scholarly journals Community-Onset Bloodstream Infection during the ‘After Hours’ Is not Associated with an increased Risk for Death

2012 ◽  
Vol 23 (4) ◽  
pp. 170-172 ◽  
Author(s):  
Kevin B Laupland ◽  
Pamela C Kibsey ◽  
John C Galbraith
Keyword(s):  
Bloodstream Infection ◽  
Case Fatality ◽  
Bloodstream Infections ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk ◽  
Day Of The Week ◽  
After Hours ◽  
Community Onset

BACKGROUND/OBJECTIVE: Patients admitted to hospital during the ‘after hours’ (weekends and evenings) may be at increased risk for adverse outcome. The objective of the present study was to assess whether community-onset bloodstream infections presenting in the after hours are associated with death.METHODS: All patients in the Victoria area of British Columbia, who had first admissions with community-onset bloodstream infections between 1998 and 2005 were included. The day of admission to hospital, the day and time of culture draw, and all-cause, in-hospital mortality were ascertained.RESULTS: A total of 2108 patients were studied. Twenty-six per cent of patients were admitted on a weekend. Blood cultures were drawn on a weekend in 27% of cases and, in 43%, 33%, and 25% of cases, cultures were drawn during the day (08:00 to 17:59), the evening (18:00 to 22:59) and night (23:00 to 07:59), respectively. More than two-thirds (69%) of index cultures were drawn during the after hours (any time Saturday or Sunday and weekdays 18:00 to 07:59). The overall in-hospital case fatality rate was 13%. No difference in mortality was observed in relation to the day of the week of admission or time period of sampling. After-hours sampling was not associated with mortality in a multivariable logistic regression model examining factors associated with death.CONCLUSION: Presentation with community-onset, bloodstream infection during the after hours does not increase the risk of death.

scholarly journals Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

2010 ◽  
Vol 31 (11) ◽  
pp. 1106-1114 ◽  
Author(s):  
Adrian G. Barnett ◽  
Nicholas Graves ◽  
Victor D. Rosenthal ◽  
Reinaldo Salomao ◽  
Manuel Sigfrido Rangel-Frausto
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infection ◽  
Latin American ◽  
Severity Of Illness ◽  
Central Line ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk ◽  
Latin American Countries

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.

scholarly journals Excess Length of Stay Due to Central Line–Associated Bloodstream Infection in Intensive Care Units in Argentina, Brazil, and Mexico

2010 ◽  
Vol 31 (11) ◽  
pp. 1106-1114 ◽  
Author(s):  
Adrian G. Barnett ◽  
Nicholas Graves ◽  
Victor D. Rosenthal ◽  
Reinaldo Salomao ◽  
Manuel Sigfrido Rangel-Frausto
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infection ◽  
Latin American ◽  
Severity Of Illness ◽  
Central Line ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk ◽  
Latin American Countries

Objective.To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection.Design.A cohort of 3,560 patients followed up for 36,806 days in ICUs.Setting.Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico.Patients.All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours.Results.The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI.Conclusions.CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections.

scholarly journals Burden of bloodstream infection in older persons: a population‐based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kevin B. Laupland ◽  
Kelsey Pasquill ◽  
Lisa Steele ◽  
Elizabeth C Parfitt
Keyword(s):  
Bloodstream Infection ◽  
Older Persons ◽  
Case Fatality ◽  
Bloodstream Infections ◽  
Population Based ◽  
Annual Incidence ◽  
Increased Risk ◽  
Co Morbidity ◽  
Aging Populations ◽  
Healthcare Associated

Abstract Background Advancing age is a major risk factor for developing and dying from bloodstream infections (BSI). However, there is a paucity of population-based studies investigating the epidemiology of BSI in older persons. Objective To define the incidence, clinical determinants, and risk factors for death among those aged 65 years and older with BSI. Methods Population-based surveillance was conducted in the western interior of British Columbia, Canada, between April 1, 2010 and March 31, 2020. Chart reviews were conducted for clinical details and all cause case-fatality was established at 30-days follow-up. Results A total of 1854 incident BSI were identified among 1657 individuals aged 65 and older for an annual incidence of 533.9 per 100,000 population; the incidence for those aged 65-74, 75-84, and ≥85 years was 375.3, 678.9, and 1046.6 per 100,000 population, respectively. Males were at significantly increased risk as compared to females (incidence rate ratio, IRR 1.44; 95% confidence interval, CI, 1.32-1.59; p<0.0001). The crude annual incidence increased by 50% during the study. However, this was related to shift in population demographics with no increase evident following age- and sex-standardization. Older patients were more likely to have healthcare-associated infections and genitourinary sources and less likely to have bone/joint or soft tissue infections. The proportion of patients with underlying congestive heart failure, stroke, and dementia increased, whereas diabetes and liver disease decreased with older age. The overall 30-day all cause case-fatality rate was 22.0% (364/1657). After adjustment for clinical focus, onset of infection, etiology, and co-morbidity in a logistic model, those aged 75-84 years (odds ratio, OR, 1.66; 95% CI, 1.25-2.21) and ≥ 85 years (OR, 1.98; 95% CI, 1.41-2.77) were at significantly increased risk for death as compared to those aged 65-74 years. Conclusion Bloodstream infection is common in older persons and is a major cause of death. Countries with aging populations worldwide should expect an increase burden associated with BSI in the coming years.

scholarly journals Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kylie Martin ◽  
Yves S Poy Lorenzo ◽  
Po Yee Mia Leung ◽  
Sheri Chung ◽  
Emmet O’flaherty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Jugular Vein ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Left Internal Jugular Vein ◽  
Hemodialysis Catheter ◽  
Increased Risk ◽  
Catheter Related Bloodstream Infection ◽  
Reduced Risk

Abstract Diabetes and left internal jugular vein insertion site were significantly associated with increased risk of a catheter-related bloodstream infection from a tunneled hemodialysis catheter. Ex-smoker status was significantly associated with reduced risk.

A pooled analysis of 1,546 patients with AIDS-related lymphoma (ARL): An assessment of prognostic factors by treatment era.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8524-8524
Author(s):  
Stefan K. Barta ◽  
Michael Samuel ◽  
Xiaonan Xue ◽  
Jeanette Y. Lee ◽  
Nicolas Mounier ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Prognostic Significance ◽  
Pooled Analysis ◽  
Cd4 Count ◽  
Significant Prognostic Factor ◽  
Poor Prognostic Factor ◽  
Risk Of Death ◽  
Time Period ◽  
Increased Risk

8524 Background: Management of ARL evolved in the last 2 decades. We previously reported prognostic factors in a pooled analysis of 1,546 patients with ARL, and here present analysis of these factors over time to determine if their prognostic significance has changed. Methods: Following a systematic review, we assembled individual patient data from 19 prospective phase 2/3 clinical trials (published 1993-2010) for ARL (n=1,546). Factors analyzed include age, sex, histology, CD4 count, prior history of (h/o) AIDS, & age-adjusted (aa) IPI. The endpoint was overall survival (OS) expressed as the hazard ratio (HR) for death. We used separate Cox proportional hazard models adjusted for the other covariates to determine the significance of each variable in the following time periods: pre-cART [combination antiretroviral therapy] (<1996; n=388), early cART (‘96-‘00; n=694), modern cART (‘01-‘04; n=282) & current era (‘05-‘10; n=182). We also combined all enrollments in one Cox model to test for difference in association with OS over enrollment periods. Results: Rituximab use was limited in the early cART (20%) compared with the modern cART (83%) and current (93%) eras. Histology & sex were not significantly associated with OS in any time period. Increasing age was associated with worse OS in the pre-cART (HR 1.02; p<0.01) and current (HR 1.05, p=0.04) eras. A prior h/o AIDS increased risk of death during early cART (HR 1.31, p=0.047) but was not significant after 2000. Meanwhile, baseline CD4 count <50 was a poor prognostic factor during early (HR 1.78, p<0.01) and modern cART (HR 2.76, p=0.001) eras, but not in the current era. The aaIPI predicted worse OS in each time period (pre-cART: HR 1.54, p<0.0001; early cART: HR 1.49, p<0.0001; modern cART: HR 1.52, p<0.01; current era: HR 2.34, p<0.0001). No significant interaction between each prognostic factor with enrollment was found. Conclusions: In this pooled analysis of 1,546 patients with ARL, aaIPI was the only consistently significant prognostic factor and its effect was magnified in the current era. HIV-related factors gained prognostic relevance in the early and modern cART era but may not be as relevant with current treatment strategies.

scholarly journals Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Prosper J. Bashaka ◽  
Hendry R. Sawe ◽  
Victor Mwafongo ◽  
Juma A. Mfinanga ◽  
Michael S. Runyon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Fatality ◽  
Descriptive Study ◽  
High Rate ◽  
World Health ◽  
Mortality Data ◽  
Children Under Five ◽  
Under Five ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania. Methods This was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR). Results A total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively. Conclusions In an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.

scholarly journals Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system

2020 ◽  
Author(s):  
Massimo Fabiani ◽  
Alberto Mateo-Urdiales ◽  
Xanthi Andrianou ◽  
Antonino Bella ◽  
Martina Del Manso ◽  
...  
Keyword(s):  
Surveillance System ◽  
Negative Binomial ◽  
Healthcare Access ◽  
Delayed Diagnosis ◽  
Case Fatality ◽  
Negative Binomial Regression ◽  
Adjusted Relative Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Epidemiological Characteristics

Background International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers, and refugees. Methods We analysed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case-fatality rate and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis. Results We analysed 213,180 COVID-19 cases, including 15,974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalised [(adjusted relative risk (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44)] and admitted to ICU (ARR=1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower HDI. We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR=1.32, 95% CI: 1.01-1.75). Conclusions A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality.

scholarly journals Impact of Early Corticosteroids on 60-day Mortality in Critically Ill Patients with COVID-19: A Multicenter Cohort Study of the OUTCOMEREA Network

2021 ◽  
Author(s):  
Claire Dupuis ◽  
Etienne de Montmollin ◽  
Niccolò Buetti ◽  
Dany Goldgran-Toledano ◽  
Jean Reignier ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
Bloodstream Infections ◽  
Survival Models ◽  
Multicenter Cohort Study ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Increased Risk ◽  
Study Population ◽  
High Doses ◽  
Hospital Acquired

Abstract ObjectivesIn severe COVID-19 pneumonia, the appropriate timing and dosing of corticosteroids(CS) is not known. Patient subgroups for which CS could be more beneficial also need appraisal. The aim of this study was to assess the effect of early CS in COVID-19 pneumonia patients admitted to the ICU on the occurrence of 60-day mortality, ICU-acquired-bloodstream infections(ICU-BSI), and hospital-acquired pneumonia and ventilator-associated pneumonia(HAP-VAP).MethodsWe included patients with COVID-19 pneumonia admitted to 11 ICUs belonging to the French OutcomeReaTM network from January to May 2020. We used survival models with ponderation with inverse probability of treatment weighting (IPTW). Inflammation was defined as Ferritin >1000 µg/l or D-Dimers >1000 µg/l or C-Reactive Protein >100 mg/dL.ResultsThe study population comprised 302 patients having a median age of 61.6(53-70) years of whom 78.8% were male and 58.6% had at least one comorbidity. The median SAPS II was 33(25-44). Invasive mechanical ventilation was required in 34.8% of the patients. Sixty-six (21.8%) patients were in the Early-CS-subgroup. Most of them (n=55, 83.3%) received high doses of steroids. Overall, 60-day mortality was 29.4%. The risks of 60-day mortality (IPTWHR =0.88;95% CI 0.55 to 1.39, p=0.58), ICU-BSI and HAP-VAP were similar in the two groups. Importantly, early CS treatment was associated with a lower mortality rate in patients aged 60 years or more (IPTWHR, 0.51;95% CI, 0.29 – 0.91; p=0.02). But, CS was associated with an increased risk of death for the patients younger than 60 years without inflammation on admission (IPTWHR =8.17;95% CI, 1.76, 37.85; p=0.01).ConclusionFor patients with COVID-19 pneumonia, early CS treatment was not associated with patient survival. Interestingly, inflammation and age can significantly influence the effect of CS.

Risk Factors for In-Hospital Mortality among a Cohort of Children with Clostridium difficile Infection

2015 ◽  
Vol 36 (10) ◽  
pp. 1183-1189 ◽  
Author(s):  
Neika Vendetti ◽  
Theoklis Zaoutis ◽  
Susan E. Coffin ◽  
Julia Shaklee Sammons
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Severe Disease ◽  
Treatment Strategies ◽  
Severity Of Illness ◽  
Median Number ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Death ◽  
Increased Risk

OBJECTIVEThe incidence of Clostridium difficile infection (CDI) has increased and has been associated with poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was to identify risk factors for all-cause in-hospital mortality among children with CDI.METHODSA multicenter cohort of children with CDI, aged 1–18 years, was established among children hospitalized at 41 freestanding children’s hospitals between January 1, 2006 and August 31, 2011. Children with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression model.RESULTSWe identified 7,318 children with CDI during the study period. The median age of this cohort was 6 years [interquartile range (IQR): 2–13]; the mortality rate was 1.5% (n=109); and the median number of days between C. difficile testing and death was 12 (IQR, 7–20). Independent risk factors for death included older age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40–3.77)], underlying malignancy [3.57 (2.36–5.40)], cardiovascular disease [2.06 (1.28–3.30)], hematologic/immunologic condition [1.89 (1.05–3.39)], gastric acid suppression [2.70 (1.43–5.08)], and presence of >1 severity of illness marker [3.88 (2.44–6.19)].CONCLUSIONPatients with select chronic conditions and more severe disease are at increased risk of death. Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit from targeted CDI prevention and treatment strategies.Infect Control Hosp Epidemiol 2015;36(10):1183–1189

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