scholarly journals Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights from the Prevention of Arrhythmia Device infection Trial (PADIT)

2021 ◽  
Author(s):  
Yves Longtin ◽  
Philippe Gervais ◽  
David H Birnie ◽  
Jia Wang ◽  
Marco Alings ◽  
...  
Keyword(s):  
Electronic Device ◽  
Risk Of Infection ◽  
Cardiac Implantable Electronic Device ◽  
Coagulase Negative Staphylococci ◽  
Exact Test ◽  
Post Hoc Analysis ◽  
Perioperative Prophylaxis ◽  
Device Infection ◽  
Significant Difference ◽  
Post Hoc

Abstract Background The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the peri-operative administration of cefazolin, vancomycin, bacitracin and cephalexin did not significantly decrease the risk of infection. Our objective is to compare the microbiology of infections between study arms in PADIT. Methods Post-hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher’s exact test. Results Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS, 82/209; 39.2%) and S. aureus (75/209; 35.9%). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs. 46.6%, p=0.04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs. 26.8%, respectively; p=0.05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs. 64.3%; p=0.10) or vancomycin (90.8% vs. 90.2%; p=0.90). Conclusions Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections.

scholarly journals Contamination and washing of cloth masks and risk of infection among hospital health workers in Vietnam: a post hoc analysis of a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e042045
Author(s):  
Chandini Raina MacIntyre ◽  
Tham Chi Dung ◽  
Abrar Ahmad Chughtai ◽  
Holly Seale ◽  
Bayzidur Rahman
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Poor Performance ◽  
Full Time ◽  
Risk Of Infection ◽  
Viral Contamination ◽  
Post Hoc Analysis ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Post Hoc

BackgroundIn a previous randomised controlled trial (RCT) in hospital healthcare workers (HCWs), cloth masks resulted in a higher risk of respiratory infections compared with medical masks. This was the only published RCT of cloth masks at the time of the COVID-19 pandemic.ObjectiveTo do a post hoc analysis of unpublished data on mask washing and mask contamination from the original RCT to further understand poor performance of the two-layered cotton cloth mask used by HCWs in that RCT.Setting14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam.ParticipantsA subgroup of 607 HCWs aged ≥18 years working full time in selected high-risk wards, who used a two-layered cloth mask and were part of a randomised controlled clinical trial comparing medical masks and cloth masks.InterventionWashing method for cloth masks (self-washing or hospital laundry). A substudy of contamination of a sample of 15 cloth and medical masks was also conducted.Outcome measureInfection rate over 4 weeks of follow up and viral contamination of masks tested by multiplex PCR.ResultsViral contamination with rhinovirus was identified on both used medical and cloth masks. Most HCW (77% of daily washing) self-washed their masks by hand. The risk of infection was more than double among HCW self-washing their masks compared with the hospital laundry (HR 2.04 (95% CI 1.03 to 4.00); p=0.04). There was no significant difference in infection between HCW who wore cloth masks washed in the hospital laundry compared with medical masks (p=0.5).ConclusionsUsing self-reported method of washing, we showed double the risk of infection with seasonal respiratory viruses if masks were self-washed by hand by HCWs. The majority of HCWs in the study reported hand-washing their mask themselves. This could explain the poor performance of two layered cloth masks, if the self-washing was inadequate. Cloth masks washed in the hospital laundry were as protective as medical masks. Both cloth and medical masks were contaminated, but only cloth masks were reused in the study, reiterating the importance of daily washing of reusable cloth masks using proper method. A well-washed cloth mask can be as protective as a medical mask.Trial resgistration numberACTRN12610000887077.

scholarly journals 121. Cardiac Implantable Electronic Device-Related Infective Endocarditis (CIED-IE): Clinical Features and Outcomes of Patients with Definite IE Who Fulfill Both Major Duke Criteria

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S91-S91
Author(s):  
Siddhi Gupta ◽  
Thomas F Wierzba ◽  
James E Peacock ◽  
Larry M Baddour ◽  
Muhammad R Sohail ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Device ◽  
Late Onset ◽  
Symptom Duration ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Implantable Electronic Device ◽  
Coagulase Negative Staphylococci ◽  
Risk Of Death ◽  
Duke Criteria ◽  
Device Infection

Abstract Background Cardiac implantable electronic device-related infective endocarditis (CIED-IE) comprises 10–57% of total CIED infections. Patients with definite CIED-IE who fulfill both major modified Duke criteria have not been well characterized. Methods Data from the Multicenter Electrophysiologic Device Infection Cohort, a prospective, multinational study of CIED infections were used to describe a subset of patients with CIED-IE who met both major Duke criteria for definite IE (bloodstream infection and intracardiac vegetations [VEG]). Results Of 433 patients with CIED infection, 144 (33.3%) had definite CIED-IE. The median age was 68 years and 77.1% were male. Twelve (8.3%) had past CIED infection. Seventy-seven patients (53.5%) had permanent pacemakers, 38 (26.4%) had implantable cardioverter defibrillators, and 29 (20.1%) had combination devices. The median time following the last device procedure was 550 days. CIED-IE was early in 60 patients (41.7%) and late in 84 (58.3%). Most patients presented with fever (77.8%) and sepsis (44.4%) with a median symptom duration of 7 days. On echocardiography, lead VEG was noted in 125 patients (86.8%) and valvular VEG in 54 patients (37.5%) with the tricuspid valve involved in 56.5%. On the basis of VEG location, there were 90 patients (62.5%) with isolated lead-associated IE (LAE), 19 patients (13.2%) with isolated valve-associated IE (VAE), and 35 patients (24.3%) with both (LVAE). All patients had positive blood cultures and 63/119 (52.9%) had positive lead cultures. The predominant organism in blood was Staphylococcus aureus (42.4%), followed by coagulase-negative staphylococci (20.1%). CIED removal occurred in 131 patients (91%). There were 25 deaths during the index hospitalization and 34 total deaths (24.3%) by 6 months. Mortality correlated with age >75 (P = 0.023) and sepsis on presentation (P = 0.052). Infecting organism, site of VEG, and device removal did not impact the risk of death. Conclusion Definite CIED-IE is relatively common. The majority of patients tend to have late-onset infection and often present with sepsis. S. aureus is the dominant organism causing definite CIED-IE. Isolated LAE occurs in 63% of patients. Older age and sepsis on admission are associated with higher mortality. Disclosures All authors: No reported disclosures.

scholarly journals Cardiac implantable electronic device infection: prevalence and risk factors

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Ghazaryan ◽  
T Hovakimyan ◽  
A Khachatryan
Keyword(s):  
Risk Factors ◽  
Antibiotic Therapy ◽  
Electronic Device ◽  
Demographic Data ◽  
Chronic Obstructive ◽  
Infection Prevalence ◽  
Risk Of Infection ◽  
Postoperative Hematoma ◽  
Device Infection ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of CIED  implantation procedures has increased dramatically in recent decades due to population aging  and expansion of indications. At the same time, the number of CIED-associated complications has increased too. Infection is a very important and heavy complication of CIED implantation, which significantly increases mortality and morbidity. Aim and objectives This study aimed to estimate the risk of CIED-infection in a group of patients who received an aggressive scheme of postprocedural antibiotic therapy and compare with the risk of infection in another group, where a mild antibiotic therapy scheme was used. The study objectives were to assess the incidence and prevalence of CIED-related infection in patients operated in a tertiary cardiovascular center, as well as identify infection-related risk factors. Methods A retrospective, observational, cross-sectional study was performed. The study sample included 355 patients, who underwent CIED-related procedure in a single center between 01.12.2017 and 30.07.2020. Two antibiotic prophylaxis and wound follow-up protocols (mild and aggressive) were used. In this study, we compared the effectiveness of both methods to prevent a CIED related infection. Patient’s demographic data, clinical features, comorbidities, the device and procedure-related information were also assessed for having a relationship with CIED infection rate. Data entry and statistical analyses were performed with SPSS version 23 software. Binomial logistic regression analyses were performed for adjusted analyses. Results The prevalence of infection was 3.5% in the group with mild scheme and 1.13% in the group with the aggressive scheme. The difference in two subgroups was not significant (p = 0,149). In the whole sample the prevalence of infection was 1,69%. According to this study severe renal failure with glomerular filtration rate (GFR)<30 mL/min (OR = 32.6, CI = 2.5-420.8, p = 0.008),  chronic obstructive pulmonary disease (OR = 8.2, CI = 1.4-47.6, p = 0.019), and  thyroid disfunction (OR = 7.065, CI = 1.2-40.6, p = 0.028) were found as significant predictors for having CIED infection. In participants who underwent a reimplantation and in those with postoperative hematoma the odds of having infection was respectively 6.2 fold (CI = 1.086-35.5, p = 0.04) and 48.8 fold (CI = 8.4-285.9, p = 0.028) higher, compared to patients with primary implantation and absence of hematoma. Age of participants with CIED-infection (mean age = 52.5 )  was younger  compared to patients without infection (mean age = 61.2, p = 0.039). Conclusion According to our study the risk of infection in our center is comparable to recorded prevalence in other countries. There is no statistically significant difference on CIED infection between mild and aggressive antibiotic therapy schemes. Recommendations   The routine use of  aggressive antibiotic therapy is not justified and carries a risk of microbial resistance, as well as additional healthcare costs.

scholarly journals Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta‐analysis

2021 ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Chanavuth Kanitsoraphan ◽  
Sittinun Thangjui ◽  
Thiratest Leesutipornchai ◽  
Sakditad Saowapa ◽  
...  
Keyword(s):  
Electronic Device ◽  
Meta Analysis ◽  
Cardiac Implantable Electronic Device ◽  
Device Infection ◽  
Pocket Hematoma

scholarly journals Brucella cardiac implantable electronic device infection: A single-center case series

2021 ◽  
pp. 102568
Author(s):  
Fatehi Elzein ◽  
Eid Alsufyani ◽  
Yahya Al Hebaishi ◽  
Mohammed Mosaad ◽  
Moayad Alqurashi ◽  
...  
Keyword(s):  
Electronic Device ◽  
Case Series ◽  
Single Center ◽  
Cardiac Implantable Electronic Device ◽  
Device Infection

scholarly journals Using Wearable Cameras to Assess Foods and Beverages Omitted in 24 Hour Dietary Recalls and a Text Entry Food Record App

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1806
Author(s):  
Virginia Chan ◽  
Alyse Davies ◽  
Lyndal Wellard-Cole ◽  
Silvia Lu ◽  
Hoi Ng ◽  
...  
Keyword(s):  
Dietary Assessment ◽  
Fats And Oils ◽  
Point Of View ◽  
Self Report ◽  
Smartphone App ◽  
Food Record ◽  
Post Hoc Analysis ◽  
Significant Difference ◽  
Post Hoc ◽  
Paired T Test

Technology-enhanced methods of dietary assessment may still face common limitations of self-report. This study aimed to assess foods and beverages omitted when both a 24 h recall and a smartphone app were used to assess dietary intake compared with camera images. For three consecutive days, young adults (18–30 years) wore an Autographer camera that took point-of-view images every 30 seconds. Over the same period, participants reported their diet in the app and completed daily 24 h recalls. Camera images were reviewed for food and beverages, then matched to the items reported in the 24 h recall and app. ANOVA (with post hoc analysis using Tukey Honest Significant Difference) and paired t-test were conducted. Discretionary snacks were frequently omitted by both methods (p < 0.001). Water was omitted more frequently in the app than in the camera images (p < 0.001) and 24 h recall (p < 0.001). Dairy and alternatives (p = 0.001), sugar-based products (p = 0.007), savoury sauces and condiments (p < 0.001), fats and oils (p < 0.001) and alcohol (p = 0.002) were more frequently omitted in the app than in the 24 h recall. The use of traditional self-report methods of assessing diet remains problematic even with the addition of technology and finding new objective methods that are not intrusive and are of low burden to participants remains a challenge.

scholarly journals The effect of liraglutide and sitagliptin on oxidative stress in persons with type 2 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Suvanjaa Sivalingam ◽  
Emil List Larsen ◽  
Daniel H. van Raalte ◽  
Marcel H. A. Muskiet ◽  
Mark M. Smits ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Type 2 Diabetes ◽  
Nucleic Acid ◽  
Urinary Excretion ◽  
Post Hoc Analysis ◽  
Significant Difference ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Post Hoc

AbstractGlucagon-like peptide 1 receptor agonists have shown cardioprotective effects which have been suggested to be mediated through inhibition of oxidative stress. We investigated the effect of treatment with a glucagon-like peptide 1 receptor agonist (liraglutide) on oxidative stress measured as urinary nucleic acid oxidation in persons with type 2 diabetes. Post-hoc analysis of two independent, randomised, placebo-controlled and double-blinded clinical trials. In a cross-over study where persons with type 2 diabetes and microalbuminuria (LIRALBU, n = 32) received liraglutide (1.8 mg/day) or placebo for 12 weeks in random order, separated by 4 weeks of wash-out. In a parallel-grouped study where obese persons with type 2 diabetes (SAFEGUARD, n = 56) received liraglutide (1.8 mg/day), sitagliptin (100 mg/day) or placebo for 12 weeks. Endpoints were changes in the urinary markers of DNA oxidation (8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG)) and RNA oxidation [8-oxo-7,8-dihydroguanosine (8-oxoGuo)]. In LIRALBU, we observed no significant differences between treatment periods in urinary excretion of 8-oxodG [0.028 (standard error (SE): 0.17] nmol/mmol creatinine, p = 0.87) or of 8-oxoGuo [0.12 (0.12) nmol/mmol creatinine, p = 0.31]. In SAFEGUARD, excretion of 8-oxodG was not changed in the liraglutide group [2.8 (− 8.51; 15.49) %, p = 0.62] but a significant decline was demonstrated in the placebo group [12.6 (− 21.3; 3.1) %, p = 0.02], resulting in a relative increase in the liraglutide group compared to placebo (0.16 nmol/mmol creatinine, SE 0.07, p = 0.02). Treatment with sitagliptin compared to placebo demonstrated no significant difference (0.07 (0.07) nmol/mmol creatinine, p = 0.34). Nor were any significant differences for urinary excretion of 8-oxoGuo liraglutide vs placebo [0.09 (SE: 0.07) nmol/mmol creatinine, p = 0.19] or sitagliptin vs placebo [0.07 (SE: 0.07) nmol/mmol creatinine, p = 0.35] observed. This post-hoc analysis could not demonstrate a beneficial effect of 12 weeks of treatment with liraglutide or sitagliptin on oxidatively generated modifications of nucleic acid in persons with type 2 diabetes.

To study or not to study abroad? students’ decision in perspective of motivations, barriers and attachment

Human Affairs ◽  
2021 ◽  
Vol 31 (2) ◽  
pp. 175-193
Author(s):  
Filip Sulejmanov ◽  
Klára Seitlová ◽  
Martin Seitl ◽  
Barbora Kasalová
Keyword(s):  
Attachment Style ◽  
Thematic Analysis ◽  
Secure Attachment ◽  
Thematic Structure ◽  
Exact Test ◽  
Studying Abroad ◽  
Significant Difference ◽  
Post Hoc ◽  
Attachment Dimensions ◽  
Inductive Thematic Analysis

Abstract The aim of this study is to explore the antecedents of studying abroad. First, we explore motivations for and barriers against studying abroad in two groups of students (who had studied abroad, and who had not studied abroad). Second, differences in attachment dimensions and styles are examined in both groups. A deductive thematic analysis supported the thematic structure identified by Krzaklewska (2008) in regard to motivations. Furthermore, five barriers were identified using inductive thematic analysis. Although the same motivational and barrier themes were found in both groups, there were some notable qualitative differences in meaning attached to them. A one-way MANOVA showed non-significant differences between the two groups of students and attachment dimensions. Finnaly, Fisher’s exact test was conducted, and the post hoc comparison showed that there was a statistically significant difference in the proportion of students who had studied abroad and had a secure attachment style compared to students who had not studied abroad.

scholarly journals Diastolic function in patients with preeclampsia during pre- and post-partum period using tissue doppler imaging

2016 ◽  
Vol 25 (2) ◽  
pp. 93-7 ◽  
Author(s):  
I B Rangga Wibhuti ◽  
Amiliana M. Soesanto ◽  
Fahmi Shahab
Keyword(s):  
Diastolic Function ◽  
Tissue Doppler Imaging ◽  
Pregnancy Termination ◽  
Post Partum ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Post Hoc Analysis ◽  
Significant Difference ◽  
Post Partum Period ◽  
Post Hoc

Background: Prior studies have compared the E/e’ elevation in preeclampsia patients to normal patients, however there are no data whether this elevation persists after birth. The aim of this study is to analyze diastolic function in preeclampsia patients during pre- and post-partum period using E/e’ parameter measurement.Methods: This is a prospective cohort study of pregnant women with preeclampsia who were hospitalized and planned for pregnancy termination. Basic clinical characteristics were obtained from all samples. Echocardiography was done prepartum, 48-72 hours after termination, and 40-60 days postpartum. Post hoc analysis using least significant difference method was used to compare the results between measurements.Results: 30 subjects were enrolled in the study. Analysis on E/e’ characteristics showed statistical difference between prepartum E/e’ and 40 days postpartum E/e’ (11.87±3.184 vs 9.43±2.529, p=0.001, CI=1.123-3.751), as well as between 48 hours post-partum and 40 days post-partum period (12.12±2.754 vs 9.43±2.529, p<0.001, CI=1.615-3.771). There were no statistical differences between pre-partum E/e’ and 48 hours post-partum E/e’ (11.87±3.184 vs 12.12±2.754, p=0.633, CI=-1.345-0.832).Conclusion: This study showed diastolic dysfunction in preeclampsia patients persists up until a few days after birth, but resolves in time (40 days after birth) as measured by tissue doppler imaging.

A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery

1988 ◽  
Vol 69 (5) ◽  
pp. 687-691 ◽  
Author(s):  
Ross Bullock ◽  
James R. van Dellen ◽  
William Ketelbey ◽  
S. Gustav Reinach
Keyword(s):  
Controlled Trial ◽  
Prophylactic Antibiotics ◽  
Risk Of Infection ◽  
Broad Spectrum Antibiotic ◽  
Wound Sepsis ◽  
Double Blind ◽  
Content Type ◽  
Exact Test ◽  
Significant Difference ◽  
To Receive

✓ In this study, 417 patients undergoing “clean” elective neurosurgical operative procedures were randomized to receive a broad-spectrum antibiotic (piperacillin) or placebo given as three perioperative doses, each 6 hours apart. Randomization was carried out by hospital pharmacists, and the investigators remained blinded until the end of the study. Twenty cases were excluded from analysis because either an unforeseen second operation was performed or antibiotic therapy was initiated within 30 days after surgery to treat infection or the risk of infection. Twelve of the 205 patients treated with placebo developed postoperative wound sepsis, and four of the 192 piperacillin-treated patients developed wound sepsis — a statistically significant difference (p < 0.05, Fisher's exact test). Piperacillin thus appeared to reduce the incidence of neurosurgical wound infection in this study.

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