scholarly journals Difference in the clinical outcome of bloodstream infections caused by Klebsiella aerogenes and Enterobacter cloacae complex

2021 ◽  
Author(s):  
Minji Jeon ◽  
Kyungmin Huh ◽  
Jae-Hoon Ko ◽  
Sun Young Cho ◽  
Hee Jae Huh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Bloodstream Infections ◽  
Enterobacter Cloacae ◽  
Klebsiella Aerogenes ◽  
Retrospective Case ◽  
Hospitalised Patients ◽  
All Cause Mortality ◽  
Independent Risk Factors ◽  
Enterobacter Cloacae Complex

Abstract Background The difference in clinical outcomes between Klebsiella aerogenes (formerly Enterobacter aerogenes) bacteremia (KAB) and Enterobacter cloacae complex bacteremia (ECB) is controversial. Objectives We compared the clinical outcomes of patients with KAB and ECB and examined the risk factors associated with mortality. Methods We conducted a retrospective case-control study of hospitalised patients with monobacterial KAB and ECB between January 2011 and June 2020. The primary outcome measure was 30-day all-cause mortality. Multiple logistic regression and propensity-score (PS) matching were used to identify independent risk factors for mortality. The models included demographic characteristics, comorbidities, recent healthcare contact, patient status at the onset of bacteremia, and severity of infection as covariates. Results A total of 282 patients with KAB or ECB were included, among whom 194 patients were selected after PS matching. The 30-day all-cause mortality rate was higher in the ECB group than in the KAB group (24.1% vs. 10.6%, p=0.003). In a multivariable model, ECB was an independent risk factor for 30-day mortality in both overall and PS-matched cohorts (adjusted odds ratio, 3.528; 95% confidence interval, 1.614–7.714; P=0.002). Stay in the intensive care unit at the onset of bacteremia and higher Pitt bacteremia score were found to be independent risk factors for 30-day mortality. Conclusion In our study, mortality was significantly higher in patients with ECB than in those with KAB. Further studies are warranted to clarify the virulence mechanisms of E. cloacae complex.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

scholarly journals Risk factors Affecting the 1-year Outcomes of Minor Ischemic Stroke: Results from Xi’an Stroke Registry Study of China

2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Clinical Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Multivariate Logistic Regression ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: The incidences of stroke recurrence, disability, and all-cause mortality of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year rates of stroke recurrence, disability, and all-cause mortality were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the rates of stroke recurrence, disability, and all-cause mortality at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause mortality. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China. Early identification of risk factors for poor clinical outcomes, attention to high risk populations, and targeted interventions contribute to reducing the risk for poor clinical outcomes of patients at 1 year after onset of MIS.

Clinical Risk Score for Prediction of Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Bloodstream Isolates

2016 ◽  
Vol 38 (3) ◽  
pp. 266-272 ◽  
Author(s):  
Matthew R. Augustine ◽  
Traci L. Testerman ◽  
Julie Ann Justo ◽  
P. Brandon Bookstaver ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Characteristic Curve ◽  
Severity Of Illness ◽  
Bloodstream Infections ◽  
Patient Specific ◽  
Retrospective Case ◽  
Extended Spectrum ◽  
High Discrimination ◽  
Independent Risk Factors

OBJECTIVETo develop a risk score to predict probability of bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE).DESIGNRetrospective case-control study.SETTINGTwo large community hospitals.PATIENTSHospitalized adults with Enterobacteriaceae BSI between January 1, 2010, and June 30, 2015.METHODSMultivariate logistic regression was used to identify independent risk factors for ESBLE BSI. Point allocation in extended-spectrum β-lactamase prediction score (ESBL-PS) was based on regression coefficients.RESULTSAmong 910 patients with Enterobacteriaceae BSI, 42 (4.6%) had ESBLE bloodstream isolates. Most ESBLE BSIs were community onset (33 of 42; 79%), and 25 (60%) were due to Escherichia coli. Independent risk factors for ESBLE BSI and point allocation in ESBL-PS included outpatient procedures within 1 month (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 3.1–22.9; 1 point), prior infections or colonization with ESBLE within 12 months (aOR, 26.8; 95% CI, 7.0–108.2; 4 points), and number of prior courses of β-lactams and/or fluoroquinolones used within 3 months of BSI: 1 course (aOR, 6.3; 95% CI, 2.7–14.7; 1 point), ≥2 courses (aOR, 22.0; 95% CI, 8.6–57.1; 3 points). The area under the receiver operating characteristic curve for the ESBL-PS model was 0.86. Patients with ESBL-PSs of 0, 1, 3, and 4 had estimated probabilities of ESBLE BSI of 0.7%, 5%, 24%, and 44%, respectively. Using ESBL-PS ≥3 to indicate high risk provided a negative predictive value of 97%.CONCLUSIONSESBL-PS estimated patient-specific risk of ESBLE BSI with high discrimination. Incorporation of ESBL-PS with acute severity of illness may improve adequacy of empirical antimicrobial therapy and reduce carbapenem utilization.Infect Control Hosp Epidemiol 2017;38:266–272

scholarly journals Prognostic model to identify and quantify risk factors for mortality among hospitalised patients with COVID-19 in the USA

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047121
Author(s):  
Devin Incerti ◽  
Shemra Rizzo ◽  
Xiao Li ◽  
Lisa Lindsay ◽  
Vincent Yau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Model ◽  
Vital Signs ◽  
Saturation Temperature ◽  
Full Model ◽  
Good Discrimination ◽  
Hospitalised Patients ◽  
Laboratory Results ◽  
All Cause Mortality ◽  
The Usa

ObjectivesTo develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.DesignRetrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores and calibration plots in the test set.SettingOptum de-identified COVID-19 Electronic Health Record dataset including over 700 hospitals and 7000 clinics in the USA.Participants17 086 patients hospitalised with COVID-19 between 20 February 2020 and 5 June 2020.Main outcome measureAll-cause mortality while hospitalised.ResultsThe full model that included information on demographics, comorbidities, laboratory results, and vital signs had good discrimination (C-index=0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were similar on the training and test sets, suggesting that there was little overfitting. Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index=0.79) was only slightly better than a model that only included age (C-index=0.76). Across the study period, predicted mortality was 1.3% for patients aged 18 years old, 8.9% for 55 years old and 28.7% for 85 years old. Predicted mortality across all ages declined over the study period from 22.4% by March to 14.0% by May.ConclusionAge was the most important predictor of all-cause mortality, although vital signs and laboratory results added considerable prognostic information, with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase and white cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The full model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.

Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock

2021 ◽  
Author(s):  
Mariana Chumbita ◽  
Pedro Puerta-Alcalde ◽  
Carlota Gudiol ◽  
Nicole Garcia-Pouton ◽  
Júlia Laporte-Amargós ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Kidney Injury ◽  
Bloodstream Infections ◽  
Gram Positive ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Prospective Cohorts ◽  
Independent Risk Factors ◽  
The Impact

Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.

Ventricular Fibrillation After Release of an Aortic Cross-Clamp in Valvular Surgery: Independent Risk Factors, Outcomes, and Incidence from Access Routes

2021 ◽  
Author(s):  
Weichao LI ◽  
heng li ◽  
Jianping Gong ◽  
Weihua Liu ◽  
BaoJun Fu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Fibrillation ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Smoking Status ◽  
Left Ventricular ◽  
Aortic Cross Clamp ◽  
Valvular Surgery ◽  
Htk Solution ◽  
Independent Risk Factors

Abstract Background Predictors and clinical outcomes of VF-ACC and the relative VF-ACC incidence with various access routes have not been well documented. This study aimed to identify predictors, clinical outcomes, and relative incidences of ventricular fibrillation after the release of an aortic cross-clamp (VF-ACC) with various access routes in valvular surgery.Patients and methods In this single-center and retrospective cohort study, we screened 228 consecutive patients undergoing valve surgery, and a total of 119 patients were included in the study. The primary outcomes were the relative incidence and predictors of VF-ACC with access routes, and secondary endpoints included effects of VF-ACC on 30-day mortality, perioperative ventricular arrhythmias (VAs), and heart failure with ejection fraction < 50% (HFEF < 50%).Results VF-ACC incidence varied on the basis of access routes. VF-ACC occurred in 58.3% of patients with aortic valve replacement via transverse aortotomy (TAo-AVR), in 48.6% of patients with aortic and mitral replacements via transseptal and transverse aortotomy access (TSAo-MAVR), and in 20% of patients with mitral valve replacement via transseptal access (TS-MVR). Seven independent risk factors were identified: HTK solution (AOR: 4.90, p = 0.002), smoking status (AOR: 6.30, p = 0.001), cerebrovascular disease (CBD) [(AOR: 7.08, p = 0.022)], regional wall motion abnormality (RWMA) [(AOR: 8.33, p < 0.001)], perioperative VAs (AOR: 4.85, p = 0.001), HFEF < 50% (AOR: 5.66, p = 0.002), and left ventricular mass index (LVMI) [(AOR: 0.962, CI: 0.941–0.984)].Conclusions VF-ACC was the most common in TAo-AVR and the least common in TS-MVR. HTK solution, smoking status, CBD, perioperative VAs, HFEF < 50%, and RWMA were associated with an increased risk of VF-ACC, and low LVMI acted as a protective factor. Patients with VF-ACC commonly experienced perioperative VAs or HFEFs < 50%.Clinical trial registration: ChiCTR2100050961.

scholarly journals Risk for Cardiovascular Disease and One-Year Mortality in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome Overlap Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Manyun Tang ◽  
Yidan Wang ◽  
Mengjie Wang ◽  
Rui Tong ◽  
Tao Shi
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Overlap Syndrome ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Independent Risk Factors

Background: Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSAS) overlap syndrome (OS) are thought to be at increased risk for cardiovascular diseases.Objective: To evaluate the burden of cardiovascular diseases and long-term outcomes in patients with OS.Methods: This was a retrospective cohort study. The prevalence of cardiovascular diseases and 1-year mortality were compared among patients diagnosed with OS (OS group), COPD alone (COPD group) and OSAS alone (OSAS group), and Cox proportional hazards models were used to assess independent risk factors for all-cause mortality.Results: Overall, patients with OS were at higher risk for pulmonary hypertension (PH), heart failure and all-cause mortality than patients with COPD or OSAS (all p &lt; 0.05). In multivariate Cox regression analysis, the Charlson comorbidity index (CCI) score [adjusted hazard ratio (aHR): 1.273 (1.050–1.543); p = 0.014], hypertension [aHR: 2.006 (1.005–4.004); p = 0.048], pulmonary thromboembolism (PTE) [aHR: 4.774 (1.335–17.079); p = 0.016] and heart failure [aHR: 3.067 (1.521–6.185); p = 0.002] were found to be independent risk factors for 1-year all-cause mortality.Conclusion: Patients with OS had an increased risk for cardiovascular diseases and 1-year mortality. More efforts are needed to identify the causal relationship between OS and cardiovascular diseases, promoting risk stratification and the management of these patients.

scholarly journals Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e052582
Author(s):  
Martin Holmbom ◽  
Maria Andersson ◽  
Sören Berg ◽  
Dan Eklund ◽  
Pernilla Sobczynski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Bloodstream Infection ◽  
Case Control Study ◽  
Case Control ◽  
Important Risk Factor ◽  
Retrospective Case ◽  
Prehospital Delay ◽  
All Cause Mortality ◽  
Control Study

ObjectivesThe aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden.MethodsA retrospective case–control study of 1624 patients with CA-BSI (2015–2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality.ResultsOf the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6–52) for non-survivors and 7 hours (3–24) for survivors (p<0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p<0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p<0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p<0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p<0.01. In a multivariable model, prehospital delay >24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p<0.01.ConclusionPrehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.

Risk Factors for Central Line–Associated Bloodstream Infections in the Era of Prevention Bundles

2014 ◽  
Vol 36 (2) ◽  
pp. 214-216 ◽  
Author(s):  
Devin Callister ◽  
Pauline Limchaiyawat ◽  
Samantha J. Eells ◽  
Loren G. Miller
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Hemodynamic Monitoring ◽  
Bloodstream Infections ◽  
Central Line ◽  
Infection Risk ◽  
Case Control ◽  
Infect Control Hosp ◽  
Infection Risk Factors ◽  
Independent Risk Factors

Little is known about central line–associated bloodstream infection risk factors in the bundle era. In our case-control investigation, we found that independent risk factors for central line–associated bloodstream infection at our center included the number of recent lab tests, catheter duration, and lack of hemodynamic monitoring as the insertion indication.Infect Control Hosp Epidemiol 2014;00(0): 1–3

scholarly journals Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae: Risk Factors, Molecular Epidemiology, and Clinical Outcome

2006 ◽  
Vol 50 (2) ◽  
pp. 498-504 ◽  
Author(s):  
Mario Tumbarello ◽  
Teresa Spanu ◽  
Maurizio Sanguinetti ◽  
Rita Citton ◽  
Eva Montuori ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Treatment Failure ◽  
Bloodstream Infections ◽  
Initial Response ◽  
Infected Group ◽  
Retrospective Case ◽  
Extended Spectrum ◽  
Epidemiological Characteristics ◽  
Length Of Hospitalization

ABSTRACT Bloodstream infections caused by extended-spectrum-β-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are a major concern for clinicians, since they markedly increase the rates of treatment failure and death. One hundred forty-seven patients with K. pneumoniae bloodstream infections were identified over a 5-year period (January 1999 to December 2003). The production of ESBLs in bloodstream isolates was evaluated by molecular methods. A retrospective case-case-control study was conducted to identify risk factors for the isolation of ESBL-producing K. pneumoniae or non-ESBL-producing K. pneumoniae isolates in blood cultures. Forty-eight cases infected with ESBL-producing K. pneumoniae isolates and 99 cases infected with non-ESBL-producing K. pneumoniae isolates were compared to controls. Risk factors for isolation of ESBL-producing K. pneumoniae isolates were exposure to antibiotic therapy (odds ratio [OR], 11.81; 95% confidence interval [CI], 2.72 to 51.08), age (OR, 1.14; 95% CI, 1.08 to 1.21), and length of hospitalization (OR, 1.10; 95% CI, 1.04 to 1.16). Independent determinants for isolation of non-ESBL-producing K. pneumoniae were previous urinary tract infection (OR, 8.50; 95% CI, 3.69 to 19.54) and length of hospitalization (OR, 1.07; 95% CI, 1.04 to 1.10). When the initial response was assessed at 72 h after antimicrobial therapy, the treatment failure rate for the ESBL-producing K. pneumoniae-infected group was almost twice as high as that of the non-ESBL-producing K. pneumoniae-infected group (31% versus 17%; OR, 2.19; 95% CI, 0.98 to 4.89). The 21-day mortality rate for all patients was 37% (54 of 147); it was 52% (25 of 48) for patients with ESBL-producing K. pneumoniae bloodstream infections and 29% (29 of 99) for patients with non-ESBL-producing K. pneumoniae bloodstream infections (OR, 2.62; 95% CI, 1.28 to 5.35). In summary, this investigation identifies epidemiological characteristics that distinguish ESBL-producing K. pneumoniae infections from non-ESBL-producing K. pneumoniae ESBL bloodstream infections.

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