scholarly journals Risk Factors for and Outcomes Associated with Clinical Isolates ofEscherichia coliandKlebsiellaSpecies Resistant to Extended-Spectrum Cephalosporins among Patients Admitted to Canadian Hospitals

2009 ◽  
Vol 20 (3) ◽  
pp. e43-e48 ◽  
Author(s):  
Marianna Ofner-Agostini ◽  
Andrew Simor ◽  
Michael Mulvey ◽  
Alison McGeer ◽  
Zahir Hirji ◽  
...  

BACKGROUND: Clinical features associated with Gram-negative bacterial isolates with extended-spectrum beta-lactamase (ESBL)- and AmpC-mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL- or AmpC-mediated resistant organisms in Canadian hospitals.METHODS: Patients with clinical cultures ofEscherichia coliorKlebsiellaspecies were matched with patients with a similar organism but susceptible to third-generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.RESULTS: Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P-value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first-generation cephalosporins (OR 2.38, P=0.02) or third-generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).CONCLUSION: The importance of patient medical history, present admission and antibiotic use should be considered for allE coliorKlebsiellaspecies patients pending susceptibility testing results.

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yisen Zhang ◽  
Chao Wang ◽  
Zhongbin Tian ◽  
Wei Zhu ◽  
Wenqiang Li ◽  
...  

Abstract Background The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world database. Methods From August 2016 to March 2017, 167 patients were enrolled. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic stroke. Results Among the 167 cases, periprocedural ischemic stroke occurred in 20 cases (11.98%). After univariate analysis, the ischemic group had a higher proportion of large (≥ 10 mm) aneurysms than the control group (45.0% vs. 23.1%, p = 0.036). The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter (21.6%) or stent-assisted coiling (11.8%) than in cases treated by coiling only (2.7%), and the differences were statistically significant (p = 0.043). After multivariate logistic regression analysis, treatment modality was the independent risk factor for periprocedural ischemic stroke. Compared with the coiling-only procedure, flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke (OR 9.931; 95% CI 1.174–84.038; p = 0.035). Conclusions Aneurysm size and treatment modality were associated with periprocedural ischemic stroke. Larger aneurysms were associated with increased risk of periprocedural ischemic stroke. Flow diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.


2021 ◽  
Vol 27 ◽  
pp. 107602962110379
Author(s):  
Xiao Li ◽  
Shu-Ling Hou ◽  
Xi Li ◽  
Li Li ◽  
Ke Lian ◽  
...  

This study investigated the risk factors of thromboembolism (TE) in lymphoma patients undergoing chemotherapy and its clinical significance. A total of 304 lymphoma patients who received chemotherapy from January 2012 to July 2019 were retrospectively analyzed, including 111 patients with and 193 patients without TE. The clinical characteristics and related laboratory test results were compared between the 2 groups using univariate analysis, while the risk factors for TE in lymphoma patients undergoing chemotherapy were analyzed using multivariate logistic regression analysis. Univariate analysis revealed an increase in the risk of TE among lymphoma patients with chemotherapy in the following categories: female patients, patients with body mass index <18.5 or > 24, patients aged ≥60 years, those with platelet abnormality before chemotherapy, single hospital-stay patients, and Ann Arbor stage III/IV patients. Multivariate logistic regression analysis revealed that for platelet count abnormality before chemotherapy, Ann Arbor stage III/IV and female patients represented independent risk factors for TE among lymphoma patients after chemotherapy ( P < .05). For lymphoma patients treated with chemotherapy, the risk of TE occurring in women, patients with platelet abnormalities before chemotherapy, and patients at Ann Arbor stage III/IV was significantly higher compared with other patients. For these patients, we recommend prophylactic anticoagulant therapy.


2022 ◽  
Author(s):  
Xueqian Wang ◽  
Xuejiao Ma ◽  
Mo Yang ◽  
Yan Wang ◽  
Yi Xie ◽  
...  

Abstract Background Lung cancer was often accompanied by depression and anxiety. Nowadays, most investigations for depression and anxiety were concentrated in western medical hospitals, while few related studies have been carried out in the tradition Chinese medicine (TCM) ward. It was necessary to understand the prevalence and risk factors of depression and anxiety in the inpatients with lung cancer in TCM hospital. Methods This study adopted cross-sectional research method, which enrolled a total of 222 inpatients with lung cancer in TCM hospital. PHQ-9 and GAD-7 scales were used to assess depression and anxiety for the inpatients, respectively. Demographic and clinical data were also collected. Statistical methods of the univariate analysis and the multivariate logistic regression model were used. Results The prevalence of depression and anxiety in the inpatients with lung cancer were 58.1% and 34.2%, respectively. Multivariate logistic regression analysis prompted that the common risk factor of depression and anxiety was the symptom of insomnia. Constipation and gender were the two anther risk factors of depression. Conclusion Depression and anxiety were common for the inpatients with lung cancer in TCM hospital. Gender, insomnia and constipation were risk factors for depression, and insomnia was risk factor for anxiety. Therefore, medical workers should pay close attention to the emotional changes of these high-risk patients and intervene the symptoms as early as possible.


Author(s):  
Yunling Lin ◽  
Jianmin Sun ◽  
Xun Yuan ◽  
Hui Liu

IntroductionThe purpose of this study was to analyze the risk factors of post-operative atrial fibrillation (POAF) after thoracic surgery, and to build a predictive model for accurate preoperative identification of high-risk patients.Material and methodsIn this study, data of 2072 patients with pulmonary masses and esophageal cancer who attended our hospital in the period from January 1, 2017 to December 31, 2018 were analyzed retrospectively. According to whether AF occurred after the operation, the patients were divided into atrial fibrillation (AF) and non-AF (NAF) groups. The general information (age, sex, height, etc.), previous medical history (chronic lung disease, hypertension, etc.), medication history, preoperative ultrasound and cardiogram results, and preoperative and postoperative electrocardiogram (ECG) were collected. The operation mode, resection scope, histopathology and hospitalization were recorded. Univariate and multivariate logistic regression were used to screen out the risk factors of AF and establish a prediction model.ResultsThe incidence of POAF was 5.98%. Univariate analysis showed that sex, age, body mass index, left atrial diameter and operation organ were the risk factors of POAF. The above factors were included in the multivariate logistic regression analysis, and the results showed that male sex, age, anteroposterior diameter of left atrium and surgical organs were related to POAF. On this basis, a POAF prediction model was constructed, which had good discrimination and calibration. The area under the curve (AUC) is 0.784 with 95% CI: 0.746–0.822.ConclusionsThe prediction model of POAF based on the risk factors selected in this study can accurately predict the occurrence of AF after thoracic surgery.


2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Cabral ◽  
S Fernandes ◽  
LG Santos ◽  
R Carvalho ◽  
FM Sa ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Infective endocarditis (IE) is described as an uncommon and challenging infective disease, due to its presentation variability. Its mortality remains high besides the better disease knowledge and therapeutic progress. The aim of this study was to describe the clinical features and the incidence of IE. Furthermore, we try to identify the risk factors associated with early mortality. A retrospective study was conducted and all patients diagnosed with definite or possible IE between January 2015 and June 2020, according to the modified Duke criteria, were included. Patient selection and information collection were obtained through medical records. Outcomes were in-hospital and 3 months after discharge mortality. Group comparisons and multivariate logistic regression analysis were performed. A p-value less than 0.05 is statistically significant. We analysed 51 patients, which 41 were admitted between 2015 and 2019 with a mean incidence of 8.2 cases per year. In 2020, 10 cases were diagnosed, corresponding to a percentual increase of 143.9%. Of the 51 patients, 70.6% were male. The mean age was 65 years. Fever was the main presentation feature at admission. We counted 33.3% prosthetic valve endocarditis (PVE) and 5.9% IE device-related. The most common pathogens were Streptococcus gallolyticus (13.7%) and Streptococcus oralis (13.7%). 35 patients (68.6%) had local complications and 26 patients (51%) had systemic complications. One-third of the patients was referenced to surgical treatment. Overall in-hospital mortality was 19.6% and early mortality at 3 months was 27.5%. In the univariate analysis, early mortality was higher in diabetes mellitus (DM) patients (p &lt; 0.01) and in those who developed sepsis during hospitalization (p = 0.04). In multivariate logistic regression, only DM (OR = 15.8, 95% CI [3.2, 79.0]) was shown to be an independent factor of mortality. The incidence of IE increased during the first semester of 2020, possibly due to the increased attention given to patients with fever. Diabetes mellitus was found to be the only independent predictor of mortality. More national multicentre studies are needed. Predictive factors of 3 months mortalitySurvivors (n = 37)Non-survivors (n = 14)p-valueAge, med (IQ)70.0 (23.0)70.5 (14.0)0.42Female, n(%)11 (29.7)4 (28.6)1.00Diabetes mellitus, n(%)6 (16.2)11 (78.6)&lt;0.01Local complication, n(%)24 (64.9)11 (78.4)0.50Sepsis, n(%)2 (5.4)4 (28.6)0.04Univariate analysis (resumed version). med-median, IQ-interquartile range, n-absolute frequencyAbstract Figure. ROC curve for logistic regression model


2021 ◽  
Author(s):  
Yisen Zhang ◽  
Chao Wang ◽  
Zhongbin Tian ◽  
Wei Zhu ◽  
Wenqiang Li ◽  
...  

Abstract BackgroundThe aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world prospective database.MethodsFrom August 2016 to March 2017, 200 patients with 217 aneurysms who underwent 206 endovascular procedures were enrolled. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic stroke.ResultsAmong the 206 endovascular procedures, periprocedural ischemic stroke occurred in 23 procedures (11.17%). After univariate analysis, the ischemic group had a higher proportion of large (≥ 10 mm) aneurysms than the control group (39.1% vs. 20.2%, p = 0.040). The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter (18.60%) or stent-assisted coiling (12.28%) than in cases treated by coiling only (2.04%), and the differences were statistically significant (p = 0.036). After multivariate logistic regression analysis, treatment modality was the independent risk factor for periprocedural ischemic stroke. Compared with the coiling-only procedure, flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke (OR 13.839; 95% CI 1.617–118.416; p = 0.016). Stent-assisted coiling also tended to present more often with periprocedural ischemic stroke than coiling alone (OR 7.559; 95% CI 0.958–59.618; p = 0.055).ConclusionsAneurysm size and treatment modality were associated with periprocedural ischemic stroke. Larger aneurysms were associated with increased risk of periprocedural ischemic stroke. Flow diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Lin Qiu ◽  
Weihua Wang ◽  
Rina Sa ◽  
Feng Liu

Objective. To understand the prevalence and its risk factors of hypertension, diabetes mellitus, and dyslipidemia among adults aged over 18 years in Northwest China and provide data for the prevention and control of chronic diseases in Northwest China. Methods. Three waves of survey on chronic diseases and nutrition monitoring with multistage stratified cluster random sampling were conducted in 10 counties of Northwest China in 2013, 2015, and 2018, respectively. Personal information, socioeconomic status (SES), and behavioral risk factors (cigarettes smoking, alcohol consumption, diets, and physical activity) were collected by face-to-face interview. Height, weight, and blood pressure were measured, and blood glucose and serum lipid were tested. Prevalence of hypertension, diabetes, and dyslipidemia of the three waves was estimated, and multivariate logistic regression was used to analyze their risk factors. Results. The prevalence of hypertension, diabetes, and dyslipidemia was 41.59%, 11.16%, and 32.48%, respectively. Their standardized prevalence was 29.31%, 7.94%, and 31.54%. Univariate analysis showed that the prevalence of hypertension, diabetes, and dyslipidemia was significantly different among educational levels, marital status, occupation, smoking, drinking, central obesity, and BMI classification ( P < 0.05 ). Multivariate logistic regression analysis showed that factors like male gender, central obesity, overweight, and obesity were associated with hypertension, diabetes, and dyslipidemia ( P < 0.05 ). High BMI index is one of the risk factors of the three diseases. The odds ratio (OR) of general overweight associated with hypertension, diabetes, and dyslipidemia was 1.663, 1.206, and 1.579 compared to normal body weight, respectively. And that was 3.094, 1.565, and 2.285 for obesity. Age was one of the risk factors for hypertension and diabetes ( P < 0.05 ). Age groups of 45–59 years and 60 years and above were more associated with hypertension than of 18–44 age group (OR45-59 group = 2.777, OR60 years and above = 6.948), similar to their association with diabetes (OR45-59 group = 2.357, OR60 years and above = 3.521). Daily smoking is associated with diabetes and dyslipidemia (OR for diabetes = 1.217, OR for dyslipidemia = 1.287) and alcohol drinking associated with hypertension and dyslipidemia (OR for hypertension = 1.014, OR fordyslipidemia = 1.034). Hypertension, diabetes, and dyslipidemia were also associated with each other ( P < 0.05 ). The number of participants with hypertension, diabetes, and dyslipidemia accounted for 2.33% of all the participants, 15.60% for participants with hypertension and dyslipidemia, 4.58% for hypertension and diabetes, and 3.57% for diabetes and dyslipidemia, respectively. Conclusion. Factors like male, smoking, drinking, central obesity, overweight, and obesity were associated with hypertension, diabetes, and dyslipidemia in northwest China. Interventions on these risk factors and coexistence of the three diseases may help improve public health in this area.


2020 ◽  
Vol 8 ◽  
Author(s):  
Chen Dong ◽  
Minhui Zhu ◽  
Luguang Huang ◽  
Wei Liu ◽  
Hengxin Liu ◽  
...  

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p &lt; 0.001), larger volume of expander (200–400 ml vs &lt;200 ml; OR, 1.74; p = 0.032; &gt;400 ml vs &lt;200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of &lt;1 year, expander volume of &gt;200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.


Author(s):  
Elisabetta Schiaroli ◽  
Anna Gidari ◽  
Giovanni Brachelente ◽  
Sabrina Bastianelli ◽  
Alfredo Villa ◽  
...  

IntroductionCOVID-19 is characterized by a wide range of clinical expression and by possible progression to critical illness and death. Therefore it is essential to identify risk factors predicting progression towards serious and fatal diseases. The aim of our study was to identify laboratory predictive markers of clinical progression in patients with moderate/severe disease and in those with acute respiratory distress syndrome (ARDS).Material and methodsUsing electronic medical records for all demographic, clinical and laboratory data, a retrospective study on all consecutive patients with COVID-19 admitted to the Infectious Disease Clinic of Perugia was performed. The PaO2/FiO2 ratio (P/F) assessment cut‑off of 200 mm Hg was used at baseline to categorize the patients into two clinical groups. The progression towards invasive ventilation and/or death was used to identify critical outcome. Statistical analysis was performed. Multivariate logistic regression analysis was adopted to identify risk factors of critical illness and mortality.ResultsIn multivariate logistic regression analysis neutrophil/lymphocyte ratio (NLR) was the only significant predictive factor of progression to a critical outcome (p = 0.03) and of in-hospital mortality (p = 0.03). In ARDS patients no factors were associated with critical progression. Serum ferritin > 1006 ng/ml was the only predictive value of critical outcome in COVID-19 subjects with moderate/severe disease (p = 0.02).ConclusionsNeutrophil/lymphocyte ratio and serum ferritin are the only biomarkers that can help to stratify the risk of severity and mortality in patients with COVID-19.


Sign in / Sign up

Export Citation Format

Share Document