Risk of hypoglycemia induced by pivalate-conjugated antibiotics in young children: a population-based retrospective study in Japan

AbstractInfection is a common cause for an outpatient visit for young children. Pivalate-conjugated antibiotics (PCAs) are often used for these patients in Japan. However, a few case reports have shown that PCAs can provoke hypoglycemia in children, but no larger study has shown that PCAs increase the risk of hypoglycemia. The current study was performed as a retrospective review of children aged 1 month to 5 years old with at least once prescription of PCAs or other beta-lactam antibiotics from January 2011 to December 2013, using a medical and pharmacy claims database. Hypoglycemia was defined based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision code or prescription of 10% or 20% glucose injection, and the incidence of hypoglycemic events was investigated. Logistic regression analysis was performed to examine the risk of hypoglycemia with PCAs compared with control antibiotics. The study cohort contained 179,594 eligible patients (male: 52.2%, mean age: 3.2 years). The numbers of prescriptions were 454,153 and 417,287 for PCAs and control antibiotics, respectively. Multivariate analysis showed that PCAs were associated with hypoglycemia (adjusted OR 1.18, 95% CI 1.12 to 1.24, P < 0.01), and the risk of hypoglycemia was also significantly increased with use of PCAs for ≤7 days (adjusted OR 1.17, 95% CI 1.11 to 1.24, P < 0.01). These results suggest that prescription of PCAs to young children should be avoided, even for a short time period.

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839. Epidemiology of Extended-Spectrum Beta-lactamase (ESBL) Producing Enterobacteriaceae in the South East Tennessee, October-December 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1028 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S460-S461

Author(s):

Daniel Muleta ◽

Cullen Adre ◽

Benji-Byrd Warner

Keyword(s):

Klebsiella Oxytoca ◽

Health Department ◽

Population Based ◽

Klebsiella Pneumonia ◽

Drug Resistant ◽

Beta Lactam ◽

Extended Spectrum Beta Lactamase ◽

Catchment Population ◽

Beta Lactam Antibiotics ◽

Extended Spectrum

Abstract Background The increasing spread of drug resistant gram-negative organisms is one of the major public health challenges. ESBL-producing Enterobacteriaceae has become the most common multi drug resistant pathogen in the last three decades. These organisms confer resistance to most beta-lactam antibiotics, including penicillins, third generation cephalosporins, monobactams and tazobactam. Methods The Tennessee Health Department (TDH) collaborated with CDC to pilot population based surveillance of ESBL producing organisms in Maury, Wayne, Lewis and Marshall Counties during October to December 2017. A case was defined as isolation of Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca resistant to at least one extended-spectrum cephalosporin (ceftazidime, cefotaxime or ceftriaxone) and non-resistant to all carbapenem antibiotics from urine or normally sterile body sites from a resident of the surveillance catchment area. A line list of ESBL-producing organisms was received from the labs that serve the catchment population. Case report forms were completed for the first ESBL culture collected from a single patient in a 30 day-period. Results A total of 154 cases were identified during the study period. E.coli constitutes 92.2% of the ESBL producing organisms followed by Klebsiella pneumonia (5.2%) and K. oxytoca (2.6%). The estimated annual incidence rate was 400.7 per 100,000 population which is more than twice of the average rates of other sites that conducted similar studies. The most common isolate source was urine (97%), and 81.2% of all cases were female. Patient ages ranged from 3-99 years, with average of 67 years. Thirty-two isolates underwent additional sequence typing and 76.7% (23) of the isolates were ST 131. 21 (91.3%) of ST-131 isolates were resistant to ciprofloxacin. Conclusion The study revealed that the incidence of ESBL producing organisms is very high in the Tennessee study area compared to other sites. The most common ESBL-producing pathogen was found to be ST 131 and most of these were resistant to ciprofloxacin suggesting that resistance to fluoroquinolone may be co-transmitted in ESBL producing pathogens through plasmids. Continued surveillance of molecular epidemiology is important to guide the prevention of the spread of drug resistant pathogens. Disclosures All Authors: No reported disclosures

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Earthquake-Induced Injuries: Retrospective Epidemiological Analysis of the 2015 Hindu Kush Earthquake in Pakistan

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.134 ◽

2018 ◽

Vol 13 (4) ◽

pp. 732-739

Author(s):

Junaid Ahmad ◽

Mokbul Morshed Ahmad ◽

Elena Espigares Rodríguez

Keyword(s):

Active Regions ◽

Population Based ◽

Body Region ◽

Time Data ◽

Body Regions ◽

Retrospective Data Analysis ◽

Hindu Kush ◽

Classification Of Diseases ◽

International Statistical Classification ◽

Refusal To Participate

ABSTRACTObjectiveThe aim of this study was to analyze retrospectively the earthquake-induced injuries caused by the October 2015 Hindu Kush earthquake in Pakistan. This is the first population-based study to assess epidemiologically earthquake-induced injuries in the Hindu Kush region, one of the world’s most mountainous and seismically active regions. Unfortunately, only limited studies have investigated the earthquake-induced injuries and deaths in the region epidemiologically.MethodsThe 5 worst affected districts were selected according to the highest number of deaths and injuries recorded. A total of 1,790 injuries and 232 deaths were reported after the 2015 earthquake. In our study area, 391 persons were recorded and verified to have been injured as a result of the earthquake. We attempted to investigate all of the 391 injured people, but the final study looked at 346 subjects because the remaining 45 subjects could not be traced because of the non-availability of their complete records and their refusal to participate in the study.ResultsUsing the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD 10), we found that the highest number – 20.23% (70 of 346) – of injuries in the earthquake fall in the class of “Injuries to an unspecified part of trunk, limb, or body region (T08-T14).” The class of “Injuries to knee and lower leg (S80-S89),” which count 15.61% (54 out of 346), followed it, and “Injuries involving multiple body regions (T00-T07)” were making 14.74% of total injuries (51 out of 346).ConclusionIn times of natural disasters like earthquakes, collecting and analyzing real-time data can be challenging. Therefore, a retrospective data analysis of deaths and injuries induced by the earthquake is of high importance. Studies in these emerging domains will be crucial to initiate health policy debates and to prevent and mitigate future injuries and deaths. (Disaster Med Public Health Preparedness. 2018;13:732–739).

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Productivity losses among people with back pain and among population-based references: a register-based study in Sweden

BMJ Open ◽

10.1136/bmjopen-2019-036638 ◽

2020 ◽

Vol 10 (8) ◽

pp. e036638

Author(s):

Filip Gedin ◽

Kristina Alexanderson ◽

Niklas Zethraeus ◽

Korinna Karampampa

Keyword(s):

Back Pain ◽

Reference Group ◽

Productivity Loss ◽

Work Capacity ◽

Population Based ◽

Productivity Losses ◽

Classification Of Diseases ◽

International Statistical Classification ◽

Years Lived With Disability

ObjectiveBack pain is the leading cause for years lived with disability globally and among the main reasons for sickness absence (SA) and disability pension (DP). The objective of this study was to explore the occurrence of SA and DP and to estimate productivity losses among individuals with back pain compared with among matched population-based references.DesignExplorative prospective cohort study using register microdata.Participants and settingA total of 23 176 people, aged 19–60 years, with a first visit to inpatient or specialised outpatient healthcare for back pain (International Statistical Classification of Diseases and Related Health Problems code M54) in 2010 in Sweden and a matched population-based reference group (n=115 880).OutcomesLong-term SA (in SA spells >14 days) and DP and productivity losses, measured in € (2018 prices) by multiplying the SA and DP net days by the societal cost of each such day.ResultsIn the back-pain group, 42% had SA or DP days; in the reference group, the corresponding proportion was 15%. Productivity loss per patient with back pain was €8928 during the 12-month follow-up period; in the reference group, it was €3499 (p<0.0001).ConclusionsSA and DP, leading to excess productivity losses among people with back pain, reflect the challenges these patients are facing to maintain their work capacity. Interventions to promote that individuals with back pain remain in paid work should be a priority in order to address the high costs.

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Cloxacillin-Induced Acute Tubulo Interstitial Nephritis

Annals of Pharmacotherapy ◽

10.1177/106002809202601010 ◽

1992 ◽

Vol 26 (10) ◽

pp. 1241-1242 ◽

Cited By ~ 5

Author(s):

Roberto García-Ortiz ◽

Roberto S. Espinoza ◽

Gonzalo R. Silva ◽

Rodrigo K. Alonso ◽

Hector S. Opazo ◽

...

Keyword(s):

Renal Function ◽

Interstitial Nephritis ◽

Case Reports ◽

Urinary Output ◽

Lumbar Pain ◽

Dramatic Improvement ◽

Beta Lactam ◽

Drug Induced ◽

Beta Lactam Antibiotics ◽

Sterile Pyuria

OBJECTIVE: To report a case of possible cloxacillin-induced acute tubulo interstitial nephritis (AIN). CASE SUMMARY: A 15-year-old male patient presented with hypertension, edema, lumbar pain, sterile pyuria, eosinophiluria (ten percent), and severe renal dysfunction three months after the ingestion of cloxacillin. A renal biopsy revealed diffuse edema and inflammatory infiltrate of the interstitium (five percent eosinophils). He received four sessions of peritoneal dialysis with dramatic improvement in urinary output and renal function. His biochemical parameters returned to normal values 21 days after admission, without the use of glucocorticosteroids. DISCUSSION: Published case reports on AIN induced by penicillin and related drugs are reviewed and compared. The role of interstitial edema in acute renal failure associated with drug-induced AIN is mentioned. CONCLUSIONS: AIN is a rare but significant complication of therapy with penicillin and related drugs. The clinical picture is similar for all of these drugs, but skin rash and fever are absent in AIN induced by cloxacillin and cloxacillin-related drugs. Dialysis improved the patient's urinary output and renal function. Beta-lactam antibiotics should be avoided in patients with cloxacillin-induced AIN.

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Eight-year outcome after invasive treatment of infrainguinal intermittent claudication: A population-based analysis from the Swedish vascular register (Swedvasc)

SAGE Open Medicine ◽

10.1177/2050312120926782 ◽

2020 ◽

Vol 8 ◽

pp. 205031212092678

Author(s):

Thordur Gunnarsson ◽

Anders Gottsäter ◽

Stefan Bergman ◽

Thomas Troëng ◽

Hans Lindgren

Keyword(s):

Intermittent Claudication ◽

Circulatory System ◽

Population Based ◽

High Morbidity ◽

Invasive Treatment ◽

Classification Of Diseases ◽

Icd 10 ◽

Positive Treatment ◽

International Statistical Classification

Objectives: Invasive treatment of infrainguinal intermittent claudication is controversial, and long-term outcomes are scarce. The study aim was to evaluate 8 years results regarding new vascular interventions on index and contralateral limb, hospitalization, mortality, and amputation in 775 patients revascularized for infrainguinal intermittent claudication in 2009. Methods: Data on new vascular interventions retrieved from the Swedish vascular register (Swedvasc) were linked to the Inpatient Register and Cause of Death Register with information on hospitalizations, primary discharge diagnoses according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), deaths, causes of death, and amputations. Results: During 8 years of follow-up, 486 new vascular interventions were performed. Patients were admitted for a total of 4662 hospitalizations and spent 25,970 days in hospital. Between 79% and 99% of surviving subjects were hospitalized each year. During follow-up, 311 (40.1%) patients died. The most common causes of hospitalization and death were cerebrovascular disease, ischemic heart disease, or other diseases of the circulatory system, causing 47.5% of hospitalizations and 42.4% of deaths. Seventy-seven major lower limb amputations were performed in 52 patients. Conclusion: As patients undergoing invasive treatment of infrainguinal intermittent claudication have high morbidity and mortality, during 8 years of follow-up, the indication for invasive treatment should be carefully weighed against concomitant comorbidities and the timing of this treatment optimized with regard to the patient’s possibilities to enjoy positive treatment effects on quality of life.

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The Economic Burden of Hospital-Acquired Clostridium difficile Infection: A Population-Based Matched Cohort Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.122 ◽

2016 ◽

Vol 37 (9) ◽

pp. 1068-1078 ◽

Cited By ~ 13

Author(s):

Natasha Nanwa ◽

Jeffrey C. Kwong ◽

Murray Krahn ◽

Nick Daneman ◽

Hong Lu ◽

...

Keyword(s):

Cohort Study ◽

Clostridium Difficile ◽

Population Based ◽

Matched Cohort ◽

Matched Cohort Study ◽

Payer Perspective ◽

Classification Of Diseases ◽

Costing Study ◽

International Statistical Classification ◽

Hospital Acquired

BACKGROUNDHigh-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making.OBJECTIVETo evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective.METHODSWe conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.7) from January 1, 2003, through December 31, 2010, in Ontario, Canada. Infected subjects were matched to uninfected subjects (those without the code A04.7) on age, sex, comorbidities, geography, and other variables, and followed up through December 31, 2011. We stratified results by elective and nonelective admissions. The main study outcomes were up-to-3-year costs, which were evaluated in 2014 Canadian dollars.RESULTSWe identified 28,308 infected subjects (mean annual incidence, 27.9 per 100,000 population, 3.3 per 1,000 admissions), with a mean age of 71.5 years (range, 0–107 years), 54.0% female, and 8.0% elective admissions. For elective admission subjects, cumulative mean attributable 1-, 2-, and 3-year costs adjusted for survival (undiscounted) were $32,151 (95% CI, $28,192–$36,005), $34,843 ($29,298–$40,027), and $37,171 ($30,364–$43,415), respectively. For nonelective admission subjects, the corresponding costs were $21,909 ($21,221–$22,609), $26,074 ($25,180–$27,014), and $29,944 ($28,873–$31,086), respectively.CONCLUSIONSHospital-acquired CDI is associated with substantial healthcare costs. To the best of our knowledge, this study is the first CDI costing study to present longitudinal costs. New strategies may be warranted to mitigate this costly infectious disease.Infect Control Hosp Epidemiol 2016;37:1068–1078

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Diagnostic code agreement for electronic health records and claims data for tuberculosis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0792 ◽

2020 ◽

Vol 24 (7) ◽

pp. 706-711

Author(s):

S. A. Iqbal ◽

C. J. Isenhour ◽

G. Mazurek ◽

B. I. Truman

Keyword(s):

Electronic Health Records ◽

Latent Tuberculosis ◽

Population Based ◽

Positive Tuberculin Skin Test ◽

Diagnostic Code ◽

Snomed Ct ◽

Health Records ◽

Classification Of Diseases ◽

International Statistical Classification ◽

Electronic Health

OBJECTIVE: To measure the frequency of diseases related to latent tuberculosis infection (LTBI) and tuberculosis (TB), we assessed the agreement between diagnosis codes for TB or LTBI in electronic health records (EHRs) and insurance claims for the same person.METHODS: In a US population-based, retrospective cohort study, we matched TB-related Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT) EHR codes and International Statistical Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) claims codes. Furthermore, LTBI was identified using a published ICD-based algorithm and all LTBI- and TB-related SNOMED CT codes.RESULTS: Of people with the 10 most frequent TB-related claim codes, 50% did not have an exact-matched EHR code. Positive tuberculin skin test was the most frequent unmatched EHR code and people with the 10 most frequent TB EHR codes, 40% did not have an exact-matched claim code. The most frequent unmatched claim code was TB screening encounter. EHR codes for LTBI matched to claims codes for TB testing; pulmonary TB; and nonspecific, positive or adverse tuberculin reaction.CONCLUSION: TB-related EHR codes and claims diagnostic codes often disagree, and people with claims codes for LTBI have unexpected EHR codes, indicating the need to reconcile these coding systems.

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Risk of psoriatic arthritis depending on age: analysis of data from 65 million people on statutory insurance in Germany

RMD Open ◽

10.1136/rmdopen-2021-001975 ◽

2021 ◽

Vol 7 (3) ◽

pp. e001975

Author(s):

Madeline Deike ◽

Ralph Brinks ◽

Stephan Meller ◽

Matthias Schneider ◽

Philipp Sewerin

Keyword(s):

Psoriatic Arthritis ◽

Meta Analysis ◽

Age Groups ◽

Population Based ◽

Insurance Companies ◽

Data Sets ◽

Survey Period ◽

Continuous Increase ◽

Classification Of Diseases ◽

International Statistical Classification

ObjectivesThis study aims to provide a comprehensive analysis of the age-dependent risk of psoriatic arthritis (PsA). For this purpose, it focuses on the varying incidences within the different age groups.MethodsThe data were collected as part of the morbidity-based risk adjustment of the statutory health insurance companies in Germany. This survey recorded the International Statistical Classification of Diseases and Related Health Problems (ICD)-coded diagnoses of 65 million German citizens. Our population-based study used these raw data to calculate the prevalence of PsA in the first step. Subsequently, we employed a new approach for the estimation of the age-specific and sex-specific incidence of PsA.ResultsThe age-specific and sex-specific incidence of PsA showed a continuous increase with rising age until it peaked slightly before the age of 60 and declined thereafter. The maximum value was higher in women (40 per 100 000 py) than in men (30 per 100 000 py). Furthermore, the incidence rate tends to climb over the survey period.ConclusionsThe data sets identified an unexpected high incidence. A meta-analysis by Scotti et al and other recent population-based studies served as a reference for the comparison. The pattern of the age-specific incidence illustrated that the risk for PsA disease shows considerable variations depending on age.

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Income, income inequality and schizophrenia in China: a population-based multilevel analysis

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-213049 ◽

2020 ◽

pp. jech-2019-213049

Author(s):

Ruoxi Ding ◽

Lei Zhang ◽

Ping He ◽

Xinming Song ◽

Xiaoying Zheng

Keyword(s):

Income Inequality ◽

National Sample ◽

Population Based ◽

Sample Survey ◽

Older Individuals ◽

Absolute Income ◽

Classification Of Diseases ◽

International Statistical Classification ◽

Province Level

BackgroundPrevious studies have suggested that socio-environmental factors interact with genetic risk in the genesis of schizophrenia. This study aimed to investigate the relationship between income, income inequality and schizophrenia and its heterogeneity among different geographic scales and subgroups.MethodsWe used data from the Second China National Sample Survey on Disability (2006). The sample consisted of 1 909 205 participants aged 18 years or older. Individuals who were suspected to be psychiatrically disabled were administered the WHO Disability Assessment Schedule, Version II and the International Statistical Classification of Diseases, Tenth Revision Symptom Checklist for Mental Disorders by trained clinical psychiatrists to diagnose schizophrenia. Gross household income per capita was used to calculate the Gini coefficient to measure income inequality. Multilevel logistic regression with cross-level interaction was applied to examine the association of income, income inequality and schizophrenia.ResultsA total of 7 628 persons (0.40%) were identified as having schizophrenia. Income was independently associated with schizophrenia. At the province level, greater income inequality was significantly associated with a higher risk of schizophrenia (OR, 1.03; 95% CI 1.00 to 1.06), and no significant association was observed at the county level. The analysis with cross-level interaction showed that the association at the province level was most pronounced in the highest income quartile (OR, 1.02; 95% CI 1.00 to 1.03).ConclusionThe significant association between income and schizophrenia was consistent with the absolute income hypothesis. The adverse effect of income inequality on the risk of schizophrenia starts to operate at a larger area level, and it is more pronounced for the affluent population in China. This finding further supports the relative income hypothesis and social causation pathway for schizophrenia and calls attention to the vulnerability of high-income groups.

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Association Between Use of Anti-gout Preparations and Dementia: Nested Case–Control Nationwide Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2020.607808 ◽

2021 ◽

Vol 7 ◽

Author(s):

Tsung-Ju Chuang ◽

Yu-Hsun Wang ◽

James Cheng-Chung Wei ◽

Chih-Jung Yeh

Keyword(s):

Cohort Study ◽

Lower Risk ◽

Conditional Logistic Regression ◽

Final Analysis ◽

The Elderly ◽

Population Based ◽

Research Database ◽

Incident Dementia ◽

Classification Of Diseases ◽

International Statistical Classification

Objectives: Gout is the most common form of inflammatory arthritis and was found to be independently associated with incident dementia in the elderly. However, the associations between anti-gout preparations and dementia were not well-studied.Methods: Data were collected from Taiwan's National Health Insurance Research Database (NHIRD). A 2005–2013 retrospective cohort study was conducted, and all investigated subjects were identified by International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Clinical Modification. Conditional logistic regression was used to evaluate the odds ratio of dementia in relation to different gout preparations (benzbromarone, allopurinol, sulfinpyrazone, probenecid) and number of days of anti-gout preparation use, after adjustment for potential confounding variables.Results: A total of 3,242 gout patients with and without dementia were selected from the NHIRD and included in the final analysis after 1:1 matching for age, gender, and diagnosis year of gout. In the anti-gout preparations, only use of Benzbromarone decreased the risk of dementia (adjusted OR, 0.81; 95% CI, 0.68–0.97). The result of the subgroup analysis revealed a trend toward a lower risk of dementia with longer use of benzbromarone. Use of benzbromarone for ≥180 days showed a significantly lower risk of dementia (adjusted OR, 0.72; 95% CI, 0.58–0.89). Moreover, the protective effect was more pronounced in males compared with females.Conclusion: This cohort study reveals that gout patients taking benzbromarone are at a decreased risk of developing incident dementia, especially with longer use and in male. Further prospective trials are warranted to confirm our findings.

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