Gastrointestinal carriage is a major reservoir of K. pneumoniae infection in intensive care patients

AbstractBackgroundKlebsiella pneumoniae is an opportunistic pathogen and a leading cause of hospital-associated (HA) infections. Patients in intensive care units (ICUs) are particularly at risk, and outbreaks are frequently reported in ICUs. K. pneumoniae is also part of the healthy human microbiome, providing a potential reservoir for HA infection. However, the frequency of K. pneumoniae gut colonization and its contribution to HA infections are not well characterized.MethodsWe conducted one-year prospective cohort study of ICU patients. Participants (n=498) were screened for rectal and throat carriage of K. pneumoniae shortly after admission, and clinical information was extracted from hospital records.K. pneumoniae isolated from screening swabs and clinical diagnostic samples were characterized using whole genome sequencing. Genomic and epidemiological data were combined to identify likely transmission events.Results and ConclusionsK. pneumoniae carriage frequencies were estimated at 6% (95% CI, 3%-8%) amongst ICU patients admitted direct from the community, and 19% (95% CI, 14% – 51%) amongst those who had recent contact with healthcare. Gut colonisation on admission was significantly associated with subsequent K. pneumoniae infection (infection risk 16% vs 3%, OR=6.9, p<0.001), and genome data indicated a match between carriage and infection isolates in most patients. Five likely transmission chains were identified, resulting in six infections (12% of K. pneumoniae infections in ICU). In contrast, 49% of K. pneumoniae infections were caused by a strain that was unique to the patient, and 48% of patients with K. pneumoniae infections who participated in screening were positive for prior colonisation. These data confirm K. pneumoniae colonisation is a significant risk factor for subsequent infection in ICU, and indicate that half of all K. pneumoniae infections result from patients’ own microbiota. Screening for colonisation on admission could limit risk of infection in the colonised patient and others.

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Designing a bed-side system for predicting length of stay in a neonatal intensive care unit

Scientific Reports ◽

10.1038/s41598-021-82957-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Harpreet Singh ◽

Su Jin Cho ◽

Shubham Gupta ◽

Ravneet Kaur ◽

S. Sunidhi ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Length Of Stay ◽

Neonatal Intensive Care ◽

Financial Burden ◽

Significant Risk ◽

Model Performance ◽

Significant Risk Factor ◽

Validation Dataset ◽

Patient Records

AbstractIncreased length of stay (LOS) in intensive care units is directly associated with the financial burden, anxiety, and increased mortality risks. In the current study, we have incorporated the association of day-to-day nutrition and medication data of the patient during its stay in hospital with its predicted LOS. To demonstrate the same, we developed a model to predict the LOS using risk factors (a) perinatal and antenatal details, (b) deviation of nutrition and medication dosage from guidelines, and (c) clinical diagnoses encountered during NICU stay. Data of 836 patient records (12 months) from two NICU sites were used and validated on 211 patient records (4 months). A bedside user interface integrated with EMR has been designed to display the model performance results on the validation dataset. The study shows that each gestation age group of patients has unique and independent risk factors associated with the LOS. The gestation is a significant risk factor for neonates < 34 weeks, nutrition deviation for < 32 weeks, and clinical diagnosis (sepsis) for ≥ 32 weeks. Patients on medications had considerable extra LOS for ≥ 32 weeks’ gestation. The presented LOS model is tailored for each patient, and deviations from the recommended nutrition and medication guidelines were significantly associated with the predicted LOS.

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Neisseria meningitidis carriage and risk factors among teenagers in Suizhou city in China

Epidemiology and Infection ◽

10.1017/s0950268820002113 ◽

2020 ◽

Vol 148 ◽

Author(s):

Fei He ◽

Hong mei Yang ◽

Guo ming Li ◽

Bing qing Zhu ◽

Yating Zhang ◽

...

Keyword(s):

Risk Factors ◽

Population Density ◽

Neisseria Meningitidis ◽

Old Age ◽

Age Groups ◽

Significant Risk ◽

Epidemiological Data ◽

Significant Risk Factor ◽

Antibiotic Use ◽

Carriage Rate

Abstract Teenagers are important carriers of Neisseria meningitidis, which is a leading cause of invasive meningococcal disease. In China, the carriage rate and risk factors among teenagers are unclear. The present study presents a retrospective analysis of epidemiological data for N. meningitidis carriage from 2013 to 2017 in Suizhou city, China. The carriage rates were 3.26%, 2.22%, 3.33%, 3.53% and 9.88% for 2013, 2014, 2015, 2016 and 2017, respectively. From 2014 to 2017, the carriage rate in the 15- to 19-year-old age group (teenagers) was the highest and significantly higher than that in remain age groups. Subsequently, a larger scale survey (December 2017) for carriage rate and relative risk factors (population density, time spent in the classroom, gender and antibiotics use) were investigated on the teenagers (15- to 19-year-old age) at the same school. The carriage rate was still high at 33.48% (223/663) and varied greatly from 6.56% to 52.94% in a different class. Population density of the classroom was found to be a significant risk factor for carriage, and 1.4 persons/m2 is recommended as the maximum classroom density. Further, higher male gender ratio and more time spent in the classroom were also significantly associated with higher carriage. Finally, antibiotic use was associated with a significantly lower carriage rate. All the results imply that attention should be paid to the teenagers and various measures can be taken to reduce the N. meningitidis carriage, to prevent and control the outbreak of IMD.

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Dexmedetomidine and Iatrogenic Withdrawal Syndrome in Critically Ill Children

Critical Care Nurse ◽

10.4037/ccn2021462 ◽

2021 ◽

Vol 41 (1) ◽

pp. e17-e23

Author(s):

Barbara M. Geven ◽

Jolanda M. Maaskant ◽

Catherine S. Ward ◽

Job B.M. van Woensel

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Cumulative Dose ◽

Withdrawal Syndrome ◽

Significant Risk ◽

Pediatric Intensive Care ◽

Significant Risk Factor ◽

Preventive Effect ◽

Iatrogenic Withdrawal Syndrome

Background Iatrogenic withdrawal syndrome is a well-known adverse effect of sedatives and analgesics commonly used in patients receiving mechanical ventilation in the pediatric intensive care unit, with an incidence of up to 64.6%. When standard sedative and analgesic treatment is inadequate, dexmedetomidine may be added. The effect of supplemental dexmedetomidine on iatrogenic withdrawal syndrome is unclear. Objective To explore the potentially preventive effect of dexmedetomidine, used as a supplement to standard morphine and midazolam regimens, on the development of iatrogenic withdrawal syndrome in patients receiving mechanical ventilation in the pediatric intensive care unit. Methods This retrospective observational study used data from patients on a 10-bed general pediatric intensive care unit. Iatrogenic withdrawal syndrome was measured using the Sophia Observation withdrawal Symptoms-scale. Results In a sample of 102 patients, the cumulative dose of dexmedetomidine had no preventive effect on the development of iatrogenic withdrawal syndrome (P = .19). After correction for the imbalance in the baseline characteristics between patients who did and did not receive dexmedetomidine, the cumulative dose of midazolam was found to be a significant risk factor for iatrogenic withdrawal syndrome (P < .03). Conclusion In this study, supplemental dexmedetomidine had no preventive effect on iatrogenic withdrawal syndrome in patients receiving sedative treatment in the pediatric intensive care unit. The cumulative dose of midazolam was a significant risk factor for iatrogenic withdrawal syndrome.

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Physiological Exophoria Did Not Increase The Incidence of Myopia in Rural School Children in Taiwan

10.21203/rs.3.rs-701227/v1 ◽

2021 ◽

Author(s):

Jui-Hung Hsu ◽

Li-Ju Lai ◽

Tao-Hsin Tung ◽

Wei-Hsiu Hsu

Keyword(s):

Elementary School ◽

Logistic Regression ◽

Elementary School Students ◽

Multinomial Logistic Regression ◽

Significant Risk ◽

Epidemiological Data ◽

Significant Risk Factor ◽

Categorical Variables ◽

School Students

Abstract Purpose:This study evaluated the incidence rate and risk factors for developing myopia in elementary school students in Chiayi, Taiwan.Methods:This prospective cohort study comprised 1816 students without myopia (grades 1 to 5 in Chiayi County). The students underwent a noncycloplegic ocular alignment examinations using an autorefractometer and completed a questionnaires at baseline and at a 1-year follow-up. A univariate logistic regression was used to assess the effects of the categorical variables on new cases of myopia. A multinomial logistic regression was then conducted. A chi-squared test was used to compare new cases of myopia in terms of ocular alignment. A Cox hazard ratio model was then used to validate factors associated with changes in ocular alignment. A P value of <.05 was considered significant.Results: In 370 participants with new cases of myopia out of 1816 participants, a spherical error of −1.51 ± 0.6 diopters was noted at follow-up. The baseline ocular alignment was not a significant risk factor for developing myopia (exophoria vs orthophoria: OR 1.26, 95% CI 0.97-1.62; other vs. orthophoria: OR 1.15, 95% CI 0.73-1.82). However, new cases of myopia (HR 1.36, 95% CI 1.14-1.61), and baseline ocular alignment (exophoria vs orthophoria: HR 3.76, 95% CI 3.20-4.42; other vs orthophoria: HR 3.02, 95% CI 2.05-4.45) were associated with exophoria at follow-up.Conclusions: This study provided epidemiological data on the incidence of myopia in elementary school students in Chiayi, Taiwan. It also demonstrated that physiological exophoria does not predispose patients to developing myopia.

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Clostridium difficile infection in patients hospitalized in the gastroenterology ward – retrospective analysis

Polish Journal of Surgery ◽

10.5604/01.3001.0011.5953 ◽

2018 ◽

Vol 90 (1) ◽

pp. 7-12

Author(s):

Kinga Podlaszewska ◽

Ewa Małecka‑Panas ◽

Anita Gąsiorowska

Keyword(s):

Clostridium Difficile ◽

Retrospective Analysis ◽

Clostridium Difficile Infection ◽

Clinical Course ◽

Significant Risk ◽

Epidemiological Data ◽

Significant Risk Factor ◽

Medical Documentation ◽

Hospitalization Period ◽

Future Outbreak

INTRODUCTION. Clostridium difficile associated colitis became over last years a worldwide medical issue. It involves patients of the Polish hospitals too. The aim of the study was the analysis of CDAD incidence and the course of infection in Gastroenterology Ward of Regional Specialist Hospital of Zgierz, 2012-2015. MATERIAL AND METHODS. Retrospective analysis of the medical documentation of 79 patients with CDAD was performed. Demographic and epidemiological data and the clinical course of infection were analyzed. RESULTS. The study group comprised of women in 59,5% and men in 40,5%. The patients’ average age was 70,5 years. The average hospitalization period was 10,3 days. CDAD infection seasonality was proved, with statistically significant peak in springtime. 73% of patients were previously hospitalized and 85% - had co-morbidities. 76% of patients underwent antibiotherapy, whilst 29% - used PPI prior to CDAD diagnosis. 50,6% of patients had severe CDAD diagnosed. The recurrence reached 14%. In 19% of patients CDAD resulted in death. DISCUSSION. The results of the study confirm increase of the incidence of the patients with CDAD in Gastroenterology Ward over 4-years’ observation. The prevalence was higher among 65+ patients, after prior hospitalization and antibiotherapy. The co-morbidities was a significant risk factor, especially common in severe cases. CONCLUSION. The results we obtained confirm substantial importance of Clostridium difficile infection leading to antibiotherapy- associated diarrhea among adults, causing prolonged hospitalization, increased prevalence and mortality of patients. Getting to know and minimizing the risk factors will prevent the future outbreak of the disease.

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Endemicity ofAcinetobacter calcoaceticus-baumanniiComplex in an Intensive Care Unit in Malaysia

Journal of Pathogens ◽

10.1155/2015/789265 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Amreeta Dhanoa ◽

Ganeswrie Rajasekaram ◽

Soo Sum Lean ◽

Yuet Meng Cheong ◽

Kwai Lin Thong

Keyword(s):

Intensive Care ◽

Genetic Relatedness ◽

Acinetobacter Calcoaceticus ◽

Opportunistic Pathogen ◽

Multidrug Resistant ◽

Control Measures ◽

Effective Control ◽

Icu Patients ◽

Infection Control Measures ◽

High Degree

Introduction.Acinetobacter calcoaceticus-baumanniicomplex (ACB complex) is a leading opportunistic pathogen in intensive care units (ICUs). Effective control of spread requires understanding of its epidemiological relatedness. This study aims to determine the genetic relatedness and antibiotic susceptibilities of ACB complex in an ICU in Malaysia.Methodology. Pulsed field gel electrophoresis (PFGE), E-test, and disk diffusion were used for isolates characterization.Results. During the study period (December 2011 to June 2012), 1023 patients were admitted to the ICU and 44 ACB complex (blood,n=21, and blind bronchial aspirates,n=23) were recovered from 38 ICU patients. Six isolates were from non-ICU patients. Of the 44 ICU isolates, 88.6% exhibited multidrug-resistant (MDR) patterns. There was high degree of resistance, with minimum inhibitory concentration90(MIC90) of >32μg/mL for carbapenems and ≥256μg/mL for amikacin, ampicillin/sulbactam, and cefoperazone/sulbactam. Isolates from the main PFGE cluster were highly resistant. There was evidence of dissemination in non-ICU wards.Conclusion. High number of clonally related MDR ACB complex was found. While the ICU is a likely reservoir facilitating transmission, importation from other wards may be important contributor. Early identification of strain relatedness and implementation of infection control measures are necessary to prevent further spread.

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COVID-19 and Obesity: An Epidemiologic Analysis of the Brazilian Data

International Journal of Endocrinology ◽

10.1155/2021/6667135 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Diego Assis Gonçalves ◽

Victória Ribeiro ◽

Ana Gualberto ◽

Fernanda Peres ◽

Michaela Luconi ◽

...

Keyword(s):

Goodness Of Fit ◽

Ventilatory Support ◽

Significant Risk ◽

Epidemiological Data ◽

Significant Risk Factor ◽

Nonparametric Tests ◽

Categorical Variables ◽

Chi Square ◽

Effective Prevention ◽

Prevention Campaign

Brazil has the second highest number of deaths due to COVID-19. Obesity has been associated with an important role in disease development and a worse prognosis. We aimed to explore epidemiological data from Brazil, discussing the potential relationships between obesity and COVID-19 severity in this country. We used a public database made available by the Ministry of Health of Brazil (182700 patients diagnosed with COVID-19). Descriptive statistics were used to characterize our database. Continuous data were expressed as median and analyzed by the nonparametric tests Mann–Whitney or one-sample Wilcoxon. The frequencies of categorical variables have been analyzed by chi-square tests of independence or goodness-of-fit. Among the number of deaths, 74% of patients were 60 years of age or older. Patients with obesity who died of COVID-19 were younger (59 years (IQR = 23)) than those without obesity (71 years (IQR = 20), P < 0.001 , and η2 = 0.0424). Women with obesity who died of COVID-19 were older than men (55 years (IQR = 25) vs. 50 (IQR = 22), P < 0.001 , and η2 = 0.0263). Furthermore, obesity increases the chances of needing intensive care unit (OR: 1.783, CI: 95%, and P < 0.001 ), needing ventilatory support (OR: 1.537, CI: 95%, and P < 0.001 and OR: 2.302, CI: 95%, and P < 0.001 , for noninvasive and invasive, respectively), and death (OR: 1.411, CI: 95%, and P < 0.001 ) of patients hospitalized with COVID-19. Our analysis supports obesity as a significant risk factor for the development of more severe forms of COVID-19. The present study can direct a more effective prevention campaign and appropriate management of subjects with obesity.

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Risk factors for tuberculous empyema in pleural tuberculosis patients

Scientific Reports ◽

10.1038/s41598-019-56140-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Peng Wen ◽

Min Wei ◽

Chao Han ◽

Yu He ◽

Mao-Shui Wang

Keyword(s):

Risk Factors ◽

Protective Factor ◽

Significant Risk ◽

Multivariate Logistic Regression Analysis ◽

Epidemiological Data ◽

Significant Risk Factor ◽

Multidrug Resistant ◽

Mortality And Morbidity ◽

Pulmonary Tb ◽

Pleural Tuberculosis

AbstractTuberculous empyema (TE) is associated with high mortality and morbidity. In the retrospective cohort study, we aimed to find risk factors for TE among pleural tuberculosis (TB) patients. Between July 2011 and September 2015, all culture-confirmed pleural TB patients (474 cases) were enrolled in our study. Empyema was defined as grossly purulent pleural fluid. Demographic and epidemiological data were collected for further analysis. Multivariate logistic regression analysis was used to evaluate risk factors of TE in pleural TB, age–adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to show the risk. The mean age was 35.7 ± 18.1 years old, males comprised 79.1% of the participants (375 cases). Forty-seven patients (9.9%) were multidrug-resistant TB (MDR-TB), 29 (6.1%) had retreatment TB, 26 (5.5%) had diabetes mellitus. The percentage of empyema patients was 8.9% (42 cases). Multivariate analysis revealed that male (adjusted OR = 4.431, 95% CI: 1.411, 13.919), pleural adenosine deaminase (ADA, >88 U/L) (adjusted OR = 3.367, 95% CI: 1.533, 7.395) and white blood cell (WBC, >9.52 109/L) (adjusted OR = 5.763, 95% CI: 2.473, 13.431) were significant risk factors for empyema in pleural TB, while pulmonary TB (adjusted OR = 0.155, 95% CI: 0.072, 0.336) was the protective factor for the patients. TE remains a serious threat to public health in China. Male sex is a significant risk factor for TE while the presence of pulmonary TB is protective, and high levels of pleural ADA and WBC count could aid in early diagnosis of TE. This finding would help towards reducing the mortality and morbidity associated with TE.

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Risk factors for Clostridium difficile infection in C. difficile colonized ICU patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1007 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S403-S403

Author(s):

Yuan Zhou ◽

Larissa Lewis ◽

Michelle McIntosh ◽

Ferric C Fang ◽

Ronald Pergamit ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Disease Transmission ◽

Significant Risk ◽

Retrospective Chart Review ◽

Signs And Symptoms ◽

Significant Risk Factor ◽

Antibiotic Use ◽

Research Support ◽

Icu Patients

Abstract Background Clostridium difficile is a major cause of healthcare-associated infections leading to significant morbidity and mortality; however, data-driven interventions to decrease C. difficile infections (CDI) are lacking due to an incomplete understanding of disease transmission and risk factors. Asymptomatic C. difficile carriers may be an important source of nosocomial transmission and disease but few studies have examined colonized patients who later develop CDI. We describe risk factors for the development of CDI in a critical care population screened for C. difficile colonization. Methods All patients admitted to our medical or trauma ICUs were screened for toxigenic C. difficile by PCR via rectal swab. Colonized patients were placed in contact enteric precautions for their entire hospitalization and monitored for signs and symptoms of CDI. Retrospective chart review assessed risk factors associated with development of CDI. Results 868 rectal swabs were collected from 4/01/16 to 10/31/16. 40 patients were colonized with C. difficile on ICU admission and 20 developed symptomatic CDI (Table 1). Risk factors for CDI in colonized patients include enteral feeding and exposure to antibiotics (Table 2). Conclusion 50% of C. difficile colonized ICU patients progressed to symptomatic CDI during their hospitalization. Antibiotic use was a significant risk factor for CDI. C. difficile carriers may be a particularly vulnerable population for CDI, warranting further investigation for early identification of colonized patients and strategies for infection prevention. Disclosures F. C. Fang, BioFire: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research support and Speaker honorarium; Cepheid: Collaborator, Consultant and Scientific Advisor, Consulting fee, Educational grant, Research support and Speaker honorarium

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Infection in the Immobile Host: A Practical Review for the Intensive Care Physician

Journal of Intensive Care Medicine ◽

10.1177/088506669801300305 ◽

1998 ◽

Vol 13 (3) ◽

pp. 135-143

Author(s):

Jeremy D. Gradon ◽

Carrie Adamson

Keyword(s):

Intensive Care ◽

Urinary Tract ◽

Pressure Ulcers ◽

Significant Risk ◽

Significant Risk Factor ◽

Care Physician ◽

Empiric Antibiotic Therapy ◽

Critically Ill Patient ◽

Clinical Approach ◽

Tract Infections

Immobility in the critically ill patient is a significant risk factor for infection, independent of the patient's underlying critical illness. Specific causes of infection related to immobility in the intensive care setting are explored. The pathogenesis, treatment, complications, and prevention of pressure ulcers, pneumonia, and urinary tract infections in the immobile patient are emphasized. Featured topics include the differentiation of colonization versus infection in pressure ulcers and the urinary tract, the significance and optimal treatment of positive fungal cultures, as well as a rational clinical approach to the immobile patient with a fever and no obvious source of infection. The clinical relevance of anaerobic infections in this population is emphasized because it influences empiric antibiotic therapy and differential diagnosis.

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