scholarly journals Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

2014 ◽  
Vol 58 (8) ◽  
pp. 4630-4635 ◽  
Author(s):  
Teena Chopra ◽  
Dror Marchaim ◽  
Paul C. Johnson ◽  
Reda A. Awali ◽  
Hardik Doshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Acinetobacter Baumannii ◽  
Bloodstream Infection ◽  
Medical Center ◽  
Care Facility ◽  
Health Care Facility ◽  
Positive Culture ◽  
Acinetobacter Calcoaceticus ◽  
Content Type

ABSTRACTIdentifying patients at risk for bloodstream infection (BSI) due toAcinetobacter baumannii-Acinetobacter calcoaceticuscomplex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ≥3 (odds ratio [OR], 2.34;P= 0.001), a direct admission from another health care facility (OR, 4.63;P< 0.0001), a prior hospitalization (OR, 3.11;P< 0.0001), the presence of an indwelling central venous line (OR, 2.75;P= 0.011), the receipt of total parenteral nutrition (OR, 21.2;P< 0.0001), the prior receipt of β-lactams (OR, 3.58;P< 0.0001), the prior receipt of carbapenems (OR, 3.18;P= 0.006), and the prior receipt of chemotherapy (OR, 15.42;P< 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40;P< 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.

scholarly journals Risk factors for death in patients with severe asthma

2014 ◽  
Vol 40 (4) ◽  
pp. 364-372 ◽  
Author(s):  
Andréia Guedes Oliva Fernandes ◽  
Carolina Souza-Machado ◽  
Renata Conceição Pereira Coelho ◽  
Priscila Abreu Franco ◽  
Renata Miranda Esquivel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Asthma Control ◽  
Severe Asthma ◽  
Airflow Obstruction ◽  
Care Facility ◽  
Health Care Facility ◽  
Control Program ◽  
Male Gender ◽  
Respiratory Causes

OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.

Risk Factors for Atherothrombotic Brain Infarction in Persons Over 62 Years of Age in a Long-Term Health Care Facility

1987 ◽  
Vol 35 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Wilbert S. Aronow ◽  
Laurence Starling ◽  
Fritzner Etienne ◽  
Peter D'Alba ◽  
Mildred Edwards ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Brain Infarction ◽  
Care Facility ◽  
Health Care Facility

scholarly journals Risk Factors for Development of Carbapenem Resistance Among Gram-Negative Rods

2019 ◽  
Vol 6 (3) ◽  
Author(s):  
Stefan E Richter ◽  
Loren Miller ◽  
Jack Needleman ◽  
Daniel Z Uslan ◽  
Douglas Bell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Carbapenem Resistance ◽  
High Morbidity ◽  
Index Hospitalization ◽  
Hospital System ◽  
Gram Negative ◽  
C Statistic

Abstract Background Infections due to carbapenem-resistant Gram-negative rods (CR-GNR) are increasing in frequency and result in high morbidity and mortality. Appropriate initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay. Methods To determine risk factors for recovery on culture of CR-GNR, cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. Ertapenem resistance (ER-GNR) and antipseudomonal (nonertapenem) carbapenem resistance (ACR-GNR) patterns were analyzed separately. A total of 30951 GNR isolates from 12370 patients were analyzed, 563 of which were ER and 1307 of which were ACR. Results In multivariate analysis, risk factors for ER-GNR were renal disease, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) agent in the prior 30 days (c-statistic, 0.74). Risk factors for ACR-GNR were male sex, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (c-statistic, 0.76). Conclusions A straightforward scoring system derived from these models can be applied by providers to guide empiric antimicrobial therapy; it outperformed use of a standard hospital antibiogram in predicting infections with ER-GNR and ACR-GNR.

Expert-based approach to rank critical asset assessment factors for healthcare facilities

Facilities ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Dalia Salem ◽  
Emad Elwakil
Keyword(s):  
Health Care ◽  
Asset Management ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Assessment Model ◽  
Loss Assessment ◽  
Content Type ◽  
Care Facilities ◽  
General Safety

Purpose This research’s main objective is to develop an expert-based approach to rank critical asset assessment factors for health-care facilities. This approach will improve the asset management of health-care buildings. This paper aims to study and prioritize the relative importance of asset criticality factors. Design/methodology/approach The research methodology begins with a comprehensive literature review of state-of-the-art health-care facilities management, asset management tools, critical asset assessment and approaches to model techniques. Then, using the expert-based opinion and the collected data through the analytical hierarchy process approach to developing the asset assessment model contains physical, environmental, general safety and revenue loss assessment models. Findings Results showed that the general safety factors and the sub-factors of life safety and physical safety contributed to asset condition assessment. Practical implications The proposed critical asset assessment ranking will benefit health-care facility organizations by assessing their asset performance according to capital renewal needs. Originality/value This study offers a novel conceptual framework to understand and determine rank critical asset assessment factors for health-care facilities.

scholarly journals Types and Prevalence of Carbapenem-Resistant Acinetobacter calcoaceticus-Acinetobacter baumannii Complex in Northern Taiwan

2013 ◽  
Vol 58 (1) ◽  
pp. 201-204 ◽  
Author(s):  
Wen-Shyang Hsieh ◽  
Nai-Yu Wang ◽  
Jou-An Feng ◽  
Li-Chuan Weng ◽  
Hsueh-Hsia Wu
Keyword(s):  
Acinetobacter Baumannii ◽  
Medical Center ◽  
Carbapenem Resistance ◽  
Acinetobacter Calcoaceticus ◽  
Pulsed Field Gel Electrophoresis ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Acinetobacter Baumannii Complex ◽  
High Level ◽  
Northern Taiwan

ABSTRACTThe frequency of the carbapenem-resistantAcinetobacter calcoaceticus-Acinetobacter baumannii(CRACB) complex increases annually in our hospitals. However, the types and prevalence of carbapenemases among isolates still remain unclear. In this study, we identified and collected 672 carbapenem-resistant isolates from a medical center in Northern Taiwan between April and December of 2010. There were 577 genospecies 2 (Acinetobacter baumannii), 79 genospecies 13TU, and 16 genospecies 3 isolates. The isolates had an acquiredblaOXA-24-like gene, which was confirmed by sequencing for the encoded OXA-72 carbapenemase, and were often associated with high-level carbapenem resistance. These CRACB complex isolates remained susceptible to colistin (100%). The genotyping of isolates was conducted using pulsed-field gel electrophoresis with ApaI digestion. In most clonally related groups, patients were from both branch hospitals. The results indicate that interhospital dissemination of clones occurred. This study provides updated data on the types and prevalence of the CRACB complex. In addition, it presents a warning on the emergence and spread of CRACB complex harboringblaOXA-24-like genes in northern Taiwan.

scholarly journals Risk Factors and Clinical Outcomes of Cancer Patients with Clostridium difficile Associated Diarrhea Co-infected with a Second Enteropathogen

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S362-S363
Author(s):  
Harika Yalamanchili ◽  
Andrew Chao ◽  
Eduardo Yepez Guevara ◽  
Samuel L Aitken ◽  
Micah Bhatti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Cancer Patients ◽  
Clinical Symptoms ◽  
Care Facility ◽  
Health Care Facility ◽  
Exact Test ◽  
Increased Risk ◽  
Clostridium Difficile Associated Diarrhea ◽  
The Impact

Abstract Background Cancer patients are at an increased risk for C. difficile infection (CDI) which is often identified along with other enteropathogens. The impact of co-infections on outcomes has not been established in this population. We compared the risk factors and clinical characteristics of patients with CDI monoinfection (CDIM) and patients coinfected with bacterial (CDIB) or viral (CDIV) enteropathogens. Methods Adult patients presenting with primary or recurrent CDI (n = 88) identified on a two-step GI multiplex assay (Biofire) followed by toxin A/B EIA, were classified into CDIM (n = 66), CDIB (n = 12), and CDIV (n = 10) groups. Demographic and clinical data were collected and risk factors and outcomes compared by Fisher’s exact test, ANOVA, and the Kruskal–Wallis test. CDI severity was determined using Zar’s criteria, presence of bacteremia, and ICU stay. Results During the study period, 2,017 diarrheal samples were submitted to the microbiology laboratory. An enteric pathogen was identified in 311 (15%) patients. CDI was identified in 88 cases of which 22 (25%) had a second pathogen. CDIM was found in 66 (21%), CDIB in 12 (4%), and CDIV in 10 (3%) subjects. The most common co-pathogens identified were diarrheagenic E. coli in the CDIB group (9/12, 75%) and norovirus in the CDIV group (8/10, 80%). Groups were similar in terms of demographics, number of recurrences, health care acquisition, co-morbidities, disease severity, serum creatinine at presentation, presence of toxin by EIA, and mortality. Patients with CDIM were more likely to have a recent hospitalization than the CDIB group (44/66 67% vs.. 3/12 25%, P = 0.01). Clinical symptoms at presentation were similar for the three groups except for nausea which was more common in the CDIV group when compared with CDIM (8/10, 80% vs. 25/66, 38%; P = 0.02). The use of proton pump inhibitors was similar in the three groups. There was however, a higher proportion of patients taking GABA-like drugs within 90 days among the CDIB patients (10/12, 83%) than the group with CDIM (26/66, 40%) P = 0.01. Conclusion In CDI cancer patients, co-infection with other enteropathogens is common. Patients with CDIB were less likely to have a recent admission to a health care facility. The use of GABA-like drugs was associated with a higher risk of bacterial co-infection. Disclosures All authors: No reported disclosures.

Factors affecting health tourism and international health-care facility choice

2017 ◽  
Vol 11 (1) ◽  
pp. 16-36 ◽  
Author(s):  
Gökhan Aydin ◽  
Bilge Karamehmet
Keyword(s):  
Health Care ◽  
Decision Process ◽  
International Health ◽  
Care Facility ◽  
Health Care Facility ◽  
Consumer Decision ◽  
Content Type ◽  
Factors Affecting ◽  
Consumer Decision Process ◽  
International Health Care

Purpose Health-care tourism has become a major industry in the past decade. Following the increasing activity in health-care tourism, the decision-making process of consumers in choosing an international health-care facility has become increasingly important to the related parties. The present study aims to offer a holistic model of international health-care facility choice that incorporates the important dimensions by assessing the growth drivers and the alternative factors proposed in the literature and by validating them via a survey study. Design/methodology/approach The factors deemed important in the existing literature were used as the basis of a study in Turkey. In total, 65 structured interviews were conducted with health-care professionals and international health tourists to understand the perspective of the two important parties that affect policymaking. Findings The findings of the study support the significance of the majority of the variables proposed as important factors affecting international health-care facility choice. Research limitations/implications The study was carried out in four large hospital chains in Turkey; however, this creates a limitation in scope and may have limited representativeness of the overall market. The model has yet to be tested on a larger scale. Practical implications There are significant differences in the opinions of professionals and international health-care tourists in terms of choice criteria. This indicates problems with health professionals’ understanding of the consumer decision process. Originality/value The study provides a model that can be used to gain insights on the consumer decision process and also provides the policymakers and stakeholders of the international health-care industry with a sound theoretical foundation to build further studies upon. Only a limited number of studies was carried out in Turkey that focus on international health-care tourism, and the present study will fill a substantial research gap.

scholarly journals Antibiotic Exposure and Risk for Hospital-Associated Clostridioides difficile Infection

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Brandon J. Webb ◽  
Aruna Subramanian ◽  
Bert Lopansri ◽  
Bruce Goodman ◽  
Peter Bjorn Jones ◽  
...  
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Content Type ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Intermountain Healthcare ◽  
Health Care Associated Infection

ABSTRACT Clostridioides difficile infection (CDI) is a health care-associated infection associated with significant morbidity and cost, with highly varied risk across populations. More effective, risk-based prevention strategies are needed. Here, we investigate risk factors for hospital-associated CDI in a large integrated health system. In a retrospective cohort of all adult admissions to 21 Intermountain Healthcare hospitals from 2006 to 2012, we identified all symptomatic (i) hospital-onset and (ii) health care-facility-associated, community-onset CDI. We then evaluated the risk associated with antibiotic exposure, including that of specific agents, using multivariable logistic regression. A total of 2,356 cases of CDI among 506,068 admissions were identified (incidence, 46.6 per 10,000). Prior antibiotic use was the dominant risk factor, where for every antibiotic day of therapy prior to the index admission, the odds of subsequent CDI increased by 12.8% (95% confidence interval [CI], 12.2 to 13.4%; P < 0.0001). This was a much stronger association than was inpatient antibiotic exposure (odds ratio [OR], 1.007 [95% CI, 1.005 to 1.009]; P < 0.0001). The highest-risk antibiotics included second-generation and later cephalosporins (especially oral), carbapenems, fluoroquinolones, and clindamycin, while doxycycline and daptomycin were associated with a lower CDI risk. We concluded that cumulative antibiotic exposure prior to admission is the greatest contributor to the risk of subsequent CDI. Most classes of antibiotics carry some risk, which varies by drug and route. This information may be useful for antimicrobial stewardship efforts.

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