The Emergence ofClostridium difficileInfection among Peripartum Women: A Case-Control Study of aC. difficileOutbreak on an Obstetrical Service

Objective. An outbreak of 20 peripartumClostridium difficileinfections (CDI) occurred on the obstetrical service at the University of Washington Medical Center (UWMC) between April 2006 and June 2007. In this report, we characterize the clinical manifestations, describe interventions that appeared to reduce CDI, and determine potential risk factors for peripartum CDI.Methods. An investigation was initiated after the first three peripartum CDI cases. Based on the findings, enhanced infection control measures and a modified antibiotic regimen were implemented. We conducted a case-control study of peripartum cases and unmatched controls.Results. During the outbreak, there was an overall incidence of 7.5 CDI cases per 1000 deliveries. Peripartum CDI infection compared to controls was significantly associated with cesarean delivery (70% versus 34%;P=0.03), antibiotic use (95% versus 56%;P=0.001), chorioamnionitis (35% versus 5%;P=0.001), and the use of the combination of ampicillin, gentamicin, and clindamycin (50% versus 3%;P<0.001). Use of combination antibiotics remained a significant independent risk factor for CDI in the multivariate analysis.Conclusions. The outbreak was reduced after the implementation of multiple infection control measures and modification of antibiotic use. However, sporadic CDI continued for 8 months after these measures slowed the outbreak. Peripartum women appear to be another population susceptible to CDI.

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Outbreak ofTsukamurellaSpecies Bloodstream Infection among Patients at an Oncology Clinic, West Virginia, 2011–2012

Infection Control and Hospital Epidemiology ◽

10.1086/675282 ◽

2014 ◽

Vol 35 (3) ◽

pp. 300-306 ◽

Cited By ~ 5

Author(s):

Isaac See ◽

Duc B. Nguyen ◽

Somu Chatterjee ◽

Thein Shwe ◽

Melissa Scott ◽

...

Keyword(s):

Infection Control ◽

Bloodstream Infection ◽

Case Control Study ◽

Significant Risk ◽

Bloodstream Infections ◽

Case Control ◽

Control Measures ◽

Multiple Infection ◽

Common Source ◽

Control Study

Objective.To determine the source and identify control measures of an outbreak ofTsukamurellaspecies bloodstream infections at an outpatient oncology facility.Design.Epidemiologic investigation of the outbreak with a case-control study.Methods.A case was an infection in whichTsukamurellaspecies was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors forTsukamurellaspecies bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.Results.Fifteen cases ofTsukamurella (Tsukamurella pulmonisorTsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September–October 2011 (P= .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.Conclusion.Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.

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Use of Vaporized Hydrogen Peroxide Decontamination during an Outbreak of Multidrug-ResistantAcinetobacter baumanniiInfection at a Long-Term Acute Care Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/657139 ◽

2010 ◽

Vol 31 (12) ◽

pp. 1236-1241 ◽

Cited By ~ 33

Author(s):

Amy Ray ◽

Federico Perez ◽

Amanda M. Beltramini ◽

Marta Jakubowycz ◽

Patricia Dimick ◽

...

Keyword(s):

Susceptibility Testing ◽

Case Control Study ◽

Acute Care Hospital ◽

Case Control ◽

Control Measures ◽

Care Hospital ◽

Infection Control Measures ◽

Environmental Decontamination ◽

Control Study

Objectives.To describe vaporized hydrogen peroxide (VHP) as an adjuvant in the control of multidrug-resistant (MDR)Acinetobacter baumanniiinfection in a long-term acute care hospital (LTACH) and to describe the risk factors for acquisition of MDRA. baumanniiinfection in the LTACH population.Design.Outbreak investigation, case-control study, and before-after intervention trial.Setting.A 54-bed LTACH affiliated with a tertiary care center in northeastern Ohio.Methods.Investigation of outbreak with clinical and environmental cultures, antimicrobial susceptibility testing, polymerase chain reaction assay of repetitive chromosomal elements to type strains, and case-control study; and intervention consisting of comprehensive infection control measures and VHP environmental decontamination.Results.Thirteen patients infected or colonized with MDRA. baumanniiwere identified from January 2008 through June 2008. By susceptibility testing, 10 (77%) of the 13 isolates were carbapenem-resistant. MDRA. baumanniiwas found in wound samples, blood, sputum, and urine. Wounds were identified as a risk factor for MDRA. baumanniicolonization. Ventilator-associated pneumonia was the most common clinical syndrome caused by the pathogen, and the associated mortality was 14% (2 of the 13 case patients died). MDRA. baumanniiwas found in 8 of 93 environmental samples, including patient rooms and a wound care cart; environmental and clinical cultures were genetically related. Environmental cultures were negative immediately after VHP decontamination and both 24 hours and 1 week after VHP decontamination. Nosocomial acquisition of the pathogen in the LTACH ceased after VHP Intervention. When patients colonized with MDRA. baumanniireoccupied rooms, environmental contamination recurred.Conclusion.Environmental decontamination using VHP combined with comprehensive infection control measures interrupted nosocomial transmission of MDRA. baumanniiin an LTACH. The application of this novel approach to halt the transmission of MDRA. baumanniiwarrants further investigation.

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Risk Factors for Nosocomial Bacteremia in a Large Spanish Teaching Hospital: A Case-Control Study

Infection Control and Hospital Epidemiology ◽

10.1086/646308 ◽

1991 ◽

Vol 12 (3) ◽

pp. 150-156 ◽

Cited By ~ 9

Author(s):

Antoni Trilla ◽

Josep M. Gatell ◽

Josep Mensa ◽

Xavier Latorre ◽

Manuel Almela ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Strong Support ◽

Case Control ◽

Control Measures ◽

University Hospital ◽

Stepwise Logistic Regression ◽

Infection Control Measures ◽

Nosocomial Bacteremia ◽

Control Study

AbstractObjective:Identify independent risk factors associated with the development of nosocomial bacteremia.Design:Exploratory, unmatched, case-control study.Setting:A 970-bed Spanish university hospital.Patients:All non-neutropenic adult patients with nosocomial bacteremia admitted during a 12-month period were eligible as cases. All adult non-neutropenic patients without nosocomial bacteremia were eligible as controls.Results:The incidence of bacteremia in the study population was 6.9/1000 admissions/ year. One hundred eighty cases and 180 controls were analyzed. Multivariate analysis (stepwise logistic regression techniques) identified seven risk factors independently associated with nosocomial bacteremia: age above 65 years; prior admission (within six months) to the hospital; underlying diseases that were ultimately or rapidly fatal; indwelling urethral catheter in place for more than three days; intravenous central lines or peripheral venous lines (if in place for more than four days); “high-risk surgery” (i.e., lower abdominal, cardiac or thoracic); and admission to an intensive care unit.Conclusions:Although five variables are not modifiable, the remaining two relate to the use and duration of devices. Our data give strong support for the value of testing strict guidelines for limiting vascular catheters and evaluating the need for prolonged urethral catheterization. If effective infection control measures are identified, we could target hospital-wide surveillance to patients whose risk factors are amenable to intervention.

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The Identification and Significance of a Thr→Pro Polymorphism in Kringle IV Type 8 of Apolipoprotein(a)

Thrombosis and Haemostasis ◽

10.1055/s-0038-1656083 ◽

1997 ◽

Vol 77 (05) ◽

pp. 0949-0954 ◽

Cited By ~ 8

Author(s):

J Prins ◽

F R Lues ◽

Y Y van der Hoek ◽

J J.P Kastelein ◽

B N Bouma ◽

...

Keyword(s):

Case Control Study ◽

Amino Acid Position ◽

Case Control ◽

Binding Studies ◽

Binding Characteristics ◽

Apolipoprotein A ◽

Significant Independent Risk Factor ◽

And Gender ◽

Control Study

SummaryElevated plasma levels of lipoprotein(a) [Lp(a)] represent a significant independent risk factor for the development of atherosclerosis. Interindividual levels of apo(a) vary over 1000-fold and are mainly due to inheritance that is linked to the locus of the apolipoprotein(a) [apo(a)] gene. The apo(a) gene encodes multiple repeats of a sequence exhibiting up to 85% DNA sequence homology with plasminogen kringle IV (K.IV), a lysine binding domain. In our search for sequence polymorphisms in the K.IV coding domain, we identified a polymorphism predicting a Thr→Pro substitution located at amino acid position 12 of kringle IV type 8 of apo(a). The functional and clinical significance of this polymorphism was analysed in a case-control study and by comparing the in vitro lysine binding characteristics of the two Lp(a) subtypes.The case-control study (involving 153 subjects having symptomatic atherosclerosis and 153 age and gender matched normolipidemic controls) revealed an overall allele frequency for the Thr12-→Pro substitution in kringle IV type 8 of 14% and a negative association between presence of the Pro12-subtype and symptomatic atherosclerosis (p <0.03). The in vitro lysine binding studies, using Lp(a) isolated from subjects homozygous for either Thr12 or Pro12 in K.IV type 8, revealed comparable lysine-Sepharose binding fractions for the two subtypes. The binding affinity (Kd) for immobilised plasmin degraded des- AA-fibrin (DesafibTM-X) was also comparable for the two subtypes, however a decreased maximal attainable binding (Bmax) for immobilised desafibTM-X was observed for the Pro12-subtype Lp(a).

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Increased Mortality Associated With a Clonal Outbreak of Ceftazidime-ResistantKlebsiella pneumoniae: A Case–Control Study

Infection Control and Hospital Epidemiology ◽

10.1086/502488 ◽

2005 ◽

Vol 26 (1) ◽

pp. 63-68 ◽

Cited By ~ 12

Author(s):

Abdul Qavi ◽

Sorana Segal-Maurer ◽

Noriel Mariano ◽

Carl Urban ◽

Carl Rosenberg ◽

...

Keyword(s):

Infection Control ◽

Bacterial Infections ◽

Case Control Study ◽

Community Hospital ◽

Case Control ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Environmental Cleaning ◽

Serious Bacterial Infections ◽

Control Study

AbstractObjectives:To determine risk factors for ceftazidime-resistantKlebsiella pneumoniaeinfection and the effect of cef-tazidime-resistantK. pneumoniaeinfection on mortality during an isolated outbreak.Design:Case–control investigation using clinical and molecular epidemiology and prospective analysis of infection control interventions.Setting:Surgical intensive care unit of a university-affiliated community hospital.Patients:Fourteen case-patients infected with ceftazidime-resistantK. pneumoniaeand 14 control-patients.Results:Ten of 14 case-patients had identical strains by pulsed-field gel electrophoresis. Broad-spectrum antibiotic therapy before admission to the unit was strongly predictive of subsequent ceftazidime-resistantK. pneumoniaeinfection. In addition, patients with ceftazidime-resistantK. pneumoniaeinfection experienced increased mortality (odds ratio, 3.77).Conclusions:Cephalosporin restriction has been shown to decrease the incidence of nosocomial ceftazidime-resistantK. pneumoniae. However, isolated clonal outbreaks may occur due to lapses in infection control practices. Reinstatement of strict handwashing, thorough environmental cleaning, and repeat education led to termination of the outbreak. A distinct correlation between ceftazidime-resistantK. pneumoniaeinfection and mortality supports the important influence of antibiotic resistance on the outcome of serious bacterial infections.

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Risk factors for sporadic Campylobacter infection: an all-Ireland case-control study

Eurosurveillance ◽

10.2807/ese.14.07.19123-en ◽

2009 ◽

Vol 14 (7) ◽

Author(s):

K Danis ◽

M Di Renzi ◽

W O’Neill ◽

B Smyth ◽

P McKeown ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Population Attributable Fraction ◽

Case Control ◽

Control Measures ◽

Safety Education ◽

First Case ◽

The Republic ◽

Campylobacter Infection ◽

Control Study

We report the findings of the first case-control study conducted in both the Republic of Ireland and Northern Ireland to determine risk factors for sporadic Campylobacter infections. A total of 197 cases and 296 case-nominated controls matched for age, were included. Based on Population Attributable Fraction (PAF), the most important risk factors were consuming chicken [adjusted matched (am) OR 6.8; 95%CI 2.1-21.9], consuming lettuce (amOR 3.3; 95%CI 1.5-7.1) and eating in takeaways (amOR=3.1; 95%CI 1.4-6.6). Contact with sheep (amOR=11; 95%CI 1.6-78), peptic ulcer (amOR=19; 95%CI 3.8-93.7), hiatus hernia (amOR=20.3; 95%CI 2.3-183.3), lower bowel problems (amOR=4.5; 95%CI 1.2-16.8) were also independently associated with infection. Mains water supply showed protective effect (amOR=0.2; 95 CI 0.1-0.9). The findings highlight the continued need for consumer food safety education and further control measures throughout the food chain on the island of Ireland.

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Antibiotic use and the development of inflammatory bowel disease: a national case-control study in Sweden

The Lancet Gastroenterology & Hepatology ◽

10.1016/s2468-1253(20)30267-3 ◽

2020 ◽

Vol 5 (11) ◽

pp. 986-995 ◽

Cited By ~ 2

Author(s):

Long H Nguyen ◽

Anne K Örtqvist ◽

Yin Cao ◽

Tracey G Simon ◽

Bjorn Roelstraete ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Case Control Study ◽

Antibiotic Use ◽

Case Control ◽

Inflammatory Bowel ◽

Control Study

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Antibiotic use and the risk of rheumatoid arthritis: a population-based case-control study

BMC Medicine ◽

10.1186/s12916-019-1394-6 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 6

Author(s):

Alyshah Abdul Sultan ◽

Christian Mallen ◽

Sara Muller ◽

Samantha Hider ◽

Ian Scott ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Case Control Study ◽

Antibiotic Use ◽

Population Based ◽

Case Control ◽

Control Study

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Malaria Outbreak Facilitated by Appearance of Vector-Breeding Sites after Heavy Rainfall and Inadequate Preventive Measures: Nwoya District, Northern Uganda, February–May 2018

Journal of Environmental and Public Health ◽

10.1155/2020/5802401 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Godfrey Nsereko ◽

Daniel Kadobera ◽

Denis Okethwangu ◽

Joyce Nguna ◽

Damian Rutazaana ◽

...

Keyword(s):

Heavy Rainfall ◽

Case Control Study ◽

Preventive Measures ◽

Case Fatality ◽

Case Control ◽

Control Measures ◽

Northern Uganda ◽

Entire Study ◽

Breeding Sites ◽

Control Study

Background. Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, Northern Uganda, exceeding expected limits and thereby requiring epidemic response. We investigated this outbreak to estimate its magnitude, identify exposure factors for transmission, and recommend evidence-based control measures. Methods. We defined a malaria case as onset of fever in a resident of Anaka subcounty, Koch Goma subcounty, and Nwoya Town Council, Nwoya District, with a positive rapid diagnostic test or microscopy for malaria from 1 February to 25 May 2018. We reviewed medical records in all health facilities of affected subcounties to find cases. In a case-control study, we compared exposure factors between case-persons and asymptomatic controls matched by age and village. We also conducted entomological assessments on vector density and behavior. Results. We identified 3,879 case-persons (attack rate [AR] = 6.5%) and two deaths (case-fatality rate = 5.2/10,000). Females (AR = 8.1%) were more affected than males (AR = 4.7%) (p<0.0001). Of all age groups, 5–18 years (AR = 8.4%) were most affected. Heavy rain started in early March 2018, and a propagated outbreak followed in the first week of April 2018. In the case-control study, 55% (59/107) of case-persons and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H = 5.6, 95% CI = 3.0–11); 25% (27/107) of case-persons and 51% (55/107) of controls wore full extremity covering clothes during evening hours (ORM-H = 0.30, 95% CI = 0.20–0.60); 71% (76/107) of case-persons and 85% (91/107) of controls slept under a long-lasting insecticide-treated net (LLIN) 14 days before symptom onset (ORM-H = 0.43, 95% CI = 0.22–0.85); 37% (40/107) of case-persons and 52% (56/107) of controls had access to at least one LLIN per 2 household members (ORM-H = 0.54, 95% CI = 0.30–0.97). Entomological assessment indicated active breeding sites in the entire study area; Anopheles gambiae sensu lato species were the predominant vector. Conclusion. Increased vector-breeding sites after heavy rainfall and inadequate malaria preventive measures were found to have contributed to this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites in the area.

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