scholarly journals 1120. Clostridium difficile Infection Risk Factors, Severity, and Outcomes in Patients Infected with NAP1/027 Strain in a Non-Epidemic Setting

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S336-S336
Author(s):  
Julie Nahar
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Severity Of Illness ◽  
Healthcare Facility ◽  
Control Analysis ◽  
Retrospective Case ◽  
The North ◽  
Infection Risk Factors ◽  
Positive Stool Sample ◽  
Case Control Analysis

Abstract Background Evidence surrounding outcomes with the North American pulsed-field gel electrophoresis type 1 (NAP1) Clostridium difficile (CDI) strain remains conflicting. We compared risk factors, severity of illness, and mortality of patients infected with NAP1 strain compared with patients with non-NAP1 strains in our multihospital health system. Methods This is a retrospective case–control analysis of patients admitted to one of five hospitals (one academic and four community hospitals) and diagnosed with CDI from April 2014 through July 2017. CDI definition included three or more stools per day with positive stool sample polymerase chain reaction (PCR) testing for C. difficile. Results A total of 490 patients met inclusion, of which 155 had the NAP1 strain and 335 patients were infected with non-NAP1 strains. More patients with NAP1 were older, female, had CHF, and presented from a healthcare facility as opposed to from the community (all P < 0.05). No difference in 90-day antibiotic class use was found. NAP1 patients had increased ICU admission (12.3 vs. 6.0%, P = 0.016), a shorter length of stay (10.8 vs. 13.4 days, P = 0.037), abnormal CT findings (P < 0.023), and trend toward more ID consults (P = 0.067). Per IDSA classification, 61.9% in the NAP1 CDI group had severe CDI as opposed to 49.6% in the non-NAP1 study group. (P ≤ 0.038). There was no observed difference in inpatient mortality (7.7 vs. 5.7%, P = 0.381). Conclusion CDI caused by NAP1 strain did result in increased severity but did not result in increased mortality compared with CDI caused by non-NAP1 strains. Evidence continues to mount that while the NAP1 strain may affect severity, its effect on mortality remains in question. Disclosures All authors: No reported disclosures.

Epidemiology and factors associated with candidaemia following Clostridium difficile infection in adults within metropolitan Atlanta, 2009–2013

2015 ◽  
Vol 144 (7) ◽  
pp. 1440-1444 ◽  
Author(s):  
S. VALLABHANENI ◽  
O. ALMENDARES ◽  
M. M. FARLEY ◽  
J. RENO ◽  
Z. T. SMITH ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Population Based ◽  
Case Control ◽  
Control Analysis ◽  
Factors Associated ◽  
Matched Case ◽  
Case Control Analysis

SUMMARYWe assessed prevalence of and risk factors for candidaemia following Clostridium difficile infection (CDI) using longitudinal population-based surveillance. Of 13 615 adults with CDI, 113 (0·8%) developed candidaemia in the 120 days following CDI. In a matched case-control analysis, severe CDI and CDI treatment with vancomycin + metronidazole were associated with development of candidaemia following CDI.

An insight into Clostridium difficile infection: a single-center retrospective case-control study

2019 ◽  
Vol 57 (10) ◽  
pp. 1183-1195
Author(s):  
Fady G. Haddad ◽  
Julie Zaidan ◽  
Abhishek Polavarapu ◽  
Hafiz Khan ◽  
Asif Khan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Patient Characteristics ◽  
Healthcare Facility ◽  
Control Group ◽  
Retrospective Case ◽  
Neutrophil Lymphocyte Ratio ◽  
Factors Associated ◽  
Icu Transfer

Abstract Background Clostridium difficile infection (CDI) has become a worldwide health problem in view of its significant incidence and medical and economic impact on the health system. Prior studies have been undergone about risk factors and disease characteristics. We wanted to study the characteristics, prognostic factors associated with CDI at our institute, as well as a new prognostic factor. Methods Our study aimed at describing the risk factors, patient characteristics, and outcomes associated with healthcare facility–acquired CDI (HCFA-CDI) and community-acquired CDI (CA-CDI). We intended to identify the factors associated with worse outcomes. We evaluated the characteristics associated with CDI over 3 years. We also evaluated a simple neutrophil-lymphocyte ratio (NLR) and its predictive value for worse outcomes. Results Six hundred patients were enrolled (333 in a control group; 171 in the HCFA-CDI group and 96 in the CA-CDI group). NLR > 5 predicted increased mortality and intensive care unit transfer in all CDI if done as early as day 2 after CDI diagnosis. In HCFA-CDI, NLR > 5 predicted a higher ICU transfer if done as early as day 1 post-diagnosis and with increased mortality as early as day 2 post-diagnosis. In CA-CDI, NLR > 5 predicted a higher mortality and ICU transfer if done at least 4 days after diagnosis. Moreover, every 10-unit increase in NLR was associated with a significant increase in mortality and ICU transfer in patients with CDI. Conclusion A timely use of NLR can be used as a mean to predict worse outcomes, namely ICU transfer and mortality, in patients with CDI.

scholarly journals Pneumothorax and/or Pneumomediastinum Worsens the Prognosis of COVID-19 Patients with Severe Acute Respiratory Failure: A Multicenter Retrospective Case-Control Study in the North-East of Italy

2021 ◽  
Vol 10 (21) ◽  
pp. 4835
Author(s):  
Matteo Bonato ◽  
Alessia Fraccaro ◽  
Nicholas Landini ◽  
Giuseppe Zanardi ◽  
Cosimo Catino ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Case Control ◽  
Control Group ◽  
Control Analysis ◽  
Retrospective Case ◽  
Mechanically Ventilated ◽  
North East ◽  
The North ◽  
Incidence Risk ◽  
Case Control Analysis

Pneumothorax (PNX) and pneumomediastinum (PNM) are potential complications of COVID-19, but their influence on patients’ outcomes remains unclear. The aim of the study was to assess incidence, risk factors, and outcomes of severe COVID-19 complicated with PNX/PNM. Methods: A retrospective multicenter case-control analysis was conducted in COVID-19 patients admitted for respiratory failure in intermediate care units of the Treviso area, Italy, from March 2020 to April 2021. Clinical characteristics and outcomes of patients with and without PNX/PNM were compared. Results: Among 1213 patients, PNX and/or PNM incidence was 4.5%. Among these, 42% had PNX and PNM, 33.5% only PNX, and 24.5% only PNM. COVID-19 patients with PNX/PNM showed higher in-hospital (p = 0.02) and 90-days mortality (p = 0.048), and longer hospitalization length (p = 0.002) than COVID-19 patients without PNX/PNM. At PNX/PNM occurrence, one-third of subjects was not mechanically ventilated, and the respiratory support was similar to the control group. PNX/PNM occurrence was associated with longer symptom length before hospital admission (p = 0.005) and lower levels of blood lymphocytes (p = 0.017). Conclusion: PNX/PNM are complications of COVID-19 associated with a worse prognosis in terms of mortality and length of hospitalization. Although they are more frequent in ventilated patients, they can occur in non-ventilated, suggesting that mechanisms other than barotrauma might contribute to their presentation.

A case control analysis investigating risk factors and outcomes for nephrocalcinosis and renal calculi in neonates

2017 ◽  
Vol 13 (4) ◽  
pp. 356.e1-356.e5 ◽  
Author(s):  
Melissa Huynh ◽  
Roderick Clark ◽  
Jenny Li ◽  
Guido Filler ◽  
Sumit Dave
Keyword(s):  
Risk Factors ◽  
Renal Calculi ◽  
Case Control ◽  
Control Analysis ◽  
Case Control Analysis

Molecular Epidemiology and Risk Factors for Colonization by Vancomycin-ResistantEnterococcusin Patients with Hematologic Malignancies

2011 ◽  
Vol 32 (5) ◽  
pp. 490-496 ◽  
Author(s):  
N. G. Almyroudis ◽  
A. J. Lesse ◽  
T. Hahn ◽  
G. Samonis ◽  
P. A. Hazamy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Molecular Epidemiology ◽  
Hospital Admissions ◽  
Severity Of Illness ◽  
Hematologic Malignancies ◽  
Observation Time ◽  
Patient Specific ◽  
Common Source ◽  
Retrospective Case ◽  
Hematopoietic Stem

Objective.To study the molecular epidemiology of vancomycin-resistantEnterococcus(VRE) colonization and to identify modifiable risk factors among patients with hematologic malignancies.Setting.A hematology-oncology unit with high prevalence of VRE colonization.Participants.Patients with hematologic malignancies and hematopoietic stem cell transplantation recipients admitted to the hospital.Methods.Patients underwent weekly surveillance by means of perianal swabs for VRE colonization and, if colonized, were placed in contact isolation. We studied the molecular epidemiology in fecal and blood isolates by pulsed-field gel electrophoresis over a 1-year period. We performed a retrospective case-control study over a 3-year period. Cases were defined as patients colonized by VRE, and controls were defined as patients negative for VRE colonization. Case patients and control patients were matched by admitting service and length of observation time.Results.Molecular genotyping demonstrated the primarily polyclonal nature of VRE isolates. Colonization occurred at a median of 14 days. Colonized patients were characterized by longer hospital admissions. Previous use of ceftazidime was associated with VRE colonization (P< .001), while use of intravenous vancomycin and antibiotics with anaerobic activity did not emerge as a risk factor. There was no association with neutropenia or presence of colonic mucosal disruption, and severity of illness was similar in both groups.Conclusion.Molecular studies showed that in the majority of VRE-colonized patients the strains were unique, arguing that VRE acquisition was sporadic rather than resulting from a common source of transmission. Patient-specific factors, including prior antibiotic exposure, rather than breaches in infection control likely predict for risk of fecal VRE colonization.

scholarly journals Management of Esophageal Carcinoma Associated with Cirrhosis: A Retrospective Case-Control Analysis

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Florence Trivin ◽  
Eveline Boucher ◽  
Elodie Vauléon ◽  
Isabelle Cumin ◽  
Elisabeth Le Prisé ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Esophageal Carcinoma ◽  
Case Control ◽  
Control Analysis ◽  
Retrospective Case ◽  
Compensated Cirrhosis ◽  
Dismal Prognosis ◽  
Chemotherapy Dose ◽  
Case Control Analysis ◽  
Control Study

Objectives. Esophageal carcinoma and cirrhosis have the overlapping etiologic factors.Methods. In a retrospective analysis conducted in 2 Breton institutions we wanted to asses the frequency of this association and the outcome of these patients in a case-control study where each case (cirrhosis and esophageal cancer) was paired with two controls (esophageal cancer).Results. In a 10-year period, we have treated 958 esophageal cancer patients; 26 (2.7%) had a cirrhosis. The same treatments were proposed to the 2 groups; cases received nonsignificantly different radiation and chemotherapy dose than controls. Severe toxicities and deaths were more frequent among the cases. At the end of the treatment 58% of the cases and 67% of the controls were in complete remission; median and 2-year survival were not different between the 2 groups. All 4 Child-Pugh B class patients experienced severe side effects and 2 died during the treatment.Conclusions. This association is surprisingly infrequent in our population! Child-Pugh B patients had a dismal prognosis and a bad tolerance to radiochemotherapy; Child-Pugh A patients have the same tolerance and the same prognosis as controls and the evidence of a well-compensated cirrhosis has not modified our medical options.

scholarly journals Prevalence and Risk Factors Associated with Vancomycin-Resistant Staphylococcus aureus Precursor Organism Colonization among Patients with Chronic Lower-Extremity Wounds in Southeastern Michigan

2013 ◽  
Vol 34 (9) ◽  
pp. 954-960 ◽  
Author(s):  
Pritish K. Tosh ◽  
Simon Agolory ◽  
Bethany L. Strong ◽  
Kerrie VerLee ◽  
Jennie Finks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Lower Extremity ◽  
Chronic Wounds ◽  
Cohort Analysis ◽  
Case Control ◽  
Control Analysis ◽  
Vancomycin Resistant ◽  
Clinical Records ◽  
Case Control Analysis

Background.Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Incl8-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer.Objective.Identify the prevalence of VRSA precursor organisms.Design.Prospective cohort with embedded case-control study.Participants.Southeastern Michigan adults with chronic lower-extremity wounds.Methods.Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Incl8-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis).Results.Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Incl8-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses.Conclusions.Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.

Sign in / Sign up

Export Citation Format

Share Document