scholarly journals Systematic Literature Review on Burden of Clostridioides difficile Infection in India

2021 ◽  
Vol 14 ◽  
pp. 2632010X2110138
Author(s):  
Canna J Ghia ◽  
Shaumil Waghela ◽  
Gautam S Rambhad
Keyword(s):  
Risk Factors ◽  
Multiple Testing ◽  
Final Analysis ◽  
Antibiotic Usage ◽  
Diagnostic Methods ◽  
North India ◽  
Enzyme Linked Immunosorbent Assay ◽  
Chi Square ◽  
Clostridioides Difficile ◽  
The Impact

Background: Owing to limited diagnostic facilities and surveillance protocols, there is a paucity on the prevalence data of Clostridioides difficile infections (CDIs) in developing countries such as India. Objective: The aims of these studies are (1) to determine the prevalence of CDI in India, (2) to understand the risk factors of CDI, and (3) to determine the impact of different diagnostic methods on reported CDI rates. Method: A systematic literature search was conducted using PubMed and Google Scholar database to identify Indian studies reporting the prevalence of CDI. A total of 31 studies, published between 1990 and 2020 were included in the final analysis. A chi-square test was used to determine statistically significant association between prevalence rates, accuracy of different diagnosis methods, and antibiotic usage rates of CDI. Results: The prevalence of CDI was in the range of 3.4% to 18%, and the difference between regional prevalence of CDI was statistically significant ( P < .001). The use of antibiotics, hospital stay, comorbidities, recent surgery, and the use of proton-pump inhibitors was considered as risk factors for the development of CDI. Compared to other regions, the rate of antibiotic usage was significantly higher in North India ( P < .001). Among different diagnostic methods, C. difficile detection was significantly higher with enzyme-linked immunosorbent assay (18.02%) versus other multiple testing methods used ( P < .001). Conclusion: There is a significant burden of CDI across the country. Further surveillance studies are required to monitor changes in prevalence of CDI, risk factors, and accuracy of diagnosis methods for a better understanding of the disease burden in India.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals Deep brain stimulation hardware–related infections: 10-year experience at a single institution

2019 ◽  
Vol 130 (2) ◽  
pp. 629-638 ◽  
Author(s):  
Kingsley O. Abode-Iyamah ◽  
Hsiu-Yin Chiang ◽  
Royce W. Woodroffe ◽  
Brian Park ◽  
Francis J. Jareczek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Single Institution ◽  
Chi Square ◽  
Related Factors ◽  
Exact Test ◽  
Vancomycin Powder ◽  
The Impact ◽  
Deep Brain

OBJECTIVEDeep brain stimulation is an effective surgical treatment for managing some neurological and psychiatric disorders. Infection related to the deep brain stimulator (DBS) hardware causes significant morbidity: hardware explantation may be required; initial disease symptoms such as tremor, rigidity, and bradykinesia may recur; and the medication requirements for adequate disease management may increase. These morbidities are of particular concern given that published DBS-related infection rates have been as high as 23%. To date, however, the key risk factors for and the potential preventive measures against these infections remain largely uncharacterized. In this study, the authors endeavored to identify possible risk factors for DBS-related infection and analyze the efficacy of prophylactic intrawound vancomycin powder (VP).METHODSThe authors performed a retrospective cohort study of patients who had undergone primary DBS implantation at a single institution in the period from December 2005 through September 2015 to identify possible risk factors for surgical site infection (SSI) and to assess the impact of perioperative (before, during, and after surgery) prophylactic antibiotics on the SSI rate. They also evaluated the effect of a change in the National Healthcare Safety Network’s definition of SSI on the number of infections detected. Statistical analyses were performed using the 2-sample t-test, the Wilcoxon rank-sum test, the chi-square test, Fisher’s exact test, or logistic regression, as appropriate for the variables examined.RESULTSFour hundred sixty-four electrodes were placed in 242 adults during 245 primary procedures over approximately 10.5 years; most patients underwent bilateral electrode implantation. Among the 245 procedures, 9 SSIs (3.7%) occurred within 90 days and 16 (6.5%) occurred within 1 year of DBS placement. Gram-positive bacteria were the most common etiological agents. Most patient- and procedure-related characteristics did not differ between those who had acquired an SSI and those who had not. The rate of SSIs among patients who had received intrawound VP was only 3.3% compared with 9.7% among those who had not received topical VP (OR 0.32, 95% CI 0.10–1.02, p = 0.04). After controlling for patient sex, the association between VP and decreased SSI risk did not reach the predetermined level of significance (adjusted OR 0.32, 95% CI 0.10–1.03, p = 0.06). The SSI rates were similar after staged and unstaged implantations.CONCLUSIONSWhile most patient-related and procedure-related factors assessed in this study were not associated with the risk for an SSI, the data did suggest that intrawound VP may help to reduce the SSI risk after DBS implantation. Furthermore, given the implications of SSI after DBS surgery and the frequency of infections occurring more than 90 days after implantation, continued follow-up for at least 1 year after such a procedure is prudent to establish the true burden of these infections and to properly treat them when they do occur.

scholarly journals GRADING prognostic factors for severe and recurrent Clostridioides difficile infection: expected and unexpected findings. A systematic review.

2021 ◽  
Author(s):  
Tessel Meike van Rossen ◽  
Rogier E. Ooijevaar ◽  
Christina M.J.E. Vandenbroucke-Grauls ◽  
Olaf M. Dekkers ◽  
Ed J. Kuijper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Prognostic Factors ◽  
Laboratory Data ◽  
Final Analysis ◽  
Cochrane Library ◽  
Case Control Studies ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection

Background Clostridioides difficile infection (CDI), its subsequent recurrences (rCDI), and severe CDI (sCDI) provide a significant burden for both patients and the healthcare system. Treatment consists of oral antibiotics. Fidaxomicin, bezlotoxumab and fecal microbiota transplantion (FMT) reduce the number of recurrences compared to vancomycin, but are more costly. Identifying patients diagnosed with initial CDI who are at increased risk of developing sCDI/rCDI could lead to more cost-effective therapeutic choices. Objectives In this systematic review we aimed to identify clinical prognostic factors associated with an increased risk of developing sCDI or rCDI. Methods PubMed, Embase, Emcare, Web of Science and COCHRANE Library databases were searched from database inception through March, 2021. Study selection was performed by two independent reviewers on the basis of predefined selection criteria; conflicts were resolved by consensus. Cohort and case-control studies providing an analysis of clinical or laboratory data to predict sCDI/rCDI in patients ≥18 years diagnosed with CDI, were included. Risk of bias was assessed with the Quality in Prognostic Research (QUIPS) tool and the quality of evidence by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, modified for prognostic studies. Overview tables of prognostic factors were constructed to assess the number of studies and the respective direction of an association (positive, negative, or no association). Results and conclusions 136 studies were included for final analysis. Higher age and the presence of multiple comorbidities were prognostic factors for sCDI. Identified risk factors for rCDI were higher age, healthcare-associated CDI, prior hospitalization, PPIs started during/after CDI diagnosis and previous rCDI. Some variables that were found as risk factors for sCDI/rCDI in previous reviews were not confirmed in the current review, which can be attributed to differences in methodology. Risk stratification for sCDI/rCDI may contribute to a more personalized and optimal treatment for patients with CDI.

scholarly journals Clinical profile and management of breast cancer in women in a rural based tertiary care hospital our experience

2017 ◽  
Vol 4 (2) ◽  
pp. 697
Author(s):  
Ambikavathy Mohan ◽  
Chandan Kumar
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Carcinoma ◽  
Health Care Providers ◽  
Diagnostic Methods ◽  
Care Hospital ◽  
Care Providers ◽  
Increased Risk ◽  
The Impact ◽  
Women In India

Background: Breast cancer is the second most common cancer among women in India and accounts for 7% of global burden of breast cancer and one-fifth of all cancers among women in India. The risk factors are related to lifestyle, early menarche, nulli parity, prolonged use of oral contraceptive pills, hormone replacement therapy, not breast‑feeding, alcohol, obesity, lack of exercise, and induced abortion. A woman who attains menopause after fifty five years of age has an increased risk of ovarian, breast, and uterine cancers. The risk is greater if a woman also began menstruating before twelve years of age. A longer exposure to estrogen increases a woman’s risk of breast cancers.Methods: This is a prospective observational study, conducted in the department of surgery, between December 2013 and June 2015(2 years). Patients diagnosed as breast carcinoma and admitted in surgical wards were included, Data pertaining to demography, clinical and pathological tumor profile, and treatment details were collected prospectively for each patient based on patient interviews and medical records. To analyse the Prevalence of breast cancer, clinical presentation, risk factors, diagnostic methods, treatment protocols, difference between pre and post‑menopausal breast cancer women regarding risk factors, assess the impact of treatment given and women’s knowledge about breast cancer.Results: A total number of 25 cases of breast carcinoma based on detailed history, clinical examination, Trucut biopsy, ultrasonography breast and axilla, ultrasound abdomen, mammogram and chest x-ray were analysed. All of them received three cycles of anterior chemotherapy consisting of 5- Fluorouracil 500 mg/m2,Adriamycin 50 mg/m2 Cyclophosphamide 80 mg/m2 (FAC regimen) administered intravenously followed by modified radical mastectomy. There were no recurrences seen on follow up till date.Conclusions: Late stage at presentation of breast cancer is a challenge to the health care providers. Cancer awareness programmes, multidisciplinary approach and evidence‑based strategies for early detection and effective management of the disease can go a long way in prevention.

scholarly journals Check-up and cardiovascular risk progression: is there a room for innovation?

2015 ◽  
Vol 13 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Raquel Dilguerian de Oliveira Conceição ◽  
Antonio Gabriele Laurinavicius ◽  
Nea Miwa Kashiwagi ◽  
José Antonio Maluf de Carvalho ◽  
Carlos Alberto Garcia Oliva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Alcohol Consumption ◽  
Smoking Habit ◽  
Final Analysis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
The Impact ◽  
Number Of Individuals

ABSTRACT Objective: To evaluate the impact of traditional check-up appointment on the progression of the cardiovascular risk throughout time. Methods: This retrospective cohort study included 11,126 medical records of asymptomatic executives who were evaluated between January, 2005 and October, 2008. Variables included participants’ demographics characteristics, smoking habit, history of cardiovascular diseases, diabetes, dyslipidemia, total cholesterol, HDL, triglycerides, glucose, c-reactive protein, waist circumference, hepatic steatosis, Framingham score, metabolic syndrome, level of physical activity, stress, alcohol consumption, and body mass index. Results: A total of 3,150 patients was included in the final analysis. A worsening was observed in all risk factors, excepting in smoking habit, incidence of myocardial infarction or stroke and in the number of individuals classified as medium or high risk for cardiovascular events. In addition, a decrease in stress level and alcohol consumption was also seen. Conclusion: The adoption of consistent health policies by companies is imperative in order to reduce the risk factors and the future costs associated with illness and absenteeism.

Seroprevalence and comparative study of serological tests for detection of mycoplasma gallisepticum infection in commercial layer farms at few districts of Tamil Nadu, India

2016 ◽  
Author(s):  
K. Vadivalagan ◽  
K. Sukumar ◽  
V. Sudha Rani ◽  
M Sivachandran ◽  
P. Logesh ◽  
...  
Keyword(s):  
Tamil Nadu ◽  
Mycoplasma Gallisepticum ◽  
Diagnostic Methods ◽  
Screening Tools ◽  
Economic Losses ◽  
Enzyme Linked Immunosorbent Assay ◽  
Chi Square ◽  
Serological Tests ◽  
Avian Mycoplasmosis ◽  
Commercial Poultry

Avian mycoplasmosis causes great economic losses to the poultry industry, and one of the major agents involved is Mycoplasma gallisepticum (MG). The study was conducted from October 2008 to September 2010 to detect the presence of antibodies against MG in poultry layers. Serum from commercial poultry layers (n = 1350) was tested for MG by using enzyme-linked immunosorbent assay (ELISA) and serum plate agglutination (SPA). A total of 1350 sera from commercial poultry farm were collected and tested in winter, 453 (33.6%) and 350 (26.0%) were positive in SPA test and ELISA, and in summer, 297 (22.0%) and 219 (16.2%) were positive in SPA test and ELISA respectively. In Pearson chi-square test, statistical significant differectnce (p = 0.000) were observed between serological tests (SPA test and ELISA), and it was also demonstrated that seasonal occurrence of infection were higher in zone C. It has been found that MG infection is still an important disease problem in commercial layer farms and there is need for a stringent surveillance and control to combat avian mycoplasmosis in Tamil Nadu and these diagnostic methods (SPA and ELISA) should be only used as screening tools in monitoring programs.

scholarly journals 2791. Burden of Respiratory Infections in Trainees Higher Than Healthcare Records Indicate: Results from an Anonymous Survey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S986-S986
Author(s):  
Stephanie Richard ◽  
Patrick Danaher ◽  
Brian White ◽  
Katrin Mende ◽  
Timothy Burgess ◽  
...  
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Respiratory Infections ◽  
Smoking Status ◽  
Activity Level ◽  
Mitigation Strategies ◽  
Military Population ◽  
Chi Square ◽  
Potential Risk Factors ◽  
The Impact

Abstract Background Influenza-like illnesses (ILIs) are common in military populations, particularly among trainees, and can impair mission-readiness. To develop effective preventive measures against ILIs, it is vital to understand the ILI burden in the military population and identify potential risk factors for infection. Methods Anonymous ILI surveys were administered from January 2017 to March 2019 to military medical trainees living in a congregated setting on Fort Sam Houston (JBSA-FSH), TX. The surveys included questions about sociodemographic characteristics, weight, height, smoking status, activity level, as well as some basic questions about ILI and potential risk factors. Factors associated with ILI were identified using chi-square, t-tests, and multivariate models. Results 2,381 surveys were returned that included age, sex, and ILI information. Respondents were 16–54 years old, 1,301 (55%) were male, 782 (33%) were Air Force, 817 (34%) were Army, and 763 (32%) were Navy/Marines. 39% of those surveyed (929) reported having experienced an ILI during their training with 40% (370) seeking healthcare for those symptoms. The primary reasons for seeking healthcare included the severity of the illness (59%), concern about spreading the illness (50%), and the accessibility of healthcare (41%). 53% of the respondents reported that ILI had an impact on their performance, among whom 77% stated reduced study time, 66% missing physical training, and 53% missed class. The final multivariate model indicates that men and participants 30+ years old were less likely to report ILI (OR 0.69 (0.58, 0.82); OR 0.65, (0.45, 0.94)) (Figure 1). In addition, participants who reported washing their hands after they coughed or sneezed were less likely to report having had an ILI (OR 0.73 (0.61, 0.89)). Conclusion Although 39% of respondents reported having an ILI during their training, only 40% sought healthcare, indicating that ILIs are more common during training than healthcare records indicate. More information is needed regarding how training outcomes vary among those with ILI who seek care, those with ILI who do not seek care and those without ILI during training, to allow a better estimate of the impact of ILI and development of ILI mitigation strategies. Disclosures All authors: No reported disclosures.

scholarly journals Temporal Change of Risk Factors in Hospital-Acquired Clostridioides difficile Infection Using Time-Trend Analysis

2020 ◽  
Vol 41 (S1) ◽  
pp. s403-s403
Author(s):  
Jiyoun Song ◽  
Bevin Cohen ◽  
Philip Zachariah ◽  
Jianfang Liu ◽  
Elaine Larson
Keyword(s):  
Risk Factors ◽  
New York ◽  
High Risk ◽  
Kendall Test ◽  
Incidence Rates ◽  
Clostridioides Difficile ◽  
Significant Downward Trend ◽  
Hospital Acquired ◽  
The Impact ◽  
Over Time

Background: In the past few decades, the epidemiology of Clostridioides difficile infection (CDI) has evolved. Given recent changes in the incidence of CDI and prevention efforts, we investigated temporal changes over a period of 8 years (2009–2016) in the incidence of and risk factors for CDI. Methods: Both pediatric and adult inpatients discharged from hospitals in metropolitan New York City were included. Individual and environmental (eg, pharmacological) risk factors were identified through a matched case-control by the length of stay at a ratio of 1:4. A Cochran–Armitage test or Mann-Kendall test was used to investigate trends of incidence and risk factors. Results: During the study period, 6,038 of 694,849 (0.87%) patients had a positive test for C. difficile during their hospitalization. Of these, 2,659 of 6,038 (44.04%) were identified as hospital-acquired CDI (HA-CDI) and just over half (3,379 of 6,038, 55.96%) were identified as community-acquired CDI (CA-CDI). There were no trends in total CDI incidence rates; rather, we detected downward trends in HA-CDI and upward trends in CA-CDI (Ptrend < .05). Younger patients and patients with lower risk of illness had HA-CDI over time (Ptrend < .05). Antibiotics were administered to more patients over time and in longer cumulative days (+3% and +3.1% per year). We detected a reduction in the receipt of high-risk antibiotics in all cohorts (−0.12% per year) and a decrease in cumulative days of high-risk antibiotics in the cohort with HA-CDI (−1.1% per year). When stratified by the type of high-risk antibiotics, the use of carbapenem, cephalosporins, clindamycin, and monobactam increased (+0.53%, +1.8%, +0.5%, and +0.39% per year, respectively), whereas the use of broad-spectrum penicillins and glycylcycline significantly decreased over time in all cohorts (−1.8% and −0.22% per year). Among the cohorts with HA-CDI, only cephalosporins showed a significant upward trend (+ 5.7% per year) and only fluoroquinolones showed a significant downward trend (−2.2% per year). Lastly, a reduction of proton pump inhibitors and an increased use of histamine-2 blockers were detected in all cohorts (−3.8% and +7.3% per year) (all Ptrend < .05). Conclusions: Although the incidence of HA-CDI decreased, more effort to decrease all antibiotics use and cumulative days should be emphasized as part of antibiotic stewardship. The downward trends of high-risk antibiotics might have been associated with the decrease in the trend of HA-CDI; however, the impact of the trends of risk factors on the trend of HA-CDI should be further investigated.Funding: NoneDisclosures: None

scholarly journals Seroprevalence and Risk Factors of Toxoplasma gondii Infection among Domestic Ruminants in East Hararghe Zone of Oromia Region, Ethiopia

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Berhanu Tilahun ◽  
Yacob Hailu Tolossa ◽  
Getachew Tilahun ◽  
Hagos Ashenafi ◽  
Shihun Shimelis
Keyword(s):  
Risk Factors ◽  
Toxoplasma Gondii ◽  
Water Source ◽  
Cross Sectional Study ◽  
Water Sources ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cross Sectional ◽  
Domestic Ruminants ◽  
Potential Risk Factors ◽  
The Impact

A cross-sectional study was carried out from July 2011 to September 2013 to assess the seroprevalence and identify risk factors of Toxoplasma gondii infection in domestic ruminants of East Hararghe zone of Oromia region, Ethiopia. Sera of 1360 domestic ruminants were analyzed for the presence of anti-T. gondii IgG antibodies using the indirect enzyme-linked immunosorbent assay (iELISA). Additionally, the owners were also interviewed using a structured questionnaire to identify the potential risk factors of T. gondii infection. Overall, the prevalence of T. gondii infection in domestic ruminants was 22.2% (302/1360). The seroprevalence in sheep, goats, cattle, and camels was 33.7%, 27.6%, 10.7%, and 14.4%, respectively. District, species, sex, age, and water source were identified as risk factors for T. gondii infection. Increased seropositivity was observed in females (OR = 2.63) and also with the use of pond (OR = 4.25) and pipe (OR = 9.57) water sources in sheep; age >1 year old (OR = 3.45) and with drinking from pond (OR = 6.03) and pipe (OR = 11.61) water sources in goats; with the use of pond (OR = 5.60) and pipe (OR = 10.68) water sources in cattle; and in >4-year-old camels (OR = 2.49). In conclusion, T. gondii infection is common and widespread among the domestic ruminants of the study area, indicating the potential transmission to humans from these animals when they are used as a source of food. Hence, it is crucial to raise awareness of the people about T. gondii infection and conduct further study to explore the impact of the disease on food animal production.

scholarly journals Assessment of the Impact of Seafarers' Professional Experience on the Perception of Risk Factors from the Perspective of Polish Container Ships Crews Members

2021 ◽  
Author(s):  
Ludmiła Filina-Dawidowicz ◽  
Daria Możdrzeń ◽  
Włodzimierz Rosochacki
Keyword(s):  
Risk Factors ◽  
Human Factor ◽  
Professional Experience ◽  
Container Shipping ◽  
Perception Of Risk ◽  
Chi Square ◽  
Factors Affecting ◽  
Work Related ◽  
Professional Groups ◽  
The Impact

Safety of navigation is the important issue especially related to the dynamically developing container shipping. The main purpose of the article is to demonstrate the results of research on the perception of risk factors by seafarers working on container ships in terms of their professional experience. The ranking of risk factors considering their impact on the safety of container shipping has been created. An additional goal of the research was to acquire the knowledge on ships crews members' assessment of the impact of the human factor on the safety of navigation, including factors related to the organization of seafarers' work (systemic aspects) and those directly resulting from the operations carried out on ship. The assessment of risk factors affecting the navigation safety was performed from the perspective of Polish crew members working on container ships. The research was carried out with the use of an empirical study questionnaire. 161 seafarers' opinions were analyzed. On the basis of the created risk factors ranking analysis, it was found that seafarers perceive the human factor, and consider both the systemic and the work-related aspects having the greatest impact on the safety of container shipping. Moreover, the conducted non-parametric Pearson chi-square independence test proved the hypothesis that assessments of the five highest rated risk factors, reviewed by studied young and experienced professional groups of seafarers, didn’t differ significantly.

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