Isolation of Imipenem-Resistant Enterobacter Species: Emergence of KPC-2 Carbapenemase, Molecular Characterization, Epidemiology, and Outcomes

ABSTRACT The prevalence of isolation of imipenem-resistant Enterobacter (IRE) strains is rising, with potential serious consequences in terms of patients' outcomes and general care. The study objective was to define the various epidemiological aspects of the isolation of these strains in comparison to cases of isolation of imipenem-susceptible Enterobacter (ISE) strains. Molecular analysis of IRE strains included genotyping and defining the presence of carbapenemases. We conducted a matched retrospective case-control study of patients hospitalized from April 2003 to December 2006. Each IRE case was matched with an ISE case by age and source of isolation. A multivariate analysis using conditional logistic regression was performed to compare the two patient groups. There were 33 cases of IRE isolations during the study period. Twenty isolates were analyzed and found to belong to three distinct pulsotypes. Cell extracts of all of these isolates hydrolyzed imipenem. PCR and sequencing revealed that these isolates harbored a KPC-2 gene. In multivariate analysis, a high invasive-device score (P = 0.02) remained a predictor of IRE isolation. The mortality in the IRE group was 33%, compared to 9% among controls. Being an IRE case was significantly associated with increased mortality after controlling for confounders in a multivariate model (odds ratio, 8.3 ± 8.6; 95% confidence interval, 1.07 to 64; P = 0.043). Resistance to imipenem due to bla KPC-2 among Enterobacter isolates has occurred in several clones in Tel Aviv, affecting particularly patients with multiple invasive devices compared to ISE controls. IRE infections are associated with increased mortality. Enhanced measures to control the hospital spread of IRE are warranted.

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Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study

BMC Neurology ◽

10.1186/s12883-020-02005-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nan Zhang ◽

Lin Zhang ◽

Qiu Wang ◽

Jingwei Zhao ◽

Jia Liu ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Young Adults ◽

Ischemic Stroke ◽

Case Control Study ◽

Conditional Logistic Regression ◽

Case Control ◽

Retrospective Case ◽

Factors Associated ◽

Control Study

Abstract Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.

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Incidence and Risk of Severe Ileus After Orthopedic Surgery: A Case-Control Study

HSS Journal ® ◽

10.1007/s11420-019-09712-z ◽

2019 ◽

Vol 16 (S2) ◽

pp. 272-279 ◽

Cited By ~ 1

Author(s):

Lisa A. Mandl ◽

Mayu Sasaki ◽

Jingyan Yang ◽

Sara Choi ◽

Kelianne Cummings ◽

...

Keyword(s):

Orthopedic Surgery ◽

Case Control Study ◽

Conditional Logistic Regression ◽

International Classification Of Diseases ◽

Case Control ◽

Orthopedic Procedures ◽

Retrospective Case ◽

Full Diet ◽

Increased Risk ◽

Control Study

Abstract Background Post-operative ileus (POI) is common and can be associated with significant morbidity. Questions/Purposes We aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery. Methods We conducted a retrospective case–control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI. Results Of 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI. Conclusions In this retrospective case–control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.

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Drainage smell and peritonitis are efficient indicators of anastomotic leakage after laparoscopic rectal cancer resection

Journal of International Medical Research ◽

10.1177/0300060520970766 ◽

2020 ◽

Vol 48 (11) ◽

pp. 030006052097076

Author(s):

Enesh Shiwakoti ◽

Jianning Song ◽

Jun Li ◽

Shanshan Wu ◽

Zhongtao Zhang

Keyword(s):

Rectal Cancer ◽

Multivariate Analysis ◽

Anastomotic Leakage ◽

Roc Curves ◽

Retrospective Case ◽

Cancer Resection ◽

Rectal Cancer Resection ◽

Friendship Hospital ◽

Beijing Friendship Hospital ◽

Control Study

Objective Anastomotic leakage (AL) is a frequent complication after laparoscopic rectal cancer resection (LRCR). The main objective of the present study was to identify accurate indicators of AL after LRCR. Methods A retrospective case-control study was performed of 185 patients who underwent laparoscopic surgery for rectal cancer between March 2012 and February 2017 at Beijing Friendship Hospital. Potential indicators of AL were examined via univariate and multivariate analyses. The performance of multivariate analysis was evaluated using receiver operating characteristic (ROC) curves. Results The overall AL rate was 17.84%. Multivariate analysis identified drainage smell (odds ratio [OR = 35.318, 95% confidence interval [CI] = 7.114 to 175.338) and peritonitis [OR = 17.475, 95% CI = 1.540 to 198.318) as independent indicators of AL. The area under the ROC curve was 0.720 (95% CI = 0.606 to 0.835). Conclusion Drainage smell and peritonitis could be reliable and accurate indicators of AL after LRCR.

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Initial Experience with Robotic Retropubic Urethropexy Compared to Open Retropubic Urethropexy

Obstetrics and Gynecology International ◽

10.1155/2013/315680 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Pooja R. Patel ◽

Mostafa A. Borahay ◽

Audrey R. Puentes ◽

Ana M. Rodriguez ◽

Jessica Delaisse ◽

...

Keyword(s):

Case Series ◽

University Hospital ◽

Open Approach ◽

Robotic Approach ◽

Retrospective Case ◽

Study Objective ◽

Intraoperative Complication ◽

Feasible Alternative ◽

A Minor ◽

Control Study

Study Objective. To compare the clinical outcomes of robotic retropubic urethropexy versus open retropubic urethropexy.Design. Retrospective case-control study (II-2).Setting. University Hospital.Patients. All patients who underwent robotic retropubic urethropexy from 1/1/12 to 6/1/12 by a single gynecologic surgeon were included in the case series. The control cases consisted of the last five consecutive open retropubic urethropexies performed by the same surgeon.Main Results. A total of 10 patients (5 robotic cases and 5 open cases) were included in this study. Both groups were similar with respect to age, BMI, and obstetrical history. Mean hospital stay length and mean EBL were overall less for robotic cases than for open cases (1.2 days versus 2.6 days; 169 mL versus 300 mL). One of the 5 patients who underwent the open approach and 2 of the 5 patients who underwent the robotic approach sustained a minor intraoperative complication. All but one patient from each group experienced resolution of incontinence after the procedure. Two of the patients who underwent the open approach had postoperative complications.Conclusions. Robotic retropubic urethropexy may be a feasible alternative to open retropubic urethropexy. A larger study is necessary to support our observations.

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Risk Factors Associated with Ischemic Stroke in a Young Non-Diabetic and Non-Hypertensive Population: A Retrospective Case-Control Study

10.21203/rs.3.rs-81463/v1 ◽

2020 ◽

Author(s):

Nan Zhang ◽

Lin Zhang ◽

Qiu Wang ◽

Jingwei Zhao ◽

Jia Liu ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Young Adults ◽

Ischemic Stroke ◽

Case Control Study ◽

Conditional Logistic Regression ◽

Case Control ◽

Retrospective Case ◽

Factors Associated ◽

Control Study

Abstract Background: Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes.Methods: This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models.Results: We recruited 60 IS patients and 180 controls with mean ages of 44.37±4.68 and 44.31±4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P< 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165-1.977, P= 0.002 and OR 2.418, 95%CI 1.061-5.511, P=0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000-0.083, P=0.003 and OR 0.053, 95%CI 0.008-0.326, P=0.002, respectively).Conclusion: In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.

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Transmission of SARS-CoV-2 considering shared chairs in outpatient dialysis: a real-world case-control study

BMC Nephrology ◽

10.1186/s12882-021-02518-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ravi Thadhani ◽

Joanna Willetts ◽

Catherine Wang ◽

John Larkin ◽

Hanjie Zhang ◽

...

Keyword(s):

Case Control Study ◽

Conditional Logistic Regression ◽

Case Control ◽

Positive Patient ◽

Transmission Risk ◽

Sensitivity Analyses ◽

Retrospective Case ◽

Control Pair ◽

Logistic Regression Models ◽

Control Study

Abstract Background SARS-CoV-2 can remain transiently viable on surfaces. We examined if use of shared chairs in outpatient hemodialysis associates with a risk for indirect patient-to-patient transmission of SARS-CoV-2. Methods We used data from adults treated at 2,600 hemodialysis facilities in United States between February 1st and June 8th, 2020. We performed a retrospective case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) treated in the same dialysis shift. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count. For each case-control pair, we traced backward 14 days to assess possible prior exposure from a ‘shedding’ SARS-CoV-2 positive patient who sat in the same chair immediately before the case or control. Conditional logistic regression models tested whether chair exposure after a shedding SARS-CoV-2 positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient. Results Among 170,234 hemodialysis patients, 4,782 (2.8 %) tested positive for SARS-CoV-2 (mean age 64 years, 44 % female). Most facilities (68.5 %) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30 % (95 %CI 0.90 %, 1.87 %) of cases and 1.39 % (95 %CI 0.97 %, 1.97 %) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR = 0.94; 95 %CI 0.57 to 1.54; p = 0.80). Results remained consistent in adjusted and sensitivity analyses. Conclusions The risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low.

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