/50, 12%) and group 3 (18/11, 16.2%), p < 0.001. The risk factors for IPA occurrence were solid cancer and prolonged corticosteroid use in ICU of >5 days. Group 1 patients had significantly longer hospital stay and higher medical expenditure than the other two groups. The risk factors for mortality in group 1 patients included patients’ Charlson comorbidity index, presenting APACHE II score, and complication of severe acute respiratory distress syndrome. Overall, IPA has a significant adverse impact on the outcome and economic burden of severe influenza patients, who should be promptly managed based on risk host factors for IPA occurrence and mortality risk factors for coinfection with both diseases.

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Early liver injury is closely related to organ failure of sepsis

10.21203/rs.2.21859/v1 ◽

2020 ◽

Author(s):

Milin Peng ◽

Yuhang Ai ◽

Lina Zhang ◽

Shuangping Zhao ◽

Zhiyong Liu ◽

...

Keyword(s):

Regression Analysis ◽

Liver Injury ◽

Renal Dysfunction ◽

Organ Failure ◽

Rank Test ◽

Apache Ii Score ◽

Icu Admission ◽

Kaplan Meier ◽

Injury Group ◽

The Impact

Abstract Backgrounds: Sepsis induced organ failure is main cause of mortality in intensive care units (ICU), however, the impact of early liver injury on clinical ending of sepsis is not clear and has not been discussed in context of clinical research on sepsis before. Our study aimed at the investigation of the clinical effect of early liver injury within 48h at ICU admission on sepsis outcomes. Methods: A single-centered, retrospective cohort of 198 adult critical patients diagnosed with sepsis were included in different ICU departments of Xiangya hospital from 2016 to 2018. Patients were divided into two groups, early liver injury and non-early liver injury within 48h at ICU admission. Baseline characteristics, clinical outcomes and risk factors of these two groups were studied. Logistic regression analysis, Cox hazard analysis, Kaplan-Meier and log-rank test were used. Results: In total, 198 patients with sepsis were included, with 106 (53.5%) with early liver injury and overall in-hospital mortality was 45.9% (n=91). Compared to non-early liver injury group, patients with early liver injury had significant higher SOFA (7.44±3.83 vs. 5.55±2.61, P<0.001), APACHE II score (15.22±23.14 vs. 9.14±8.72, P=0.013) , procalcitonin (37.10±59.20 vs. 19.24±48.10, P=0.021) , and rate of shock (63.2% vs. 48.9%, P=0.046). Primary outcome showed that early liver injury group had significant higher rate of renal dysfunction (62.3 vs. 33.7%, P<0.001), coagulation (31.1% vs. 13.0%, P=0.004) and hematologic system (72.6% vs. 52.2%, P=0.003) dysfunction hinting at higher organ failure rate. Age (OR 0.966; 95% CI 0.944-0.989; P=0.004), hypertriglyceridemia (OR 1.636; 95% CI 1.049-2.551; P=0.030), serum total bile acid (TBA, OR 1.071; 95% CI 1.030-1.113; P=0.001), hemoglobin (OR 1.030; 95% CI 1.013-1.046; P<0.001) and renal dysfunction (OR 3.403; 95% CI 1.631-7.099; P=0.001) were the independent predictors for early liver injury in sepsis by multiple regression analysis. Kaplan-Meier survival analyze demonstrated early liver injury and non-early liver injury group had similar survival time. Conclusion: Early liver injury within 48 hours on ICU admission is closely related to organ failure for patients with sepsis. Future study with big data is required to verify our viewpoint.

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Comparison of the Clinical Outcomes of Patients With Positive Xpert Carba-R Tests for Carbapenemase-Producing Enterobacterales According to Culture Positivity

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab594 ◽

2022 ◽

Vol 9 (1) ◽

Author(s):

Hyeonji Seo ◽

Jeong-Young Lee ◽

Seung Hee Ryu ◽

Sun Hee Kwak ◽

Eun Ok Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Positive Culture ◽

Antibiotic Use ◽

Rapid Identification ◽

Tertiary Referral Hospital ◽

Klebsiella Pneumoniae Carbapenemase ◽

Culture Positivity ◽

Significant Difference ◽

History Of ◽

Lower Transmission

Abstract Background We aimed to compare the clinical outcomes of patients with positive Xpert Carba-R assay results for carbapenemase-producing Enterobacterales (CPE) according to CPE culture positivity. Methods We retrospectively collected data for patients with positive CPE (positive Xpert Carba-R or culture) who underwent both tests from August 2018 to March 2021 in a 2700-bed tertiary referral hospital in Seoul, South Korea. We compared the clinical outcomes of patients positive for Xpert Carba-R according to whether they were positive (XPCP) or negative (XPCN) for CPE culture. Results Of 322 patients with CPE who underwent both Xpert Carba-R and culture, 313 (97%) were positive for Xpert Carba-R for CPE. Of these, 87 (28%) were XPCN, and 226 (72%) were XPCP. XPCN patients were less likely to have a history of previous antibiotic use (75.9% vs 90.3%; P = .001) and to have Klebsiella pneumoniae carbapenemase (21.8% vs 48.9%; P < .001). None of the XPCN patients developed infection from colonization within 6 months, whereas 13.4% (29/216) of the XPCP patients did (P < .001). XPCN patients had lower transmission rates than XPCP patients (3.0% [9/305] vs 6.3% [37/592]; P = .03). There was no significant difference in CPE clearance from positive culture results between XPCN and XPCP patients (40.0% [8/20] vs 26.7% [55/206]; P = .21). Conclusions Our study suggests that XPCN patients had lower rates of both infection and transmission than XPCP patients. The Xpert Carba-R assay is clinically useful not only for rapid identification of CPE but also for predicting risks of infection and transmission when performed along with culture.

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Survival in a cohort of patients with lung cancer: the role of age and gender in prognosis

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016000000298 ◽

2017 ◽

Vol 43 (6) ◽

pp. 431-436 ◽

Cited By ~ 3

Author(s):

Juliana Pereira Franceschini ◽

Sérgio Jamnik ◽

Ilka Lopes Santoro

Keyword(s):

Lung Cancer ◽

Age Distribution ◽

Age Groups ◽

Rank Test ◽

Age Group ◽

Tertiary Referral Hospital ◽

Kaplan Meier ◽

Stage Disease ◽

And Gender ◽

Disease Stages

ABSTRACT Objective: To determine the demographic and clinical characteristics of patients with non-small cell lung cancer (NSCLC), as well as their disease course, by age group and gender. Methods: This was a retrospective cohort study of patients diagnosed with NSCLC from 2000 to 2012 and followed until July 2015 in a tertiary referral hospital in the city of São Paulo, Brazil. Based on the 25th and 75th percentiles of the age distribution, patients were stratified into three age groups: < 55 years; ≥ 55 and < 72 years; and ≥ 72 years. Survival time was evaluated during the follow-up period of the study. Functions of overall and gender-specific survival stratified by age groups (event: all-cause mortality) were calculated using the Kaplan-Meier method. Differences among survival curves were assessed via the log-rank test. Results: We included 790 patients with the following age distribution: < 55 years, 165 patients; ≥ 55 and < 72 years, 423; and ≥ 72 years, 202. In the entire sample, there were 493 men (62.4%). Adenocarcinoma was the most common histological pattern in the < 72-year age groups; 575 patients (73%) presented with advanced disease (stages IIIB-IV). The median 5-year survival was 12 months (95% CI: 4-46 months), with no significant differences among the age groups studied. Conclusions: NSCLC remains more common in men, although we found an increase in the proportion of the disease in women in the < 55-year age group. Adenocarcinoma predominated in women. In men, squamous cell carcinoma predominated in the ≥ 72-year age group. Most patients presented with advanced-stage disease at diagnosis. There were no statistical differences in survival between genders or among age groups.

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Bacterial and Fungal Co-Infections in Patients with COVID-19 Related Pneumonia: A Retrospective Cohort Study

Journal of Bacteriology and Mycology ◽

10.26420/jbacteriolmycol.2021.1183 ◽

2021 ◽

Vol 8 (5) ◽

Author(s):

Bedini A ◽

◽

Menozzi M ◽

Cuomo G ◽

Franceschini E ◽

...

Keyword(s):

Risk Factors ◽

Fungal Infections ◽

Multivariable Analysis ◽

Cumulative Risk ◽

Positive Culture ◽

Antifungal Prophylaxis ◽

Cumulative Probability ◽

Kaplan Meier ◽

Enterococcus Spp ◽

The Impact

Background: The study analyzed risk factors for bacterial and fungal coinfection in patients with COVID-19 and the impact on mortality. Methods: This is a single-center retrospective study conducted on 387 patients with confirmed COVID-19 pneumonia admitted to an Italian Tertiarycare hospital, between 21 February 2020 and 31 May 2020. Bacterial/fungal coinfection was determined by the presence of characteristic clinical features and positive culture results. Multivariable logistic regression was used to analyze risk factors for the development of bacterial/fungal co-infection after adjusting for demographic characteristics and comorbidities. Thirty-day survival of the patients with or without co-infections was analyzed by Kaplan- Meier method. Results: In 53/387 (13.7%) patients with COVID-19 pneumonia, 67 episodes of bacterial/fungal co-infection occurred (14 presented >1 episode). Pneumonia was the most frequent co-infection (47.7%), followed by BSI (34.3%) and UTI (11.9%). S. aureus was responsible for 24 episodes (35.8%), E. coli for 7 (10.4%), P. aerugionsa and Enterococcus spp. for 5 episodes each (7.4%). Five (7.4%) pulmonary aspergillosis, 3 (4.4%) pneumocystosis and 5 (7.4%) invasive candidiasis were observed. Multivariable analysis showed a higher risk of infection in patients with an age >65 years (csHR 2.680; 95% CI: 1.254-5.727; p=0.054), with cancer (csHR 5.243; 95% CI: 1.173-23.423; p=0.030), with a LOS >10 days (csHR 12.507; 95% CI: 2.659 - 58.830; p=0.001), early (within 48h) admitted in ICU (csHR 11.766; 95% CI: 4.353-31.804; p<0.001), and with a SOFA score >5 (csHR 3.397; 95% CI: 1.091-10.581; p=0.035). Estimated cumulative risk of developing at least 1 bacterial/fungal co-infection episode was of 15% and 27% after 15 and 30 days from admission, respectively. Kaplan-Meier estimated a higher cumulative probability of death in patients with bacterial/fungal co-infection (log-rank=0.031). Thirty-day mortality rate of patients with pneumonia was 38.7%, higher than those with BSI (30.4%). Conclusions: Bacterial and fungal infections are a serious complication affecting the survival of patients with COVID-19- related pneumonia. Some issues need to be investigated, such as the best empirical antibiotic therapy and the need for possible antifungal prophylaxis.

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Preoperative albumin-to-fibrinogen ratio predicts chemotherapy resistance and prognosis in patients with advanced epithelial ovarian cancer

Journal of Ovarian Research ◽

10.1186/s13048-019-0563-8 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 6

Author(s):

Wen Yu ◽

Zhongxue Ye ◽

Xi Fang ◽

Xingzhi Jiang ◽

Yafen Jiang

Keyword(s):

Risk Factors ◽

Ovarian Cancer ◽

Prognostic Factors ◽

Chemotherapy Resistance ◽

Curve Analysis ◽

Rank Test ◽

Debulking Surgery ◽

Roc Curve Analysis ◽

Log Rank Test ◽

Kaplan Meier

Abstract Background Epithelial ovarian cancer (EOC) is the majority ovarian cancer (OC) type with a poor prognosis. This present study aimed to investigate potential prognostic factors including albumin-to-fibrinogen ratio (AFR) for advanced EOC patients with neoadjuvant chemotherapy (NAC) followed by debulking surgery. Methods A total of 313 advanced EOC patients with NAC followed by debulking surgery from 2010 to 2017 were enrolled. The predictive value of AFR for the overall survival (OS) was evaluated by receiver operating characteristic (ROC) curve analysis. The univariate and multivariate Cox proportional hazards regression analyses were applied to investigate prognostic factors for advanced EOC patients. The association between preoperative AFR and progression free survival (PFS) or OS was determined via the Kaplan–Meier method using log-rank test. Results The ROC curve analysis showed that the cutoff value of preoperative AFR in predicting OS was determined to be 7.78 with an area under the curve (AUC) of 0.773 (P < 0.001). Chemotherapy resistance, preoperative CA125 and AFR were independent risk factors for PFS in advanced EOC patients. Furthermore, chemotherapy resistance, residual tumor and AFR were significant risk factors for OS by multivariate Cox analysis. A low preoperative AFR (≤7.78) was significantly associated with a worse PFS and OS via the Kaplan–Meier method by log-rank test (P < 0.001). Conclusions A low preoperative AFR was an independent risk factor for PFS and OS in advanced EOC patients with NAC followed by debulking surgery.

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Mortalidade de indivíduos idosos cardíacos tratados com digoxina

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/rrecien2358-3088.2020.10.29.120-128 ◽

2020 ◽

Vol 10 (29) ◽

pp. 120-128

Author(s):

Edivaldo Cremer ◽

Almir Conrrado Rodrigues de Lima ◽

Larissa Laila Cassarotti ◽

Gabrielle Rodrigues Munhoz ◽

Romulo Jordão Barbosa Pedrinho ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Survival Rates ◽

Rank Test ◽

Factors Associated ◽

Kaplan Meier ◽

Insuficiencia Cardiaca ◽

Cardiology Clinic ◽

Factores De Riesgo ◽

Potential Risk Factors

Objetivou-se descrever as taxas de mortalidade e sobrevida de idosos com insuficiência cardíaca que fizeram uso de digoxina, bem como identificar os fatores de risco associados à mortalidade. Prontuários de pacientes idosos (≥60 anos) atendidos no ambulatório de cardiologia para insuficiência cardíaca e que fizeram uso de digoxina foram triados e selecionados para este estudo retrospectivo. Variáveis sociodemográficas e clínicas foram mensuradas. A sobrevida foi verificada pelas curvas de Kaplan-Meier e teste log-rank. A regressão logística múltipla ajustada foi utilizada para avaliar os potenciais fatores de risco associados à mortalidade. Dos 65 prontuários analisados a sobrevida foi menor nos pacientes que utilizavam a dosagem de 0,125mg (p=0,093). A taxa de mortalidade foi de 35,9% e as chances de óbitos aumentaram nos indivíduos com idade acima de 76 anos (p=0,010; ORaj: 4,021), que possuíam outras doenças cardíacas (p=0,004; ORaj: 5,943) e com maior tempo de uso da digoxina (p=0,047; ORaj: 1,164).Descritores: Digoxina, Mortalidade, Idoso. Mortality of digoxin-treated elderly cardiac subjectsAbstract: This study aimed to describe the mortality and survival rates of elderly with heart failure who used digoxin, as well as to identify the risk factors associated with mortality. Records of elderly patients (≥60 years old) treated at the heart failure outpatient cardiology clinic were screened and selected for this retrospective study. Sociodemographic and clinical variables were measured. Survival was verified by Kaplan-Meier curves and log-rank test. Adjusted multiple logistic regression was used to assess potential risk factors associated with mortality. Of the 65 medical records analyzed, survival was lower in patients using 0.125 mg (p=0.093). The mortality rate was 35.9% and the chances of death increased in individuals over the age of 76 years (p=0.010; ORaj: 4.021), who had other heart disease (p=0.004; ORaj: 5.943) and with longer use of digoxin (p=0.047; ORaj: 1.164).Descriptors: Digoxin, Mortality, Aged. Mortalidad de ancianos cardiacos tratados con digoxinaResumen: El objetivo es describir las tasas de mortalidad y supervivencia de personas mayores con insuficiencia cardíaca que usaban digoxina, así como identificar los factores de riesgo asociados con la mortalidad. Los registros de pacientes ancianos (≥60 años de edad) tratados en la clínica ambulatoria de cardiología con insuficiencia cardíaca se examinaron para este estudio retrospectivo. Se midieron variables sociodemográficas y clínicas. La supervivencia se verificó mediante curvas de Kaplan-Meier y prueba de log-rank. Se utilizó la regresión logística múltiple ajustada para evaluar los posibles factores de riesgo asociados con la mortalidad. De los 65 registros médicos analizados, la supervivencia fue menor en los pacientes que utilizaron 0.125 mg (p=0.093). La tasa de mortalidad fue de 35.9% y las posibilidades de muerte aumentaron en personas mayores de 76 años (p=0.010; ORaj: 4.021), que tenían otras enfermedades cardíacas (p=0.004; ORaj: 5.943) y con uso más prolongado de digoxina (p=0.047; ORaj: 1.164).Descriptores: Digoxina, Mortalidad, Anciano.

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Risk factors for periorbital dermatitis in patients using dorzolamide/timolol eye drops

Scientific Reports ◽

10.1038/s41598-021-97565-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Myungjin Kim ◽

Hyoju Jang ◽

Seungsoo Rho

Keyword(s):

Risk Factors ◽

Corneal Thickness ◽

Systemic Hypertension ◽

Rank Test ◽

Eye Drops ◽

Ocular Surgery ◽

Log Rank Test ◽

Kaplan Meier ◽

History Of ◽

Univariate Analyses

AbstractThis study assessed the clinical risk factors for periorbital dermatitis (PD) after using dorzolamide/timolol eye drops in a total of 1282 glaucoma patients. Both the PD(+) group and the PD(−) group were evaluated using clinical data such as age, sex, dosing duration, presence of benzalkonium chloride (BAK) in the formulation, ocular surgery history (e.g. cataract or glaucoma operations), height, weight, personal history of systemic hypertension, smoking, alcohol consumption, intraocular pressure, best-corrected visual acuity (BCVA), central corneal thickness, axial length, and visual field index (VFI). Univariate analyses showed that shorter dosing duration, higher rate of BAK-included cases, worse BCVA, worse VFI, more systemic hypertension history, and more ocular surgery history were more associated with the PD(+) group than the PD(−) group. The BAK(−) group showed a lower PD rate than the BAK-included group, which was supported by the Kaplan–Meier analysis (log-rank test, p = 0.0014). Multivariate analyses revealed that the probability of PD increased by 8 times if they had a history of ocular surgery and increased by 2.3% when the VFI decreased by 1% (Cox’s hazard regression test, p < 0.001). Therefore, a preservative-free dorzolamide/timolol can benefit the subjects for those who had ocular surgery or who have worse VFI.

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Risk Factors for Viridans Group Streptococcal Bacteremia in Neutropenic and Non-neutropenic Patients: A Single Center Case-Case-Control Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx260 ◽

2017 ◽

Vol 5 (1) ◽

Cited By ~ 1

Author(s):

Augusto Dulanto Chiang ◽

Ninet Sinaii ◽

Tara N Palmore

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Conditional Logistic Regression ◽

Multivariable Analysis ◽

Positive Culture ◽

Case Control ◽

Rank Test ◽

Clinical Factors ◽

Neutropenic Patients ◽

Control Study

Abstract Background Viridans group streptococcal (VGS) bacteremia is common among neutropenic patients. Although VGS bacteremia occurs in non-neutropenic patients, risk factors are not well established. We conducted a case-case-control study to identify risk factors for VGS among neutropenic and non-neutropenic patients. Methods Patients with VGS bacteremia between January 2009 and December 2014 in our 200-bed clinical research hospital were identified using microbiology records. Neutropenic and non-neutropenic patients at the time of positive culture were matched 1:1 to controls on the basis of neutrophil count (ANC), ward, and length of stay. We extracted demographic, laboratory, medication, and other clinical data from chart reviews. Data were analyzed using McNemar’s test, Wilcoxon signed-rank test, and conditional logistic regression modeling. Results Among 101 patients, 63 were neutropenic and 38 non-neutropenic at the time of VGS bacteremia. In multivariable analysis of neutropenic patients, only lower ANC predicted VGS bacteremia (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.05–0.59; P = 0.006). Recent use of vancomycin was protective (OR, 0.23; 95% CI, 0.07–0.73; P = 0.013). No clinical factors were associated with VGS in the non-neutropenic cases. Conclusions Only lower ANC nadir increased the risk for VGS bacteremia in the neutropenic group, and vancomycin was protective. Other previously described factors (chemotherapy, radiation, oral conditions) related to neutropenia were not independently associated with VGS bacteremia. No tested clinical factors predicted infection in the non-neutropenic group. Our results suggest that VGS bacteremia should be anticipated when making antimicrobial choices in profoundly neutropenic patients, and merit further exploration in non-neutropenic patients.

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