scholarly journals Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Huseyin Bilgin ◽  
Murat Haliloglu ◽  
Ali Yaman ◽  
Pinar Ay ◽  
Beliz Bilgili ◽  
...  
Keyword(s):  
Predictive Value ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Pentraxin 3 ◽  
Surgical Intensive Care ◽  
Nested Case Control ◽  
Control Study

Purpose. The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods. We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results. The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p<0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions. With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

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

2005 ◽  
Vol 26 (1) ◽  
pp. 63-68 ◽  
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.

scholarly journals Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Akane Takamatsu ◽  
Kenta Yao ◽  
Shutaro Murakami ◽  
Yasuaki Tagashira ◽  
Shinya Hasegawa ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Control Study ◽  
Tertiary Care ◽  
Previous History ◽  
Multivariate Logistic Regression Analysis ◽  
Case Control ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

Abstract Background Postprescription review and feedback (PPRF) is one of the most common strategies in antimicrobial stewardship program (ASP) intervention. However, disagreements between the prescribers and ASP personnel can occur. The aim of the present study was to identify the factors associated with nonadherence to PPRF intervention. Methods The present retrospective nested case-control study was performed at a tertiary care center, which has been conducting a once-weekly PPRF for carbapenems and piperacillin/tazobactam since 2014. Nonadherence to ASP recommendations was defined as the failure of the primary care team to modify or stop antimicrobial therapy 72 hours after the issuance of PPRF recommendations. Factors associated with nonadherence to PPRF intervention were identified using multivariate logistic regression analysis. Results In total, 2466 instances of PPRF in 1714 cases between April 2014 and September 2019 were found. The nonadherence rate was 5.9%, and 44 cases were found in which carbapenems or piperacillin/tazobactam continued to be used against PPRF recommendations. Factors associated with nonadherence to PPRF recommendations were a previous history of hospitalization within 90 days (adjusted odds ratio [aOR], 2.62; 95% confidence interval [CI], 1.18–5.81) and a rapidly fatal McCabe score at the time of PPRF intervention (aOR, 2.87; 95% CI, 1.18–6.98). A review of the narrative comments in the electronic medical records indicated that common reasons for nonadherence were “the patient was sick” (n = 12; 27.3%) and “the antimicrobial seemed to be clinically effective” (n = 9; 20.5%). Conclusions Nonadherence to PPRF recommendations was relatively uncommon at the study institution. However, patients with a severe disease condition frequently continued to receive broad-spectrum antimicrobials against PPRF recommendations. Understanding physicians’ cognitive process in nonadherence to ASP recommendations and ASP interventions targeting medical subspecialties caring for severely ill patients is needed to improve ASP.

scholarly journals The Predictive Value of Selenium in Diagnosis of Gestational Diabetes: A Nested Case-Control Study

2020 ◽  
Vol Volume 13 ◽  
pp. 53-60
Author(s):  
Zeinab Moshfeghy ◽  
Khadigeh Bashiri ◽  
Mohammad H Dabbaghmanesh ◽  
Marzieh Akbarzadeh ◽  
Nasrin Asadi ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Predictive Value ◽  
Case Control Study ◽  
Case Control ◽  
Nested Case Control ◽  
Control Study

scholarly journals What does it mean if a patient is positive for anti-Jo-1 in routine hospital practice? A retrospective nested case-control study

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 698
Author(s):  
Paresh Jobanputra ◽  
Feryal Malick ◽  
Emma Derrett-Smith ◽  
Tim Plant ◽  
Alex Richter
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Predictive Value ◽  
Case Control Study ◽  
Diagnostic Testing ◽  
Case Control ◽  
Trna Synthetase ◽  
Routine Practice ◽  
Nested Case Control ◽  
Control Study

Background:  It is widely believed that patients bearing auto-antibodies to histidyl tRNA synthetase (anti-Jo-1) very likely have a connective tissue disease including myositis and interstitial lung disease.  The value of positive tests in low disease prevalence settings such as those tested in routine care is unknown.  We sought to determine the value of anti-Jo-1 auto-antibodies in routine practice. Methods: Our study was a nested case control study within a retrospective cohort of all patients tested for anti-ENA our hospital, from any hospital department, between January 2013 and December 2014.  Data was extracted from electronic records of anti-Jo-1 positive patients and randomly selected ENA negative patients (ratio of 1:2), allowing for a minimum follow up of at least 12 months after first testing. Results: 4009 samples (3581 patients) were tested.  Anti-ENA was positive in 616 (17.2%) patients, 40 (1.1%) were anti-Jo-1 positive. Repeat ENA testing was done for 350/3581 (9.8%) patients (428 of 4009 (10.7%) samples) and in 7/40 (17.5%) of anti-Jo-1 positive patients. The median interval between the first and second request was 124 days (inter-quartile range 233 days).  The frequencies of interstitial lung disease (ILD), myositis and Raynaud’s were comparable for anti-Jo-1 positive patients (n=40) and 80 randomly selected ENA negative controls.  Positive tests led to additional diagnostic testing in the absence of clinical disease.  Sensitivity of Jo-1 for ILD was 50% (CI 19-81%), specificity 68% (CI 59-77%), positive predictive value 12.5% (CI 4 to 27%) and negative predictive value 93.8% (CI 86-98%). Of 10 (25%) patients with high anti-Jo1 levels, 3 had ILD, one myositis and two a malignancy (disseminated melanoma and CML).  Conclusion: Anti-Jo-1 is uncommon in a heterogenous hospital population and is only weakly predictive for ILD.  Repeated test requests were common and potentially unnecessary indicating that controls over repeat requests could yield significant cost savings.

scholarly journals Predictive value of prostate-specific antigen for prostate cancer: a nested case-control study in EuroSIDA

2014 ◽  
Vol 17 ◽  
pp. 19510
Author(s):  
Leah Shepherd ◽  
Álvaro Humberto Borges ◽  
Lene Ravn ◽  
Richard Harvey ◽  
Jean-Paul Viard ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Predictive Value ◽  
Case Control Study ◽  
Specific Antigen ◽  
Case Control ◽  
Nested Case Control ◽  
Control Study

scholarly journals Association between serum ca-125 levels and severity of pre-eclampsia: a case-control study conducted in a tertiary care centre, West Bengal

2020 ◽  
Vol 9 (10) ◽  
pp. 4176
Author(s):  
Bijoya Mukherjee ◽  
Amiya Das
Keyword(s):  
Blood Pressure ◽  
Predictive Value ◽  
Screening Test ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Ca 125 ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Control Study

Background: Screening test for pre-eclampsia has been a topic of extensive research in last few decades, and to identify a cost effective and accurate one is of immense importance. This study was conducted to determine an association between serum CA-125 levels and severity of pre-eclampsia, and thus to specify clinical utility of this biochemical marker in prediction, diagnosis and follow-up of pre-eclampsia.Methods: A case-control study involving 40 women with non-severe pre-eclampsia, 40 women with severe pre-eclampsia and 40 healthy pregnant women matched for age, parity and gestational age at enrolment were taken in a tertiary care centre in West Bengal.Results: The CA-125 levels in three categories of participants were: normotensive (15.76±2.95), non-severe pre-eclampsia (26.98±2.28), severe pre-eclampsia (44.99±11.23), p<0.001. CA-125 levels correlated positively with systolic blood pressure (r=0.78, p<0.001), diastolic blood pressure (r=0.79, p<0.001), negatively with platelet levels (r=-0.67, p<0.001) and with birth weight of baby (r=-0.54, p<0.001). When cut-off for serum CA-125 levels was accepted as 35 IU/ml, the sensitivity and specificity of the marker was found to be 92.1% and 97.1% respectively. Positive predictive value 95.5%, Negative predictive value 94.4%.Conclusions: We can infer from this study that maternal serum CA-125 levels are associated with pre-eclampsia and its severity. As it is much more available and less expensive, it seems to be a promising as a screening test.

scholarly journals Clinical and Laboratory Markers of Brain Abscess in Tetralogy of Fallot (‘BA-TOF’ Score): Results of a Case–Control Study and Implications for Community Surveillance

2021 ◽  
Author(s):  
Vidyasagar Kanneganti ◽  
Sumit Thakar ◽  
Saritha Aryan ◽  
Prayaag Kini ◽  
Dilip Mohan ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Brain Abscess ◽  
Predictive Value ◽  
Case Control Study ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
Case Control ◽  
Retrospective Case ◽  
Neutrophil Lymphocyte Ratio ◽  
Control Study

Abstract Background Cardiogenic brain abscess (CBA) is the commonest noncardiac cause of morbidity and mortality in cyanotic heart disease (CHD). The clinical diagnosis of a CBA is often delayed due to its nonspecific presentations and the scarce availability of computed tomography (CT) imaging in resource-restricted settings. We attempted to identify parameters that reliably point to the diagnosis of a CBA in patients with Tetralogy of Fallot (TOF). Methods From among 150 children with TOF treated at a tertiary care institute over a 15-year period from 2001 to 2016, 30 consecutive patients with CBAs and 85 age- and sex-matched controls without CBAs were included in this retrospective case–control study. Demographic and clinical features, laboratory investigations, and baseline echocardiographic findings were analyzed for possible correlations with the presence of a CBA. Statistical Analysis Variables demonstrating significant bivariate correlations with the presence of a CBA were further analyzed using multivariate logistic regression (LR) analysis. Various LR models were tested for their predictive value, and the best model was then validated on a hold-out dataset of 25 patients. Results Among the 26 variables tested for bivariate associations with the presence of a CBA, some of the clinical, echocardiographic, and laboratory variables demonstrated significant correlations (p < 0.05). LR analysis revealed elevated neutrophil–lymphocyte ratio and erythrocyte sedimentation rate values and a lower age-adjusted resting heart rate percentile to be the strongest independent biomarkers of a CBA. The LR model was statistically significant, (χ2 = 23.72, p = <0.001), and it fitted the data well. It explained 53% (Nagelkerke R 2) of the variance in occurrence of a CBA, and correctly classified 83.93% of cases. The model demonstrated a good predictive value (area under the curve: 0.80) on validation analysis. Conclusions This study has identified simple clinical and laboratory parameters that can serve as reliable pointers of a CBA in patients with TOF. A scoring model—the ‘BA-TOF’ score—that predicts the occurrence of a CBA has been proposed. Patients with higher scores on the proposed model should be referred urgently for a CT confirmation of the diagnosis. Usage of such a diagnostic aid in resource-limited settings can optimize the pickup rates of a CBA and potentially improve outcomes.

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