1591. Antibiotic Utilization Trends in Veterans Affairs (VA) Patients with Carbapenem Resistant Enterobacteriaceae (CRE) Infections

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are classified as an “urgent threat” to public health. Historically, colistin and tigecycline had been considered the drugs of choice for CRE infections, while other agents such as aminoglycosides and carbapenems had been used as adjunctive therapy. However, the FDA approval of ceftazidime-avibactam in 2015, meropenem-vaborbactam in 2017, and plazomicin in 2018 has expanded treatment options. Our purpose was to assess trends in CRE treatment for “new” antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) as compared with other antibiotics with CRE activity. Methods This was a retrospective cohort study describing treatment of CRE blood stream infections (BSI) across 134 VA facilities from 2012-2018. Patients were censored at their first positive blood culture with CRE. Categorical data was assessed with a Fisher’s exact test or chi-square test. Trends test and logistic regression were used to describe changes in CRE treatment over time. Results 724 patients with positive blood cultures for CRE were identified during the study period. Most patients were male (94%), white (32%) or Hispanic (38%), and the mean age was 71.5+11.9. Of those patients that received antibiotics (N=697), 53.4% carbapenems, 40.3% received aminoglycosides, 39.3% received polymyxins, 32.9% penicillins, 32.6% extended spectrum cephalosporins, 26.1% fluoroquinolones, 11.6% ceftazidime/avibactam, and 0.4% ceftolazone/tazobactam. Over the study period, there was decreased utilization of aminoglycosides (P < 0.0026) and colistin (P< 0.002) and increases in extended spectrum cephalosporins (P < 0.001) and ceftazidime/avibactam (P < 0.001). Conclusion Utilization of “older” agents such as aminoglycosides and polymyxins for the treatment of CRE blood stream infections is decreasing in the VA. Treating CRE with ceftazidime/avibactam, a newly approved antibiotic, and extended spectrum cephalosporins are increasing. Disclosures All Authors: No reported disclosures

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2145. Carbapenem-Resistant Enterobacteriaceae infections at the Maharaj Nakorn Chiang Mai Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1825 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S727-S727

Author(s):

Romanee Chaiwarith ◽

Wisarut Supparatpinyo

Keyword(s):

Univariate Analysis ◽

Tertiary Care ◽

Control Measures ◽

Fisher Exact Test ◽

Care Hospital ◽

Chiang Mai ◽

Chi Square ◽

Exact Test ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Nowadays, carbapenem-resistant enterobacteriaceae (CRE) infection has been spreading worldwide in a tertiary care hospital and causing globally health damage. In Thailand, the studies of the epidemiology of CRE are scarce. This study aimed to describe epidemiology, clinical characteristics and treatment outcome of CRE infection. Methods A retrospective cohort study was conducted among patients admitted to the Maharaj Nakorn Chiang Mai Hospital between January 2014 and December 2016 who had clinical diagnosis of CRE infection. Characteristics between groups were compared using Chi-square, Fisher exact test or Student t-test, Mann–Whitney U test. Factors associated with mortality in univariate analysis were analyzed in the logistic regression model. Results Among 241 patients who had clinical specimens grew CRE, 51 had infection. Twenty-five patients (49%) were previously hospitalized within 90 days and 42 patients (82.4%) had exposed to antibiotics before documented CRE infection. The most common sites of clinical isolates were urine (33.3%), sputum (29.4%), and blood (21.6%). The mortality rate was 47.1%, which 17 (33.3%) patients’ death was attributable to CRE infection. Factor associated with mortality was higher body temperature (OR 4.8, P = 0.005) and thrombocytopenia. Conclusion CRE infections cause high mortality. Strategies to prevent emergence through prudent uses of antibiotics and transmission through infection control measures should be implemented in order to reduce mortality. Disclosures All authors: No reported disclosures.

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CARBAPENEM-RESISTANT ENTEROBACTERIACEAE: NEW MENACE TO OUR ANTIBIOTIC ARMAMENTARIUM!

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i9.19448 ◽

2017 ◽

Vol 10 (9) ◽

pp. 335

Author(s):

Ankita Porwal ◽

Sevitha Bhat

Keyword(s):

Risk Factors ◽

Polymyxin B ◽

Isolation Rate ◽

Chi Square ◽

Carbapenem Resistant ◽

Chi Square Test ◽

Vitek 2 ◽

The Common ◽

Common Infection ◽

Carbapenem Resistant Enterobacteriaceae

Objective: To study the risk factors, clinical characteristics, and outcome in patients with infections due to CRE infections.Methods: Retrospective study was carried out in a microbiology laboratory for 6 months. 152 CRE isolates identified by the Vitek 2 compact system were included in the study. The risk factors, antibiotic treatment and clinical outcome were studied from the case sheets, Chi-square test was used for statistical analysis.Results: Of the 2520 positive cultures for Enterobacteriaceae, isolation rate of CRE was 152 (6%). 76 (50%) belonged to exudates, 22 (14.1%) blood culture, 90 (59.2%) urine. The common infection was UTI. The risk factors were prior exposure to antimicrobials, admission to intensive care unit, indwelling devices and prior hospitalization. The effective antibiotic was colistin, polymyxin B, tigecycline, cefoperazone-sulbactum, piperacillin-tazobactum. The mortality was 19.7%.Conclusion: We have demonstrated the value of understanding local epidemiology to help modify our risk-based screening as a strategy to limit the spread of CRE.

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Phenotypic Detection of Carbapenemase Production in Carbapenem-Resistant Enterobacteriaceae by Modified Hodge Test and Modified Strip Carba NP Test

Journal of Laboratory Physicians ◽

10.1055/s-0041-1723859 ◽

2021 ◽

Author(s):

Nisha Patidar ◽

Nitya Vyas ◽

Shanoo Sharma ◽

Babita Sharma

Keyword(s):

Carbapenem Resistance ◽

Nonparametric Test ◽

Multidrug Resistant ◽

Clinical Samples ◽

Chi Square ◽

Carbapenem Resistant ◽

The Social ◽

Significant Difference ◽

High Degree ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Objective Carbapenems are last resort antibiotics for multidrug-resistant Enterobacteriaceae. However, resistance to carbapenem is increasing at an alarming rate worldwide leading to major therapeutic failures and increased mortality rate. Early and effective detection of carbapenemase producing carbapenem-resistant Enterobacteriaceae (CRE) is therefore key to control dissemination of carbapenem resistance in nosocomial as well as community-acquired infection. The aim of present study was to evaluate efficacy of Modified strip Carba NP (CNP) test against Modified Hodge test (MHT) for early detection of carbapenemase producing Enterobacteriaceae (CPE). Material and Methods Enterobacteriaceae isolated from various clinical samples were screened for carbapenem resistance. A total of 107 CRE were subjected to MHT and Modified strip CNP test for the detection of CPE. Statistical Analysis It was done on Statistical Package for the Social Sciences (SPSS) software, IBM India; version V26. Nonparametric test chi-square and Z-test were used to analyze the results within a 95% level of confidence. Results Out of 107 CRE, 94 (88%) were phenotypically confirmed as carbapenemase producer by Modified strip CNP test and 46 (43%) were confirmed by Modified Hodge Test (MHT). Thirty-eight (36%) isolates showed carbapenemase production by both MHT and CNP test, 56 isolates (52%) were CNP test positive but MHT negative, eight (7%) isolates were MHT positive but CNP test negative and five (5%) isolates were both MHT and CNP test negative. There is statistically significant difference in efficiency of Modified CNP test and MHT (p < 0.05). Conclusion Modified strip CNP test is simple and inexpensive test which is easy to perform and interpret and gives rapid results in less than 5 minutes. It has high degree of sensitivity and specificity. Modified strip CNP test shows significantly higher detection capacity for carbapenemase producers as compared with MHT.

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Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

Vascular and Endovascular Surgery ◽

10.1177/15385744211022598 ◽

2021 ◽

pp. 153857442110225

Author(s):

Joel Mathew John ◽

Vimalin Samuel ◽

Dheepak Selvaraj ◽

Prabhu Premkumar ◽

Albert A Kota ◽

...

Keyword(s):

Clinical Outcomes ◽

Interventional Procedure ◽

Tertiary Care ◽

Arterial Disease ◽

Multivariable Logistic Regression Analysis ◽

Tertiary Care Centre ◽

Chi Square ◽

Exact Test ◽

Institutional Review ◽

Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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Association of cervical carcinogenesis risk with HPV16 E6 and E7 variants in the Taizhou area, China

BMC Cancer ◽

10.1186/s12885-021-08531-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mei-Zhen Dai ◽

Yi Qiu ◽

Xing-Hong Di ◽

Wei-Wu Shi ◽

Hui-Hui Xu

Keyword(s):

Cervical Cancer ◽

Cervical Carcinogenesis ◽

Chi Square ◽

Major Health Problem ◽

Hpv16 E6 ◽

Exact Test ◽

Chi Square Test ◽

E6 And E7

Abstract Background Human papillomavirus (HPV) type 16 accounts for a larger share of cervical cancer and has been a major health problem worldwide for decades. The progression of initial infection to cervical cancer has been linked to viral sequence properties; however, the role of HPV16 variants in the risk of cervical carcinogenesis, especially with longitudinal follow-up, is not fully understood in China. Methods We aimed to investigate the genetic variability of HPV16 E6 and E7 oncogenes in isolates from cervical exfoliated cells. Between December 2012 and December 2014, a total of 310 single HPV16-positive samples were selected from women living in the Taizhou area, China. Sequences of all E6 and E7 oncogenes were analysed by PCR-sequencing assay. Detailed sequence comparison, genetic heterogeneity analyses and maximum-likelihood phylogenetic tree construction were performed with BioEdit Sequence Alignment Editor and MEGA X software. Data for cytology tests and histological diagnoses were obtained from our Taizhou Area Study with longitudinal follow-up for at least 5 years. The relationship between HPV16 variants and cervical carcinogenesis risk was analysed by the chi-square test or Fisher’s exact test. Results In this study, we obtained 64 distinct variation patterns with the accession GenBank numbers MT681266-MT681329. Phylogenetic analysis revealed that 98.3% of HPV16 variants belong to lineage A, in which the A4 (Asian) sublineage was dominant (64.8%), followed by A2 (12.1%), A1 (11.4%), and A3 (10.0%). The A4 (Asian) sublineage had a higher risk of CIN2+ than the A1–3 (European) sublineages (OR = 2.69, 95% CI = 1.04–6.97, P < 0.05). Furthermore, nucleotide variation in HPV16 E6 T178G is associated with the development of cervical cancer. Conclusion These data could provide novel insights into the role of HPV16 variants in cervical carcinogenesis risk in China.

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Hardy-Weinberg Testing for Continuous Data

Genetics ◽

10.1093/genetics/147.4.1965 ◽

1997 ◽

Vol 147 (4) ◽

pp. 1965-1975

Author(s):

Lauren M McIntyre ◽

B S Weir

Keyword(s):

Intraclass Correlation ◽

Kernel Density ◽

Variable Number ◽

Continuous Data ◽

Test Statistic ◽

Test Procedures ◽

Chi Square ◽

Exact Test ◽

Chi Square Test ◽

The Many

Abstract Estimation of allelic and genotypic distributions for continuous data using kernel density estimation is discussed and illustrated for some variable number of tandem repeat data. These kernel density estimates provide a useful representation of data when only some of the many variants at a locus are present in a sample. Two Hardy-Weinberg test procedures are introduced for continuous data: a continuous chi-square test with test statistic TCCS and a test based on Hellinger's distance with test statistic TCCS. Simulations are used to compare the powers of these tests to each other and to the powers of a test of intraclass correlation TIC, as well as to the power of Fisher's exact test TFET applied to discretized data. Results indicate that the power of TCCS is better than that of THD but neither is as powerful as TFET. The intraclass correlation test does not perform as well as the other tests examined in this article.

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Leadership and Motivation as Important Aspects of the International Company’s Corporate Culture

Sustainability ◽

10.3390/su13073916 ◽

2021 ◽

Vol 13 (7) ◽

pp. 3916

Author(s):

Ingrida Košičiarová ◽

Zdenka Kádeková ◽

Peter Štarchoň

Keyword(s):

Corporate Culture ◽

Rank Correlation ◽

Chi Square ◽

Exact Test ◽

Main Research ◽

Leadership Motivation ◽

Kendall Rank Correlation ◽

Friedman's Test ◽

Chi Square Test

Although the issue of corporate culture has been taken over and addressed in the literature from various perspectives, there are very few researchers about the role of leadership and motivation in it, respectively very few researchers have addressed them as important components of the international company’s corporate culture. The present paper aims to point out that leadership and motivation can be perceived as important aspects of the international company’s corporate culture. The object of the investigation was an international company (situated in Italy) and its five subsidiaries (situated in Italy, Czech Republic, Germany, and Turkey). As the main research method, there was chosen the method of the questionnaire survey, which was attempted by all the company’s employees (totally 270 respondents). The questionnaire was divided into three separate, but logically related parts—leadership, motivation, and corporate culture, and submitted to two groups of respondents—the company’s management and its employees. In total 11 hypotheses were formulated and further evaluated by the methods of Pearson Chi-square Test, Fisher’s Exact Test, Cramer’s V coefficient, Kendall rank correlation coefficient, Eta coefficient, Spearman coefficient, Mann–Whitney U test and Wilcoxon W statistics, Kruskal–Wallis test, and Friedman’s test. The results of the research have proven that leadership and motivation are important parts of the corporate culture.

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F-Test Alternatives to Fisher’s Exact Test and to the Chi-Square Test of Homogeneity in 2 × 2 Tables

Journal of Educational Statistics ◽

10.3102/10769986008001059 ◽

1983 ◽

Vol 8 (1) ◽

pp. 59-73 ◽

Cited By ~ 1

Author(s):

John E. Overall ◽

Robert R. Starbuck

Keyword(s):

Beta Distribution ◽

Binary Response ◽

Binomial Model ◽

Chi Square ◽

Exact Probability ◽

Exact Test ◽

Mutual Dependence ◽

Treatment Groups ◽

Test Of Homogeneity ◽

Chi Square Test

A binomial model is proposed for testing the significance of differences in binary response probabilities in two independent treatment groups. Without correction for continuity, the binomial statistic is essentially equivalent to Fisher’s exact probability. With correction for continuity, the binomial statistic approaches Pearson’s chi-square. Due to mutual dependence of the binomial and F distributions on the beta distribution, a simple F statistic can be used for computation instead of the binomial.

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Association between tumor mutational burden (TMB) and immune-related adverse events (irAEs) in patients (pts) with metastatic urothelial carcinoma (mUC) during checkpoint immunotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.489 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 489-489

Author(s):

Elie W. Akl ◽

Pier Vitale Nuzzo ◽

Elio Adib ◽

Amin Nassar ◽

Sarah Abou Alaiwi ◽

...

Keyword(s):

Sequencing Data ◽

Chi Square ◽

P Values ◽

Exact Test ◽

Radiological Data ◽

Tumor Mutational Burden ◽

Chi Square Test ◽

Metastatic Urothelial Carcinoma ◽

Multivariable Regression ◽

The Relationship

489 Background: Immune checkpoint inhibition (ICI) has greatly improved clinical outcomes for pts with mUC and other cancers. ICI is associated with a class of AEs, deemed irAEs due to immune activation. Nonetheless, biomarkers associated with irAE are still lacking. We hypothesized that the immune response against neoantigens is partly responsible for irAEs and investigated the association between irAEs, TMB and response to ICI. Methods: We identified patients with mUC at Dana Farber Cancer Institute who were treated with ICI (monotherapy or combination) and had available tumor sequencing data through Oncopanel. TMB was calculated using the number of non-synonymous exonic mutations per megabase. The severity of irAEs was graded using CTCAE v.5.0. Mann-Whitney U test was performed to identify association between TMB, incidence and grade of irAEs. A cut-off of 10/mb was assigned for TMB. Fisher’s exact test was used to evaluate the radiologic response between pts with and without irAEs and low vs. high TMB. Multivariable linear regression was used to assess the relationship between TMB, irAEs and response. p-values were adjusted using Benjamini-Hochberg method. Results: Of 101 pts with mUC who met the inclusion criteria, 32 (32%) reported irAEs. 6 (6%) were grade (G)1, 20 (20%) were G2, and 6 (6%) were G3. Median(m) time on therapy was 84 days for pts without irAEs and 88 days for pts with irAEs. Pts with irAEs had higher mTMB (15.4/mb) compared to pts with no irAEs (9.8) ( p = 0.01). In pts on monotherapy (93), those with irAEs (n=27) had a higher mTMB (15.13/mb) compared to pts with no irAEs (n=66) (mTMB = 10.20/mb) ( p = 0.01). Out of 94 pts with radiological data, response was achieved in 16 (50%) pts with irAE vs 10 (16%) pts with no irAE ( p < 0.001). When both irAE and response were included in a multivariable regression, the association between irAE and TMB was not significant ( p = 0.4). Pts with both irAE and high TMB had a response rate of 56% which was significantly higher than those with either irAE but low TMB (28.6%) or high TMB but no irAE (21.2 %) or low TMB and no irAE (10.3%) (Chi-square test p = 0.002; FDR corrected p-values for individual comparisons in Table). There was no association between TMB and irAE grade. Conclusions: Higher TMB was associated with higher incidence of irAEs in pts with mUC on ICIs. Moreover, pts with both high TMB and irAEs exhibited better response rates than those with only high TMB or irAEs, suggesting that they may provide complementary tumor and host characteristics. Further evaluation in mUC is needed to confirm this relationship between TMB, irAEs and response in a larger cohort and explore specific mutational signatures that may be associated with irAEs. [Table: see text]

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